What Killed Arafat?

Nearly a week after his death, speculation still swirls around what killed Yasser Arafat. Cirrhosis of the liver, AIDS, a blood disorder and poisoning are frequently mentioned in unconfirmed reports - all consistent with the little that is publicly known about the medical condition that landed the Palestinian leader in a French hospital.

However, the mystery may soon be resolved: the French say they will hand Arafat's records to Nasser al-Kidwa - a relative, as required, but also the Palestinians' ambassador to the United Nations. Al-Kidwa is scheduled to fly to Paris on Friday to collect the medical files.

"The full medical report of President Arafat is a historical document for the Palestinian people," Hassan Abu Libdeh, the Palestinian Cabinet secretary, said Thursday. "We will get the report and the Palestinian Authority will take the necessary decisions, including informing the Palestinian people about the full details of the report."

Officials in Paris insist French law prevents them from making Arafat's medical records public, and they have refused to announce the cause of his death Nov. 11 in a hospital outside Paris. What little information they did release in the days preceding the death, they prefaced by saying it was being disclosed with the consent of Arafat's family.

French law does not specify how closely related a family member must be to have access to medical information and it is unclear whether al-Kidwa knew all along what was wrong with his uncle. French officials said Thursday they have determined that al-Kidwa qualifies as a close enough relative to have access to the files. It was not clear whether Arafat's wife, Suha, agreed to the release or even whether her consent was required.

There is widespread opinion among Palestinians that their leader was poisoned by the Israelis. Arafat's Jordanian physician, Dr. Ashraf al-Kurdi, has called for an autopsy, citing poisoning as a possible cause of death.

However, al-Kidwa has said there is no evidence Israel poisoned Arafat and Palestinian officials who met with Arafat's French doctors before his death had said poisoning had been ruled out.

Israeli media reports have speculated that HIV infection may be involved, but medical experts say that is less likely than other possible diagnoses.

Before his death, French doctors had disclosed Arafat had a low platelet count, a high white blood cell count, that leukemia had been ruled out and that he was in a coma. Palestinian officials said he had a brain hemorrhage shortly before he died.

That is consistent with a variety of illnesses from pneumonia to cancer.

On Wednesday, the French newspaper Le Monde cited "very good sources" as saying Arafat died of a blood disorder called disseminated intravascular coagulation, or DIC - where platelets are depleted by the formation of a multitude of microscopic blood clots all over the body and blood oozes easily from anywhere that's vulnerable.

Experts say that condition could explain Arafat's clinical picture of low platelets, high white cells, coma and brain hemorrhage, but that DIC is only a secondary disease, triggered by something else - usually severe infection or cancer.

Le Monde, as well as the French magazine Le Canard Enchaine, also cited sources saying Arafat had cirrhosis of the liver. Le Monde also reported that, although they saw nodules on the liver, doctors did not reach a definitive diagnosis of cirrhosis because the platelet problem meant it was too dangerous to do a liver biopsy.

The existence of liver nodules would rule out a diagnosis of leukemia or the pre-leukemia condition myelodysplasia, said hematologist Dr. David Grimwade of Guy's Hospital in London.

Cirrhosis fits, experts say, but would not be directly linked to the blood problem and may not be linked to DIC, or infection, even indirectly.

Cirrhosis, or scarring of the liver, is the end result of many types of liver disease, including that caused by alcohol, medication toxicity, autoimmune disorders or chronic hepatitis infection.

Liver disease is more common in the Middle East than in other parts of the world, and infection with hepatitis B or hepatitis C virus are the most likely causes there, said Dr. Robert Brown of the Center for Liver Disease and Transplantation at Columbia Presbyterian Hospital in New York.

The immune systems of liver disease patients don't work well and they are more prone to serious infections.

"If he did have cirrhosis, the liver disease itself is unlikely to have killed him because people very rarely die of liver failure. Usually they die of infection leading to multi-organ failure, with or without DIC," Brown said.

However, an infection leading to DIC can occur at the same time as, but not because of, liver disease, Brown said.

The type of infections that can lead to the platelet disease include meningitis and septicemia.

Hepatitis infection also increases the risk of liver cancer, which can also cause the platelet disease.

By Emma Ross
By Emma Ross