JERUSALEM, Sept. 7 - The medical records of Yasir Arafat, which have been kept secret since his unexplained death last year at a French military hospital, show that he died from a stroke that resulted from a bleeding disorder caused by an unidentified infection.
On Oct. 29, 2004, a fading Yasir Arafat was taken by helicopter from Ramallah, on the West Bank, en route to a military hospital near Paris, where he died two weeks later. His last diagnosis has just been released.
The first independent review of the records, obtained by The New York Times, suggests that poisoning was highly unlikely and dispels a rumor that he may have died of AIDS. Nonetheless, the records show that despite extensive testing, his doctors could not determine the underlying infection.
Arafat seemed frail in his final months but not, by anyone's account, at death's door when he suddenly fell ill last October. After more than two weeks without improvement, he was airlifted to a French hospital, where he died on Nov. 11. The cause of death was never announced and speculation has remained rife.
The records indicate that Arafat did not receive antibiotics until Oct. 27, 15 days after the onset of his illness, which was originally diagnosed as "a flu." That was only two days before he was transferred to the Percy Army Teaching Hospital in Clamart, outside Paris, and it was probably too late to save him, according to Israeli and American experts consulted by The Times, who agreed to review the records on condition they not be named.
His doctors in Ramallah also did not seem to recognize that he suffered from a serious blood disorder, disseminated intravascular coagulation, or D.I.C., which was never controlled and led to his death.
But even the French doctors never discovered the specific cause of the infection that led to the bleeding disorder, the records show. "It's a big puzzle," said a specialist in infectious diseases.
The records make no mention of an AIDS test, an omission the experts found bizarre. An Israeli infectious disease specialist said he would have performed the test, if only to be thorough and to refute the rumors that surrounded the case.
He said news accounts during Arafat's illness made him strongly suspect that Arafat had AIDS. But after studying the records, he said that was improbable, given the sudden onset of the intestinal troubles.
A senior Palestinian official provided the medical records to Avi Isacharoff and Amos Harel, Israeli journalists who are working on a new edition of their book, "The Seventh War: How We Won and Why We Lost the War With the Palestinians." They agreed to share the records in collaboration with The Times, which did its own investigation.
Arafat's final illness began suddenly on the evening of Oct. 12, when he vomited and had abdominal pain and diarrhea four hours after eating supper in his compound in Ramallah, where the Israelis had kept him isolated for three years. These symptoms continued without fever for two weeks. He slipped into a stupor and lost six and a half pounds.
Arafat was treated for thrombocytopenia, an abnormally low platelet count, with transfusions of platelets and injections of gamma globulin.
Many senior Palestinian officials say Arafat was poisoned. In a recent telephone interview from Amman, Jordan, for example, Arafat's personal doctor, Ashraf al-Kurdi, said he believed Arafat was poisoned.
But the newly released findings argue strongly against poisoning.
The French doctors sent specimens to three different laboratories for standard toxicology tests to detect metals and drugs like barbiturates, opiates and amphetamines. None were detected. The laboratories included the Toxicology Department of the Criminal Division of Physics and Chemistry in the Institute of Criminal Research of the National Gendarmerie; the Department of Clinical Biochemistry, Toxicology and Pharmacology at Percy; and the French Army's Radiotoxicology Control Laboratory.
The researchers said Arafat did not suffer the extensive kidney and liver damage they would expect from a poison, although he did have jaundice.
Arafat did improve for a time in the Percy hospital, talking and walking with members of his entourage. Then he slipped into a coma on Nov. 3, when he was transferred to intensive care from the hematology service. That would seem to contradict the idea of poison, the experts said.
The biggest mystery is the exact nature of the infection that seemed to start the prolonged, irreversible course of the bleeding disorder, D.I.C.
The consultants, like the French doctors, could not determine where in the bowel the infection was located and what microbes caused it. Arafat's doctors in Ramallah provided some clinical information to the French. Some of the samples taken in Ramallah were sent for analysis to Tunis first, but some biopsies did not arrive there, the records said.
One possibility is a food-borne illness from a toxin produced by staphylococcal bacteria. The illness occurs commonly from food contamination. Theoretically, someone could have put the toxin in what Arafat ate. But Arafat did not have some of the features of this type of food-borne illness.
The French doctors clearly were baffled by what was wrong with the frail 75-year-old, who had led a reclusive life effectively under house arrest and had no obvious cause for the infection. Arafat had medical care in Ramallah before he went to Paris. Four Egyptian doctors came, and five doctors from Tunis, summoned by Mr. Arafat's wife, Suha.
The Ramallah doctors initially thought Arafat had "a flu." His own physician, Dr. Kurdi, was not allowed to come to Ramallah until Oct. 28, the day before Mr. Arafat was evacuated to Paris, an indication of the war over Arafat's care between Suha Arafat and his closest political colleagues, which continued until his death, and afterward.
The French summary of Arafat's medical history cites the Faculty of Medicine in Tunis as saying cultures of blood, stool, urine and bone marrow were negative, as were tests for cancer and leukemia. It is not known how long the cultures were in transit from Ramallah and their condition on arrival in Tunis. A stool culture, for example, would be worthless if it was allowed to dry out.
But the antibiotics given in Ramallah might also have prevented growth in a laboratory culture of any bacteria that might have caused Arafat's intestinal infection, the consultants said.
The biopsies performed in France and Ramallah did not show evidence of any infectious agent or cancer. The bleeding disorder kept the French doctors from doing some tests they said they would have liked to have done.
Although the French doctors also prescribed a number of antibiotics, Arafat's condition worsened.
An American hematology consultant theorized that Arafat might have had a common infection known as diverticulitis, which develops in sacs in the large bowel. An infected diverticulum can burst, leaking its contents into the abdominal cavity to cause a localized abscess or an infection like peritonitis.
The French doctors said they did not find this condition, but it can be hard to detect, the consultant said.
This consultant also said that prescribing heparin for Arafat's disseminated intravascular coagulation probably hastened his death, but that it was inevitable at this stage. American hematologists generally do not recommend heparin for D.I.C., the American specialist said.
Israelis note that Prime Minister Ariel Sharon saw Arafat as a terrorist and an obstacle to peace. In 2002 Mr. Sharon told the newspaper Maariv that he regretted not "eliminating" Arafat in 1982, during the Lebanese war. Arafat's death would have saved many lives, Mr. Sharon said, "but we had a commitment" not to harm him, "and commitments must be honored."
But he also said then, "We have no intention of harming Arafat personally."
In September 2003, Mr. Sharon's deputy prime minister, Ehud Olmert, said of Arafat that "killing him is definitely one of the options." He added: "We are trying to eliminate all the heads of terror, and Arafat is one of the heads of terror."
There have been reports in the Israeli press of a secret cabinet decision made in late 2003 to eliminate Arafat, which Uri Dan, a Sharon confidante, describes as "a deliberately vaguely worded decision: to remove Arafat, since he was an obstacle to peace." Officials have hinted that operational plans were also drawn up to eliminate Arafat, though they say no action was taken.
Under American pressure, Mr. Sharon agreed simply to isolate Arafat in his Ramallah headquarters after the Israeli military operation to retake control of the West Bank in the spring of 2002.
But Mr. Sharon himself said he informed President Bush on April 14, 2004, that he no longer felt bound by his promise to Mr. Bush in March 2001 not to harm Arafat, Mr. Dan says, adding: "President Bush replied that it would perhaps be best to leave Arafat's fate in the hands of the Almighty. Sharon said that one should sometimes help him."
It's no surprise, then, Mr. Dan concluded, that many Palestinians "are spreading a conspiracy theory that Israel poisoned Arafat."
Dr. Kurdi, Arafat's physician, is convinced of it. "I believe today he was poisoned," Dr. Kurdi said. "All the symptoms were showing that."
But the French records say Arafat died of natural causes. And Israel denies it had anything to do with Arafat's illness or death. On Wednesday a senior Sharon aide, Raanan Gissin, repeated the denial and pointed out that Mr. Sharon offered any medical help necessary last October to care for Arafat, allowed doctors to visit him and allowed him to seek medical care abroad.
An autopsy might have answered the mystery, but Mrs. Arafat refused to allow one, Dr. Kurdi said. "The A B C of medicine is an autopsy, especially when there's a doubt about the cause of death," he said, and without one, he refused an invitation from the Palestinian Authority to be part of a committee to investigate the death.
Dr. Bruno Pats, the chief intensive-care doctor at Percy, concluded his medical report into Arafat's death by listing his various syndromes: the digestive distress, the hematological disorders, the obstructive jaundice, the neurological stupor and coma.
He concluded: "After consultations with numerous experts of various specialties and the results of medical tests we carried out, the association of these syndromes could not be explained by a single pathology."
Or as an American expert said: "We certainly see a lot of people die and cannot figure out why, particularly at age 75."
