June 23, 2004
His Excellency Mu'ammar al-Gaddafi
Leader of the Revolution
Office of the Leader of the Revolution
Tripoli
Great Socialist People's Libyan Arab Jamahiriya
Dear Your Excellency al-Gaddafi:
As leading virologists and other scientists and physicians, we join our health professional colleagues internationally in calling on you urgently to commute the death sentences imposed by the Benghazi Criminal Court in Libya on five Bulgarian nurses and one Palestinian physician. We also respectfully ask your government to review the procedures that have led to the targeting of these foreign health workers in this affair. The individuals have been charged and convicted of deliberately infecting more than 400 children with HIV while working in al-Fateh Children’s Hospital. Prominent independent scientific experts have concluded, however, that the systematic infection was not perpetrated by those accused. Many of the children were infected prior to the arrival of these health practitioners, and the evidence further shows that unsanitary health conditions are to blame. It is an unfortunate reality that in many countries throughout the world, particularly those in Africa and Asia, inadequate health conditions, training, and care can hasten the spread of HIV/AIDS.
Those sentenced to death are Kristiana Malinova Valcheva, Nasya Stojcheva Nenova, Valentina Manolova Siropulo, Valya Georgieva Chervenyashka, Snezhanka Ivanova Dimitrova, and Ashraf Ahmad Jum’a.
Libyan authorities took an appropriate step in investigating the cause of the nosocomial HIV infection at al-Fateh Children’s hospital when the Gaddafi Foundation appointed Professor Vittorio Colizzi, who is with the Tor Vegatta University in Rome, and Professor Luc Montagnier, co-discoverer of HIV, the virus that causes AIDS, as international scientific consultants. However, we believe the Benghazi Criminal Court has disregarded the explicit findings of these prominent physicians and has proceeded without a firm grasp of the scientific realities.
After several trips to Libya, which included a comprehensive and thorough investigation of the al-Fateh Children’s hospital, Drs. Montagnier and Colizzi highlighted the unlikelihood of a deliberate injection by the accused health workers and concluded that “all the genetic analyses performed strongly indicate that the nosocomial infection in Benghazi Children’s Hospital has been caused by a single. . . subtype of A/G HIV-1...by one. . . HIV infected child who was originally infected by his mother through vertical transmission. This infection was already present in the Benghazi Hospital in April 1997 [before the foreign health workers arrived]. . . and was still operating in March 1999.”
Dr. Montagnier’s assertion that the infections were caused by poor medical conditions is consistent with the international community’s recognition that unsterile medical equipment can and does transmit HIV. Outbreaks with similar causes have been documented in Egypt, Romania, and the Kalmyk Autonomous Region of Russia. In fact, according to the World Health Organization, it is estimated that 260,000 HIV infections occur each year because of medical injections given with unsterile needles and syringes.
When HIV infections are transmitted through medical procedures or other unsterile conditions at health facilities, the transmissions do not occur because of ill will on the part of health care workers. Rather, the causes tend to be systemic to the health facility or health systems, including improper training of health workers, a high workload, insufficient supplies, or inadequate infection prevention and control procedures.
That more than 400 children at al-Fateh Children’s Hospital were infected with HIV is truly tragic. However, accusing health professionals of deliberately infecting the children with HIV, contrary to the evidence, and sentencing these health professionals to death, will not help protect other patients from a similar fate. Policies that promote strong infection prevention and control regime will provide significant protection. We believe it is critical that Libyan authorities, with international assistance as needed, investigate and determine the conditions at al-Fateh Children’s Hospital that enabled these children to become infected, and ensure that such conditions no longer exist at that or any other Libyan health facility. The World Health Organization’s Regional Office for the Eastern Mediterranean can be contacted to assist with the investigation or direct the Libyan authorities to those who are best positioned to do so.
We are glad to hear that most of the children infected with HIV at al-Fateh Children’s Hospital are still alive, and that Libyan authorities are providing for their treatment at home and abroad. Children, like adults, can be successfully treated with anti-retroviral medication, keeping them alive for many years.
Due to the scientific evidence and to credible reports that the health workers were tortured into false confessions, we believe that the defendants have suffered extreme prejudice in their case. Accordingly, we urge the Libyan authorities to dismiss the case, and to release to their home countries the imprisoned medical personnel who were invited to your country to help treat the sick. We urge you to ensure that these health professionals are protected, given any medical attention they may need, and are not further abused while still in detention.
Sincerely,
Michael Adler, MD, FRCP
Professor of Medicine
University College London
ENGLAND
Arash Alaei, MD
Co-director, Pars Curative Researchers Institute for HIV/DU/STI
Shaheed Beheshti University of Medical Sciences
Co-director, TB/HIV International Programs
National Research Institute of Tuberculosis and Lung Disease
Tehran & Kermanshah
IRAN
Kamiar Alaei, MD
Co-director, Pars Curative Researchers Institute for HIV/DU/STI
Shaheed Beheshti University of Medical Sciences
Co-director, TB/HIV International Programs
National Research Institute of Tuberculosis and Lung Disease
Tehran & Kermanshah
IRAN
John G. Bartlett, MD
Johns Hopkins University
Baltimore, MD
USA
Stephane Blanche, MD
Unité d Immunologie-Hematologie Departement
Hospital Necker-Enfants Malades
Paris
FRANCE
Rafael E. Campo, MD
Infectious Diseases Research Unit
Division of Infectious Diseases
University of Miami School of Medicine
Miami, FL
USA
Vittorio Colizzi, MD, PhD
Professor, University of Tor Vergata
Rome
ITALY
Douglas T. Dieterich, MD
Vice Chair and Chief Medical Officer
The Mount Sinai Medical Center
New York, NY
USA
Jan Desmyter, MD, PhD
Rega Instituut
Leuven
BELGIUM
Aida Seif El-Dawla, MD
Professor of Psychiatry, Ain Shams University
Founding Member, El Nadim Center for Psychological Rehabilitation of Victims of Violence
Chairperson, Egyptian Association against Torture
Cairo
EGYPT
Wafaa El-Sadr, MD, MPH
Harlem Hospital Center
Columbia University
New York, NY
USA
Robert C. Gallo, MD
Director, Institute of Human Virology and
Division of Basic Science
University of Maryland Biotechnology Institute
Baltimore, MD
USA
Ashley T. Haase, MD
Regents’ Professor and Head, Department of Microbiology
Director, AHC Biomedical Genomics Center
Director, Minnesota Division, Great Lakes Regional Center for AIDS Research
University of Minnesota
Minneapolis, MN
USA
Daniel R. Kuritzkes, MD
Associate Professor of Medicine
Harvard Medical School
Vice-President, Board of Directors
HIV Medicine Association
Cambridge, MA
USA
Professor Thomas Lehner, CBE, MD
Professor of Basic and Applied Immunology
Guy's King's and St Thomas' Hospitals
King's College London
ENGLAND
Haytham Manna, MD, PhD
Board of Directors, Arab Commission for Human Rights
FRANCE
Abdallah Mansour, MD
Director, El Nadim Centre for Psychological Management and
Rehabilitation of Victims of Violence
Cairo
EGYPT
Moncef Marzouki, MD
Associate Professor of Public Health
University of Paris
FRANCE
Kenneth Mayer, MD
Director, Brown University AIDS Program
Professor of Medicine and Community Health, Brown University
Medical Research Director, Fenway Community Health
Boston, MA
USA
Luc Montagnier, MD, PhD
Co-founder, World Foundation for AIDS Research and Prevention
Co-director, Program for International Viral Collaboration
FRANCE
Jeffrey Nadler, MD
Director, Clinical Research, Division of Infectious Diseases
University of South Florida College of Medicine
Tampa, FL
USA
Dr. Rafael Nájera
Chief, Department of Viral Pathogenesis
National Center for Microbiology
Instituto de Salud Carlos III
Madrid
SPAIN
Jumana Odeh, MD, MPH
Director, Palestinian Happy Child Centre
WEST BANK AND GAZA
Mobeen Rathore, MD
Chief, Division of Pediatric Infectious Diseases/Immunology
Professor and Assistant Chairman for Research and Academic Affairs
Department of Pediatrics
University of Florida Health Sciences Center
Jacksonville, FL
USA
Douglas D. Richman, MD
Professor of Pathology and Medicine
Director, Center for AIDS Research
Florence Seeley Riford Chair in AIDS Research
University of California San Diego
La Jolla, CA
USA
Michael Saag, MD
Professor of Medicine
Director, AIDS Outpatient Clinic
University of Alabama at Birmingham
Birmingham, AL
USA
Robert T. Schooley, MD
Tim Gill Professor and Head, Division of Infectious Diseases
Director, Colorado Center for AIDS Research
University of Colorado Health Sciences Center
Denver, CO
USA
Valerie E. Stone, MD, MPH
Associate Chief, General Medicine Unit
Director, Primary Care Residency Program
Massachusetts General Hospital
Harvard Medical School
Boston, MA
USA
Anita Vaughn, MD
Medical Director, Homeless Healthcare Clinic
Newark Department of Health and Human Services
Newark, NJ
USA
Paul Volberding, MD
President, HIV Medicine Association
Professor of Medicine and Vice Chair of Medicine
University of California, San Francisco (UCSF)
Co-Director UCSF-GIVI Center for AIDS Research
Chairman of the Board, International AIDS Society-USA
San Francisco, CA
USA
Hans Wigzell, MD, PhD
Director, Karolinska Institute
SWEDEN
S. Bruce Williams, MD
University of New Mexico School of Medicine
Albuquerque, NM
USA