On Wednesday, in Jdeida prison on the outskirts of Tripoli, five nurses and a doctor prepared themselves for the worst: word that after seven years in prison, they were to be executed by firing squad. The six, who left their countries to work at the Children’s Hospital in Libya’s second city, Benghazi, were arrested and locked up after being accused of deliberately injecting HIV-tainted blood into more than 400 children. Since then, at least 52 of the children have died from run-of-the-mill infections that a working immune system would ordinarily shrug off.
What happened at Benghazi hospital is a monumental tragedy, but the chain of events that followed has been absurd, arbitrary and terrifying. Colonel Moammar Gadaffi, the country’s leader for 37 years, claims that the HIV outbreak was orchestrated by either the CIA or Mossad, the Israeli security service, who, he says, designed a potent form of HIV for the medical staff to spread. World experts who have visited the hospital and pored over medical records beg to differ. They found a hospital where poor practice and unsterilised equipment was the norm, a hospital where an HIV outbreak was an accident waiting to happen. They say the outbreak began before the accused arrived and continued after their incarceration. They found no signs of wrongdoing. They say the six have become scapegoats in an awful bid to deflect attention from a health service gone badly wrong.
This week defence lawyers for the prisoners addressed a court, which in September heard the prosecution’s case for a death sentence. They argued that confessions, since retracted, by three of the six — Ashraf al-Hazouz, a Palestinian doctor, and two Bulgarian nurses — were obtained only after an interrogation process in which they were stripped, beaten, attacked by dogs, electrocuted and, in at least one case, sexually assaulted with a police baton. They planned to ask the court to appoint two independent scientific experts, both of whom have experience of sudden HIV outbreaks, to give their own views of what took place at Benghazi. But the defence was not hopeful.
It would not be the first time scientists have been asked for an opinion on what happened in Benghazi. Shortly after the six were arrested in February 1999, the Gadaffi Foundation asked the man who discovered HIV, Luc Montagnier, a professor at the Pasteur Institute in Paris, and Vittorio Colizzi, one of Europe’s most eminent HIV experts at Tor Vergata University in Rome, to visit the hospital and investigate. Their report did not go down well with the government. “We found that in many cases, children were infected before the [accused] even arrived at the hospital,” said Montagnier.
The children also had unusually high levels of hepatitis C infection, leading the scientists to suspect that dirty needles and catheters were to blame for spreading infections throughout the wards. Their report gave a damning assessment of medical practice at the hospital. “There is an impressive absence of procedures, guidelines, clinical protocols, safety measures, training of personnel, psychological support, communication capacity, etc, etc,” they wrote. The outbreak, they concluded, almost certainly began with a single child, a patient zero, who arrived at the hospital in April 1997 infected with a sub-Saharan strain of HIV. The virus from patient zero spread devastatingly, inevitably. But it was not spread intentionally.
To Libyan officials, the report was unacceptable. It did not help that the tragedy happened in Benghazi, a city where Gadaffi does not enjoy strong support. The report was put to one side and a second team of doctors, this time Libyan non-specialists, was appointed to interpret its findings. They reached the opposite conclusion, not least, says Montagnier, because of a fatal mistranslation that saw the correct word “recombinant”, meaning a specific strain of HIV, interpreted as “genetically modified”, suggesting the HI virus was man-made. In May 2004, long after Gadaffi had offered to reconsider the case in return for £3-billion compensation and the release of Abdel Baset al-Megrahi, the former Libyan intelligence officer jailed for the Lockerbie bombing, the Libyan courts ordered the six to be executed, for “undermining the security of the state”.
Nine Libyans also arrested in the investigation were acquitted. “They didn’t like our conclusion that they were not guilty,” says Montagnier. “I think they are intentionally ignoring the scientific evidence because they want a scapegoat. I don’t see any other reason.”
But what might have seemed an appalling conclusion to a cruel affair was far from over. Allegations by the accused that their confessions were obtained only after torture led to an investigation of the officers involved and the judgement was overturned by the supreme court. But despite admissions by one of the policemen that dogs and electric-shock equipment were used in the interrogations, all 10 policemen involved were acquitted.
In May, two years after the accused were first sentenced to death, a retrial began. Francois Cantier, director of the organisation Lawyers Without Borders in France, which is advising the defence, has said the accused, exhausted by the ordeal, have lost all hope. At a recent hearing, he said, they shouted for the nightmare to be over, even if it meant dying.
The case has fallen largely off the media radar, but mounting pressure from the scientific community and intense diplomatic efforts have been under way to secure what one diplomat called “a resolution everyone can live with”. The goal, pursued by officials from Europe, the United States and other countries, has been a delicate compromise that will see the accused spared and give the families justice, without denting the pride of the Libyan leader. “It’s clear that a death sentence and the execution of the [six] would play very badly with Europe and many other countries around the world,” said one Western diplomat, who asked not be named. He said life sentences would also be unacceptable.
Pressure is also mounting from scientists who are appalled that crucial evidence is being ignored in the trial. Last month, a letter to the London Times newspaper from a group of British scientists called for global authorites to “exert their utmost influence on President Gadaffi to prevent what might amount to judicial murder”. Last Friday, 44 of the world’s leading scientists wrote to the US journal, Science, calling for the prisoners to be released. “What has happened to the accused sends a chilling message to all healthcare workers who choose to work in difficult circumstances to deliver life-saving care to HIV-1-infected or at-risk people worldwide,” they wrote.
Whether international pressure and diplomatic manoeuvrings influence the outcome may never emerge, but the final fate of the accused may not become public for days or even weeks after the defence gives evidence this week. For the families of Benghazi, there is at least the knowledge that lessons have been learned from the tragedy and that their children are now getting the best care possible. With aid from Europe, the US and elsewhere, Benghazi hospital is being transformed and the city will have a world-class infectious disease centre. Its staff have been trained extensively in the best techniques to control and prevent the spread of HIV.
The Palestian prisoner, Ashraf al-Hazouz, who is unlikely to work again as a doctor because of damage to his fingers sustained during his interrogation, was interviewed after being refused bail at the beginning of the retrial in May. “We are also victims like those children, but we hope that this tragedy will end soon,” he said. — Â