Focus on kidney sales by bonded labourers

Today, Idrees, 27, is a free man, after nearly 10 years in bondage at a brick-kiln near Sheikhupura, some 100 km north of the eastern Pakistani border city of Lahore. He won his freedom by selling his left kidney. With the Rs 90,000 (US $1,500) he got, he was able to pay off a debt of around Rs 60,000 ($1,000) he and his elderly parents owed to the kiln owner. The debt had accumulated over nearly 15 years. But after paying off the amount, he had little left over, and less than six months after undergoing surgery at a private clinic to remove his kidney, he is once more in debt, having borrowed Rs 5,000 ($840) from a cousin a few days ago. “It’s a pity I can’t sell my other kidney,” he said only half jokingly, adding: “But at least we are free. Allah (God) will help us now.” Idrees’s own ill-health since the surgery prevents him finding work, while his father earns less than $100 a month as a ‘day wager’ at construction sites. Idrees is not alone in his plight. In March, Pakistani newspapers printed chilling photographs of at least a dozen brick kiln workers posing shirtless outside the Lahore Press Club. Each displayed a large, diagonal scar above the left hip. They had sold their kidneys to pay off debts to kiln owners, and earn freedom for themselves or close family members. The workers were protesting against the lack of official attention to their plight, and that of thousands others like them. COMMON PRACTICE Hundreds of bonded workers across the country are believed to have sold kidneys to pay off debts. Though debt bondage is banned under the 1992 Bonded Labour Abolition Act, it flourishes at kilns scattered across the central Punjab province and on agricultural estates in the southern province of Sindh. “The continued existence of bonded labour shows that the authorities simply have no wish to see it end or to enforce the law,” Asma Jahangir, a leading lawyer, rights activist and chairperson of the Human Rights Commission of Pakistan (HRCP), told IRIN. A campaigner for over 15 years against bonded labour, she added: “We will just have to fight on for the rights of people enslaved by debt.” An appeal, seeking the upholding of the law on bonded labour, is now before the Supreme Court. It was moved by HRCP after the Sindh High Court in 2002 dismissed the petitions of 94 bonded farm workers, and ruled that disputes over debt should be settled under the Sindh Tenancy Act of 1950. HRCP pointed out that the Sindh High Court had failed to make any reference to the 1992 law banning debt bondage. Jumma Khan, 60, who spent over 25 years at a brick kiln near Rawalpindi, twin city to the capital Islamabad in the northern Punjab, until his son sold a kidney to buy freedom for the family, told IRIN that brick kiln owners and their foremen “encourage workers to take loans, knowing they will not be able to pay back the sums. They then keep them at the kiln as virtual slaves, sometimes holding them in fetters or in iron cages so they cannot escape.” KIDNEY MAFIA The problem of impoverished workers selling organs is a growing one in the country. Legislation to ban sales has still to come in, and unscrupulous private clinics, using ‘middlemen’ to find donors, are doing a roaring trade. Each kidney, bought from donors on average for between $1,000 and $2,000, depending on the age and health of the donor, is sold to rich recipients for up to 10 times that amount. An increased number of visitors from abroad are travelling to the country to fly out with a brand new kidney, and Pakistan is now thought to be a growing centre of global ‘organ tourism’. The trade has flourished in the country, most notably since India placed a ban on the practice 10 years ago, diverting traffic to Pakistan. “It is spurred on by the desperate poverty of people, by the lack of laws and by unscrupulous doctors, clinics and their ‘agents’,” said Dr Yasir Agha, a urologist who has recently begun practice in Lahore. Agha argued that several clinics have indeed “made this their major business because elsewhere in the world there are long waiting lists for organs, and here a kidney can be obtained within days.” Certainly, more and more desperate people see the sale of a kidney as at least a temporary solution to their woes. In Sultanpur More, a village not far from Islamabad, many adult men and women carry the distinctive, angry scar showing they have sold a kidney. From the small town of Kot Momin, near Sargodha in the agricultural heartland of the Punjab, 4,000 people were estimated to have sold kidneys. NO ESCAPE FROM POVERTY The numbers in other villages and impoverished areas of Lahore are even higher. For most sellers, long-term improvement in the quality of their life has not come. Saleemuddin is one of four brick kiln labourers who sold a kidney nearly a year ago. He was able to pay off debts, leave the kiln he was held at, and put his four children in school. But today his plight is even worse than before. Unable to find a job in times of high unemployment, his children are once more out of school. On many days in the month, the family eats only dry bread and tea without milk for their meals, the children wear no shoes, and now, Salemullah’s wife, Bashiran Bibi, is planning to sell a kidney. “I don’t want to, but what else can we do?” she asks, adding while talking to IRIN: “My youngest child is sick and we cannot afford a doctor or medicines.” “It’s a terrible cycle of debt and poverty and unemployment. Then middlemen exploit these people, offering huge amounts for a kidney. Often the sum promised is not given, and the costs of medicines after the kidney removal are so high that people lose much of what they earned,” Iqbal Masih, a church worker in the impoverished, mainly Christian area of Jauhanabad, on the outskirts of the city, where in more and more households at least one and often more family members have sold kidneys. Iqbal and his team advise against kidney sales, but say “many are simply not in a position to listen.” Amid reports last year of the expanding operations of a ‘kidney mafia’ comprising doctors and middlemen, operating in many areas of the Punjab, and stories suggesting more and more people had been lured into selling their kidneys or even kidnapped for the sake of removing a kidney without their consent, the federal government announced it had drafted a bill to ban the practice. The draft has still to be converted into legislation. In the meanwhile, across the country, more and more impoverished people are selling kidneys as a way of paying of debt and buying freedom from bondage, or simply as a means of putting food on family tables in times of growing joblessness, rising inflation and relentless poverty that has left few families untouched.