They didn’t tell their 15-year-old son Khalil Ahmad why he was brought from their shantytown mud house to a nearby hospital. “If we had told him, he might not have agreed,” Mr. Mohammad said.
At the hospital, doctors put the child under anesthesia. Then they removed his kidney. His parents sold it for $4,500, just enough to cover what they owed.
Afghans are resorting to desperate measures to survive an unprecedented crisis, which has accelerated since the Taliban ousted the US-backed government, and the subsequent economic collapse.
More than half the country’s 39 million population are now facing acute hunger, according to the United Nations, and 95% don’t get enough to eat. Prices of basic food staples like flour and oil have doubled since the Taliban took over. Much of the economy has ground to a halt, while the international community has frozen Afghanistan’s foreign assets, imposed sanctions and stopped most aid.
For those willing, an illegal but barely hidden business in the western city of Herat offers a reprieve from the downward spiral. Two hospitals in town offer kidney transplants that attract Afghans from across the country, performing 15-20 surgeries a month. Officials turn a blind eye. Buying and selling organs is illegal, as in most other countries. But scores of Afghans have come here to make the trade.
“The number of requests for kidney transplantations has increased during the past six months,” said the director of one hospital offering the surgery in Herat. in return for their organs. He said his staff was forbidden from playing any role in the exchange of money. The hospital itself charges around $4,600 for the surgery and $1,500 for medication.
Finding a seller of a kidney isn’t hard. Notes advertising private organ sales are plastered on walls and lampposts in Herat and other cities. Kidney brokers distribute business cards offering to put buyers in touch with sellers.
Mr. Mohammad, who found a buyer for his son’s kidney through a relative, worked for years as a construction worker. But as work dried up, he bought food on credit from shopkeepers and borrowed cash from neighbors to feed his wife and 12 children.
When the Taliban prepared to attack Herat, his creditors came knocking, daily. Once, Mr. Mohammad said, a group of men used candy to lure his 2-year-old out of the gate and put him in their car, before letting him go. They told Mr. Mohammad that next time they would take his boy for good if he didn’t pay up.
Mr. Mohammad and his wife decided that unless they sold a child, they would have to sell an organ. Both of them were unsuited, as Mr. Mohammad had kidney stones and his wife had diabetes. Their oldest son made up to three dollars a day collecting plastic for recycling, so was spared. The choice fell on Khalil Ahmad, their second son.
“The night I made the decision, I cried so much. It was the last option,” Mr. Mohammad said. “No father in the world wants to sell his son’s kidney.”
The buyer offered roughly $4,500 for Khalil’s kidney. Mr. Mohammad didn’t have the heart to take his son to the hospital himself, sending his uncle instead. Since the surgery, Khalil said, he has been in pain, and too exhausted to play with his friends.
“After the operation I became weak,” Khalil said, sitting on the floor of his parents’ mud house as his siblings played noisily outside.
Taliban spokesman Zabiullah Mujahid accused “international smugglers” of being behind the kidney trade in Herat, which he said his government was its best to stop.
“Our people have an enormous amount of problems. A government alone can’t address them all,” Mr. Mujahid said. “The international community should give us a hand.”
Many Afghans have lived their entire life in destitution, which has deepened under Taliban rule. Others were well-heeled until recently, but have suffered a rapid descent into poverty.
“The middle class is disappearing from one day to another. People are falling into poverty, needing assistance they have never needed before,” Charlotte Slente, secretary-general of the Danish Refugee Council, an aid agency, said in Kabul.
Many Afghans who sell kidneys have found themselves struggling with insurmountable debt, with no apparent way out. Kidneys sell for thousands of dollars, and most people can live with just one.
Abdul Salam owned a medium-size business for a decade, importing fuel and food from Iran, and contracting with the government. When the government was topped in August, Mr. Salam was left with massive unsettled payments and a collapsing business, and owed nearly $6 million to his suppliers. After selling all his vehicles and properties, he was $70,000 short inside Afghanistan, and owed $300,000 to Iranian traders, he said.
“The Taliban told me, ‘you’re rich, you have to find the money for the people you owe,'” Mr. Salam said. He used to spend 50,000 afghanis, equivalent to around $575, in a single night, “But now I don’t even have 50,000 afghanis in my house.”
Mr. Salam said he couldn’t find work under the Taliban, who once kidnapped him on the highway, burning his neck and body with hot metal rods as punishment for contracting with the previous Western-backed government. He showed the scars he bears, though the Taliban has said that those who cooperated with the previous government have been forgiven.
Recently, Mr. Salam approached two prospective kidney buyers, with the aim of making enough money to leave Afghanistan with his wife.
He then had second thoughts, but has since decided he has no alternative. “I hadn’t found the courage,” he said.
For the poorest of Afghan families, even a moderate economic shock can be a calamity. Nazanin, a mother of five in her late 20s, earns less than a dollar a day doing laundry for local families. Her husband Mohammad is an opium addict, unable to work. Their 12-year-old son, who is speech-impaired, makes about 50 cents a day collecting garbage. Like some other Afghans, the couple went by one name only.
The couple already owed $1,000 to local shopkeepers when the whole household, including Mohammad’s aging father, caught Covid-19 last year. Medical expenses mounted, and then his father died, leaving the couple to also shoulder funeral costs.
“Selling my wife’s kidney was a sin, but we were pushed to do it,” Mohammad said, raspy-voiced, his eyes nestled deep in a gaunt, weathered face. His opium-ravaged kidney was no good for donation. the sale covered the couple’s debts, funeral costs and medical expenses from their bout with Covid, but it sapped Nazanin, the breadwinner, who was already malnourished.
“My head is spinning all the time, I feel nauseous,” Nazanin said, sitting on the bare floor while her children fetched water from a well in the yard.
The hospital director in Herat said his clinic has more kidney surgeries than cancer patients.
Ghulam Hossein came to Herat from the eastern Nangarhar province after a doctor told him his kidneys were failing. It took him 25 days to find a seller.
“I have no words to thank this man,” Mr. Hossein said about the donor, who needed money after being forced to sell his small grocery store, and who visited Mr. Hossein after the operation.
“I know he was poor but it takes huge courage and sacrifice to sell your kidney,” Mr. Hossein said.