Benghazi epidemic

Dr DANAIL BESHKOV, Director of the National AIDS Laboratory, works in close cooperation with Bisanti. He is in charge of the medical aspects of the case, studies similar cases in other countries and conducts the correspondence with foreign experts Frenchman Luc Montaigner and Geneva-based virologist Luc Perrin.

According to Beshkov, research done by Perrin and Montaigner corroborates the theory that the HIV epidemic in Benghazi was the result of an in-hospital infection.

The experts would like to see more research being done to determine the causes for the epidemic and to take measures to prevent such cases in the future.

Citing expert opinions, Beshkov thinks that the influx of citizens of other African countries is among the factors that facilitated the spread of AIDS. Beshkov quoted data according to which 36 per cent of the population of Botswana and 20 per cent of the population of South Africa are HIV positive.

Beshkov elaborates that in-hospital infections and in particular those caused by blood-transmitted agents such as microbes and viruses have been recorded as far back as the early 20th century when the mass use of syringes started. The first recorded case of an in-hospital infection dates to the year 1917 when in England during the treatment of soldiers for syphilis they were infected with malaria. This is the first documented epidemiological outbreak caused by an in-hospital infection.

The first recorded case of an AIDS epidemic caused by an in-hospital infection occurred at the pediatric hospital in the town of Elisa in the Kalmyk Republic. One hundred children were infected after the reuse of syringes.

Some 2,000 children from maternity homes, pediatric hospitals and nursery schools in Romania were infected in 1990 with AIDS due to use of infected blood for transfusions and the reuse of syringes. Beshkov noted other cases of infection that affected fewer people. In 1992, a dentist in Florida infected five of his patients with instruments that were not sterilized properly. A case of AIDS infection was reported in 1993 at a private clinic in Australia. Two cases of AIDS infection were reported in 1999 in Denmark and France which were again the result of in-hospital infections caused by the reuse of instruments and improper sterilization. These cases show that even in the industrialized countries there are no guarantees that an in-hospital infection will not break out.

There is also information on in-hospital AIDS infections in Africa but these cases are not well documented, Beshkov said. The case in Libya is not the first one and will not be the last, he thinks. Poor infection control standards, shortage of consumables and the medical staff’s insufficient knowledge of the mechanism for the transmission of infections are among the main factors for the epidemics.

Ten years after the first case of mass AIDS infection, the issue remains topical for the global medical community, Beshkov said. A lot has been done in the field of prophylaxis but there are still some unresolved problems, he said, noting that 16,000 people around the world are infected with AIDS every day.

The main factors for the transmission of infectious diseases through syringes are the improper sterilization and reuse. Such practices facilitate the transmission of hepatitis B and C, AIDS, ebola, lasa and malaria. Between 20 and 80 per cent of new cases of hepatitis B are the result of syringe-transmitted infection. Almost all cases of hepatitis C are the result of reuse of syringe needles. In the Western World, hepatitis C is referred to as the disease of drug addicts since 70-90 per cent of them are infected.

Experts consider in-hospital infections with blood-transmitted agents to be the main problem of hospital care in countries with limited financial resources. On the basis of representative research, WHO has concluded that every year in developing countries between 8 and 16 million people contract hepatitis B, 2.3-4.7 million contract hepatitis C and 80,000-160,000 are infected with AIDS.

Prof. LUC MONTAIGNER of the Institut Pasteur in Paris takes credit for the first publication in world medical literature on the discovery of the human immunodeficiency virus in 1983. The 67-years-old professor holds the Prix Rosen for cancer research, the Gallien Prize, the Heineken Prize for Medicine, the Lasker Prize and a number of other international honours. He is Commander of the Legion d’Honneur.. Montaigner visited Libya together with Prof. Stephane Blanche, in whose Paris clinic part of the Libyan children were tested. Prof. Montaigner has co-founded the New York-based World Foundation for AIDS Research.

The other prominent virologist contacted by lawyer Bisanti is LUC PERRIN of Switzerland. He works at the Geneva University Hospital and is one of the greatest living specialists in the field of retroviruses.

PROF. VITTORIO COLIZZI is one of the most eminent researchers of HIV/AIDS in Europe. He heads the Laboratory of Immunochemical and Molecular Pathology with the Biology Department of Tor Vergata University in Rome, Italy. Together with his French counterpart Prof. Luc Montagnier, in 2002 he begins working on a report about how and when nearly 400 Libyan children in the Benghazi chidlern's hospital came to be infected with the AIDS visrus. The final report drawn by the two scholars is submitted to the Libyan authorities, who have commissioned it, in April 2003. By the middle of 2003, Colizzi has visited Libya three times. He explores the modifications of HIV isolated from the organisms of Libyan children in three hospitals - in Rome, Geneva, and France. The general conclusion is that all modifications bear a close similarity and that they even have a common origin.

According to Colizzi, the AIDS infection in the Benghazi hospital is of an iatric character. Its source is a child who was a HIV carrier but was hospitalized for the treatment of another disease.

Dr PAOLO LUSSO, head of and AIDS testing department at the San Raffaele Hospital in Milan, and Dr PAOLA NASCA, member of the National Anti-AIDS League, came to the limelight in a major article about the treatment of some 200 HIV-infected Libyan children in clinics in Rome and Milan, which appeared in the Italian magazine Diario on February 2, 2001. The two Italian doctors told the magazine that the AIDS epidemic at the Benghazi children’s hospital was most probably caused by multiple use of syringes and non-sterile instruments.

Professor GEORGE JOFFE is an expert at the Center for International Studies at Cambridge, the UK. He specializes in the problems of Northern Africa and the Middle East and is known for his commentaries and scientific theses on the problems of terrorism and international politics.

In an interview for BBC Professor Joffe suggests that the decisions of the court in Benghazi on Case 213/2002 indicate that the Libyan authorities probably realize that the Bulgarian medical professionals are not responsible for the outbreak of AIDS in Libya in 1997-1998.

At the invitation of Bulgarian members of the International Association of Democratic Lawyers, two international observers attended several of the hearings of the People’s Court in Tripoli: Mohammad Baqar of Tunisia, Secretary General of the Mediterranean Bar Association, and Zubeida Amrani of Algeria, Secretary General of the Association of Arab Jurists. The presence of international observers sets a precedence in Libyan administration of justice. The two observers found that the trial was conducted according to the law and that the Bulgarians were not subjected to harsher treatment on account of being foreigners. Baqar and Amrani are convinced that the Bulgarians will not be convicted because there is no sufficient incriminating evidence.

At its first hearing on July 8, 2003 the Criminal Court in Benghazi proceeds with the AIDS infection case. The court schedules another hearing for August 4, also in Benghazi and dismisses a request by defence lawyer Plamen Yalnuzov to release the defendants on the recognizance of the Bulgarian Government as certified in a letter by the Bulgarian Embassy in Tripoli.

During the one-hour session the court hears statements by the defence lawyers of the Bulgarians and the other defendants (one Palestinian and nine Libyans).

Yalnuzov requests that a report by prominent AIDS experts Luc Montagnier and Vittorio Colizzi be admitted in evidence. Yalnuzov argues that a profound scientific examination is essential for the court to establish the truth about the tragedy, which caused suffering to the infected children and their families as well as to the Bulgarian defendants who "have been subject to arbitrary and violent treatment." He urges the court to release the Bulgarian defendants on the recognizance of the Bulgarian authorities which undertake to ensure that the defendants will appear in court during the trial.

The two prosecutors in the case insist that the Bulgarians' remand in custody be continued, and the court grants their request.

A lawyer of the parents of one of the infected children lodges a compensation claim for 15 million Libyan dinars. The claim is handed over to the lawyers of the defendants.

During the hearing, tight security measures are in place in the city outskirts. Many police officers with submachine guns and pistols guard the venue of the hearing near the Al-Kawafiyah Prison.

Only several relatives of some of the infected children are admitted in the court room. The six Bulgarian defendants sit behind bars in a partitioned section of the room. Sitting in the back rows are about a dozen Libyans whom an Arraignment Chamber in Benghazi found responsible for duress committed against the Bulgarians during the preliminary investigation.

Italy's Consul General in Benghazi, Giovanni Pirello, attends the hearing as an observer and as representative both of his country and the European Union, as Italy is holding the rotating Presidency of the Union.

In front of the building where the hearing is held, members of the committee of relatives of infected children meet with Bulgarian journalists. In a message to the Bulgarian people they say they wish to learn the truth about the case, regardless of who caused the infection.

August 4, 2003. At its second hearing on August 4, the criminal court in Benghazi decides to admit AIDS experts Prof. Luc Montagnier and Prof. Vittorio Colizzi as witnesses in Case No. 213/2002. The decision is made in response to the explicit request of Plamen Yalnuzov, the Bulgarian lawyer of the defendants.

The court decides to give the two scientists a hearing on September 3, when its next hearing will be held.

At this second hearing of Case No. 213/2002, Yalnuzov submits in writing six motions. One motion is to call Professors Luc Montagnier and Vittorio Colizzi, as witnesses. He also moves that a report by Abu Zayd Umar Durda, made in connection with the causes of the AIDS epidemic in Libya and presented to the UN Security Council, be admitted in evidence. The Durda report blames the bad state of the Libyan health care system on the UN embargo imposed against Libya in 1992.

Another one of Yalnuzov's motions is that the court admit in evidence the last issue of the "La" magazine, which in 1998 conducted an investigation into the causes of the AIDS epidemic at the Al Fatah children's hospital in Benghazi and was suppressed in consequence. Yalnuzov hands the panel of judges a copy of the "La" last issue.

Yalnuzov also moves that the defendants' lawyers be given access to the protocol on the results of the analysis of five banks containing plasma protein that were seized from the home of one of the nurses charged in the case, Kristiyana Vulcheva.

The Bulgarian medical workers' lawyer insists for an investigation in connection with the place of detainment of the six Bulgarians between June 1999 and February 2002, the period of the preliminary investigation. According to Yalnuzov, the place where the Bulgarians were detained during that period is in contradiction with the Libyan law.

Once again Yalnuzov insists on changing the measure of restraint applied to the Bulgarians - "remand in custody", into a milder one.

Nine Libyan nationals - officers of the security services, appear at the hearing held by the criminal court. A year ago, issuing a ruling in connection with the testimony of the Bulgarian medics that they were tortured during the preliminary investigation, the Arraignment Chamber in benghazi determined that the officers should be held liable for what they did.

The Libyan lawyer of the Bulgarian defendants, Osman Bizanti, is represented by his assistant Hanan Alaueti. The hearing lasts for more than an hour and is attended by Italian Consul Giovanni Pirello and, for the first time, by Fatma al-Masri, Human Rights Department Coordinator at the Qaddafi International Foundation for Charity Associations, as observers.

The Bulgarian medics' defence lawyers confirm that the panel on Case No. 213/2002 is composed of judges from Derma, a town neighboring Benghazi.

The reason is that several judges from Tripoli and Benghazi refused to take on the case due to public sentiments in the two cities.

The court panel is constituted following a ten-month break in the court proceedings involved in the case.

Libya-Bulgaria-trial: AIDS trial of Bulgarians in Libya adjourned again

Agence France-Presse - July 8, 2003

TRIPOLI, July 8 (AFP) - The trial of six Bulgarians and a Palestinian accused of spreading an AIDS epidemic in Libya reopened but was adjourned again indefinitely Tuesday, court sources said.

No other details were given of the trial on Tuesday's hearing in Benghazi, east of Tripoli, which had recommenced following an earlier ten-month adjournment.

Six Bulgarians -- five nurses and one doctor -- along with a Palestinian doctor, worked at a hospital in Benghazi when they were arrested in 1998 on charges of infecting 393 Libyan children with the HIV virus that causes AIDS, through tainted blood products.

The case was thrown out for lack of evidence when it first went to a special court in 2002, but the prosecution refiled the charges and Benghazi judicial authorities decided in August to reopen the case before a criminal court.

AIDS-related diseases have already killed at least 23 of the children at the Al-Fateh children's hospital.

The medics have been in prison for almost three years. They face the death sentence if found guilty, in a case which has aroused strong feelings in Bulgaria and a slump in relations between Sofia and Tripoli.

The Bulgarians were also accused of illegally distilling alcohol, having sex outside marriage and trading currency on the black market.

The seven have denied all the charges against them, while two nurses and the Palestinian doctor have said in court that confessions they made to police were made under duress.

28/9/2001: Libya: detention, torture and risk of an unfair trial of five Bulgarian nurses and one doctor, one Palestinian and 9 Libyans

http://www.omct.org/displaydocument.asp?DocType=Appeal&Index=1138&La

Case LBY 280901
Arbitrary Arrest and Detention/Torture/Fair Trial

The International Secretariat of OMCT requests your URGENT intervention in the following situation in Libya.

Brief description of the situation:

The International Secretariat of OMCT has been informed by the Assistance Centre for Torture Victims (ACET) and the International Rehabilitation Council for Torture Victims (IRCT), both of whom are members of the OMCT network, as well as the Bulgarian Helsinki Committee and Greek Helsinki Monitor, of the detention, torture and risk of an unfair trial of five Bulgarian nurses and one doctor, one Palestinian and 9 Libyans in Libya. The trial has been postponed 14 times by the judge, reportedly upon requests from the defence, most recently on September 22nd, at which time a verdict was expected. The verdict is now expected to be announced when the court next convenes, on December 22nd.

According to the information received, on February 9th, 1999, over seventy health professionals from Bulgaria (23 persons), Egypt, Hungary, the Philippines and Poland were arrested in Benghazi, Libya, following an investigation into an HIV virus epidemic in the Al-Fateh Pediatric Hospital in Benghazi, in which 393 children were reportedly infected. At least 23 of these children have reportedly died since then. All of the persons that were arrested were released the next day, notably, it is thought, due to the active reaction and operations of their embassy representatives, except the 23 Bulgarian detainees. All but five of these were released one week later. The five persons who remained in custody were all female nurses, including: Christiana Vulcheva, Nassya Nenova, Valenitina Siropulo, Valya Chervenyashka, Snejana Dimitrova. Another Bulgarian national, Dr. Zdavko Georgiev, Christina Vulcheva’s husband, was arrested on February 9th, 1999, when he went to the police station where his wife was being detained, and has been detained and accused along with the other five persons, even though he did not work at the same hospital.

According to the information received, on February 7th, 2000 a Tripoli prosecutor signed a 1,600-page indictment against the six Bulgarians, nine Libyans and one Palestinian, charging them with undermining and attacking the security of the Libyan State by intentionally spreading the HIV virus through contaminated blood. The specific charges include: intentional killing with a lethal substance (Article 371 of the Libyan Criminal Code), random killing with the aim of attacking the security of the State (Article 202 of the Libyan Criminal Code) and causing an epidemic through spreading harmful microbes leading to the death of persons (Article 305 of the Libyan Criminal Code). If convicted, the defendants may face the death penalty. Other charges have been brought against the Bulgarians and Palestinian defendants for violating the norms relating to Islam. Charges of this type, leveled against the Bulgarian female nurses, include extramarital sexual activity and the production and possession of alcohol. The Palestinian defendant faces a charge of exchanging money through the black market. The Libyan nationals in the case have been charged with numerous counts of negligence in their capacity as health officials, as well as abuse of authority.

Since their arrest on 9 February 1999 the accused have remained in custody. At first they were detained for about 10 months without having access to their families. They were allowed access to a defence lawyer only after trail proceedings had begun. In mid-May 2000 the Libyan defence lawyer for the Bulgarian defendants, Osman Bizanti, who was hired by the Bulgarian Embassy, told the media that he had only met his clients on two occasions.

All of the defendants have complained that during the initial stage of detention they have been subjected to torture and inhuman treatment. The forms of torture to which they have been subjected typically include: electrocution, beating with electrical wire, being kept naked and crucified for lengthy periods of time, being beaten on the soles of the feet, being drugged, the use of fire and ice-cold showers, being held in over-crowded cells, being blinded by bright lights and being intimidated and bitten by police dogs. At first the accused told Mr. Hristo Danov, the Bulgarian president's envoy, who visited them in the prison in April 2000, that during the investigation they were tortured. Before the court hearing on 12 May 2001 Mrs. Krisrtina Vulcheva told the Bulgarian “24 hours” newspaper correspondent that all the detainees were subjected to systematic torture during the first three months after their arrest. Later, the information was confirmed by Mr. Emil Manolov, Bulgaria's consul general in Tripoli, who visited the detainees on 31 May 2001 for the first time in three months.

Two of the accused - Mrs. Kristina Vulcheva and Mrs. Nassya Nenova, - who seemed to have suffered most, raised their complaints of torture during the court hearing on 2 June 2001, while being questioned as to confessions made during the investigation. Both accused withdrew their testimonies with the explanation that they were forced into confessing about offences they had not committed through the use of torture. Mrs. Vulcheva said that during the investigation she was subjected at least ten times to electric shocks. She was undressed and beaten with an electric cable. Then two men held her under arms and made her run while her legs was still paralyzed by the electricity. For nine months after the torture Mrs. Vulcheva was not able to menstruate. This allegation of torture was later confirmed by Mrs. Vulcheva's mother, Zorka Anachkova. She visited her daughter in the prison after the last court hearing on 17 June 2001. Mrs. Anachkova told the Bulgarian "Trud" newspaper that her daughter had told her that she was being tortured.

At the court hearing on 2 June 2001 Mrs. Nenova told the court that she was systematically tortured and subjected to electric shocks during detention. She later attempted to commit suicide when she heard that Major Djuma, who conducted the torture, was returning to the prison to take over the investigation. She also recounted that before and after the court hearings all the detainees were always taken to the investigation's office where investigators exerted pressure upon them. Mrs. Nenova allegations were confirmed in mid-June 2000 by Mrs. Nadya Dervisheva, a Bulgarian nurse who was arrested with the accused but later released without being prosecuted. She told the Bulgarian Helsinki Committee that Nassya Nenova had told her during a visit she made to the prison, that she had been tortured. Mrs. Dervisheva observed that, due to her mistreatment in prison, Nassya Nenova needed prison staff to help her walk. On 13 July 2001 Dr. Ivan Nenov, Nassya Nenova’s husband, visited his wife in prison. He told the Bulgarian newspaper “24 hours” that Mrs. Nenova had told him that she was beaten with a cable on her hands and feet. As a result she could not walk for one week. A month later she was reportedly subjected to electric shocks and threatened with infection with HIV if she did not make confessions.

The Palestinian detainee was allowed to be visited by his family in early 2000. They later reported that they observed black marks on his hands. He told them he had been subjected to electric shocks.

At the court hearing on 16 June 2001, Bulgarian attorney Sheitanov requested that the Court order a forensic expertise to determine whether the detainees had been tortured. He also gave a list of the people who had allegedly conducted torture, but the court ignored the request. The alleged perpetrators include: Major Djuma, General Harb Durbal, Colonel Dzuma Misheri, Selim Druma, Mohammed Harari, Dzuma Mlatem, Usama Uidad, Abdul Mazhid (a chemist), Idris (an interpreter) and a man referred to only as Mustafa.

The defence lawyers for the Bulgarian defendants requested the court to summon as witnesses Dr. Luc Montagnier from France and Dr. Luc Rerrin from Switzerland, who are prominent HIV researchers, to appear before it as medical experts. The two professors have already check-ups on some of the Libyan children and found that most of them were also infected with different types of hepatitis B and C, indicating that there were multiple sources of infection in the Benghazi hospital. The court refused to grant the request.

Under Libyan law, any of the suspects who confess will be sentenced to death. This is in violation of the rule of inadmissibility of statements extracted under torture. Article 15 of the Convention against Torture states: "Each State Party shall ensure that any statement which is established to have been made as a result of torture shall not be invoked as evidence in any proceedings, except against a person accused of torture as evidence that the statement was made." Furthermore, other evidence presented by the prosecution was collected in illegal ways, for example during searches of the defendants’ houses while they were not present, and can therefore also not be considered during the trial.

The defendants are being tried by the People's Court, which OMCT believes is not qualified to deliver a fair trial, as its members are not explicitly required to be members of the judiciary or trained lawyers and are elected by the General People's Congress on a periodic basis. These two particularities of the court appear to be inconsistent with the Basic Principles on the Independence of the Judiciary adopted by the 7th UN Congress on the prevention of Crime and the treatment of Officers, in September 1985 and approved by the 40th Session of the UN General Assembly in November 1985.

OMCT is gravely concerned for the physical and psychological integrity of the afore-mentioned detainees, given that they have been repeatedly tortured and subjected to ill-treatment, reportedly resulting in damage to their health. OMCT fears that they will continue to be subjected to ill-treatment until the verdict is announced, and fears that they may be sentenced to death at that time. OMCT is gravely concerned about the Libyan authorities’ use of arbitrary arrests, incommunicado detentions, torture and ill-treatment, as well as widespread violations of these persons’ procedural rights and right to a fair trial.

Action requested:

i. take all necessary measures to guarantee the prisoners’ physical and psychological integrity;
ii. order their immediate release in the absence of valid legal charges or, if such charges exist, bring them before an impartial, independent and competent tribunal and guarantee their procedural rights at all times;
iii. ensure the right of those detained to be allowed to meet with their lawyers and family;
iv. intervene with the appropriate authorities in order to secure that the adequate medical assistance is provided as a matter of urgency to the detainees;
v. order a thorough and impartial investigation into the circumstances of these arrests an ill-treatment and torture during the prisoners detention, in order to identify those responsible, bring them to trial and apply the penal, civil and/or administrative sanctions as provided by law;
vi. guarantee the respect of human rights and the fundamental freedoms throughout the country in accordance with national laws and international human rights standards.

Addresses:

· Colonel Mu'ammar al-Kaddafi, Leader of the Revolution, Office of the Leader of the Revolution, Tripoli, Great Socialist People's Libyan Arab Jamahiriya. Fax : + 218 21 333 01 85
· Imbarak Abdalla El Shamek, Prime Minister, Secretary of the General People's Committee Tripoli, Great Socialist People's Libyan Arab Jamahiriya. Fax : + 218 54 60 017
· Mohammed Mohammed Belgassem al-Zuia, Minister of Justice and General Security, Office of the Minister of Justice and General Security, Tripoli, Great Socialist People's Libyan Arab Jamahiriya. Fax : + 218 21 444 16 74
· The General People's Congress (Human Rights section). Fax : + 218 21 361 39 07

Please also write to the Diplomatic Representatives of Libya in your country.

Geneva, September 28th, 2001

Kindly inform us of any action undertaken quoting the code of this appeal in your reply.