In light of new alliances with crime mafias, gangs involved in the trafficking of human organs have increased in various countries of the region including Egypt, Sudan, Libya and Morocco, to name a few. The trafficking network includes university professors, doctors, members of nursing staff, and owners of medical centers and labs as well as intermediaries and brokers with prior records, and those impersonating security officials. It is a soft cross-border trade, in light of various unstable security situations, the fronts of internal Arab conflicts, and the terrorist organizations’ urgent needs for income. Other factors include pressing economic conditions, the financial profits generated by the organ trade, and a lack of deterrent legislation.
The trafficking of human organs in the Middle East is referred to as a "silent crime," as it occurs outside the bounds of accountability and control. Iran is the only country in the region that allows for organ donation from living donors, in exchange for 300 pounds. Since the trade is regulated in Iran but absent in the remainder of the region’s countries, this activity is diverted directly into the black market.
There are no statistics confirming the impact of this phenomenon in public hospitals or private clinics, but a lack of evidence does not indicate that the phenomenon does not exist. The secrecy shrouding such invisible practices makes it difficult to determine the extent of activity on the black market and the number of organs that are being illegally traded each year all over the world.
According to World Health Organization estimates for 2015, more than 10,000 sales of human organs take place on the black market each year. Around 5 to 10% of all kidney transplants worldwide are accomplished through trafficking and cross-border smuggling operations, raking in annual profits ranging between $600 million and $1.2 billion, while other estimates suggest an annual profit of $8 billion.
There are several patterns that dominate the organ trade, such as kidney, liver lobe, cornea, bone marrow, skin and hair transplants in some of the region’s countries, and are often acquired as follows:
1. Theft: In some public and private hospitals around the region, certain mobs actively try to steal organs without the knowledge or consent of the donors. The unwilling donors are usually targeted when travelling to conduct medical tests are considered to be “spare human body parts" by the mobs.
2. Extraction: ISIS recruits organ doctors in the hotbeds of Arab armed conflicts. The recruitment is not limited to their killed soldiers, but also from the abandoned injured and from individuals they have abducted.
3. Abduction: Children or homeless children are often abducted with the goal of stealing their organs. This has occurred in several Egyptian, Jordanian, Iraqi, Syrian and Sudanese provinces. The bodies are found a period of time after their disappearance with hearts, livers, kidneys and spleens missing. For example, in eastern Sudan, some children have been kidnapped from the desert and other remote areas for their organs to be sold. Refugees are also subject to the same type of abduction, such as Eritreans in asylum camps along the Sudanese border.
4. Marriage: Under-privileged girls who demonstrate willingness to selling their organs are married off to wealthy Arab men. They get divorced instantly after the extraction, which indicates that they were victims of a scam.
5. Demanding written consent: Some traffickers in the region have refugees sign a form declaring their consent to sell their organs in order to grant the process legitimacy.
The phenomenon of organ trafficking in the region can be linked to a number of factors:
The network of death:
1. The increasing number of organ traffickers: a large number of brokers who actively work as intermediaries in the black market often pose as journalists, relief aid workers, or activists working with NGOs. They can be found either online, in medical institutions, or in popular coffee shops. Some may be specialized in dealing with certain organs. Their role is comprised of preparing donors”, carrying out all the necessary compatibility tests, booking travel tickets (if needed), paying off the agreed upon remunerations, and getting the necessary consent forms signed.
Conflict zones:
2. Escalating internal Arab conflicts: The human organs trade has increased dramatically in hotbeds of Arab armed conflicts. This is most prominently evident on the Turkish-Syrian border as well as the borders separating Iraq and Syria, Turkey and Iraq, Syria and Lebanon, and Syria and Jordan. By operating within a common location, in this case Syria, trading can occur across borders easily. In an effort to fight against illegal organ harvesting, the Assad regime’s supporting troops have refused to hand over the bodies of the dead and prisoners, and instead have only agreed to hand over their identification cards.
According to the statement made by Dr. Hussein Nofal, head of the forensic medicine department at the University of Damascus and the head of the General Authority for Forensic Medicine, given to various media outlets in early 2016, about 20,000 organ trafficking operations have been conducted since the beginning of the war in Syria. The operations mainly took place in remote locations, far from areas under official surveillance and control. He added, "The majority of these operations were conducted in refugee camps in Lebanon, Turkey and other neighboring countries to Syria."
Lax geography:
3. Loose Borders: Some countries in the region have been subjected to complex territory-related threats which can be linked to the internal transformations that have swept the region following the Arab revolutions, especially in light of officials’ weakening grip on border control and on limiting gatherings by any border-invading groups linked by a common destructive interest. With the emergence of the fragile, fractured and non-controlling state after many nations’ central governments were weakened, several outlawed groups have found the chance to thrive, particularly armed cross-border groups. As a consequence, these groups have become focal points of jihad and smuggling. Organ trafficking groups come at the forefront of these unauthorized groups.
For example, the Moroccan mafia dominates human organ trafficking in North Africa through its main route, the Strait of Gibraltar, and possesses centers on the Moroccan, Tunisian and Algerian borders. The sea is utilized as a means for smuggling. Nearly three years ago, Algerian military police dismantled a network of human organ trafficking from Algeria to Morocco, which was managed by a university professor.
The Lebanese mafia carries out its organ trafficking operations in the south, near Beqaa, and the northern regions, since these areas create tempting conditions for unemployed youth who are likely to die due to conflicts. The smuggling is carried out through the southern city of Tyre to Damascus, and from there towards Turkey and Romania.
There are gangs in Syria, which are known to collaborate with other Arab and international gangs in trafficking corneas. The corneas are smuggled and sent over to European and Asian countries. The organ trade flourishes in Kurdistan as well, especially in light of the number of internally displaced individuals in the region. Additionally, organ trafficking is common in other areas in Iraq where armed clashes and explosions result in many deaths. The sheer number of these victims has helped the organ trade to flourish.
Jihad Bank:
4. Supplying funds for terrorist organizations: Organ trafficking is considered to be a source of funding terrorist organizations. With the help of some outlawed groups in the region, such as those in Turkey, ISIS members provide human organs according to certain specifications and quantities. ISIS personnel carry out the process of finding the organs, either from individuals they hold captive, or from the bodies of the injured. After the escalation in international coalition strikes on fighters, the group does not discriminate between donors from their side or that of the opposition.
ISIS sells human organs on the black market after receiving less funds from oil extraction centers. The international community became aware of the sale of human organs after l coalition forces discovered, documents and fatwas, which allowed the group to take human organs during the course of a 2015 air raid in Syria. In his speech before the Security Council on Feb. 18th, 2015, Iraqi ambassador to the United Nations Mohammed Ali Hakim stated that, "ISIS uses organ trafficking as a source of income in Iraq, and it kills doctors who refuse to engage with the phenomenon”. This was discovered after the Iraqi government eavesdropped on communications among ISIS staff in which requests for human organs were received, and after finding bodies that were disfigured and had various organs missing.
Stressful conditions:
5. Intensifying economic crisis and high pressures of living: This is what drives groups within communities in the region to sell their organs. Local mafias have played a growing role in Iraq, due to the stressful domestic situation, and have thus attracted more victims to sell their organs in return for cash. Additionally, some brokers approach residents of the Albaq'ah camp, a very poor area in Jordan, to search for individuals who would like to sell their organs, bearing in mind that the majority of them are unaware of the implications such a donation would have on their health. Therefore, the human organ trade has become more profitable and safer when compared to the drugs or arms trade.
6. Weak legal frameworks governing the transfer of human organs: The human organ trade has become stronger amid the absence of regulations related to human organ trafficking, this applies to many Arab countries which only recognize donation but not sale. Therefore, sales and transplants from donors to patients are now managed under the table, or under the guise of what is called a "sale in the name of donation" due of the inherent legal violations and health risks.
For example, Yemeni law does not criminalize human organ trafficking, which drives judges to release kidney sellers. In 2012 the Yemeni government admitted the spread of the organ trafficking phenomenon for the first time after various gangs smuggled Yemenis from the country into Egypt in order to sell their organs, similar to the situation in Iraq.
Open trade:
7. Limited governmental oversight role: Human organ trafficking is able to spread due to a lack of tight control in hospitals, as operations are conducted according to the principle of a patient and a donor. There is also a lack of security control in some areas within Syria in such way that the trade has become public, as reflected in the posters scattered in various Syrian streets and in front of government institutions, requesting "kidney donors.” It indicates that the objective is to ensure the advertisement is visible to the largest possible amount of citizens, without any control.
Human organ tourism:
8. International interest group influences: A report issued by the European Parliament in 2015 warned of the role of wealthy European nationals, especially those hailing from Eastern Europe and Kosovo, in facilitating and promoting this trade. Although the sources are people in African and Asian countries (especially China, India and Pakistan), the phenomenon has been exacerbated in Europe, and human organ tourism caters to wealthy Tunisian patients who visit European countries in order to purchase and transplant human organs. Transplant tourism is widespread in Egypt due to the advent of foreign tourism, and transplant surgeries are conducting after making purchases through brokers.
Policies to Fight Organ Trafficking:
Some policies that may contribute in varying degrees to the reduction of the human organ trade within the region are as follows:
1. Continuous coordination between state agencies to keep track of human organ trafficking: Following in the steps of the security, surveillance and health agencies in Egypt who busted the largest international network of organ trafficking in Egypt on Dec. 6th, 2016.
2. Promoting a social culture of postmortem organ donation: Social media campaigns have proven to be effective in this regard, with Morocco as a strong example. A campaign was launched bearing the name "Humanitarian Morocco," in order to consolidate the values and culture of donation among Moroccans, and to encourage citizens to register their names as postmortem donors.
3. Developing legislative frameworks and legal umbrellas: Confronting organ trafficking in the vein of the Moroccan parliament by approving a law regulating the donation of human organs and tissues, protecting donors, and allowing them to donate in special cases to protect their lives and safety.
4. Developing frameworks for domestic control in treatment institutions: By forming a board of medical and social ethics, whose members include specialized doctors, judges, and representatives of civil society to take over the supervision of such operations in hospitals and licensed clinics specified by the law, and observing their commitment to implementing the requirements of predetermined technical specifications.
5. Relying on civil society organizations to raise awareness of the importance of a comprehensive fight: especially after receiving complaints from citizens affected by the loss of those organs, such as the role of the Doctors Against Corruption movement in Tunisia.
Overall, bodies in some countries of the region have become commodities. Moreover, the above factors have helped to address some of the obstacles standing in the way of legalizing organ transplants and transfers. The increased availability of organs offered for donation or sale in a legitimate way will lead to the establishment of a more positive relationship with the organ transplant market, converting this trade into an official international market, whose prices are determined according to supply and demand, and whose participants are safeguarded by law.
