Wearing a baseball hat and smoking a shisha pipe in a cafe in Cairo, Dawitt tells me he is 19, but looks years younger. He explains that he escaped Eritrea aged 13 to avoid forced, indefinite conscription into military service.
His family helped him pay smugglers to travel via Sudan to Egypt. Struggling with debt and desperate to make the sea crossing to Europe, he looked in vain for regular work. Then he met a Sudanese man who suggested a “safe and easy way” to raise the cash – selling a kidney.
“I thought it would be a good way of getting money fast and travelling to Europe,” says Dawitt. “I was worried, but he convinced me that it is a very easy operation and you can live a normal life with one kidney. It was a lot of money. How [could] I say no to $5,000 (about R70 600) when I have nothing and my family need help?”
Dawitt was given blood and urine tests, then taken for surgery.
“We drove all night to get to the hospital. I remember walking downstairs and waiting to speak with the doctor. Then I entered a room where I was asked to change my clothes and lie down on the bed. All I remember after that was waking up and feeling a sharp pain in my side. I started shouting and cursing until the broker came to take me back to the apartment.”
Dawitt’s story is more common than statistics suggest. According to a 2018 report, the United Nations Office on Drugs and Crime has collected data on 700 incidents of organ trafficking, primarily from North Africa and the Middle East. Yet these figures are conservative, at best. The true scale of the industry is difficult to assess, as the majority of cases go unreported, with victims reluctant to come forward for fear of deportation, arrest or shame.
The trade appears to be flourishing in Egypt, bolstered by an EU-funded clampdown on refugees by security forces. There, the hostile environment created by the arbitrary detention of migrants, and the hike in smugglers’ fees, is presenting organ brokers with an opportunity to profit from those desperate to raise funds to cross the Mediterranean.
After surgery, Dawitt was taken by his broker, Ali, to an apartment in the Mohandessin district of Giza to convalesce. He was introduced to an Eritrean, Isaac, who promised to bring him to Damietta, where a fishing boat would take him to Sicily. The broker encouraged Dawitt to accept his offer, claiming he would use the money he owed Dawitt for his passage.
“I felt very comfortable with [Isaac] after talking. He was Eritrean, and he didn’t look like a thief. He told me that he smuggles hundreds of people every month and that he doesn’t need the money. He made me feel like he was the one doing me the favour. He gave me his number and told me to call him when I was ready.”
Dawitt says he spent a further two weeks at the apartment recovering from the surgery. Feeling his strength return, he called Isaac to confirm travel arrangements. But the phone line was inactive, and Ali was nowhere to be found. Dawitt is convinced that Ali used the money to make his own way to Europe. When he reported the incident to the police he was threatened with deportation.
Giza, where 19-year-old Dawitt was taken after his operation. Efesenko, Getty Images.
Anecdotal evidence suggests organ brokers are increasingly approaching migrants with the offer of a passage to Europe in exchange for donating an organ. The irony is that the trade is being driven by the broad EU policy to “externalise borders” by increasing the capacity of African states such as Libya, Egypt and Sudan to manage migration, given a boost by the EU Emergency Trust Fund for Africa.
Figures released by the European Commission in 2018 indicate that fewer people are now escaping to Europe via the north Egyptian coast. Yet while the number of migrants, asylum seekers and refugees crossing Egypt’s central Mediterranean route has decreased, the de facto closing of borders has pushed people to further extremes, increasing the hold of criminal networks. Intent on leaving Egypt by any means, migrants are being targeted for organ sale.
On a street near Tahrir Square, Ibrahim waits outside a cafe. He waves me over, gesturing to a chair. His role, he says, is to recruit migrants as part of a smuggling network operating along the north Egyptian coast.
“People come to me to organise their transport and to make the payment,” he says. “I confirm the payment with the boss, and then I bring people from Cairo to Alexandria. They stay in warehouses on chicken farms and wait there until the time is ready to go to sea.”
In response to a government crackdown, smugglers operating out of Egypt and Libya have raised fees from $1 500 to $3 500 (about R21 100 to R49 300) to maintain profits. Unable to finance travel, people smugglers are referring migrants to organ brokers in Cairo to raise the necessary capital.
“People can pay less than the asking price [of $3 500] but if you do this, you’re like a third-class passenger,” he advises. “These ones can end up in detention centres where they will only be released if they agree to work or sell their bodies for sex.”
Ibrahim shifts in his seat uncomfortably, reaching for a cigarette. He inhales slowly, taking his time to consider what he wants to say next.
“There are some people who only care about getting the money. They don’t care if you arrive at your destination or end up dying at sea. This is why I advise people to make the payment in advance, even if that means selling a kidney.”
Asha, a woman from Sudan, shows the scar from the operation she says she was coerced into in Cairo.
Ibrahim draws my attention to bullet holes over the door frame, a relic of the revolution when shots were fired at protesters during demonstrations on 25 January 2011. He knows that what he is doing is illegal but suggests the government is at fault. “I do not see my work as bad because I am helping people change their life for the better.”
A law banning organ sales was introduced in 2010 but has pushed the trade further underground. Asha, from Sudan, explains how she was recruited in Khartoum and taken to Cairo. “They said they would find me work and then they would take me to Italy. I did not trust these men, but it was impossible for me to stay in Khartoum. My children were sick from not eating. So, I listened to them.”
When she arrived in Cairo, Asha was told that she would not be going to Europe. Instead she would be “donating” her kidney. She was promised $2 000 (about R28 200) if she complied. If not, the men said, they would take her kidney by force. Asha was taken by taxi to a nondescript apartment in Alexandria.
“I know it was Alexandria because I could see the ocean from the taxi. Then I was in a room with medical equipment, but this is all I can tell you. They locked me in the room and told me to think of my children.”
After surgery, Asha reported one of the brokers to the police. He was arrested and held for 30 days, then released without charge. In July 2018, a statement from the Egyptian Health Ministry announced that 37 people had been found guilty by an Egyptian court on charges related to illicit trading in human organs. There was no mention of the victims.
A spokesman from the Egyptian Ministry of Foreign Affairs said: “Egyptian authorities continue to vigilantly pursue, investigate and bring to justice any such crimes of organ trade in accordance with the stringent provisions of the criminal law. Furthermore, this hideous illegal trade has never been condoned by the Egyptian government and law enforcement authorities. We will continue to combat such crimes and bring those engaged in the organ trade to justice, while protecting Egyptian citizens as well as our host refugee and migrant community.”
Asha lives in fear for her life, subjected to threats and intimidation by the broker and his associates. She says she was told that if she did not withdraw her statement, her children would bear the consequences.
“I am worried about what will happen to my children. I am worried they will come for their organs too.”
Names have been changed. Dr Sean Columb is a lecturer in law at the University of Liverpool. He is writing a book on the organ trade, to be published by Stanford University Press in 2020.
This is an edited version of a feature originally published as part of The Guardian’s Global Development project.
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