Medicine Politics

The Tripoli Six

A few months ago, I wrote about a horrific miscarriage of justice in Libya that could result in the deaths of innocent health care workers whose only crime was to have the wherewithal to want to work in Libya to help the people there, but who have been falsely accused of intentionally infecting children with HIV. My original post was prompted by Declan Butler and an article in Nature.. The six health care workers (known as the Tripoli Six or the Benghazi Six) were convicted in a sham trial that was rigged and far from impartial. Apparently Libyan Dictator Muammar Gaddafi found them a convenient scapegoat for the deficiencies in the health care system in Libya.

Revere at Effect Measure has provided an update, pointing out that Nature has published an exhaustive analysis of the DNA sequences from the HIV and hepatitis C outbreak that occurred in the hospital in which the Tripoli Six worked. The analysis provides very strong evidence that the strains of HIV and hepatitis C isolated from the infected children had been prevalent in Libya and North Africa before any of the workers actually arrived in Libya:

In 1998, outbreaks of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) infection were reported in children attending Al-Fateh Hospital in Benghazi, Libya. Here we use molecular phylogenetic techniques to analyse new virus sequences from these outbreaks. We find that the HIV-1 and HCV strains were already circulating and prevalent in this hospital and its environs before the arrival in March 1998 of the foreign medical staff (five Bulgarian nurses and a Palestinian doctor) who stand accused of transmitting the HIV strain to the children.


We found that, irrespective of which model was used, the estimated date of the most common recent ancestor for each cluster pre-dated March 1998, sometimes by many years (Fig. 2). In most analyses, the probability that the clusters from the Al-Fateh Hospital originated after that time was almost zero (for details, see supplementary information). For the three HCV clusters, the percentage of lineages already
present before March 1998 was about 70%; the equivalent percentage for the HIV-1 cluster was estimated at about 40%.

Our results support the existing nosocomial transmission scenario1,11 and suggest that Al-Fateh Hospital had a long-standing infection- control problem. The earlier origin and greater number of HCV clusters than HIV-1 clusters reflect the higher transmissibility of HCV compared with HIV-1 by such routes12. Crucially, we have shown that the HIV-1 and HCV strains responsible were being spread and transmitted among individuals attending the hospital before March 1998, indicating that many of the transmissions giving rise to the infection clusters must have already occurred before the foreign medical staff arrived.

There is little doubt that the “trial” of the Tripoli Six was nothing more than a kangaroo court, and these health care workers remain at serious risk of being executed for a trumped up crime, all as scapegoats for the real problem, the unsanitary conditions in the Libyan hospital. Feeding the frenzy, the relatives of the infected children demand the blood of these health care workers every time news reports suggest that they might be released, and, because of the prevailing ignorance in Libya about how HIV is transmitted, the charges that foreigners infected Libyan children with HIV seem plausible to the average Libyan. Even if the Tripoli Six are ultimately released, the travesty of justice has still been enormous, as they have been held in a Libyan prison under appalling conditions:

“I confessed during torture with electricity. They put small wires on my toes and on my thumbs. Sometimes they put one on my thumb and another on either my tongue, neck or ear,” Valentina Siropulo, one of the Bulgarian defendants, told Human Rights Watch. “They had two kinds of machines, one with a crank and one with buttons.”
Another Bulgarian defendant, Kristiana Valceva, said interrogators used a small machine with cables and a handle that produced electricity.

“During the shocks and torture they asked me where the AIDS came from and what is your role�” she told Human Rights Watch. She said that Libyan interrogators subjected her to electric shocks on her breasts and genitals.

“My confession was all in Arabic without translation,” she said. “We were ready to sign anything just to stop the torture.”

The five Bulgarian nurses are being held in a special wing of Jadida prison, where they now get regular visits from their lawyers and Bulgarian officials. The Palestinian doctor, Ashraf Ahmad Jum’a, is in the men’s section of the prison by himself in the wing for those on death row.

“We had barbaric, sadistic torture for a crime we didn’t do,” Jum’a told Human Rights Watch during an interview conducted in the presence of a prison guard. “They used electric shocks, drugs, beatings, police dogs, sleep prevention.”

“The confession was like multiple choice, and when I gave a wrong answer they shocked me,” he said. He claimed that the defendants were also forced to shock each other.

So what can you do? Revere has a suggestion:

We hope that once again the science blogosphere will help marshal the potent support of the internet community in this signal human rights case. We remind all bloggers, letter writers and anyone else that expresses an opinion about this to heed the prudent advice of those long involved in these kinds of cases: the objective is to help our colleagues held prisoner and under threat of a death sentence. It is not to relieve our own feelings. Governments don’t usually respond to abuse or condemnation. Nor is it necessary. The science speaks loudly enough on behalf of these medical workers, but it must be heard by the Libyan authorities who have it in their power to assure a fair and just outcome to this this tragedy.

Mike Dunford
‘s advice from nearly three months ago still applies;

When you write a letter to an elected official, be clear, be concise, and be respectful. If at all possible, keep the letter to no more than one page in length. Make sure that you identify the reason for the letter in the first paragraph, and make sure that you clearly state what you expect the elected official to do. In this case, I would suggest telling them that you would like to see our government publicly inform the Libyans that this conduct is unacceptable, and that there will be consequences if they continue down this path.

Janet has also chimed in with some suggestions.

Sentencing is to occur on December 19, and it’s quite possible that the sentence could be death. Science hasn’t mattered so far, but maybe it’s not too late. For what it’s worth, I throw whatever little influence this blog has behind this effort and ask my readers to write and/or call their legislators and the President to strongly request that they put the power and prestige of the United States behind an effort to overthrow this miscarriage of justice. This is not an issue of left or right. It is an issue of simple justice.

ADDENDUM: I realize that Revere threw a bit of a pot shot across my bow several days ago. I’ve been a bit busy (note the reruns yesterday, rather than fresh material, and the quick and dirty debunking of Choprawoo, which, quite frankly, takes so little effort on my part that it almost counts as no post at all in terms of time involved). Then, of course, there was the return of the Hitler Zombie on Monday, which was completed before things got hairy.

I had originally intended to respond today. However, this is far more important than a mere response to a little disagreement over what constitutes evidence-based medicine. Don’t worry, Revere, I’ll get around to your challenge to “humility” in due time. You realize, of course, that surgeons don’t know the meaning of the word, don’t you?

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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