A strong and hot wind suddenly begins to blow from the desert. The flames of the oil refineries chimneys' around the city of Ahvaz bend all in the direction of the Persian Gulf as they were the candles of a birthday cake.
The sound of a drum roll arrives from the road, a festive crowd advances in the dust raised by the wind. As in all other Iranian cities, the Shiites are celebrating Ashura. Ghaffar goes to the window, he would like to be with them, but this year he can not. He is in a hospital waiting for a kidney transplant. In the room number five of the female transplants unit, the rhythm of the drums does not stop the cheerful chatter of the three girls hospitalized. Tandis and Chaman are showing the scar on their chest, they received a kidney and now they are recovering. Narin watches the engraved signs on their bodies, she will have one of these scars too, she has sold a kidney to Ghaffar. Iran is the only country in the world where it is allowed to sell a kidney.
The "Rewarded Gifting" act was approved by the Iranian Board of Ministers in 1997, two years later the waiting list for a kidney transplant was almost disappeared. The state guarantees to the donor a cash reward, about 400 €, and one year of medical insurance. But the "rewarded gifting" is mainly based on private transactions.
Outside Iranians' hospitals there are thousands of ads, "A+ 25 years, I sell my kidney", or "B neg sells kidney, 33, a bargain". Blood type, age and phone number, are the essential informations that are reported. The closer you get to 35, maximum age to donate a kidney in Iran, the more the price drops. "I wanted to become a teacher, but I had to stop studying because of the disease. In these years I had only one purpose, to find a donor". Ghaffar has called hundreds of numbers and has found 72 possible donors with his own blood type, they were all rejected by the doctors due to incompatibilities, or because of their poor health conditions. "One year ago I found a donor, Ashkan, he passed all compatibility tests, but he escaped with the money three days before the operation. I was desperate" says Ghaffar. "Few months later, I saw the announce of Narin. I called her, she wanted 20 million Toman, I could offer her only 13. In the end we agreed to 15 million (4.900€)".
The experience of Ghaffar is an exception in Iran. Only the wealthies can afford to buy a kidney spending an amount of money equal to two years' salary of a public employee. "We sold all the family lands to pay for the transplant", says Gholamreza, the father of Ghaffar. "We had to choose between the sustenance of the family, or to save a son, we preferred Ghaffar. But how we will live now?". Also Narin comes from a poor family. She just got married, but her husband and her are both unemployed, so they are living in the parental home.
They are part of the many young Iranians out of work because of the collapse of oil prices and the economic crisis. Narin refuses to talk about the reasons of the kidney's sale, "it is an act of altruism" she says. Ghaffar explains "I hosted Narin and her husband at home for a few days before the surgery, we got the chance to know each others better. In Iran it is a shame for a married couple to still live with the parents. With the sale of the kidney, Narin and her husband will be able to rent a house and settle down, at least for a while. They hope that the price of the oil will raise, so that there will be more job opportunities".
Lari Zadeh, president of Kidneys Transplant Association of Ahvaz thinks that "one kidney can be enough. The kidneys are organs used to cope with high workloads increasing their volume and capacity". But for the World Health Organization the sale of a kidney should be banned. The Istanbul Declaration affirms "transplant commercialism targets impoverished and otherwise vulnerable donors, it leads inexorably to inequity and injustice and should be prohibited". Ana Manzano, researcher at the Centre for Health, Technologies & Social Practice at the University of Leeds, explains "it is a form of exploitation of the poors, the ones who are in need of money decide to sell a part of their body in order to survive". But the risks can be high. According to Manzano "there are no long-term studies on the health of Iranian donors, for all we know, the more the donor is poor, the higher is the possibility that he loses the functionality of the remaining kidney because of a demanding work, or inadequate health care".
The morning of the transplant Ghaffar is nervous, he does not speak. We ask to attend the intervention, but the surgeon opposes "you can not take pictures, you should not even be inside the hospital". We remain outside the door of the operating room. Narin goes first, then comes the turn of Ghaffar. After four hours, the intervention finishes successfully. Ghaffar will remain under observation for three weeks. While Narin will be back home in three days. When he wakes up from anesthesia, Ghaffar starts to think about the future "thanks to Narin I will finally become a teacher".
One month later.
A sudden gust of wind bends the candles flames in direction of the desert. A group of people is waking around a freshly dug grave. Ghaffar has died. He didn't survive a rejection crisis. Narin's kidney today is buried with him in the graveyard of the village of Benshoar.
By Francesco Alesi and Luca Muzi
Published on The Observer (UK), The Guardian (UK), Days Japan (Japan), NZZ Am Sonntag (Switzerland), Dagbladet (Norway), Alpha Magazine (Dubai), Der Spiegel (Germany).
Awarded by Jury Prize at Days Japan International Photography Award.
If you look at the birth certificates of the best Marathon runners in the world, you will discover that many of them come from Bekoji, Ethiopia.
This small and isolated town lies in the south of the country and is becoming famous for being the "town of runners".
In recent years, 6 runners from Bekoji won at least one Olympic gold medal for long distance running.
Amongst the town's most famous runners are Kenenisa Bekele, world record holder in both the 5000 metres and 10,000 metres for men, and Tirunesh Dibaba, the women's 5000 metres world record holder.
What's Bekoji's secret? It seems to be a combination of environmental and social factors: the 2800 metre elevation gives it thin and clean air, and there are no cars, but the main thing is the hard training and will to succed. At 6am at least 50 teenagers gather together in the forest near Bekoji to train among the trees, roots, and mud, running up and down the trails. They do it six days a week from the age of 16. The running fever affects the whole town. Almost everybody wears running shoes even though they are farmers, barbers or stone breakers.
When the running shoes get old, there are cobblers specialized in fixing them, recycling fabric and rubber from other objects. Usually they too are runners. In a few years, some of these kids will win gold medals, stay in luxury hotels, and sign contracts with Nike or Puma. But they'll never forget where they're from, and how they got to where they are.
Published on Internazionale (Italy), Days Japan (Japan), Runner's World (Italy), Rythms Monthy (Taiwan), Forever Sport (UK)
Awarded with Jury Prize at Days Japan International Photography Award
Nagorno Karabakh is a landlocked region in the South Caucasus.
In 1991 its inhabitants decided for independence, shortly after the collapse of the Soviet Union. But, unluckily, they never received an international legitimacy. So, since then, most of the region has been ruled by the Nagorno-Karabakh republic, an unrecognized, de facto independent state established on the basis of the Nagorno-Karabakh Autonomous Oblast.
Nevertheless this territory is still internationally recognized as part of the Azerbaijan, a country which has not exercised power over the region since then. The independence declaration led imediately to the war between Armenia and Azerbaijan, which ended in 1994 and resulted in 30.000 deaths and displacement of more of 700.000 people.
Luckily in 1994, the two nations have gone through a peace talks process and signed a cease-fire leaving Nagorno-Karabakh in a juridical limbo, an unusual state of an unrecognized country. Although it doesn't exist de jure, Nagorno-Karabakh is, de facto, a community of 140.000 people that are more concerned with their everyday lives than worrying about the legal recognition of a state.
Published on DestinAsian (Indonesia)