CAIRO – Amal, 31, the mother of an 11-year-old boy and a refugee from Darfur living in Cairo, doesn’t yield to threats easily. Here, in the capital of Egypt, a vast, sprawling megacity of 20 million people, she found shelter. But she also found her fate as a victim of organ harvesting.
Amal (like everyone else interviewed in this article, her name has been changed) is aware of the danger involved in talking to a reporter, but nevertheless plucks up her courage and meets with me. She wants her story to be heard, so people will know what happened. At one point in the interview she gets up and pulls up her top to expose a long scar on her stomach.
One morning in mid-2017, as she was leaving the house, she noticed a strange man in the stairwell. As she passed him, he grabbed her and held a rag doused with an anesthetic over her mouth. She has no memory of what happened next, only that she woke up at home. Her relatives told her that she had been gone for six days and that her abductors had brought her back unconscious. She was dirty, not having bathed for a week, and bandaged. When she removed the bandage and found a large scar, she understood that she had been deprived of a kidney.
But that wasn’t the end of it. The kidnappers, whose identity remains unknown, called and threatened to kill her if she told anyone about her ordeal. Nevertheless, she reported the abduction to the office of the United Nations High Commissioner for Refugees. “To this day I go to the commission every month to get my medications,” Diab relates. “There’s always a long line there, and many of the others are also victims of the organ trade.”
After she went to the UN agency, a stranger arrived at her house while she was at work. Her son opened the door. The uninvited guest told the boy that if his mother went on talking about her experience, he would kill her. According to the boy, the man was cross-eyed – the telltale characteristic of Mujahid, from Sudan, a prominent name in Cairo’s illegal organ-harvesting industry.
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For his part, Ali, a man in his 30s, has known Mujahid since his days as a truck driver in Sudan. “We were friends; we knew each other for five years before he left for Egypt,” Ali says. “A few months after he emigrated, in 2013, he invited me to follow in his footsteps, and he promised to find me a job in Cairo.” Mujahid met Ali at the airport and took him to his home. “He put an anesthetic in the drink, and I don’t know what happened after that.”
When he woke up, Ali recalls, he found himself in what looked like a makeshift clinic, with used bandages, syringes and scalpels in a garbage can. He was in pain and quickly noticed a large scar on his midriff. “They forced me to sign a document stating that I donated my kidney voluntarily. They gave me 150 Egyptian pounds [about $8.40] for transportation and sent me home.”
Some five years later, shame still prevents him from returning to Sudan. “No one will believe that the kidney was taken from me against my will,” he says. “To sell an organ is haram – shameful, for me and for my family.” In any event, he says, Mujahid had taken his passport, so even if he wanted to return home, he could not.
Ali is in the same situation as the other people I spoke to. He suffers from chronic pain and weakness, and is unable to do work that requires physical exertion. As a refugee whose ability to earn a living is inherently limited, he can’t count on having a regular income. Like others who endured a similar ordeal, he lives from hand to mouth.
It’s been eight years since the World Health Organization classified Egypt as one of the five countries in the world where the illegal organ trade is most rampant. It was also identified as a country where the great majority of organs for transplantation come from living donors, in contrast to places where organs are generally taken from people who have died. In 2011, the Washington, D.C.-based nonprofit Coalition for Organ-Failure Solutions, which is waging an international battle against illegal transplants, published a study based on research by its Cairo branch identifying that city’s African refugee community as being particularly vulnerable. The investigators conducted in-depth interviews with 12 refugees who had lost a kidney, and documented 60 cases in all – most of them involving refugees from the genocide in Darfur, Sudan. The COFS report estimates that several thousand of the quarter-million African refugees in Egypt had fallen victim to illegal organ trade.
A number of cases of illegal organ trade have been uncovered in Egypt more recently, and the authorities have made some arrests, but it’s difficult to point to comprehensive efforts to map the phenomenon. One thing is certain: It hasn’t diminished. In 2015, the European Parliament found that Egypt was still one of the hubs, in this regard, along with various East Asian countries.
In recent weeks, Haaretz investigated the illegal organ trade industry in Cairo, and conducted interviews with six refugees who were victimized. In some cases, a kidney was harvested without their consent; others managed to escape at the last minute, after being kidnapped or drugged. Testimony was also collected from numerous activists who are trying to combat the phenomenon and agreed to share their knowledge of the industry. For the interviewees’ safety, their real names were not used.
Conversations with people who have been victims of the organ trade are tinged with fear. Even when they were speaking anonymously, most declined to provide a detailed account of the crime, frightened of the possible consequences. “There are many victims here,” one of them said. “Who protected them? Who will protect me if I talk?” Others initially agreed to speak with me, but after a day or two changed their mind and disappeared.
Most of the interviews ended in tears. The pain and frustration also swept up those who accompanied the victims and the interpreters who assisted in the investigation. “We issue warnings, we shout, we submit complaints – but nothing,” one activist said. “These gangs go around freely and threaten us, but the authorities take no action against them.”
Haaretz found that today, as at the start of this decade, the refugee community in Cairo constitutes easy and major prey for the organ harvesters, whether the refugees are in the country legally or not. A recurring motif in the testimonies is the effort made to keep them from talking. Wherever they turn, victims of the organ trade will encounter denial and a recommendation to keep quiet. For example, according to some testimonies, those who go to the police are reminded by the officers that they are guests in the country. Others say they were advised to say nothing by physicians as well, and even by the UN refugee agency.
The testimony suggests that there are three main methods of organ harvesting in use. The first involves kidnapping, by brute force or by doping; the second is to steal an organ under the guise of treatment, in cases where refugees have sought medical care; and the third is through what appears to be a direct, organized connection between the organ-harvesting networks in Egypt and travel agents in the Sudanese capital, Khartoum. Sudanese citizens who believed they were embarking on a journey to freedom, or who went to Cairo for medical treatment, found themselves in the hands of organ harvesters in Egypt and emerged without one of their kidneys. Activists also talked about refugees who decide to sell a kidney of their own volition, in order to ease their economic plight. But often in such cases, too, the kidney is harvested without any payment given.
Forced blood tests
For Amira (also a pseudonym), it’s important to tell what happened, and she wasn’t afraid to come to a public place to describe her experience. Amira was on her way to work when a car with three occupants stopped next to her. They thrust a rag doused with anesthetic into her face and grabbed her.
“I woke up in a dark room with many refrigerators,” she relates. “There were other Sudanese there, kidnapped like me. The kidnappers did blood tests on us. Fortunately for us, the person who took the test tubes left the door unlocked. When we realized that we had a chance, we escaped. We found ourselves in a neighborhood we didn’t know. Someone who saw where we came from understood what happened and organized a car that got us out of there.”
The captors, however, had taken their UN documents and certificates, Amira says: “When I told the UN agency what happened, they told me that I needed to report the lost documents to the police, so that I could get a new certificate. Regarding the kidnapping, they recommended that I keep quiet about what happened.”
Hassan is a leading activist in the struggle against organ trade. “In the past year alone,” he says sorrowfully, “I dealt with 15 refugees who lost organs.” He adds that the few studies that try to gauge the scale of the phenomenon in Egypt ignore a large group of victims: those who are abducted and undergo medical tests, but escape at the last minute.
In his office, Hassan hosts three members of a family who have come especially to tell the story of what happened to them only last month. “The three of us got onto a bus, a regular minibus,” the family’s mother says. “On the way, we suddenly saw that the minibus is taking a different route. Before we could understand what was going on, friends of the driver pulled out knives and tried to take us in for tests. We struggled and managed to get off the bus, and then they left us alone.”
In this case, too, the threesome encountered suppression, but of a different kind. “We tried to submit a complaint to the police,” the mother says. “But the policeman said: ‘Pay 500 pounds [$28] and I will open a file.’” They didn’t have the money, and the case was never investigated.
Faiza and Nida were also victimized by would-be organ harvesters. Faiza, a stubborn woman who seemed to be in her 70s (most interviewees were in their 20s or 30s), relates that she was walking on the street when a car suddenly pulled over and three young men emerged: “They hit me, tied me up and made me get into the car. I fought and cried, but it didn’t help. When I was already in the car the driver shouted at them, ‘Why did you take an old woman, what will we do with her?’ They let me go and I ran off.”
Nida, on the other hand, worked as a cleaner in a private home. One day, the wife, who oversaw her work, wasn’t there. She found herself alone in the house with the husband. He brought in medical equipment and set up an operating table in the living room. When Nida grasped what was happening, the husband tried to grab her and inject her with an anesthetic. She fought and managed to release herself from his grip and escape.
“I ran immediately to the nearest police station and gave them the address of the house and the man’s name,” Nida recalls. “They arrested him – and let him go the same day. My employer in the cleaning company called after the incident and threatened me. He said the man I complained against has connections and that he could do whatever he wanted to me.”
The UN refugee agency provided a lawyer for Nida, but the man remains at large.
From time to time, Egyptian authorities score individual successes in curbing organ harvesting. In 2016, a network of dealers was uncovered and 45 suspects were arrested. The list of detainees included many members of the medical profession, from professors to directors of clinics and nurses. (Apparently, most of the harvested kidneys are delivered to their new owners, medical tourists, in operations in Cairo hospitals and clinics.) Merchants and mediators were rounded up as well. A court convicted 37 people, who were sentenced to prison terms of three to 15 years. A year later, 16 suspects, including a physician and a lab technician from another suspected network, were arrested.
Last year, new legislation was enacted in Egypt stipulating a three-year prison sentence and huge fines for anyone who performs an organ transplant by coercion or deceit. Under this law, if someone dies as a result of transplantation, the offender will be sentenced to life imprisonment. However, according to the testimonies of activists, arrests are few and the law has failed to alter the situation on the ground.
In recent months, the Egyptian media reported a number of cases involving trade in human organs. In February, a couple was arrested for illegal organ trade in Helwan, a city south of Cairo, on the Nile. The two tried to recruit donors via a Facebook group called “Kidney donors in return for material compensation.” In another case, last May, three more suspects were arrested, one of them a butcher, who stated in his testimony that he worked for the transplants department of a hospital in Maadi, an upscale Cairo suburb. In July, the bodies of three children were discovered on the side of a road in the Egyptian capital, and the headlines screamed “Organ harvesting,” though the authorities denied it.
An example of the involvement of physicians in the illegal industry emerges in the story of Leila, who came to the interview with her toddler son. A few weeks ago, she was referred to a specialist in a Cairo hospital when her son’s head became bloated with fluids, and he required surgery. The procedure was successful, but after a time the phenomenon recurred. According to Leila, when she went back to the surgeon, he made further treatment conditional on her donating a kidney. The head of her 3-year-old son is twice as large as the head of a normal child.
“I don’t know what to do,” she says in desperation. “He is the only doctor who understands this field. I didn’t agree to let a kidney be taken, and now we are stuck without a solution.”
A sociological study by Sean Columb of Liverpool University published last year showed a connection between the organ-harvesting industry and the societal exclusion of minorities and refugee groups in Cairo. According to the study, asylum seekers wait for months, sometimes years, to be granted formal refugee status. Those without that status are concentrated in slum neighborhoods and have limited access to the labor market. The organ trade sprang up against the background of a vulnerable population struggling with unemployment, poverty and starvation wages.
That’s how Murad, from Sudan,was drawn into the circle. I spoke to him in the cramped, bare apartment where he and his family live. “I came to Cairo to find work and rented an apartment with a roommate,” Murad says. “One day, the roommate asked me to donate a kidney for a member of his family who needed a transplant urgently. He promised to pay me. My financial situation was bad and it was for a good cause, so why not?”
The transplant was performed legally. “I signed all the forms confirming that it was a donation,” Murad explains. “I signed at the hospital, the police station and the Sudanese embassy. We went through the whole procedure and the roommate promised to pay me under the table.”
But when Murad woke up in the hospital after the operation, the roommate was nowhere to be found – neither in the hospital nor back in their apartment – and the medical team didn’t know where he was, either. Apparently, from the hospital’s standpoint, other people had been involved, but no one came forward to pay Murad, and he was left with no money, no job and one kidney.
The COFS study from 2010 also found that even people who willingly sell a kidney pay a high price in the long term, which far exceeds the payment they received. Many spend the rest of their days in an enfeebled condition and suffer from chronic pain and various medical complications. As a result, they are unable to work and are drawn even more ineluctably into the vicious cycle of poverty and debt.
According to Hassan, one of the central problems is the victims’ fear of talking. “Everyone is afraid to get entangled,” he says. “The organ trade gangs control the streets and threaten everyone who dares to speak out.”
Hassan says that he and his associates found a direct channel between Khartoum and Cairo. “The gangs here operate through travel agencies,” he says. “Some of them are in Khartoum, others here. The Sudanese go to an agency in Khartoum to buy a ticket for a bus to Cairo. The agency locates medical tourists, people who are going to Cairo for treatment not available in Sudan. All the testimony shows that the agencies transmit names and descriptions to people in Egypt. The organ merchants are waiting at the Cairo station. They make contact with the passengers they have been informed about, and figure out who has difficulty financing the treatment. They offer funding and accompaniment, and those who go with them wake up with an organ missing.”
Members of the Sudanese community often point an accusing finger at “Muhammad Kilawi” – “Muhammad Kidney.” Kilawi didn’t get that nickname by chance. Yusuf, a prominent activist working against the trade in Cairo, relates that Kilawi “sold his kidney, the kidneys of his two wives and the kidney of his wife’s brother. What’s it to him to sell someone else’s kidney?”
Kilawi likes to hang out at the card table in the same neighborhood café as Yusuf, together with many members of the Sudanese community in Cairo. Other regulars – refugees whose are struggling to survive – prefer to keep away from Kilwai’s table and mind their own business. Occasionally, though, when someone new arrives, Kilawi will quickly befriend him. In some cases, Yusuf manages to prevent the inevitable scenario, but there are times when it he doesn’t notice until it’s too late. A newcomer who hooks up with Kilawi will lose one of his organs, whether willingly or not, and may even join the network of merchants.
“Sometimes Muhammad and others like him spot refugees who have arrived without anything, and offer them a place to sleep,” says Yusuf. “We are a community who help one another, and Muhammad is Sudanese. When someone from Sudan offers them help, they’re not suspicious. They find shelter in the apartments offered them, and when they wake up, they’re missing an organ.” When Yusuf realized what Kilawi was up to, he lodged a complaint with the police, and the officer said: “‘You’re the sixth person who has complained about him this month. But my hands are tied. I can’t even give you a report. I can only recommend that you protect yourself, because I can’t do it. You ask how to protect yourself? Very simple – be silent. That’s it. But if you insist, I can give you a report number. Tell the UN High Commissioner for Refugees to contact me with the number.”
Yusuf says he approached the UN agency, but didn’t hear from them.
“The UN organizations don’t do much,” a former UN employee claims. “They depend on the Egyptian security forces for their own protection, and apparently the authorities don’t want to deal with this phenomenon.” The UNHCR, asked for comment, stated that, in principle, it does not discuss specific cases. “We examine each application in all seriousness, and in cases of suspected criminal wrongdoing we update the law enforcement authorities.”
The episode in question did not end with the filing of the complaint, Yusuf says. Not long after his visit to the police station, another officer from the security forces came to his home and told him, he says, that no one loses a kidney by coercion and that he would do best to keep quiet. He was made to sign a form declaring that he would never raise the issue again. The officer told him that, as a guest receiving asylum he should say thank you “and not bite the hand that feeds you.”
Yusuf has been suffering from Kilawi’s threats for years. He encounters him in public places and at sites where refugees customarily congregate. “One time he pulled a knife on me,” he says, “and the people around, from the community, protected me.”
Yusuf realizes that he and other anti-organ trade activists are interfering with a flourishing business. On one occasion he managed to wrest from Kilawi “walking merchandise” – a sick Sudanese citizen who had come to Egypt some time earlier, and who suffered from chronic pain. Kilawi had volunteered to take him to a clinic at his expense. Only Egyptian citizens are entitled to subsidized health care; non-citizens face a long, labyrinthine road to get treatment. In many cases, foreigners who are sick are denied medical treatment for bureaucratic and financial reasons.
Yusuf’s offer of help was accepted eagerly by the man from Sudan, but at the clinic it emerged that the tests he underwent were aimed not at resolving his medical situation but rather only to evaluate the condition of his kidney. The physician assumed the man was selling his kidney of his own volition (which is legal in Egypt), and when this turned out not to be the case he nonetheless tried to persuade the patient to go ahead with the procedure. The patient fled, and because he didn’t know anyone he ran to the café of the Sudanese community, which is where Yusuf found him.
That wasn’t the end of the drama. Kilawi arrived at the café and told the man that his kidney had already been sold, and that he was going to take it whether the man wanted him to or not. The Sudanese man barricaded himself in the café and refused to leave. Finally, Yusuf recruited one of the refugee organizations to help the unwilling donor escape from Cairo and fund the medical treatment he needed. The man fled, but Yusuf remains in the neighborhood along with his friends from the community, with all the threats and the fear.
A letter recently circulated on the social networks among the Sudanese community in Cairo describes a series of kidnappings that ended with organ harvesting. The letter calls on refugees to display vigilance and caution: “Beware, my brothers, and especially the women – the situation has changed and the danger threatens us all. If you go to work, don’t go alone. Pay heed that you do not find yourselves in a place where there are only women and children, and no one to protect you. Make sure there is someone to guard your safety.”