A Libyan court has sentenced five Bulgarian nurses and a Palestinian doctor to death for knowingly infecting hundreds of Libyan children with HIV.
The medics have been in detention since 1999, during which time 52 of the 426 infected children have died of Aids.
The nurses and doctor were sentenced to death in 2004, but the Supreme Court quashed the ruling after protests over the fairness of the trial.
The defendants say they are being made scapegoats for unhygienic hospitals.
Defence lawyers said the medics would appeal against the new verdict, expected to be the final appeal allowed under Libyan law.
The defence team told the court that the HIV virus was present in the hospital, in the town of Benghazi, before the nurses began working there in 1998.
Western nations had backed the medics' case, calling for their release.
Bulgarian officials quickly condemned the verdicts.
Foreign Minister Ivailo Kalfin described the ruling as "deeply disappointing". EU Justice Commissioner Franco Frattini expressed his shock at the verdict and urged the Libyan authorities to review the decision.
But the BBC's Rana Jawad in Tripoli, says it is highly unlikely that Libya's leadership will become involved in the case, at least in public.
Parents of the infected children said they were happy with the verdicts.
Some cried out in court as the verdicts were delivered, while others were gathered outside carrying banners.
"For the second time, justice has spoken out with a ruling against those criminals and the punishment they deserve, because they violated their obligations and sold their consciences to the devil," Abdullah Maghrebi, the father of one infected child, told the BBC.
Tsvetanka Siropoula, the sister-in-law of one of the convicted nurses, told the Reuters news agency that the sentence of death was to be expected.
"I am sure they will be released, but it will take time. It is so sad that so many years have passed and they are still in jail."
The medics protested their innocence throughout the case, retracting confessions that they said were obtained under torture.
Medical experts including the French co-discoverer of the HIV virus had testified on behalf of the medics.
And the World Medical Association and the International Council of Nurses said Tuesday's verdict ignored scientific evidence.
Oxford University in the UK said the verdict ran counter to findings by scientists from its Zoology Department.
A research team had concluded that "the subtype of HIV involved began infecting patients long before March 1998, the date the prosecution claims the crime began" paper from de Oliveira T et al. Molecular epidemiology: HIV-1 and HCV sequences from Libyan outbreak, a statement from the university said.
Libya has asked for 10m euros (£6.7m) compensation to be paid to each of the families of victims, suggesting the medics' death sentences could be commuted in return.
But Bulgaria has rejected the proposal, saying any payment would be seen as an admission of guilt.
More information: Original paper: de Oliveira T et al. Molecular epidemiology: HIV-1 and HCV sequences from Libyan outbreak