The Benghazi Six

October 17, 2005 -- Today a fairly good International Herald Tribune piece by Brian Knowlton reported that U.S. President George Bush has asked the Libyan government to release five Bulgarian nurses who, along with a Palestinian physician, face imminent execution for allegedly intentionally infecting over 400 Libyan children with the HIV virus. The New York Times and Bulgaria's Focus News English also covered the story. As the press pieces note, international health experts have found that the tragic infections were due to poor sanitation practice at the hospital, not intentional acts by these caregivers. The prisoners' plight has been the subject of protests by the European Commission and the U.S. State Department. Major human rights organizations and health care groups, including the American Nurses Association and Physicians for Human Rights, have called for their release after seven years of captivity that has allegedly included torture. If nurses' close contacts with patients subject them to criminal prosecution and even execution for what seem to be systemic health care problems, nurses will not just be unable to act as patient advocates, but may be deterred from serving vulnerable populations and having the kind of patient interactions that are critical to good outcomes. The Center thanks the press for its coverage and President Bush for his support, and we urge supporters to add their voices to those calling for the release of all six prisoners.

The International Herald Tribune piece suggests that President Bush's new support for the prisoners, whose case has been a focus of intense international concern for years, relates to Bulgaria's role as an important European supporter of the U.S. presence in Iraq. The piece does not point it out, but the President's apparent failure to mention the Palestinian physician would seem to bear that out. Be that as it may, the piece explains that the Libyan government claims that the nurses and physician intentionally infected over 400 children with HIV in order to destabilize the Libyan government in a plot involving the Israeli Mossad. However, it notes, "outsiders have found no evidence of any such conspiracy." The story says that AIDS pioneer Dr. Luc Montagnier has examined the situation and concluded that the infections resulted from poor sanitary practice at Al Fateh hospital in Benghazi, and that some of the infections occurred before the nurses even arrived in Libya. It also notes that a World Health Organization team concluded that there were multiple sources of infection, an apparent reference to the finding that some of the children had other infections that point away from any intentional act as the source of the HIV infection. Libya has reportedly sought $10 million in compensation for each of the 420 children allegedly infected--the same per person figure Libya paid for its downing of a 1988 Pan Am flight over Lockerbie, Scotland. Bulgaria has offered health aid but refused to pay "blood money." The piece notes that Libyan public sentiment is heavily against the nurses, and that Libyan leader Col. Muammar el-Qaddafi may be reluctant to go against it, or to admit that the tragic infections were the result of local conditions rather than outside meddling. The story states that the Libyan Supreme Court is to hear a final appeal of the health workers' case on November 15, but that "[b]arring a reprieve, they face death by firing squad."

The piece does a good job of presenting the basic facts of the case, especially the findings by health experts that the foreign health workers did not cause the infections through intentional acts. It might have done more to bring out the larger context, particularly that the world's nurses and other health workers may increasingly find themselves scapegoated for systemic health problems that are beyond their control, simply because they are the ones who are most visibly on the scene. This is clearly an issue with infection control, but in an era of rampant cost-cutting, nurses may be attractive targets with regard to a variety of other health care problems that may result at least in part from nurses' lack of the time and resources needed to do their jobs.

Some, including Amnesty International and the International Council of Nurses, have urged nurses to take a more active role in protecting human rights generally. Cases like this suggest that by doing so, nurses would be protecting not only their patients, but themselves. In any case, the Center believes that when health care professionals do their best for patients under difficult circumstances, poor results should not result in criminal charges, to say nothing of torture or execution. A better way to address the growing global threat of nosocomial infections is through increasing concern and resources for health care and public health systems, and reducing the poverty that drives the spread of HIV and other deadly diseases.