Thursday, November 11, 2004

PARIS — Right to the very end, some Palestinian officials believe Yasser Arafat was poisoned by Israeli security forces.

Outside physicians cite a number of rare blood orders that would account for the leader’s rapid deterioration. Palestinian officials confirmed that Mr. Arafat died early today at the military hospital outside Paris.

But one of the most persistent theories is that Mr. Arafat was suffering from AIDS.

“The doctors until now could not diagnose precisely what is wrong with him, but it is believed there is a poison,” Ali Kazak, who heads the Palestinian delegation to Australia, was quoted as saying in the Australian newspaper Herald Sun.

Such suspicions are grounded in Israel’s bungled attempt to poison Hamas leader Khaled Mashaal in Jordan in 1997, only to provide Jordanian officials with the antidote.

Other conditions that have been mentioned as possible causes of Mr. Arafat’s illness have included an absence of folic acid in the diet, as well as pernicious anemia, an autoimmune disorder. Yet another possibility, doctors have said, is an extremely rare blood disorder known as TTP, which stands for thrombotic thrombocytopenic purpura.

Initial blood tests that were performed in the West Bank, before Mr. Arafat was airlifted last month to Paris for treatment, apparently revealed a low count of blood platelets, components that aid clotting.

“There’s no way to guess” based on his low platelet count alone, because that can be symptom of almost any sickness, said Dr. Stephen Emerson, chief of hematology at the University of Pennsylvania School of Medicine.

Among conditions that can have that effect, Dr. Emerson said, and that conceivably might have a role in Mr. Arafat’s death could include “blood infections, severe vascular disease, and a syndrome known as DIC, which stands for disseminated intravascular coagulation.” The latter, he said, is a condition in which there is “simultaneous bleeding and clotting.”

Former White House speechwriter David Frum wrote in the National Review that Mr. Arafat probably had AIDS.

“We know he has a blood disease that is depressing his immune system. We know that he has suddenly dropped considerable weight — possibly as much as one-third of all his body weight. We know that he is suffering intermittent mental dysfunction. What does this sound like?” Mr. Frum wrote.

The article cites the memoirs of former Romanian intelligence chief Ion Pacepa, who said the Ceaucescu regime taped Mr. Arafat’s orgies with his bodyguards.

Official declarations on the state of his health also had been tainted with contradiction: Within a 24-hour period from Tuesday to Wednesday, Palestinian officials and French medical staff variously had pronounced Mr. Arafat, 75, as being everything from “in critical condition but still alive,” to “dead” to “in a difficult situation, but we wish him a speedy recovery.”

Part of the problem stems from France’s strict medical privacy laws, which prohibit doctors from disclosing any information without the permission of family members, in this case, Mr. Arafat’s wife, Suha.

Mrs. Arafat, who had accused Palestinian officials of toppling their longtime leader, had, until Tuesday, forbidden anyone, including a visiting Palestinian delegation, from gaining access to her husband or his medical team. Mrs. Arafat herself also remained tight-lipped.

According to France’s code of medical ethics, doctors are bound to a secrecy that covers “all that the doctor has come to know in the practice of his profession, that is, not only what has been confided to him, but also what he has seen, heard or understood.”

The law goes on to say that a fatal prognosis must not be revealed except with discretion, but those who are “close” to the patient should be warned, except where the patient had previously prohibited it.

“The code does not define what is meant by ‘close,’” said Laurent Assaya, a French lawyer. “I am not aware of any case law defining the term either.”

France’s privacy laws are so strictly enforced that they even survive the death of a patient. When the doctor of former French President Francois Mitterrand tried to publish a book about his prostate cancer — which had remained a secret up to that point — shortly after his death in 1996, the courts banned its release and Mr. Mitterrand’s family was awarded damages.

Doctors who had treated Mr. Arafat at the Percy Military Training Hospital on the outskirts of Paris had disclosed only that he was in a coma and his condition was deteriorating; that he was connected to a respirator and a feeding tube; and that he had suffered a severe brain hemorrhage.

On Tuesday, publicly acknowledging Mr. Arafat’s coma for the first time, a hospital spokesman said that Mr. Arafat’s deteriorating condition “marked a significant stage in an evolution in which the prognosis is reserved.”

That day, Palestinian officials also finally gained access to Mr. Arafat in the hospital’s intensive-care unit after his wife gave in to their demands.

Emerging from a meeting with Mr. Arafat’s doctors, Palestinian Foreign Minister Nabil Shaath revealed the first detailed description of the Palestinian leader’s state of health.

He said that Mr. Arafat had suffered a “variety of digestive-tract ailments” during his three-year siege in his Ramallah headquarters at the hands of the Israeli army, and as a result, had “serious inflammations of the stomach and the intestines … along with a period without nutrition, and this led to deterioration in the situation of the blood chemistry and the blood composition.”

• Joyce Howard Price contributed to this report from Washington.

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