The return to Bulgaria of the five Bulgarian nurses and the Palestinian doctor, who has Bulgarian citizenship, is dependent on the provisions of a 1984 Bulgarian-Libyan agreement on legal assistance. After the Libyan high judicial council (HJC) commuted the death sentences of the six medics to life imprisonment on July 17, the implementation agreement would allow the six Bulgarian nationals, accused of deliberately infecting more than 400 Libyan children with HIV, to be transferred to Bulgaria.

Minutes after the Libyan news agency Jana reported the news, Bulgarian Foreign Minister Ivailo Kalfin told a news conference "the decision of the HJC is a big step in a positive direction and all relevant Bulgarian institutions are working at top gear to apply the procedures set out in the Bulgarian-Libyan agreement".

A similar reaction came from the office of Prosecutor-General Boris Velchev. "We will send the request for the transfer of the medics as soon as possible so that the Libyan side can respond as quickly as possible," Velchev's spokesperson Margarita Popova told reporters on July 17. Velchev himself said that Bulgaria would do everything by the book and the request would be submitted "any day now". "I do not see a reason for the Libyan side to refuse to answer our request although they can do so," Velchev said.  He was referring to the fact that the Libyans have no time limit in which to post their reply. President Georgi Purvanov told reporters on July 18 "the decision triggers contradictory feelings and comments. No doubt, the positive news is that the death sentences have been annulled, which paves the way for a prompt enforcement of the legal agreement between Bulgaria and Libya".

Prime Minister Sergei Stansihev told Parliament on July 18 that "our fellow citizens are no longer threatened by death penalty, but for us the case will be over only when they come home. This outcome was one of the options we expected". Bulgaria will do its best to bring the medics home, he said. Georgi Pirinski, Speaker of Parliament, shared Stanishev's views.

There were reactions from outside Bulgaria as well. Minutes after the HJC decision became public, US state department spokesperson Sean McCormack said "We urge the Libyan government to now find a way to allow the medics to return home". Washington was "encouraged" by the lifting of the death sentences, McCormack said. The European Commission (EC) saw the ruling of HJC  as a "relief". The EC said in a statement that the main goal remained "the medics' transfer to the EU as soon as possible". "The decision of the HJC is a big step in the right direction but for us the case will be over when our compatriots return to Bulgaria," the EC said.

French president Nicolas Sarkozy said he was satisfied with the Tripoli ruling, shortly before announcing he would travel to Libya at the start of a tour of Africa.

For Amnesty International (AI), the decision was "overdue and insufficient". AI called for the medics' release. "The Libyan authorities must ensure that legal safeguards intended to protect suspects from prolonged detention without charge and torture are implemented and that all accused receive fair trials," AI said in a statement.

Nurses Snezhana Dimitrova, Nasya Nenova, Valya Cherveniashka, Valentina Siropulo and Kristiana Valcheva and doctor Ashraf Juma Hajuj have always pleaded their innocence.

The six of them said their "confessions" were extracted under torture. Renown foreign health experts have proved that the poor hygiene at the hospital was the reason for the HIV outbreak.