Taimur Alam Khondaker :
Bangladeshi men and women migrate willingly to Saudi Arabia, Bahrain, Kuwait, the United Arab Emirates (UAE), Qatar, Iraq, Lebanon, Malaysia, Liberia, and other countries for work, are often under legal and contractual terms. Most Bangladeshis who seek overseas employment through legal channels rely on the 724 recruiting agencies belonging to the Bangladesh Association of International Recruiting Agencies (BAIRA). These agencies are legally permitted to charge workers up to $1,235 and place workers in low-skilled jobs typically paying between $110 and $150 per month. However, according to NGOs, many workers are charged upwards of $6,000 for these services. A recent Amnesty International report on Malaysia indicated Bangladeshis spend more than three times the amount of recruitment fees paid by other migrant workers recruited for work in Malaysia. NGOs report many Bangladeshi migrant laborers are victims of recruitment fraud, including exorbitant recruitment fees often accompanied by fraudulent representation of terms of employment. The ILO has concluded high recruitment fees increase vulnerability to forced labor among transnational migrant workers. Women typically work as domestic servants; some find themselves in situations of forced labor or debt bondage where they face restrictions on their movements, non-payment of wages, threats, and physical or sexual abuse. Some Bangladeshi women working abroad are subsequently trafficked into commercial sexual exploitation. Bangladeshi children and adults are also trafficked internally for commercial sexual exploitation, domestic servitude, and bonded labor. Recent reports indicate many brothel owners and pimps addict Bangladeshi girls to steroids, with harmful side effects, to make them more attractive to clients; the drug is reported to be used by 90 percent of females between 15 and 35 in Bangladeshi brothels.
Bangladesh does not fully comply with the minimum standards for the elimination of trafficking; however, it is making significant efforts to do so. The government has continued to address the organ trafficking of women and children.
The Ministry of Home Affairs’ Anti-Trafficking Monitoring Cell reportedly collected data on trafficking arrests, prosecutions, and rescues, and coordinated and analyzed local-level information from regional anti-trafficking units. During the year, there was some evidence of official complicity in human trafficking. Several NGOs reported a nexus among members of parliament and corrupt recruiting agencies and village level brokers and indicated that politicians and regional gangs were involved in human trafficking. Some NGOs also report that official recruitment agencies in Dhaka have linkages with employers in destination countries who sometimes put their migrant workers in situations of servitude. Low-level government employees were also complicit in trafficking. According to the Ministry of Home Affairs, the government prosecuted a civil servant who was complicit in trafficking; the trial remained ongoing at the end of the reporting period.
The country’s National Police Academy (Bangladesh) provided anti-trafficking training to 2,876 police officers in 2009. The 12 police officers of the Ministry of Home Affairs’ “Trafficking in Human Beings Investigation Unit” continued to receive training on investigation techniques. Other government officials received training from NGOs, international organizations, and foreign governments. A 2009 report from a prominent NGO suggested that law enforcement trainings have not translated into increased prosecutions or a change in outlook.
Some eight million Bangladeshis suffer from kidney disease, mostly because of high rates of diabetes, and at least 2,000 need transplants annually. But donation is only legal between living relatives, resulting in a chronic shortage of kidneys for transplant. A lucrative black market has filled the void, with a steady stream of desperate buyers and equally desperate and poor donors. After police raided a major scheme in 2011 involving doctors, nurses and clinics, many of the illegal surgeries moved to India. “This racket has a lot of influential people on their pay rolls,” said Mustafizur Rahman, a Bangladesh nephrologist. “They can easily prepare all papers including fake passports and national identity cards in order to facilitate unlawful transplants.”
Last year police cracked down on the trade, arresting a dozen people in Kalai and Dhaka, including a donor turned “kingpin”. Authorities were spurred into action after a criminal gang cut out a six-year-old boy’s kidney and dumped his body in a pond. Police and local authorities have also launched campaigns warning of the dangers, distributing leaflets to homes, schools and madrassas in the area. But many in Kalai doubt much will change. Previous efforts have failed due to an inefficient criminal justice system.
Theoretical underpinnings
According to differential association, learning the techniques of sophisticated criminality requires the proper environment- ecological niches or enclaves where delinquent or criminal subcultures (discussed later) flourish and this education is available. Conditions of severe deprivation are coupled with readily available success models and Clifford R. Shaw and Henry D. McKay, sociologists at the University of Chicago, used that city as a laboratory for their study of patterns of criminality during the 1920s and 1930s.
Human Organization is the journal of the Society for Applied Anthropology and the leading peer reviewed outlet for scholarship in the applied social sciences. The journal advances SfAA’s mission through publishing articles that advance, synthesize, and interpret the application of anthropological method and theory to the analysis and solution of practical problems in the contemporary world. Human Organization publishes articles dealing with all areas of applied social science. In addition to those reporting on original research, the journal publishes articles detailing innovative methodological and engaged research practices.
The recent amendment to the draft Transplantation of Human Organs Act, 2017 is not only unlikely to stop illegal trade of human organs but may well cause a new problem for doctors, claim experts. With nearly 20 million of Bangladesh’s 160 million people suffering from some form of kidney disease, and given the rise in the spread of chronic kidney diseases, the country’s highest number of organ transplant surgeries are, naturally, kidney transplants. Experts say that Bangladeshis spend an estimated Tk300cr annually for kidney transplants abroad, as the procedure is still rather restricted in Bangladesh. In an effort to develop treatment services and to prevent illegal organ trade, on July 17, the Cabinet approved a draft law expanding the list of relatives who can donate organs to a person. This, move, however, may not suffice. Professor AK Azad Khan, president of the Diabetic Association of Bangladesh, told media that “The sale of any human organ is illegal in Bangladesh, but the government needs a high powered committee to address the issue so that illegal trading is identified.” “Although the amended law may help reduce the illegal trade somewhat, it may also become problematic for many patients. If they cannot manage organ from close ones, how will they get organs?” he explained. Doctors feel that desperate patients may now resort to passing off unrelated donors as relatives as it would be difficult for hospitals to verify the recipient’s true relationship with the donor. For over a decade, illegal trade of organs has reportedly been going on in as wealthy recipients and brokers convince poor and illiterate people to sell their organs by making false promises of money, jobs and travel to foreign countries. According to a 2017 report by Global Financial Integrity (GFI), entitled “Transnational Crime and the Developing World”, a kidney is available for as little as $2,000 (around Tk160,000) in Bangladesh. Although dealing in organs is illegal in Bangladesh, many poor people, particularly from rural areas, are compelled to sell their organs primarily to settle debts or for brief moments of financial respite, states the report. It suggests that out of around 120,000 organ transplants in 2014, approximately 12,000 were illegal. Two-thirds of these illegal transplants were of kidneys, followed by liver, heart, lung and pancreas transplants, respectively. “Once the law is enforced, grandparents, grandchildren and first cousins will be able to donate organs while the existing law allows only parents, spouses, children, siblings and blood-related aunts and uncles to donate. It is expected that the crisis of organs may decline as the number of donors have been increased,” says Bangabandhu Sheikh Mujib Medical University Vice Chancellor Kamrul Hasan Khan.
Doctors say over 200 kidney transplants were performed annually in the last few years at the 10 government and private hospitals approved by the ministry for carrying out such procedures. They are BSMMU, Birdem hospital, National Institute of Kidney Diseases and Urology, Kidney Foundation, Dhaka Medical College Hospital, Chittagong Medical College Hospital, Shyamoli Center for Kidney Diseases and Urology Hospital, Apollo Hospital, United Hospital and Popular Medical College and Hospital. According to BSSMU, about 1,600 kidneys have been replaced at the 10 approved hospitals in 34 years until 2016. Every year, around 45,000 patients are registered as patients suffering from kidney related diseases. Although the cost of kidney replacement is between Tk2-5 lakh in Bangladesh, some private hospitals, which are approved by the government for doing transplants, are doing it for a much higher cost. “Risk of death of from kidney disease is 10 times higher than death from heart attack. The law’s provision for relatives donating organs to patients will ensure safety, but the law should not act as a barrier for patients who fail to manage organs from relatives,” said Bangladesh Medical Association President Dr Mustafa Jalal Mohiuddin. According to the draft law, if a person gives false information about the donor, they can be punished with a maximum of two years of rigorous imprisonment or a maximum penalty of TK5 lakh or both. In addition, violating any of the other sections of the law, or for aiding or abetting anyone else to do so, can result in a maximum penalty of 3 years’ rigorous imprisonment and a fine of TK10 lakh or both. If a physician is convicted of this act, they will lose their licence. The law states that without government approval, no hospitals can conduct human organ transplantation in the country. It, however, also stipulates that public hospitals with specialised transplantation units can do the job without taking any approval.
The Bangladeshi judiciary is rife with nepotism and embezzlement and lacks independence, according to U4 Anti-Corruption Resource Centre, a Norwegian research body. This has allowed the black market trade in human organs to flourish, according to Monir Moniruzzaman, an anthropology professor at Michigan State University who has spent the past 12 years researching the trade’s commodification and exploitation of poor Bangladeshis.
In addition to people being kidnapped and their organs stolen, some willingly sell their organs on the black market through local brokers who contact regional and national syndicates to facilitate medical procedures and find buyers for kidneys and livers. Desperation, combined with a lack of law enforcement, enables brokers to entice impoverished Bangladeshis with offers of easy money. “If there was genuine concern on the government’s part we would see some action, but we haven’t seen anything,” Moniruzzaman said. “The law is not being enforced, and on the criminal justice side there are reports of cases being deliberately weakened.” In August 2011 revelations emerged of a trafficking ring based in Joypurhat district, near the Indian border. Police arrested local brokers and extended investigations to the Dhaka-based syndicates. It was revealed that more than 50 people in neighboring villages had sold kidneys or parts of their livers. While the cases brought attention to the trade, only local brokers were arrested. Promised legislative reforms and police cases stalled. Under the Organ Transplant Act, passed in 1999, violators can face sentences of three to seven years in prison and fines of 300,000 taka (about $3,850).
“The police did a great job to expose these brokers in Bangladesh and their extended networks in India,” Moniruzzaman said. “But these brokers were released on parole and are now back in their areas and selling organs just like before. There is no repercussion for them, which indicates brokers are most likely paying money [to police or government authorities] so they can continue to run their businesses.” Bangladeshi police did not respond to multiple requests to respond to accusations of corruption and complicity in the trade. To villagers, it seems obvious where the power lies.
Policy recommendation to combat
While organ transplantation is often highly successful in saving lives, it has created an illicit, but thriving, trade in human organs, including kidneys, livers, and corneas sourced from living bodies of the desperate poor. Based on challenging ethnographic fieldwork with seventy organ sellers, along with a group of recipients, brokers, and doctors, this article explains how organ trade results in violence, exploitation, and suffering against the vulnerable, who sell their live organs on the black market of Bangladesh. In opposition to allowing a “regulated organ market,” I argue that such a market is not a magic bullet that by itself would eliminate deception, coercion, and corruption that exist in the illegal trade of vital organs, nor would it ensure equity, rights, and justice to organ sellers. Instead, a regulated market would exacerbate, institutionalize, and normalize violence, exploitation, and suffering against impoverished populations. I, therefore, conclude that organ trade needs to be condemned, as there are alternative ways to resolve organ shortages. I suggest that government authorities must enact stringent laws, ensure ethical transparency, and encourage cadaveric donations to combat organ trafficking worldwide.
(The writer is a columnist and advocate (Appellate Division), e-mail: [email protected]
