The temperature is dropping to below zero in western Afghanistan and Delaram Rahmati is struggling to find food for her eight children.
Since leaving the family home in Badghis Province four years ago, the Rahmatis have been living in a mud hut with a plastic roof in one of Herat City’s slums. Drought made their village unlivable and the land unworkable. Like an estimated 3.5 million Afghans who have been forced to leave their homes, the Rahmatis now live in a neighborhood for internally displaced people (IDP).
There are no jobs, but the 50-year-old has hospital fees to pay for two of her sons, one of whom is paralyzed and the other has mental illness, as well as medicine for her husband.
Photo: AP
“I was forced to sell two of my daughters, an eight and six-year-old,” she said.
Rahmati said she sold her daughters a few months ago for 100,000 afghani each (about US$950) to families she does not know. Her daughters will stay with her until they reach puberty and then be handed over to strangers.
It is not uncommon in Afghanistan to arrange the sale of a daughter into a future marriage, but raise her at home until it is time for her to leave. However, as the country’s economic crisis deepens, families are reporting that they are handing children over at an increasingly young age, because they cannot afford to feed them.
Yet, selling her daughters’ future was not the only agonizing decision Rahmati was forced to make.
“Because of debt and hunger, I was forced to sell my kidney,” she told Rukhshana Media from outside her home in the Herat slum.
Afghanistan is on the brink of “a humanitarian crisis and economic collapse,” the UN says.
Afghan Ambassador to the UN Nasir Ahmad Andisha has said that Afghanistan is “experiencing the worst humanitarian crisis of its contemporary history.”
Drought, COVID-19 and the economic sanctions imposed after the Taliban seized power in August last year have had catastrophic consequences on the economy. Dramatic rises in inflation have resulted in soaring food prices.
The kidney trade has been growing in Afghanistan for some time. However, since the Taliban took power, the price and conditions under which the illegal organ trade takes place has changed. The price of a kidney, which once ranged from US$3,500 to US$4,000, has dropped to less than US$1,500, but the number of volunteers keeps rising.
Rahmati sold her right kidney for 150,000 afghani. However, her recovery from the operation has not been good and now, like her husband, she is also sick, with no money left to visit a doctor.
More than half of the country’s estimated 40 million population face “extreme levels of hunger, and nearly 9 million of them are at risk of famine,” the UN High Commissioner for Refugees has said.
For a growing number of Afghans, selling a kidney is their only way to get money to eat.
“It has been months since we last ate rice. We hardly find bread and tea. Three nights a week, we can’t afford to eat dinner,” said Salahuddin Taheri, who lives in the same slum as the Rahmati family.
Taheri, a 27-year-old father of four, who scrapes together enough money for five loaves of bread each day by collecting and selling recycled rubbish, is looking for a buyer for his kidney.
“I have been asking private hospitals in Herat for many days if they need any kidney. I even told them if they need it urgently, I can sell it below the market price, but I haven’t heard back,” Taheri said. “I need to feed my children, I have no other choice.”
In the past five years about 250 official kidney transplants have taken place in the hospitals in Herat Province, with a very limited number being a family member donating their organ, said Asif Kabir, a public health official in the province.
The cost of a kidney transplant is 400,000 afghani, plus the price of the kidney, Kabir said.
However, the true number of kidney operations might be far higher.
A doctor working in one of the hospitals where most of the transplants take place, who spoke on the condition of anonymity, said: “Recently the number of people who want to sell their kidney has increased in Herat and most of them live in the displaced camps, in Herat’s slums. The customers also go to the displaced camps to find a cheap kidney.”
Sayed Ashraf Sadat, a civil society activist in Herat, was a member of a delegation assigned by then-Afghan president Ashraf Ghani in May last year to investigate the illegal kidney trade.
“We found that the hospitals were not working according to the law. People are working inside and outside the country to encourage people to sell their kidneys. These people get them visas and send them to the other side of the border. There is more demand for kidney transplants outside Afghanistan. Countries like Iran need kidneys, and poor Afghans are forced to sell them,” Sadat said.
The investigation he was part of identified two hospitals in Herat where kidney transplant operations take place; one of them said it had completed 194 operations and the other said 32, but more than 500 people were claiming to have sold their kidney, 100 from a single village in Herat, he said.
“This shows the kidneys were taken outside Afghanistan,” he said.
“For example, a kidney is purchased for 300,000 afghani inside Afghanistan, and it is sold for more than £7,500 to £11,000 [US$10,160 to US$14,900] outside the country,” Sadat said.
“We found evidence that some are encouraged to sell their kidneys, taken outside the borders, and their kidneys are sold for 200,000 to 400,000 afghanis,” he said. “It seems that the doctors are involved in the illegal trade, but unfortunately, our investigation was stopped due to a worsening security situation.”
Two months have passed since Rahmati’s kidney operation, and the money has already gone to pay off medical debt. Her recovery from the operation continues to go badly.
“I am so sick. I couldn’t even walk because the wound has been infected. It is very painful,” she said, adding that the recipient of her kidney only paid for the operation fee, two nights in hospital and her first medicine bill.
On the day of the transplant, Rahmati was sick and the doctors refused to operate.
“I couldn’t breathe properly, so the doctors took me down from the hospital bed, but I returned. I told them ‘I am happy with my own death, but I can’t tolerate seeing my children hungry and ill,’” she said.
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