Stranded in Sinai: Stripped of Home, Refuge, and Organs

Vulnerable East African refugees in Egypt have little protection from inhumane abuses from traffickers. This problem has grown recently as security forces struggle to maintain law and order across the country.

Adam had been hiding in a remote suburb of Cairo for weeks when the pain first hit.

“One day I feel pain on my right side near my stomach and complain about it. My broker suggested I see a doctor, but I refused,” he said.

Adam, a 23 year-old refugee from Darfur, like thousands of fellow Sudanese migrants in Egypt, had put his faith in the services of a local man to expedite his safe passage away from his war-torn homeland. When his health began to deteriorate, with no money or registration papers, Adam had little choice but to follow his broker's advice. He had no idea what was about to unfold.

“The second day he takes me to the downstairs pharmacy and I take an injection and start to feel better. No one explains to me what is wrong,” he says.

“During the next three days, he feeds me nice food and drink, telling me I need to keep up my strength. Whenever I ate that food, though, I would be knocked out for hours sleeping. On the third day, I woke up in a hospital bed with a nurse, this man and his wife next to me. I found out that they stole my kidney.”

Adam's ordeal at the hands of organ harvesters is far from unique; his story belongs to a growing narrative of refugees and asylum-seekers, predominantly Sudanese, who fall victim to kidney theft in and around Cairo.

In January this year, the United Nations High Commissioner for Refugees (UNHCR) estimated there were more than 10,000 Sudanese refugees and over 14,000 Sudanese asylum-seekers currently in Egypt. They enter relatively easily through various poorly patrolled border crossings, the majority having fled violence or drought. Many aim to make their way into the Israeli job market in a bid to secure a wage sufficient to support families back home.

Israel’s recent purge of African migrants, coupled with increasing public antipathy towards asylum-seekers has led to scores of Sudanese, Ethiopian and Eritrean refugees being stranded in the Sinai, left as prey for organ traffickers operating along the human highway between the lawless desert region and Cairo.

Debra Budiani-Saberi, founder of the Coalition for Organ Failure Solutions (COFS), a New York-based NGO dealing with organ trafficking in Egypt, says her organisation was able to identify 57 Sudanese victims - Budiani-Saberi prefers the term “survivors” - of kidney theft during a recent research project in Cairo. All testimonies featured in this report were provided to Al-Akhbar by COFS.

After working on the issue for a decade, Budiani-Saberi has voiced her concern that the practice of luring vulnerable Sudanese into selling internal organs is on the rise in a post-revolution Egypt still struggling to maintain basic rule of law.

“We have identified Sudanese victims of organ trafficking [in Egypt] and in all my years of working on this, most concerning aspects are that the processes are getting more abusive,” Budiani-Saberi told Al-Akhbar . “Before, we did hear of kidnapping or abduction, but they were extremely rare. Now we are hearing of them occurring more in recent months since the revolution. So that's really concerning.”

COFS recently released a landmark report on the practice of organ theft in Egypt. Its findings make for grizzly reading.

Of the thousands of Sudanese that flood across Egypt's southern frontier each year, many do so with the help of a fixer, or broker – a person who makes a living out of facilitating the transit of people into a "host" nation. They often provide a refugee with false documents to aid their repatriation and, in return for a small fee, usually oversee an individual's temporary settlement in and around Cairo. Many brokers are connected with Sudanese locals in the capital, and normally provide temporary board and lodging to refugees or asylum-seekers.

Of those identified by COFS as victims of organ theft, a pattern emerges from their derisory situation: they are habitually bribed and threatened with arrest or physical harm if they don't agree to pay more than the agreed broker costs.

In their desperation, one of two things usually occurs.

Either, the refugee is tricked into giving up his or her kidney on the pretext of being offered a routine medical examination.

"I fell very ill and went to the hospital and they told me that they had to remove my gallbladder,” said one male victim interviewed by COFS. “After I left the hospital I found the pain had increased. I talked to an older Sudanese man who lived near to us about this issue…. He gave me the money and I went to get a medical checkup. The doctor surprised me when he told me…'No, you only have one kidney and the other was removed.’”

Or, individuals are coerced into selling one "voluntarily" at the promise of significant financial reward.

"I had no money for food and I began to fall ill. He then told me that I needed to sell my kidney to raise more money for my stay and help my situation,” said another victim.

Their organs end up in Israeli, Jordanian, or Libyan hospitals, in the Gulf, or even back in Sudan, sold to the highest bidder as the donor's health slowly crumbles.

These are some of the most vulnerable human beings in Egypt, and are apparently being targeted by criminal brokers precisely due to their defenselessness.

"These are men, women and children who have had to escape either persecution or clear and present danger to their lives," the COFS report said.

All who fell victim to organ theft noted a significant deterioration in their health, already likely poor as a result of their living conditions in Egypt. In each reported case, financial compensation was promised by a broker – COFS estimates a healthy human kidney can fetch between $5,000 and $40,000 on the black market – but refugees who actually received money for their organs were so rare as to be anomalous.

Often, victims are stigmatized for the theft, and are frequently disowned by their family and community for having allowed the operation to take place.

The World Health Organization estimates 6,500 kidneys are illicitly removed from patients globally each year. Thousands such thefts are thought to occur in Egypt. While the vast majority of victims of organ trafficking are Egyptian – their organs harvested and sold to a largely Egyptian market – COFS's fieldwork threw up some interesting demographic data on Sudanese survivors.

While more than 60 percent of Egyptian individuals targets were illiterate, all Sudanese victims were fully or partially literate, with a quarter holding university degrees. They were also all younger than their Egyptian counterparts, which suggests they were targeted purely on the basis of their shaky legal status as refugees or asylum-seekers.

Egypt is a signatory to the UN Protocol on Human Trafficking – a document with robust provisions against organ trafficking – yet the practice has boomed in recent months, particularly as authorities struggle to keep law and order since the fall of former president Hosni Mubarak.

With the Egyptian Army’s and security forces’ scarce presence in Sinai – limited by a provision in the Camp David peace accords – preoccupied with preventing arms spilling in from neighboring states, keeping tabs on the blooming organ trade is far from a law enforcement priority.

As Heba Morayeb, a Cairo-based researcher with Human Rights Watch put it, Egypt today provides “a very good environment for trafficking.”

Elizabeth Tan, UNHCR deputy representative in Cairo, said that while local laws existed to protect vulnerable refugees from harm, a lack of enforcement was often leaving migrants in grave danger.

“Refugees are more vulnerable since the revolution last year,” she told Al-Akhbar. “Rather than more [security] checks, there are less checks. There is less control in terms of criminality. And so refugees feel particularly vulnerable.”

The COFS report found that several Sudanese victims of kidney theft were registered with UNHCR at the time of their ordeal, a fact the organization believes demonstrates the inability of the registration process to protect refugees and asylum-seekers from the practice.

Tan agrees. “In terms of an attack on the street, it doesn't make a difference if you are registered. But in terms of protection from arbitrary arrest, deportation, there is a clear benefit in registering,” she said.

Many victims of kidney theft are understandably too scared to take the matter up with local authorities. Even if a victim possesses the relevant paperwork pertaining to their refugee status, the horror stories of imprisonment and forced rendition at the hands of the state cause the majority of survivors to demur. For the brokers, part of the attraction of targeting Sudanese migrants in Egypt is their almost total lack of legal recourse.

The Egyptian government has been accused of detaining Sudanese activists seeking to highlight their countryfolk's plight, and Tan believes the state to be in the practice of sending refugees back to Sudan. Cairo's Ministry of Foreign Affairs failed to respond to a request for comment from Al-Akhbar.

Asmaa Soliman, head of the Women's Group for Human Rights, an Egyptian NGO working in South Sinai, said that the practice of smuggling Sudanese migrants into and out of Israeli-controlled territories was proliferating.

Refugees are often captured by gunmen, detained, and even occasionally sexually abused before being sold to brokers on either side of the Israeli-Egyptian border.

Soliman believes the general lack of security, exacerbated by the Egyptian authorities’ inability to operate in the Sinai, is one reason why security forces are failing to intervene in the human trafficking trade.

“The Sinai is very difficult to move around unmolested and the Bedouin know the geography and they can cross the border very easily and evade security forces,” she said.

When contacted by Al-Akhbar, both COFS and UNHCR voiced concern over the reports of organ trafficking emanating from the Sinai. Since Egypt doesn't classify transiting migrants as asylum-seekers, aid agencies are denied access to refugees making their way through the desert.

“We have a fundamental issue with this, because people traveling on this route, given their places of origin, probably have a refugee claim,” Tan said.

COFS has submitted a number of recommendations to the Egyptian authorities and UNHCR in a bid to raise awareness on organ theft, but humanitarian organizations claim the problem is still being overlooked by relevant Egyptian ministries.

Until relevant law enforcement is achieved, COFS has said it will continue to document the plight of Sudanese refugees and asylum-seekers who, having entered Egypt in hope of a better future, end up on a hospital bed with chronic health concerns.

As one survivor of organ theft put it: “I have felt like killing myself sometimes. Sometimes I just hope I get into a car accident and die. I feel grateful that I am still alive. But I cry most of the time when I remember what happened.”