Health & Medicine / Infectious Diseases

I was in Tripoli, Libya, wiping sweat off my forehead. Sitting across from me in a back room of the Bulgarian embassy was a doctor named Zdravko Georgiev. In 1999, he and his wife, a nurse, had been arrested along with four other Bulgarian nurses and a Palestinian medical intern. They had been charged with bioterrorism, accused of intentionally infecting more than 400 children at a Libyan hospital with HIV. Georgiev, who had been working for a company on the other side of the country, had been released a few months earlier after having spent four years in prison, but the other medical workers, later dubbed the Tripoli Six, were waiting for death by firing squad.

It was a few days before Christmas three years ago, and it wasn’t hot—the Libyan capital is pleasant in December. I was sweating because Georgiev was describing what the Libyan police had done to him and the rest of the medics. The doctor was clearly uncomfortable recalling these events, speaking through parched lips and kneading his hands like bread dough. So I did my best to appear calm and professional; I focused on the irrelevant notes I scribbled in my spiral notebook as he described beatings, rape, electrocutions, and other tortures.

I remember standing up and suggesting that I open the window for some air. Then time stumbled, and I found myself on my back on the embassy carpet. Georgiev had pulled my knees up and tucked them under his chest. He held a stethoscope under my shirt. His face was inches from mine.

“Your heartbeat was below 40,” he said in his thick Slavic accent. “Not very good.” Georgiev was transformed. He looked decades younger suddenly, alert and alive, in his element once again.

“Good thing there was a doctor in the house,” I said, rising on one elbow.

Georgiev didn’t get the joke. “You remind me very much of my son,” he said. “Stay down.”

Before I was driven back to my hotel in one of the embassy’s black SUVs, Georgiev turned the tables and asked me a question. “Do you believe me, that we are innocent?” There is only one way to describe the look in his eyes at that moment: intense and desperate conviction.

I saw the same look the next day when I met with some of the Libyan parents. “We do not know why the medical workers did this, but we do know that they infected our children, that they are guilty,” said Ramadan al-Faitore, a Libyan engineer who quit his job to devote himself full-time to the case against Georgiev and the rest of the medics. These fathers chain-smoking in a shabby hotel room looked no less miserable than Georgiev, nor any less convinced.

If ever there was a job for science, this was it. Here was a case in which people needed to set aside their passions and prejudices, launch a fair investigation of the hospital outbreak (pdf), and reach a consensus based on the best evidence. And it did start out that way. Within months of realizing there had been a massive HIV outbreak at the al-Fateh Children’s Hospital in Benghazi, the Libyan government turned to the World Health Organization (WHO) for help. WHO experts arrived in Libya in December 1998 and stayed for two weeks, inspecting the hospital and interviewing the medical staff.

All evidence pointed to an accidental outbreak due to poor hygiene throughout the hospital. Not only was there a dire shortage of basic supplies, like plastic containers for discarded syringes, latex gloves, and autoclaves—a kind of pressure cooker for sterilizing equipment that is the cornerstone of safe microbiological technique—but standard procedures at the hospital also made viral cross infections inevitable. The staff were using intravenous catheters for injections in all children and then using the same syringes without sterilizing them. And sure enough, blood samples from the Libyan children were found to contain not only HIV but also several strains of hepatitis, a textbook indicator of widespread hospital infections caused by unsanitary conditions.

If such an outbreak had occurred in Europe, the results of the WHO assessment would almost certainly have been made public. But according to Kevin De Cock, director of HIV/AIDS at the WHO, “sharing such reports is usually at the discretion of the government.” The Libyans kept the WHO report secret (it has since been leaked). What happened next reveals the danger of not ensuring transparency in public-health disasters.

Early in 1999, the police secretly arrested numerous people they believed were involved with the infection at the Benghazi hospital, including a Palestinian medical intern, Ashraf al-Hadjudj, and five Bulgarian nurses, Nasya Nenova, Valya Chervenyashka, Snezhana Dimitrova, Valentina Siropulo, and Kristiana Valcheva. Georgiev was arrested as well when he desperately asked the Libyan police for information about his missing wife. It wasn’t until 2000 that they were charged with a crime. The seven foreigners stood accused of deliberately sparking an AIDS epidemic with the aim of attacking the security of the state. If found guilty, the penalty was death. Why would the medical workers do such a thing? An answer came in April 2001 when Libya’s longtime dictator, Colonel Muammar al-Qaddafi, spoke at an HIV/AIDS summit in Nigeria. The colonel went off-script and told the assembled press and world leaders about “an odious crime” committed at a Libyan children’s hospital. A devastating new form of the HIV virus had been created in a laboratory, he said, and a group of foreign medics “carried out an experiment on these children.” The authorities had not been able to stop the experiment in time, but at least they had captured the perpetrators. Qaddafi said he wasn’t sure who had fomented the plot, but he named the American CIA and the Israeli Mossad intelligence services as the top suspects.