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| August 30, 2007 | Thursday | Sha’aban 16, 1428 |
Afghanistan’s drug problem
The fight against swara
To sell or not to sell an organ
OTHER VOICES: Pushto Press
MOHAMMAD Hussain is a 43-year-old labourer with four children. He faces a debt of Rs50,000 and sees no end to his ongoing financial constraints. Finally, he decides to sell his kidney for Rs100,000. Should he be allowed to do so?
A YEAR after Nawab Akbar Bugti was killed by the security forces, Balochistan still does not know peace. Railway tracks and government offices are attacked on an almost daily basis, though the human toll continues to be low. There are tragic exceptions when security personnel or foreign workers are targeted but fatalities, thankfully, are not the norm in this simmering conflict. Perhaps these seemingly random attacks are the insurgents’ way of reminding the federation that the Balochistan ‘problem’ will not go away so easily as some may hope. In the maelstrom that is politics these days — the shift in the power equation following the CJ’s restoration, talk of deals and accommodation, the Sharif brothers’ possible return — Balochistan and its troubles have indeed been relegated to the back-burner of national consciousness. While this distraction is understandable to a degree, it does not bode well for the future. When ignored or swept under the carpet, grievances both real and imaginary tend to fester until they assume chronic proportions, by which time gentle remedy often loses its efficacy.
The need of the hour is to talk to the adversary. Nationalist militancy in Balochistan is rooted in a sense of deprivation that dates back to the post-independence regency days, and there are no easy solutions to a crisis so long in the making. A few abortive attempts at dialogue notwithstanding, such as the Mushahid Hussain committee’s exploratory parleys with Nawab Bugti, the Centre and its provincial representatives have long insisted that they will talk only with ‘like-minded’ tribal leaders. This approach can never deliver results. Those seated at the negotiation table must, by definition, include the party that feels aggrieved, for whatever reason. It is a surprising stance too for a government that has repeatedly shown its willingness to listen patiently to militants of every ilk, be they the Taliban commanders in Waziristan or the leaders of the Lal Masjid brigade. Why then this reluctance to open a channel of communication — and publicly at that — with those who have taken up arms in Balochistan? It should be clear by now that the province can never be pacified through military means and without engaging the foe outside of the theatre of conflict. Every representative section of Baloch opinion has to be accommodated if the goal is to arrive at an equitable solution that is acceptable to all.
Many in Balochistan feel alienated from the mainstream of national life and accuse the Centre of unremitting neglect over the decades. This sentiment is hardly surprising in a resource-rich province that comprises over 40 per cent of Pakistan’s total land area but remains the most backward region in the country. Promises of socio-economic uplift — such as those spelled out in the Rs19.5bn ‘Vision for Balochistan’ programme unveiled by the PM in October 2006 — must materialise sooner than later. But first things first. The very least the government can do is step up efforts to rehabilitate those who lost whatever little they owned to this summer’s rains and cyclones. The trust deficit must be bridged.
THE UN’s latest opium survey in Afghanistan is as insightful as it is alarming. While opium cultivation and production in 2007 has seen a considerable rise over last year, it is interesting to note that the previously strong connection between narcotics and poverty has weakened. This is borne out by the fact that poppy cultivation has dropped drastically in several north and north-central provinces where the people are poor. However, the south-western, insurgency-afflicted provinces along the Pakistan-Afghanistan border, although defined by the report as more fertile and richer in income levels than their northern counterparts, have witnessed a sharp surge in opium production. The nexus is clear: it is one between violence and increased poppy cultivation — not surprising as the illegal narcotics trade funds the arms that the Taliban need for their increasing operations against Nato, Afghan and Pakistan forces. In contrast, greater political stability in the northern provinces has made it easier to stop poppy cultivation, through leadership decisions, spreading greater awareness and by appealing to religious sentiments. However, as the report indicates, much still remains to be done in these provinces to prevent a relapse, especially when the narcotics trade, even in those areas no longer growing the poppy crop, continues.
The worsening drug situation in Afghanistan has led to countless proposals. For instance, cooperation between Afghanistan and bordering countries such as Iran and Pakistan — both transit points for trafficking — has been cited as essential for stemming the rot. This is especially true in the case of Pakistan, considering the high level of lawlessness prevailing in its border areas with Afghanistan. However, the real responsibility lies with the government in Kabul that has so far proved ineffectual in controlling drug trafficking. There is much corruption among officials when it comes to the disbursement of international aid meant for halting opium production. Justice is flawed and one never hears of arrests of drug barons. Development work that could enhance positive income-generating activity is slow, thus boosting the drug trade. The result is that a sizeable proportion of the Afghan population — around 14 per cent — has had to opt for opium cultivation. As Afghan refugees from Pakistan and Iran return in droves to an uncertain future, this figure could rise further. Meanwhile, the violence in the south must be firmly dealt with, and Kabul and Islamabad, instead of constantly trading allegations against each other, should actively step up their joint fight against the Taliban.
RARELY does one get to show appreciation for the police for its timely intervention in preventing a crime. However, that is what happened in Timergara in the NWFP when the police stepped in to stop a three-year-old girl from being handed over as compensation as swara. They produced the child’s father before a local court and got him to sign an undertaking that the girl would not be handed over to any family. This must be commended for it shows that the police and administration are doing their job of preventing crimes. For far too long, girls as young as three-months old have been used as compensation to settle scores between rival families. This is despite existing laws, like a Peshawar High Court ruling in 2000, that declare swara as contrary to Islamic law. It was when the Supreme Court took suo motu notice of such barbaric acts two years ago and asked all law enforcement agencies to apprehend those involved that some action began to be taken. It helps that girls who were “married” at young ages and are now of marriageable age are standing up and refusing to honour such agreements. This is because they have been educated and have become aware of opportunities that are available to them.
However, laws alone cannot make the kind of difference that society needs if it is to progress. It is unfair to expect people to abandon their traditions and cultural norms overnight. To get society to understand the obsoleteness of their thinking — be it on swara/vani or honour killings— one needs to have mass awareness campaigns on the subjects. People need to be made aware of how the world is changing for the better, that women have rights which need to be respected and upheld. This dialogue, coupled with strict action against culprits, will pave the way out of obscurantism.
In developed countries, the use of genetically unrelated donors is restricted purely to altruistic donors who have a close and emotional relationship with the recipients. By law, commercial transplantation is illegal. The situation is alarmingly different in some Third World countries, including Pakistan.
In the absence of any law in the country (the Transplantation of Human Organs and Tissue Ordinance 2007 is still under consideration), 2,000 organs are transplanted every year. Of these, 1,500 transplants (carried out in the private sector) are from unrelated donors who sell their kidneys. More than half of the recipients are foreigners from 20 different countries.
Each kidney is sold for Rs70,000-Rs120,000. Seventy per cent of these donors are bonded labourers, according to this paper (Aug 18) that also reported an organ sale scam involving a doctor and a police ASI. Many more such scandals take place, most of which are never discovered. The extent of organ trafficking is horrifying. According to rough estimates, this trade is valued at about one billion rupees every year. The objective of this article is to highlight the unethical aspects of kidney trading so that we, as responsible citizens, can understand the dire need for an ordinance.
Sometimes what could be justified for an individual case might not be justified as a general rule or policy. The main question is whether Pakistan, as a country, should allow the sale of kidneys or not. Other related questions are: is it morally just to sell a kidney? Is it morally just to allow a market for selling kidneys? Should developing countries be the sole source of donor organs? Should kidneys be bought and, if so, could a fair system of incentives or payments be constructed?Some people advance arguments in favour of legalising the sale of kidneys. It is not difficult for consenting adults to enter into a contract, it is said. If a rich man needs a kidney to save his life and he makes an offer to a poor man who would benefit financially by selling his kidney, there appears to be no reason why anyone should object to this arrangement. And many patients anyway have a kidney removed because it is diseased and they live without any problems.
In addition, there is a worldwide shortage of donor-organs, ever-growing waiting times for renal transplantation and ongoing treatment costs for dialysis. Clearly, a legal restriction would be justified only if the harm proves to outweigh the benefits for all who stand to be affected.
Before we discuss the arguments against the kidney trade, let us understand the controversial aspects of organ donation. The human body cannot be treated as property, even of the living person whose body it is. The issue of donating an organ involves mutation of the human body, which has been a debatable issue in itself. Many believe that no one has an absolute right to donate an organ and doctors are not obliged to remove an offered organ, regardless of the risks involved. Doctors have a moral duty towards the welfare of their patients and can refuse to participate in living organ donation when they believe that the risks for the donor outweigh the benefits to the recipient.
The major arguments against the kidney trade are that it amounts to the exploitation of the donor, results in coercion and systemic injustice and leads to a growing black market.
How are donors exploited? One needs to weigh the economic, social and health-related harms to donors against the benefits to the recipients. The results of studying economic and health consequences of selling a kidney in India conclude that it does not lead to a long-term economic benefit and may be associated with a decline in the health of the donor. It is not only that the money paid is inadequate to bring sellers out of debt, the trade also seems to be directed towards raising money to pay off high interest loans to local moneylenders.
As a result, the poor are caught in a never-ending cycle of borrowing and repaying. These studies strongly advise doctors and policymakers to carefully examine the value of using financial incentives to increase the supply of organs for transplantation.
Is it possible for the donors to act autonomously? The person who consents to donate a kidney should be competent, willing to donate, free from coercion, medically and psychosocially suitable, fully informed of the risks and benefits for both, the donor and the recipient. Given the possibility of limited understanding and coercion, how can we be sure that a person who offers to donate an organ is acting autonomously? A constraining situation in itself can cause a person to make a decision to sell a kidney which he might not make otherwise, thus controlling his autonomy.
Such an offer may be exploitative because it manipulates a person into an undesirable choice through incentives too attractive to be refused. The prospect of another day without food, or another threat from a debt collector could place enormous pressure on a person to accept an offer of payment for a kidney. In addition, the volunteer must fully understand the nature and consequences of the donation.
For example, a person might not adequately appreciate the risk to his health status following surgery, or the value of the money he receives, the risks of a decline in his income, or the risk that a middle man or hospital will not make full payment. Desperate volunteers may find the offer overwhelmingly attractive, causing them to underestimate the risks.
Seventy-nine per cent of the participants in the study from India afterwards said that they would not recommend selling a kidney. This fact suggests that if they fully understood the likely consequences they would be less willing to sell.
Let us see why a market in organs seems unjust. The issue is not whether the volunteers are paid a fair price. The question is whether allowing a kidney trade constitutes a fair system? This is a social situation where virtually only the poor “donate” their kidneys and the rich benefit. This ensures that transplantation is available only to the wealthy who escape all responsibility for donation (even to their relatives). Even long-term dialysis is not available to the poor in our country. Obviously there are no chances for them to receive an organ when they themselves are in need. The practice, therefore, constitutes exploitation of the poor by the rich thus promoting systemic injustice.
Also as organs become available for purchase in some countries, other countries forgo promoting and facilitating organ donation. The likely net result is a drop in donations from live, related family members, as well as a decrease in the supply of cadaver organs.
The kidney trade has created an environment of corruption and commercialisation, where the vulnerable are being exploited. Public discussions about ethics and human rights are desperately needed. Other countries have reached a consensus on live organ donation and have clear laws regulating organ transplantations. If the arguments against commercial transplantations are not convincing, why is it not legal in developed countries and why do their nationals reach out to Pakistan for a transplant? An Iranian model for kidney donation has already been proposed. We need a model of our own.
The writer is an assistant professor of psychiatry and teaches behavioural sciences at Rawalpindi Medical College.
Rehman on Durand Line
MAULANA Fazlur Rehman’s address to the Balochistan Bar Association in Quetta on August 23 not only verges on blatant interference in Afghanistan’s internal affairs, but also mirrors the patently roguish role that he has been playing in stoking the flames of a rising insurgency in our country.
In a show of all-consuming loyalty to his ... mentors, the maulana has warned the Afghan government to recognise the Durand Line as the international border or continue to live with the deadly violence raging across the war-torn country. The opposition leader ... is insouciantly unmindful of how his murderous fatwas have made life hellishly miserable for a whole nation.
Unrepentant as he is about his shenanigans causing massacres and humiliation to the Afghans, the JUI-F head is driven by an indefinable urge for self-glorification at the expense of others. Why he is so keen on the recognition of a frontier arbitrarily drawn by British colonial rulers passes all comprehension. One may well ask the firebrand, who often hides behind the fig-leaf of Islam even on mundane issues, if our great religion allows death and destruction in pursuit of petty political ends. Of course, the lingering spat over the Durand Line should be resolved peacefully with the express consent of the tribal people living on both sides of the divide — not through violence or sinister conspiracies that invariably turn out to be counterproductive.
Indubitably, all faiths and internationalism choose dialogue and rapprochement over war, which is the last but abominable option to settle disputes. But the hawk spurns a recent Pak-Afghan peace jirga, held in an environment of bonhomie and understanding, as a failure. On the face of it, his pessimistic view is rooted in MMA’s untenable decision to stay away from the grand tribal gathering that featured around 700 people of goodwill.
Although we don’t want to read too much into his utterances, perversity and malice in his speech are all too conspicuous to be overlooked. The inescapable inference to be drawn from his observations is that he seeks to do the dirty on Afghans; no other meaning can be assigned to a statement so chock-full of vitriol and venom.
After all, the ideologue is supposed to know that the politics of religion he has been practising for decades does not justify a compromise on an emotive issue that touches the lives of millions. His clarion call, laced with subtle asides, can at best be characterised as wishful thinking. Deep down, he knows full well that an amicable resolution of the tiff will take much more than bluster.— (Aug 25)
—Selected and translated by Syed Mudassir Shah
Veesa, Kabul