Libya's Supreme Court has upheld death sentences on five Bulgarian nurses and a Palestinian doctor for deliberately infecting hundreds of Libyan children with HIV.
"The court rejects the appeals of the defendants and confirms the death penalty," judge Fathi Dhan told a five-minute hearing. The six medics were not in court to hear the ruling.
The ruling came just one day after hopes were raised for a deal to win their release after eight years in detention, when Libya's Gaddafi Foundation charity said it had reached an accord with the children's families that "puts an end to the crisis".
The highly politicised case has blocked Libya's efforts to deepen links to the West after shaking off decades of isolation in 2003 when it scrapped its programme of prohibited weapons.
The six medics were sentenced to death in December after being convicted of infecting 426 Libyan children with the deadly virus while they worked at the children's hospital in the city of Benghazi in the 1990s. In jail since 1999, they say they are innocent and were tortured to make them confess.
Some Western scientists say negligence and poor hospital hygiene were the real culprits and that the six were made into scapegoats.
Now that the Supreme Court has confirmed the conviction, the case is expected to go to a government-controlled High Judicial Council which will have the power to commute the sentence or even pardon them.
Libyan officials say the Council would only agree to the release of the nurses if a settlement were reached in private talks between the families and the European Union (EU) on funding for the children's medical care.
Behind the scenes talks have been taking place between the EU and the association of the families of the children on just such a possible deal - to provide a fund of tens of millions of dollars for the families to pay for the children's future care.
Libya calls the cash "compensation" - a term Bulgaria rejects as it says it implies the medics are guilty. The families have asked for €10 million for each child, far in excess of what observers say the EU has been prepared to pay.
The Gaddafi Foundation charity, run by a son of Libyan leader Muammar Gaddafi, Saif al-Islam, has been a central player in facilitating the talks. Bulgaria and its allies in Brussels and Washington have all been trying to win their release, and failure to free the nurses would carry a diplomatic cost for Libyan leader Muammar Gaddafi.