Dr. Jagger thank you for joining us in this live dialogue today.
Can you please start by giving us an overview of the case against the health workers?
Answer
Five Bulgarian nurses and one Palestinian doctor were imprisoned in Libya in 1999 after a massive outbreak of nosocomial HIV infection was discovered at Al-Fateh Hospital in the city of Benghazi, Libya.
The foreign workers were accused of deliberately infecting 426 children and have been in prison ever since. Confessions were extracted from them under torture, which they later recanted. A trial ending in 2004 found them guilty and sentenced them to death before a firing squad.
The verdict was overturned by the Libyan Supreme Court and a new trial was ordered. However, evidence presented by world-renowned HIV/AIDS expert Luc Montagnier and Italian virologist Vittorio Colizzi refuted the charges against the healthcare workers and indicated the infections were most likely due to improper and unsafe infection control and injection practices. This evidence was thrown out of court by the Libyan prosecution, leaving the six defenseless.
Their second trial will end on October 31st and, if found guilty, they will be sentenced to death. I have joined with the scientific and healthcare communities in the 11th hour of the trail to appeal for justice and their release.
For a complete overview of the case see the article in the scientific journal Nature at http://www.nature.com/nature/journal/v443/n7114/full/443888a.html
Name
Sarah
- Egypt
Profession
Question
How can you be sure that the infection started before the arrival of the Bulgarian nurses?
Answer
There are two sources of evidence. One is the medical records of the patients reviewed by Dr. Luc Montagnier, AIDS researcher, showing that 32 patients were not in the hospital during the time that these six workers were present in the hospital.
The second source of evidence is the findings of the blood analysis and viral analysis also by Dr. Montagnier. These showed that the evolution of infection of several patients indicated that the infections had to be contracted at least one year prior to the workers arrival in the hospital and possibly even before 1997.
Name
Kamal
- Nigeria
Profession
Question
I heard a report saying that the type of HIV discovered in the hospital was a recombinant variation – isn't that enough proof that this was intentionally injected?
Answer
I am not a virologist. However, experts consulted in this case incuding Dr. Montagnier, co-discoverer of the AIDS virus, confirm that the viral strain infecting the patients was a common strain found in other African countries.
It was not a genetically modified strain but a naturally occurring one.
Name
John
- Australia
Profession
Question
Do you think that the previous verdict was pre-prepared?
Answer
Yes. This appears to be a politically motivated case. Certainly, science has played no part in the judgement of these 6 individuals. The fact that the only scientific evidence bearing on this case was excluded from court indicates that the science did not conform to the predetermined judgement.
Name
Ahmad
- United States
Profession
Question
What do you think would be a satisfactory compensation for the children's families if the nurses proved to be innocent?
Answer
I am not a legal expert but justice and fair compensation must be provided for all victims in this case. I understand that some European countries are providing care and treatment for some of the infected children. Certainly these families need assistance and support. The first thing is to provide for their needs, but I would also raise the question about compensation for the nurses and doctor who have been imprisoned since 1999.
They have become pawns in a political game and have suffered greatly as have their families.
Name
Taha
- Morocco
Profession
Question
What is the evidence that support poor infection control in Al-Fateh hospital in Libya?
Answer
This is an excellent question. One of the most disturbing aspects of this case is that an investigation of conditions present in the hospital at the time of the outbreak was conducted by the WHO but not made available to the court. Dr. Montagnier saw this report and concluded that conditions in the hospital were conducive to the spread of hospital acquired infections.
This investigation is no longer available so there are only anecdotal reports of conditions there. There were also poor infection control conditions evident in other Libyan hospitals and two other nurses working in the Al-Fateh hospital were infected with the same strain of HIV as the children.
Many of the infected children were also infected with hepatitis B and C, suggesting hospital spread and multiple sources of exposure. The absence of a complete report of conditions is one of the most disturbing factors impeding the fair judgement of these workers.
Name
Mariam
- Egypt
Profession
Question
Thanks for the live dialogue doctor
It seems to me though that the international community is focusing on the fate of the bulgarian nurses but they are ignoring the fact that over 400 children, many of them babies, have been infected with this deadly virus.
Why isn't there anything being done to help them?
Answer
Mariam, there have been efforts made to provide for the treatment of the children by AIDS experts in Europe, but I agree not enough has been done. For true justice to be done for all parties a proper investigation of the true causes of this outbreak should be conducted because how can they be sure that the same thing could not happen again?
As to the reason that there is an emphasis on the 6 workers is that the trial will be entering its last day tomorrow and what we are seeing now is an 11th hour effort, especially by the scientific and healthcare communities to save the lives of these 6 healthcare workers. It is surprising how little attention has been paid to all of the victims, the patients and the workers, over the past 8 years.
Name
MoYo
-
Profession
Question
Can you give us some details about the types of AIDS virus?
Answer
Again, I am not a virologist.
I would direct you to the report of Dr. Montagnier and Dr. Colizzi at http://declanbutler.info/blog/LIBYA1.pdf and also the Nature magazine article at http://www.nature.com/nature/journal/v443/n7114/full/443888a.html.
But, whatever has been determined by the viral typing studies done on these patients, has been excluded from evidence in the case. This evidence was considered by the defence and the scientific community to be the most powerful evidence excluding the workers as a source of the infections.
Name
Mark
-
Profession
Question
What has been the international interference in the case so far? And how have the Libyans responded to it?
Answer
Mark, that is the big question. This case is tied up in high-level international politics. There has been little international "interference" so far. There have been no governments or international bodies that have come forward forcefully to intervene in the case. There is a complex diplomatic web that has impeded the international community from taking a stand.
That is why the scientific and healthcare communities that are not tied to these political issues are making an appeal in the 11th hour.
The Libyan government has tried to link this case to sanctions imposed on it following the Lockerbie bombing and has made demands that Libya be paid the same amount to free the 6 workers as was imposed on Libya for its role in the Lockerbie case. Bringing the case back to earth and demanding that simple justice be done is the challenge.
As far as Libyan response, that has been highly controlled by the government. So far the government has refused to allow the most important evidence in the case and has not responded to pleas from any party to reconsider its position in laying blame at the feet of the 6 workers.
The infection of these children is understandably a huge national scandal in Libya. If the blame is removed from the 6 workers, where will it go?
Name
Maha Y
- Egypt
Profession
Pharmacist
Question
On what basis is the Libyan government prosecuting those health workers if there is such a lack of evidence against her?
On what ground did they ignore the report from Dr. Montagnier?
Answer
Maha,
The government based its case on the 2003 assessment of 5 government-appointed Libyan doctors who present no evidence linking the 6 individuals to the 426 patients. Their so-called "evidence" consisted of rejecting the scientific evidence in the Montagnier report, which was, by the way, commissioned by the Libyan government. Also, they argue that the outbreak had to be deliberate. They claim (without documentation) there can be no other explanation because Al-Fateh was a "model" hospital.
I have read the prosecution document and have seen no scientific or epidemiologic evidence submitted that could even suggest a causal link between these patients and these accused healthcare workers.
Name
Editor
-
Profession
Question
You came into the picture as an epidemiologist.
Can you please explain how the samples and/or results you have seen prove beyond a doubt that there is no proper evidence against the healthcare workers?
Answer
What I have seen are prosecution documents, not blood samples or biological data. Only Dr. Montagnier and other researchers who have either gotten blood samples from some of these patients or been involved with their treatment have virological evidence. What I can say is that there was no scientific or virological evidence produced by the prosecution. They excluded the only scientific evidence that was available.
That existing evidence indicated that the outbreak had to have begun before the arrival of the workers in Libya. The protein profiles of several patients indicated that their infections had to have been contracted before 1998 and possibly even before 1997. Hospital records also showed some patients had not been treated in the hospital when the workers were there.
The fact that this evidence has been excluded is the most troubling aspect of the case. If the Libyan authorities had wanted to determine the true cause of the outbreak, there would be much more evidence in the case. By epidemiologic standards, establishing a cause and effect relationship would have to be done for each of the 6 workers separately. Disease transmission cannot be established for a group.
In most courts of law, you must prove beyond a doubt a defendant's guilt, not his or her innocence.
Name
Kareem
- Syria
Profession
Question
Do you think that if the report presented by Dr. Montagnier was made by an arab organization it would have got more attention from the prosecutors?
Answer
Kareem,
It appears that the evidence was excluded based on the criteria that it refuted the prosecution's case, regardless of the source. Nevertheless, support from Arab organizations could still make a difference in this case in its 11th hour. Any group that is compelled by this humanitarian tragedy can play a role.
Name
Egfoo Yong, M.P.H.
- Hong Kong
Profession
Question
To what do you attribute the Libyans' backward failure to exact civilised standards of due process and impartial justice?
Answer
Libya has an opportunity, even in the 11th hour, to demonstrate its commitment to justice and due process. They would still be congratulated for their reconsideration of the judgement of these workers in the final hours of the case.
Healthcare workers everywhere providing their services in foreign countries need to know that they are safe from being unjustly blamed for the conditions present in their host countries.
It is never too late for justice to prevail.
Name
Harry Balz
- Costa Rica
Profession
retired
Question
I have often read of this case and have come to the conclusion that it is a fiendish plot to bring shame and humiliation upon the Arab peoples who do not know any better than to make false accusations. What is your opinion?
Answer
This is certainly not the fault of the "Arab peoples." Not even all of the families of the infected children believe these accusations.
Name
Bernard and Betty Rubble
- Australia
Profession
Question
G'day! Can one be optimistic or should we fear the worse?
Answer
At this time, the signs remain gloomy and all expressions of support for the lives of these six healthcare workers can make a difference. There is still hope. We must all do what we can.
Name
Host
-
Profession
Question
-
Answer
Thank you Dr. Jagger for joining us in this interesting session.
For more information you can read IslamOnline.net's coverage of the issue.
