IT’S A STORY Egyptian newspapers have told so many times that it has lost the ability to shock: Young man seeks job, young man gets job offer, young man undergoes medical checkup to ensure his fitness for job and/or visa, young man wakes up in hospital with searing pain in one of his sides.

A simple X-ray will soon reveal he has been robbed of a kidney.

Alaa Moussa, 27, and Sayyed Abu Deif, 25, both claim to have lost their kidneys ‘the usual way’ in 2004. Today, weakened and angry, they have launched a public relations offensive to out what they claim is the most efficient criminal organization in Egypt: the “kidney trafficking mafia.”

But who wants to hear their story? Certainly not their broker, who they allege paid them LE 700 each to drop the charges they brought against him — after threatening to send his bodyguards to pay them ‘a little visit.’ The surgeon who performed their operation, and against whom they have each pressed charges, would also like them to keep quiet, as would top brass at the established Dokki and Helwan hospitals where their operations allegedly took place.

Senior medical and regulatory officials I contacted over the past four months for this story have similarly shied from speaking.

Their story, one so common it generates dozens of newspaper clippings a year — so common that a high-profile young actor used it in an unrelated interview for this magazine last month as an example of the disasters that typically befall the poor.

Mohammed Allouba Sayyed Abu Deif and Alaa Moussa claim they were robbed of their kidneys.

My calls around the capital city tracking down official sources for this piece were often met with groans of, “Oh, not organ trafficking again,” and “Why don’t you write about something else?”

A well-known physician and owner of a lab that specializes in tissue matching for kidney transplants — and allegedly one of the centers of the organ trafficking business — refused to grant an interview because she “has nothing to gain from it.” Annoyed at being the center of allegations, the physician railed over the phone that the press has turned professionals who try to help kidney patients into little more than just common criminals.

“They write my name using my initials — as if I had committed a terrible crime,” she complains. Although she briefly seemed interested in telling her side of the story, in the end, she decided not to speak.

She wasn’t alone: She was joined by the head of the Egyptian Nephrology Society, several brand-name surgeons and the owner of another well-known medical lab.

Dr. Shawqi El-Haddad, chairman of the Egyptian Physicians’ Syndicate’s medical ethics committee, agreed to an interview. Short of the police, El-Haddad’s committee, which works closely with the Ministry of Health, is the only deterrent against physicians who become involved in illegal organ transplants, as the committee can strip a doctor of his license, either temporarily or permanently. My hopes for a productive meeting were dashed a few minutes into our discussion.

Mohammed Allouba Dr. Hamdi El-Sayyed, chairman of the Physicians’ Syndicate and of the People’s Assembly’s health committee, has spent almost a decade on the Organ Harvesting and Transplant Act.

“Are you a journalist? Don’t try to write negatively about physicians. Journalists make this many mistakes,” he snarled, lifting his hand half a meter above his desk to indicate a massive pile. “Don’t write about physicians. Write about journalists. Why are you so interested in physicians?”

Assuring him that we’d tackled corruption in the media for our July cover story did nothing to calm El-Haddad’s nerves. Without dismissing me, he casts his eyes down to his desk and started wordlessly tackling the paperwork before him.

Medical and government sources may have had their fill of journalists wanting to write about organ trafficking, a story that has made frequent headlines since the mid-1970s, when Egyptians first started seeking work in Arab countries. Most recently, the issue has become a hot one after it appeared on the pages of the South Africa’s web-only Mail & Guardian, which boldly declared Egypt the “regional hub for organ trafficking,” dubbing the country “the Brazil of the Middle East.”

It wasn’t new reporting, though: MG picked up the story from an April issue of the independent Arabic-language daily Al-Masry Al-Youm, which carried an exposé penned by Mohammed El-Hawwari, a young journalist on the paper’s investigative team.

“I have been interested in this issue for years,” El-Hawwari explains. “I like going to moulids like Sayyeda Nafeesa and such, and have observed that this phenomenon is extremely widespread. Many people talk about it.”

Mohammed Allouba The Health Ministry’s Press Counselor Dr. Abdel Rahman Shahin says the ministry has good intelligence on the organ traffickers.

The story landed in his lap as El-Hawwari sat at a Sayyeda Zeinab ahwa.

“Someone came and tried to make friends with me, trying to find out whether I needed money or a job. He left me, having made sure that we meet again soon. When he left, another guy warned me off, saying the man I was just with was a human organs broker,” El-Hawwari remembers.

Intrigued, he began talking to others around the ahwa. “I also went into the Sayyeda Zeinab Mosque, where many of those who have lost or sold their kidneys sleep,” he says. “They have no jobs, they do not go home and live in the area waiting for some charity.”

For over two months, El-Hawwari continued his investigation, making sure not to let his identity as a journalist be known.

“It would have been a dangerous thing to do. If they find out you are a journalist, they either threaten you or try to bribe you. The network of traffickers is really huge, you know. There is a broker, who works with a number of go-betweens. A go-between could be a shoeshine guy, a roast-corn peddler — anybody really. The go-between watches over the victims, making sure nobody pries too much into their business,” he says.

Mohammed Allouba Ministry of Health has taken a number of steps towards the prevention of organ trafficking. Ministry officials (L-R): Dr. Fadel Ali Fadel (first deputy minister), Dr. Mohammed Abdou and Dr. Ahmed El-Zein (director of the ministry’s Private Therapy Department).

The solution was to take his sources away from the ahwa.

I cannot even go to my relatives in Upper Egypt. They think I sold my kidney. They do not believe it was stolen. My passport is ready. I wish I could leave this country. In a place where your flesh gets stolen? I cannot live in such a place.

“I took them to a nearby cemetery. By that time they all knew I was a journalist, and I was able to record my interviews,” El-Hawwari says. “I met almost 30 victims, and they all had one story to tell: Someone offered them a job in an Arab country on the condition that they undergo tests before traveling. They were all found to have kidney stones, which the broker offered to have removed at his expense provided the victim sent him the money once he got his job abroad. They all went to hospital, and a week later, after suffering complications, headed to the Matariyya [Nephrology] Institute to find out that their kidney had been stolen.”

The journalist chose four cases to illustrate his article. One was the classic tale above. Another man was told what would happen before the operation and offered cash. The third was stripped of both his kidney and his money, while the fourth knew he was about to sell his kidney, had met the patient about to receive his kidney and was there when, a week after the operation, the patient died when the transplant failed.

“This last victim received LE 15,000 for his kidney, and, after he spent all the money, he himself became a broker. He told me how he procured victims, how much money he spent, how much he received for each,” El-Hawwari says.

El-Hawwari made himself scarce after his story ran, but returned to the area a month later to find everyone he interviewed had disappeared.

Mohammed Allouba Al-Masry Al-Youm’s Mohammed El-Hawwari went undercover to write an exposé on organ trafficking.

“It’s curious how a network operates. There is the broker at the top, working with several go-betweens who procure the victims. Following the operation, the go-betweens keep the victims very close. They give them money every day, enough for some sandwiches and a pack of cigarettes. Should the victim decide to file a police report, people are sent to advise them to go to a specific police station, where the network allegedly has contacts on the inside. In some cases, the victim gives his ID to the broker, so it is more difficult for him to go to a police station.

“In other cases, the victim who goes to the police is threatened by thugs and gives up soon afterwards. Once a network is revealed, the location is changed. They move together: broker, go-betweens and victims. Before Sayyeda Zeinab, they were in Madinet El-Salam, and before that they were in El-Gayyara. Now, they have started appearing in Mohandiseen and Dokki,” El-Hawwari reports.

According to El-Hawwari, the network includes top physicians, labs, hospitals and even employees at the Physicians’ Syndicate.

“Most buyers are non-Egyptians. Gulf Arabs come first, followed by other nationalities, and Egyptians come last,” El-Hawwari claims. “It is very lucrative. The broker takes LE 35,000, the doctor LE 75,000 to 80,000, while the donor who has consented is promised LE 15,000 to 20,000, but then most get much less, and some are cheated of their money.”

The reporter has no figures on kidney trafficking in Egypt. El-Haddad will only say that his committee sees some 500 to 1,000 cases a year, while other sources say — off the record, of course — that El-Haddad’s is far too conservative an estimate.

Mohammed Allouba Nephrologist Manal Mehanni points out that kidney transplants have become a fairly safe procedure.

Abu Deif, the 25-year-old alleged victim, says that, at one point during his ordeal, he was living in an apartment with 15 others waiting for tests before leaving abroad for work. He feels responsible for having dragged his friend Moussa into a living nightmare that has rendered him unable to eat or think about anything else.

“I work as a waiter. Someone told me about a job, so I ended up in a coffee shop across from the Dokki Police Station,” Abu Deif recalls. “I could not find my acquaintance, but someone came and told me he knew of a very good job that would take me out of the country. I told him I had to ask my family, but my parents told me it all sounded too good to be true. Why would anyone choose me, while there are better-qualified people everywhere without work? I asked my friend Alaa [Moussa], who said, ‘Let’s check it out.’

“We went together, and the person who had told me about the job, Gamal Abdel Nasser, said we had to undergo some tests first, as he could not be responsible for anything that happened afterward. He took us to the big guy, the broker I told you about. He told us the same thing and said we had to pay him back for all the tests and procedures once we started working. I said no problem, it is enough that we are about to get a job abroad. I was taken to an apartment in Bab El-Khalq. I was supposed to live there until the date of my departure. I told them I already had a home in Cairo, but Abdel Nasser said it was because they needed to carry out too many tests and I live too far away. There were 15 other people in the apartment, all waiting for jobs abroad.

“Alaa was taken to a different place. Whenever I asked about him, they said he was finishing procedures. I was never allowed to go out on my own. I underwent two weeks of tests. Then they took me by taxi to a place in Mohandiseen, where I met someone in a blue Opel. His name was Dr. Mohammed [last name withheld]. He told me to get in and said he was the doctor who was going to do my ECG [electrocardiogram, a form of heart test]. He took me to [a prominent] hospital, where they whisked me upstairs, and I was dressed in a hospital robe. I went into a room. The doctor was waiting for me there and started performing the ECG. As he did it, I felt a jab in my arm. I woke up in a hospital room, which I shared with someone. I was vomiting constantly and felt a terrible pain in my side, which was heavily bandaged.

“‘Mabrouk,’ said the nurse. ‘How much did you get for your kidney?’

“‘What kidney?’ I went crazy, and the doctors put me to sleep again. When I woke up, I grabbed a chair and broke the window. They took me downstairs and kicked me out of the hospital’s back door.

“It was nighttime, and I had nowhere to go to. I called the broker and told him what happened to me. He told me to go meet him in a place in Mostorod. His bodyguards were there; they shoved me into a car and took me to Sixth of October City, to the broker’s brother’s apartment. I was very worn-out, but that didn’t keep me from trying to lash out at the broker. His bodyguards kept me in check. He told me: ‘My dear son, your kidney was in very bad shape. We have released you of the pain it was about to cause you.’ I told him I had never had kidney trouble. He threw me LE 4,000 and left.”

At his parents’ urging, Abu Deif has since filed a report with the police. The investigator heading up his case was so stunned by the story he first thought it was a prank being played on him by colleagues, but quickly sent out a team of officers to search for the broker. They returned empty-handed; the case remains open.

Abu Deif has since found out from Abdel Nasser — and from a woman by the name of Sabah who is a friend of the broker — that his kidney had been given to an American patient.

His friend Moussa can barely sit as Abu Deif tells their story. His face is jaundiced, and he seems to be in a lot of pain. As Abu Deif and Moussa show us the gashes splitting their sides, we are surprised to find that Moussa’s wound is very long, over half a meter in length, running round the side of his body, almost from his backbone to his navel. The stitches are big and rough, as if they had been made in a hurry, unlike Abu Deif’s stitches, which, although rough, are not as crude as Moussa’s.

“They’re butchers,” Abu Deif remarks.

Moussa’s story is very similar to Abu Deif’s. His go-between went by the name of Zakaria and instead of Bab El-Khalq, the apartment he was taken to, was located in Old Cairo’s Aboul Suod. Moussa recalls one incident, which he alleges shows how influential and self-assured their broker felt while conducting his business.

He tells a very similar story: The physician has the same name, looks remarkably similar to Abu Deif’s and also drives an Opel. Moussa, too, claims he was given a dose of anesthetic while sitting for an “ECG.” The buyer of his kidney, he claims, was a Palestinian woman.

When he freaked out, he says “the broker took me out of hospital, told me my kidney was in bad shape and they had to relieve me of it. I threatened to go after him, but he told me to calm down. He gave me LE 100, and left me on the Corniche to take a taxi home,” he says.

Moussa later tracked down the broker, who, he claims, gave him LE 3,200 — and told him to be quiet “or else.”

Abu Deif and Moussa both kept in touch with police, who have since turned the case over to the Prosecutor-General’s State Prosecution Service, which has identified the go-betweens and the physician. Charges against all three are reportedly imminent, but both Moussa and Abu Deif dropped the charges against their broker after visits from his bodyguards.

“The broker says he is holding papers against us. They made us sign so many things before the operations. But we don’t care. We are going to die anyway,” says Moussa. “I feel the life seeping out of me. I will get my revenge on them, be it by law or otherwise.”

Dr. Manal Mehanni, the nephrologist in charge of kidney transplants at the private Cairo Kidney Center, points out that the transplant has become a fairly safe procedure from which donors recuperate in a few days.

“It is the patient, the recipient, who is originally sick and who has to take immunosuppressant drugs. Someone who merely had his or her kidney removed becomes completely normal after the third or fourth day. We just tell them not to lift heavy things, because they have stitches,” she explains.

Why, then, are Moussa and Abu Deif in such apparently bad health?

“They like to make up feature stories for the cinema,” Mehanni says. “Listen: All of the donors at our clinic sign consent forms. All of them. One before the operation, one afterward. We had someone who signed both forms, stayed with us for a month. The day he was released, he went to the nearest police station, claiming he went in for a kidney stone and ended up with a stolen kidney. They called us in for questioning, but of course we had all our papers in order: the preliminary and final forms, the Physicians’ Syndicate’s permission. They’re nothing but crooks.”

Still, the existence of an underground market for human organs — mainly kidneys, as other procedures, such as partial liver transplants, generally fail if the donor and recipient are not related — is a fact that cannot be contested, although there have been no reports of murders to obtain hearts for transplant, as has happened in less-developed countries.

According to a brief, undated report by the Egyptian Society for Medical Ethics obtained by Egypt Today, “Organ trafficking started in Egypt in the 1970s, and has increased to attract rich Arabs who come to Egypt to buy kidneys. Some poor Africans have joined the poor Egyptians in selling their kidneys, so much so that the International Herald Tribune wrote in 1991 about a ‘Barbaric Trade in Cairo for the Luxury of the Rich East [sic].’”

The report estimates that 98 percent of all kidney transplant operations in Egypt are made possible through trafficking. In a 2003 report by the World Health Organization on organ and tissue transplants, former Egyptian Minister of Health Ibrahim Badran notes that “Poverty, unless alleviated, will continue to engender the buying and selling of organs.”

Today, there is no law in Egypt regulating human-to-human transplant surgeries, no section of the Penal Code that makes the theft of an organ a more heinous offense than misdemeanor assault.

Worse, the only law that exists is a draft law not yet passed by the People’s Assembly or approved by the Shura Council that would make the harvesting of organs from cadavers legal, a fact that guarantees the supply of organs for transplant will continue to lag behind public demand. Instead, Egyptians who can afford the procedure head to Saudi Arabia and Jordan for surgery.

Dr. Hamdi El-Sayyed, chairman of the Physicians’ Syndicate and of the People’s Assembly’s health committee, has worked for nearly a decade now to write and pass the Organ Harvesting and Transplant Act, which was introduced in Parliament in 2001, but has yet to pass.

Although the bill has received preliminary (but not final) approval from the People’s Assembly, it has sat on the Shura Council’s docket since 2001.

“The Shura Council has frozen the law. The problem facing it is not a religious one, as the Mufti [then Dr. Ahmed El-Tayyeb], Dr. Mohamed Sayyed Tantawi [now Sheikh Al-Azhar] and [Al-Azhar’s] Islamic Research Academy have all agreed to it,” says El-Sayyed. “Other Islamic countries, including Saudi Arabia, Kuwait, Jordan, Tunisia and Pakistan, all have transplant laws.”

“There is a fatwa that permits the harvesting of organs from the deceased and the living under certain conditions,” he continues. “The people standing against the law are a number of religious leaders who have no official post, but whose mindset is a little narrow. The first to call against organ transplant was Sheikh Shaarawi, and his followers believe the same thing. They believe that the law opens the door to trafficking, which is contrary to the real spirit of the law.”

El-Sayyed counters that the law, if passed, would slowly abolish trafficking by increasing sanctions from the current one-year minimum sentence for assault to a minimum of 10 years in prison. Fines would also rise from a maximum of LE 5,000 today to a minimum of LE 100,000 for any physician who transplants a stolen organ.

Today, physicians convicted of illegally harvesting organs can be subject to assault charges and may have their licenses to practice medicine suspended or revoked. There is no penalty for brokers or go-betweens unless they can be proven to have participated in an assault.

“The law places heavy restrictions on transplants and would order the formation of a national transplant committee to screen and approve cases in need of transplants. We are waiting for the next season and will try to push for Shura Council approval,” he says. “Their approval is not mandatory, but it is advised. The Egyptian Constitution stipulates that all laws concerning people’s health or human rights be approved by the Shura Council.”

(In the past, the Supreme Constitutional Court has not hesitated to strike down laws enacted with approval from the Shura Council or Maglis El-Dawla (State Council) where required.)

The law would also establish a national organ bank — and legalize the harvesting of organs from cadavers or the clinically dead by creating a national organ donor’s card.

Mehanni says she sees no need for the law, adding that should it pass, “it would only make me feel more nervous. People in Egypt have no conscience. I would be scared of going anywhere for fear of having my organs stolen or of being killed for my organs. Three-quarters of the people in Egypt operate without a conscience.”

With the PA and the Shura Council likely to spend the next legislative season, due to start in November, debating political hot potatoes, including constitutional amendments, few observers expect El-Sayyed’s transplant bill to come up for a vote in the house. Instead, enforcement of the existing law will remain in the hands of the Physicians’ Syndicate.

Also stepping up its enforcement activities are investigators at the Private Therapy Department at the Ministry of Health, which regulate the hospitals and other facilities at which medical treatment (including transplants) take place.

Minister of Health Hatem El-Gabali, himself a respected medical doctor, has stepped up the fight against organ trafficking since taking office at the beginning of the year. Egyptian-to-foreign trafficking (including sales to Arabs) has been a particular focus.

“Some people abuse the poverty of many of our youth and convince them to sell their organs. There is the famous case of a young man who needed LE 8,000, so he sold his kidney to an Arab. The center was not a very good one, and the young man later died,” says Dr. Abdel Rahman Shahin, the Health Ministry’s press counselor and chief spokesman for El-Gabali.

Shahin says the ministry has good intelligence on the traffickers.

“We know all their haunts. We know about the centers, the hospitals and the brokers. We closely monitor centers where violations take place, and we’ve closed down many of them. The last raid took place just the other day and Dr. El-Gabali went along himself: The minister met up with inspectors from the Private Therapy Department at one of the clubs at 6am, and they raided a hospital. The illegal operations take place at dawn, you see, and they were able to find patients and donors who had just undergone transplant operations,” says Shahin.

(El-Gabali has taken to the ‘undercover’ side of his job: Barely a week after entering Cabinet, he fired two senior hospital administrators after launching a solo investigation armed only with his digital camera.)

Shahin is aware of the Mail & Guardian story, which he says was “exaggerated.”

“The Ministry of Health, together with the Syndicate, keeps a very close watch. Yes, transgressions take place. There are brokers, and there are victims who fall prey to them and who are even cheated of their money. But you cannot call it an organ trafficking ‘mafia.’ Hundreds of transplant operations take place each year, but there are relatively few violations,” he claims.

“We’re authorized by the ministers of health and justice to visit any place at any time of day or night. We can even enter an operating room during an ongoing procedure, and we can close down any institution we find violating the law — on the spot,” says Dr. Ahmed El-Zein, the director of the Health Ministry’s Private Therapy Department. El-Zein has just 10 inspectors to monitor all private-sector hospitals and allied medical institutions in Egypt.

Dr. Fadel Ali Fadel, first deputy minister and El-Zein’s immediate superior, notes that someone from the Private Therapy Department “must be present whenever a transplant operation takes place.”

Still, it’s obvious the department is working long hours. “You have no idea what I was doing last night! We raid hospitals at all times of day or night. You say they operate at dawn. How did you find this out? It is because we found it out first and notified the press,” El-Zein says.

Even so, he knows little about cases involving young men who claim their organs were stolen. His work, he says, focuses on hospitals that perform transplants without paperwork — he shuts down institutions, not individuals.

Fadel, meanwhile, hopes El-Sayyed’s law will pass this session, saying it would give El-Zein’s enforcers more clout: “The draft law is strong. We’re waiting for it. When it is passed, it will be our jobs here to enforce it.”

Abu Deif and Moussa are also waiting for a new law — one that will give them some sense of closure, one that will declare what happened to them was a felony, not a mere misdemeanor. Businessmen get longer jail terms for bouncing checks than organ traffickers do for stealing kidneys.

Only when the ‘donor’ dies does it become a felony.

“I have given up on life. I would like to commit suicide, but I cannot. All I do is think about the broker,” Abu Deif says.

Moussa: I dream of him.

Abu Deif: So do I.

Moussa: I dream of catching him. There is something strange about him. Whenever you consider doing something bad to him, you cannot.

Abu Deif: If the law cannot grant us our rights, we have to do something.

Moussa: But all hope is lost.

Abu Deif: I used to work a lot. I would make LE 200 in two days. Now, I cannot stand up for long periods of time.

Moussa: My son in 9 months old, I wish I could do something for him. I don’t think I’ll be around to see him grow up.

Abu Deif: I cannot even go home to my relatives in Upper Egypt. They think I sold my kidney. They do not believe it was stolen.

Moussa: I don’t feel safe here.

Abu Deif: My passport is ready. I wish I could leave this country. In a place where your flesh gets stolen? I cannot live in such a place. Nobody cares about us here. et