Medics face death while Libya uses HIV children as diplomatic pawns

Alex Duval Smith The Observer, Sunday 17 December 2006 13.12 GMT - The death in Libya six weeks ago of nine-year-old Marwa Annouiji from Aids was much more than just another developing world statistic. In her short, life, dominated by illness, the frail child was a pawn in a high-level game of international relations. Marwa, from al-Bayda on the Mediterranean coast, was the 52nd Libyan child to die as a result, Libya claims, of a deliberate operation by foreign medical workers to pump HIV-infected blood into 426 girls and boys at the al-Fatah Hospital in Benghazi.

On Tuesday, barring some extraordinary intervention, the six medics - a Palestinian doctor and five Bulgarian nurses who have been in prison in Libya for seven years - will have their sentence confirmed by a court in the capital, Tripoli: execution by firing squad. The case has sparked unprecedented mobilisation in support of the medics among international scientists who have found the Libyan evidence groundless. European governments and the United States stand accused of abandoning the medical workers for powerful strategic and economic reasons.

'We are still hoping wisdom will prevail,' said the head of the nurses' defence team, French lawyer Emmanuel Altit. 'The court has not granted the defence its rights, the Libyan evidence in the case is discredited, and the medics' confessions were extracted under mental, physical and sexual torture.'

The six - Dr Ashraf al-Hajuj and nurses Kristiyana Vatcheva, Nasya Nenova, Valentina Siropulo, Valya Chervenyashka and Snezhana Dimitrova - took up government contracts at the hospital in Libya's second city in March 1998. The first cases of HIV infection were reported the same year. A World Health Organisation report found that the virus had probably been spread because of a lack of proper medical equipment. The six were imprisoned in March 1999. Libyan courts ordered reports from the world's top Aids scientists and epidemiologists, including Luc Montagnier, one of the discoverers of HIV. Montagnier found the high rate of hepatitis B and C at the hospital suggested that poor hygiene was to blame for the spread of HIV. But the prosecution ignored his report and ordered one from Libyan researchers in 2003.

On 6 May, 2004, the death sentences were pronounced. On Christmas Day last year the Libyan Supreme Court ordered a retrial, which led to a new call for the death sentence this August. A verdict is expected on Tuesday.

European doctors who, under a 2m (£1.3m) EU initiative, have treated the children in Libya say most are now aged around 12. They suffer from tuberculosis and other Aids-related illnesses.

According to a French foreign ministry spokesman: 'They cannot so much as go to the dentist in Benghazi because the Aids stigma is so powerful in Libya. It also appears that, because most of them are outpatients, their parents are not all administering their tablets correctly.' As a result of care problems in Libya, the 374 surviving children are now outpatients at hospitals in Italy and France.

Libyan President Muammar Gadaffi, who is reportedly terrified of dissent in the opposition hotbed of Benghazi, is paying millions of euros for their treatment at the Vatican's Bambino Gesu Hospital as well at French clinics in Lyon, Montpellier, Strasbourg and Toulouse. Experts on Libya say Gadaffi is using the children as a pawn.

Experts on Libya say Gadaffi is using the children as a pawn in his discussions with Western powers over burning issues including contracts for oil, arms and aircraft and diplomatic relations in the Middle East. Gadaffi also remains bitter about the pariah status he acquired after the 1988 Lockerbie bombing. Earlier this year Libya said Bulgaria should pay the families of the children $2.7bn (£1.8bn) in compensation - which is exactly the sum paid by Libya for the 270 lives lost in the Pan Am 103 bombing. International scientists say the 2003 Libyan report was written by 'pseudo experts' and has no value. Last week a paper in Nature magazine by a team led by Tulio de Oliveira and Oliver Pybus - paper from de Oliveira T et al. Molecular epidemiology: HIV-1 and HCV sequences from Libyan outbreak showed that the Benghazi strain of HIV was introduced at the hospital before the arrival of the medics.

Pybus & de Oliveira, of Oxford University, said: 'By looking at the genome sequence of the virus found in children at Bambino Gesu hospital, we established that the estimated date of the most common recent ancestor for each cluster predated March 1998, sometimes by several years. The virus is of a kind found in West Africa, which makes sense as Libya has a large population of guest workers from there.'

The medics' lawyers hope that, even if the death sentences are confirmed on Tuesday, the case will return to the Supreme Court where a judicial council could throw it out for a second time. But Altit said diplomatic efforts to secure the medics' release after more than seven years in jail had been disappointing. 'Libya is coming out of the cold and there are many lucrative contracts in the works. If the sentences are confirmed it will be a disgrace for the European Union. If there is one thing Europe stands for, it is values, such as justice.' A Foreign Office spokesman would not comment on the accusation that European governments were sacrificing the medics in the name of trade relations. But he said: 'The case is not over yet and we understand it will go to the Supreme Court. The EU has made significant efforts to help the families and upgrade facilities at the hospital. We hope these efforts show that everyone sympathises with the families.'

More information: Original paper: de Oliveira T et al. Molecular epidemiology: HIV-1 and HCV sequences from Libyan outbreak

News date: 2006-12-17


Publication cited

Assessment of automated genotyping protocols as tools for surveillance of HIV-1 genetic diversity. Gifford R, de Oliveira T, Rambaut A, Myers RE, Gale CV, Dunn D, Shafer R, Vandamme AM, Kellam P, Pillay D; UK Collaborative Group on HIV Drug Resistance, AIDS (2006), 20(11):1521-9.

KRISP has been created by the coordinated effort of the University of KwaZulu-Natal (UKZN), the Technology Innovation Agency (TIA) and the South African Medical Research Countil (SAMRC).

Location: K-RITH Tower Building
Nelson R Mandela School of Medicine, UKZN
719 Umbilo Road, Durban, South Africa.
Director: Prof. Tulio de Oliveira