Personal View: Quiet diplomacy is not enough
Authors: Paul Haviland
Journal: BMJ (2004)

Here is a familiar story: a lethal infection is discovered to have spread among hospital patients. The culprits are quickly identified as substandard hygiene and poor training. On a more sinister note, there is a suspicion in some quarters that foreign staff, already present in large numbers in the country's health service, are somehow to blame.

So far, so familiar: just weeks ago parts of the British media were treating the “superbug” crisis in precisely those terms.

Now imagine that a handful of foreign hospital workers are rounded up, imprisoned, and charged with deliberately spreading the infection, a charge to which they confess under torture. After five and a half years in judicial limbo, they are found guilty and sentenced to death by firing squad. Friends and relatives of those who died pour on to the streets to welcome the verdicts with whoops of joy.


Those who should be putting pressure on Libya are acting with exaggerated caution


Implausible? Think again. On 6 May this year, in the Libyan city of Benghazi, this nightmarish scenario became reality for five Bulgarian nurses and a Palestinian doctor (Kristiyana Valcheva, Nasiya Nenova, Valentina Siropulo, Valya Chervenyashka, Snezhana Dimitrova, and Dr Ashraf Jum'a al-Hajuj) when a high court judge ordered them to be executed for causing 400 children to be infected with the HIV virus in the hospital where they had been employed.

Quite clearly, for things to have come to such an appalling conclusion, a number of extraneous factors had to enter the equation—in this case, widespread local ignorance of how HIV is transmitted, the political need to find convenient scapegoats, a Kafkaesque judicial system, and sheer xenophobia all played their part. But what struck me when I heard about the case was how easily I could imagine this scenario being repeated closer to home. In less dramatic fashion perhaps, but still...

One's rational mind tells one that “it couldn't happen here.” Yet in the short history of the HIV/AIDS crisis there is already enough evidence of political error and cynicism—from former US president Ronald Reagan's silence to South African president Thabo Mbeki's state of denial—to make one fear the worst. Would a similar mass infection in a British children's hospital go “unpunished”? Would the tabloid press resist the urge to apportion blame, particularly if a number of foreign medical workers were on the scene? Would our politicians act responsibly to calm our fears, rather than exploit them? Anyone who believes that prejudice, media hysteria, and political opportunism would not loom large in a medical panic of this nature has, I would suggest, simply not been paying attention.

As Dr Luc Montagnier, co-discoverer of the HIV virus, testified to the Libyan court: “This can happen not only in this hospital, but in many others, particularly paediatric hospitals.” Montagnier's study of the Benghazi outbreak demonstrated that the infections began long before the Bulgarian nurses set foot in Libya, but this evidence did not sway the court. According to an editorial in Nature (15 July 2004), Montagnier points out that the word “recombinant,” which he used in his report to refer to the natural recombination of wild viruses, was mistranslated in the court's judgment to imply that the accused had genetically manipulated the virus. Earlier charges that they had been working as agents for the CIA and Mossad were quietly shelved in favour of a new supposition that the six were engaged in some form of extemporaneous HIV research.

I am neither a health-care professional nor a human rights activist nor Bulgarian, so I could easily have missed the brief reports which appeared in the press the day after the sentences were handed down. Or I could have read about it and thought: “How extraordinary! What's that all about?” and gone about my business. As it happens, a Bulgarian friend alerted me to the story and eventually won me over to doing something about it. What we discovered, in the course of our attempts to raise funds for the families of the “condemned medics” (as they are known in Bulgaria), was to prove even more discouraging than the bare facts of the matter might suggest.

While the “Benghazi Six” languish in a Libyan prison (often deprived of food and water, and some in a worrying state of health), those who should be putting pressure on the Libyan regime are acting with exaggerated caution. The mercurial Colonel Gaddafi is being treated with kid gloves as he seeks to renew friendly ties with the West; “quiet diplomacy” is being urged on the Bulgarian government, for fear of alienating the Libyan authorities (nothing to do with the skyrocketing price of oil, of course); human rights organisations are preoccupied with Iraq, Afghanistan, and Sudan. And those death sentences are under appeal—which, in Libya, seems to be yet another form of judicial limbo.

Many people around the world have responded generously to our appeal (www.nishand.org), giving us the strength to continue beating the drum. But more must now happen. If it were your sister, your mother, your wife, would you be satisfied with “quiet diplomacy”?