Treat with extreme caution

Homoeopathic medicine is founded on a bogus philosophy. Its continued use is a drain on NHS resource

Two years ago, a loose coalition of like-minded scientists wrote an open letter to chief executives of the National Health Service Trusts. The signatories simply stated that homoeopathy and other alternative therapies were unproven, and that the NHS should reserve its funds for treatments that had been shown to work. The letter marked an extraordinary downturn in the fortunes of homoeopathy in the UK over the following year, because the overwhelming majority of trusts either stopped sending patients to the four homoeopathic hospitals, or introduced measures to strictly limit referrals.

Consequently, the future of these hospitals is now in doubt. The Tunbridge Wells Homoeopathic Hospital is set to close next year and the Royal London Homoeopathic Hospital is likely to follow in its wake. Homoeo paths are now so worried about the collapse of their flagship hospitals that they are organising a march to deliver a petition to Downing Street on 22 June. Local campaign groups are being formed and patients are being urged to sign the petition.

Homoeopaths believe that the medical Establishment is crushing a valuable healing tradition that dates back more than two centuries and that still has much to offer patients. Homoeopaths are certainly passionate about the benefits of their treatment, but are their claims valid, or are they misguidedly promoting a bogus philosophy?

This is a question that I have been considering for the past two years, ever since I began co-authoring a book on the subject of alternative medicine with Professor Edzard Ernst. He was one of the signatories of the letter to the NHS trusts and is the world's first professor of complementary medicine. Before I present our conclusion, it is worth remembering why homoeo pathy has always existed beyond the borders of mainstream medicine.

Homoeopathy relies on two key principles, namely that like cures like, and that smaller doses deliver more powerful effects. In other words, if onions cause our eyes to stream, then a homoeopathic pill made from onion juice might be a potential cure for the eye irritation caused by hay fever. Crucially, the onion juice would need to be diluted repeatedly to produce the pill that can be administered to the patient, as homoeopaths believe that less is more.

Initially, this sounds attractive, and not dissimilar to the principle of vaccination, whereby a small amount of virus can be used to protect patients from viral infection. However, doctors use the principle of like cures like very selectively, whereas homoeopaths use it universally. Moreover, a vaccination always contains a measurable amount of active ingredient, whereas homoeopathic remedies are usually so dilute that they contain no active ingredient whatsoever.

A pill that contains no medicine is unlikely to be effective, but millions of patients swear by this treatment. From a scientific point of view, the obvious explanation is that any perceived benefit is purely a result of the placebo effect, because it is well established that any patient who believes in a remedy is likely to experience some improvement in their condition due to the psychological impact. Homoeopaths disagree, and claim that a "memory" of the homoeopathic ingredient has a profound physiological effect on the patient. So the key question is straightforward: is homoeopathy more than just a placebo treatment?

Fortunately, medical researchers have conducted more than 200 clinical trials to investigate the impact of homoeopathy on a whole range of conditions. Typically, one group of patients is given homoeopathic remedies and another group is given a known placebo, such as a sugar pill. Researchers then examine whether or not the homoeopathic group improves on average more than the placebo group. The overall conclusion from all this research is that homoeopathic remedies are indeed mere placebos.

In other words, their benefit is based on nothing more than wishful thinking. The latest and most definitive overview of the evidence was published in the Lancet in 2005 and was accompanied by an editorial entitled "The end of homoeopathy". It argued that ". . . doctors need to be bold and honest with their patients about homoeopathy's lack of benefit".

An unsound investment

However, even if homoeopathy is a placebo treatment, anybody working in health care will readily admit that the placebo effect can be a very powerful force for good. Therefore, it could be argued that homoeopaths should be allowed to flourish as they administer placebos that clearly appeal to patients. Despite the undoubted benefits of the placebo effect, however, there are numerous reasons why it is unjustifiable for the NHS to invest in homoeopathy.

First, it is important to recognise that money spent on homoeopathy means a lack of investment elsewhere in the NHS. It is estimated that the NHS spends £500m annually on alternative therapies, but instead of spending this money on unproven or disproven therapies it could be used to pay for 20,000 more nurses. Another way to appreciate the sum of money involved is to consider the recent refurbishment of the Royal Homoeopathic Hospital in London, which was completed in 2005 and cost £20m. The hospital is part of the University College London Hospitals NHS Foundation Trust, which contributed £10m to the refurbishment, even though it had to admit a deficit of £17.4m at the end of 2005. In other words, most of the overspend could have been avoided if the Trust had not spent so much money on refurbishing the spiritual home of homoeopathy.

Second, the placebo effect is real, but it can lull patients into a false sense of security by improving their sense of well-being without actually treating the underlying conditions. This might be all right for patients suffering from a cold or flu, which should clear up given time, but for more severe illnesses, homoeopathic treatment could lead to severe long-term problems. Because those who administer homoeopathic treatment are outside of conventional medicine and therefore largely unmonitored, it is impos sible to prove the damage caused by placebo. Never theless, there is plenty of anecdotal evidence to support this claim.

For example, in 2003 Professor Ernst was working with homoeopaths who were taking part in a study to see if they could treat asthma. Unknown to the professor or any of the other researchers, one of the homoeopaths had a brown spot on her arm, which was growing in size and changing in colour. Convinced that homoeopathy was genuinely effective, the homoeopath decided to treat it herself using her own remedies. Buoyed by the placebo effect, she continued her treatment for months, but the spot turned out to be a malignant melanoma. While she was still in the middle of treating asthma patients, the homoeopath died. Had she sought conventional treatment at an early stage, there would have been a 90 per cent chance that she would have survived for five years or more. By relying on homoeopathy, she had condemned herself to an inevitably early death.

The third problem is that anybody who is aware of the vast body of research and who still advises homoeopathy is misleading patients. In order to evoke the placebo effect, the patient has to be fooled into believing that homoeopathy is effective. In fact, bigger lies encourage bigger patient expectations and trigger bigger placebo effects, so exploiting the benefits of homoeopathy to the full would require homoeopaths to deliver the most fantastical justifications imaginable.

Over the past half-century, the trend has been towards a more open and honest relationship between doctor and patient, so homoeopaths who mislead patients flagrantly disregard ethical standards. Of course, many homoeopaths may be unaware of or may choose to disregard the vast body of scientific evidence against homoeo pathy, but arrogance and ignorance in health care are also unforgivable sins.

If it is justifiable for the manufacturers of homoeopathic remedies in effect to lie about the efficacy of their useless products in order to evoke a placebo benefit, then maybe the pharmaceutical companies could fairly argue that they ought to be allowed to sell sugar pills at high prices on the basis of the placebo effect as well. This would undermine the requirement for rigorous testing of drugs before they go on sale.

A fourth reason for spurning placebo-based medicines is that patients who use them for relatively mild conditions can later be led into dangerously inappropriate use of the same treatments. Imagine a patient with back pain who is referred to a homoeopath and who receives a moderate, short-term placebo effect. This might impress the patient, who then returns to the homoeopath for other advice. For example, it is known that homoeopaths offer alternatives to conventional vaccination - a 2002 survey of homoeopaths showed that only 3 per cent of them advised parents to give their baby the MMR vaccine. Hence, directing patients towards homoeo paths for back pain could encourage those patients not to have their children vaccinated against potentially dangerous diseases.

Killer cures

Such advice and treatment is irresponsible and dangerous. When I asked a young student to approach homoeopaths for advice on malaria prevention in 2006, ten out of ten homoeopaths were willing to sell their own remedies instead of telling the student to seek out expert advice and take the necessary drugs.

The student had explained that she would be spending ten weeks in West Africa; we had decided on this backstory because this region has the deadliest strain of malaria, which can kill within three days. Nevertheless, homoeopaths were willing to sell remedies that contained no active ingredient. Apparently, it was the memory of the ingredient that would protect the student, or, as one homoeopath put it: "The remedies should lower your susceptibility; because what they do is they make it so your energy - your living energy - doesn't have a kind of malaria-shaped hole in it. The malarial mosquitoes won't come along and fill that in. The remedies sort it out."

The homoeopathic industry likes to present itself as a caring, patient-centred alternative to conventional medicine, but in truth it offers disproven remedies and often makes scandalous and reckless claims. On World Aids Day 2007, the Society of Homoeopaths, which represents professional homoeopaths in the UK, organised an HIV/Aids symposium that promoted the outlandish ambitions of several speakers. For example, describing Harry van der Zee, editor of the International Journal for Classical Homoeo pathy, the society wrote: "Harry believes that, using the PC1 remedy, the Aids epidemic can be called to a halt, and that homoeopaths are the ones to do it."

There is one final reason for rejecting placebo-based medicines, perhaps the most important of all, which is that we do not actually need placebos to benefit from the placebo effect. A patient receiving proven treatments already receives the placebo effect, so to offer homoeopathy instead - which delivers only the placebo effect - would simply short-change the patient.

I do not expect that practising homoeopaths will accept any of my arguments above, because they are based on scientific evidence showing that homoeopathy is nothing more than a placebo. Even though this evidence is now indisputable, homoeopaths have, understandably, not shown any enthusiasm to acknowledge it.

For now, their campaign continues. Although it has not been updated for a while, the campaign website currently states that its petition has received only 382 signatures on paper, which means that there's a long way to go to reach the target of 250,000. But, of course, one of the central principles of homoeopathy is that less is more. Hence, in this case, a very small number of signatures may prove to be very effective. In fact, perhaps the Society of Homoeopaths should urge people to withdraw their names from the list, so that nobody at all signs the petition. Surely this would make it incredibly powerful and guaranteed to be effective.

"Trick or Treatment? Alternative Medicine on Trial" (Bantam Press, £16.99) by Simon Singh and Edzard Ernst is published on 21 April

Homoeopathy by numbers

3,000 registered homoeopaths in the UK

1 in 3 British people use alternative therapies such as homoeopathy

42% of GPs refer patients to homoeopaths

0 molecules of an active ingredient in a typical "30c" homoeopathic solution

$1m reward offered by James Randi for proof that homoeopathy works

This article first appeared in the 21 April 2008 issue of the New Statesman, Food crisis

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Dan Jarvis is the potential Labour leader the Tories fear most

 "We'd never be able to accuse him of being weak," one minister said of the former paratrooper. 

The Tories are still jubilant at what they regard as the gift of Jeremy Corbyn's election. But they recognise that he may not be the opponent they face in 2020 (though several MPs told me they expected him to last). When George Osborne remarked that Labour could have held two leadership contests by the general election it wasn't entirely clear whether he was joking. 

In the bars of Manchester this week, the Tories found time to discuss Corbyn's potential successors. The name most often cited to me as a threat was that of Dan Jarvis. "We'd never be able to accuse him of being weak," one minister said of the former paratrooper, who served in Afghanistan and Iraq. Having rejected appeals to stand last time round, the Barnsley Central MP is now the favourite to succeed Corbyn. 

The question often asked of Jarvis in Labour circles is "what does he stand for?" He is not identified with any wing or faction of the party (recently stepping down as a vice-chair of Progress) and, though casually dubbed a "Blairite", he leans leftwards on issues such as tax. Several Tories identified this relative amorphousness as a strength, noting that Tony Blair and David Cameron travelled similarly light. But Jarvis, who has returned to the backbenches, is likely to acquire greater definition, with a lecture on the economy planned. 

It is because they believe Labour has capable leaders in the wings that the Tories are determined to contaminate the entire party's brand. Rather than referring to "Jeremy Corbyn", they spoke in their speeches of "the Labour leader", seeking to eliminate the distance between him and his MPs. Their aim is to ensure that the damage inflicted on the opposition is so great that there will be no possibility of a recovery in this parliament or, some hope, in any one. As I note in my column this week, the ambition is not merely to win in 2020 but to put Labour out of business for good. 

George Eaton is political editor of the New Statesman.

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Where are all the people going?

In a new wave of repression under the Sisi regime, Egyptians are being forcibly disappeared.

On Monday 1 June, Esraa el-Taweel, a 23-year-old sociology student, went out for dinner with two of her friends to Chili’s, a branch of a Tex-Mex chain that is popular among middle-class Egyptians. The restaurant is on a large ship permanently moored on the Nile in the Zamalek district, one of the wealthiest neighbourhoods in central Cairo. Esraa often hung out with Souhaib Sa’ad, an economics and politics undergraduate, and Omar Ali, who, when he wasn’t lounging around the city’s many cafés, could be found at an architecture college. Both men are slim with curly hair and Esraa is short, wears colourful hijabs and sometimes uses a cane to walk. Less than 18 months earlier, she had been shot in the spine by security forces at a demonstration. Despite months of physiotherapy, the feeling had not fully returned to her legs.

Earlier that afternoon, Omar had picked Esraa up from her home, as he had often done since her injury, and they went horse riding near the Pyramids. Souhaib joined them later at Chili’s. They liked to try a new restaurant every week and Omar, who initiated the tradition, had never been there before. When they finished their meal, they goofed around taking selfies. At about 8.30pm, after Souhaib had completed his evening prayers, they stepped out on to the corniche, the uneven, tree-lined pavement that runs between the river and a quiet, two-lane road. Shortly afterwards, the three friends disappeared.

By 11pm, Esraa’s younger sister Duaa, with whom she shares an apartment in Cairo, started to worry. Duaa tried calling several times but Esraa’s mobile was switched off, as were Souhaib’s and Omar’s. She tried to reassure herself that Esraa might be staying with a friend, but the next morning she learned that Souhaib and Omar were also missing. The families of the three students decided to wait until 3pm, when Souhaib was due to report to a police station as part of his bail conditions. He had been detained in January 2014 after police found footage of anti-government protests on his phone and he was one of the less-publicised defendants in the trial against the al-Jazeera journalists accused of spreading false news and supporting the recently banned Muslim Brotherhood. After more than 400 days in jail, Souhaib was freed in February pending a retrial, but had to report to the
police daily. If he didn’t show up, the families would know for certain that something was seriously wrong.

Souhaib missed the bail appointment. Relatives of the trio began to look for them frantically in hospitals and police stations across the city but found nothing. Esraa’s parents and three of her younger siblings live in Saudi Arabia, where her father works as a translator, and though her mother boarded the first available flight to Cairo, Duaa, who is 22, and her younger sister Alaa had to manage alone for the three days.

On Wednesday 3 June, 48 hours after Esraa was last seen, Duaa filed a missing person report with the prosecutor general, the standard first step when anyone goes missing in Egypt. She and a few friends set up a Facebook page and launched a Twitter campaign with the hashtag #Where_is_Esraa. They produced a video of her and posted it online. The film opens with footage of Esraa on her bicycle: she waves at the photographer and cycles into the distance. It shows a series of still photos of her with her arms wide open, a camera flung around her neck and a floppy sun hat over her headscarf, and she grins, wearing pink Mickey Mouse ears. Even in the final shot, taken while she was in a wheelchair, with a blanket over her legs and a laptop on her knees, she is smiling.

The video doesn’t show how Esraa struggled with her six-month confinement in a wheelchair – the countless times she tried to lift herself out of it, only to fall on the floor and cry with frustration – but Duaa thinks that it captures her elder sister’s personality. “She’s childlike. She just loves going out and playing and hanging out with her friends,” she said, when we first met at a Zamalek café in mid-July.

Duaa, an art student, is tiny and dresses trendily, her wavy hair piled high on her head, her iPod headphones dangling out of her handbag. She answered my questions carefully, almost robotically, and each time she finished speaking she slumped into her  chair as though she had been pushed. Esraa disappeared during Duaa’s end-of-year exams and, although some friends rallied around her, helping her to submit her coursework so that she wouldn’t fail, others were told by their parents to stay away from the el-Taweel family to avoid getting caught up in the case.

The two sisters are very close. Duaa moved to Cairo from Saudi Arabia for her studies in July 2011, a year after Esraa, and her elder sister seemed to have grown streetwise in the time they had spent apart. Two days after Duaa arrived in the city, Esraa took her to her first demonstration. When the crowd was attacked by beltagiya (“thugs”), the sisters were so scared for one another that they decided they would never protest together again, though they often went separately. I once suggested to Duaa that the way she handled her sister’s disappearance was brave but she just shrugged. She told me that she often wished that their roles were reversed: Esraa would have known what to do.

In the weeks after the disappearances, the photographs of the missing trio circulated online and the questions of their friends, relatives and young people – “Where is Esraa?” “Where is Souhaib?” “Where is Omar?” – echoed unanswered on Twitter and Facebook. Yet the families were starting to build up a picture of what had happened. They approached contacts in the security forces, who reported that all three had been arrested and were being detained. Former inmates at Egypt’s national security headquarters also reported seeing the trio there. Yet, without official acknowledgement, there was little that anyone could do. Esraa’s lawyer, Halim Hanish, told me that he had presented the families’ evidence to the prosecutor general’s office but received no response.

The three students had joined the swelling ranks of Egypt’s forcibly disappeared. The Freedom for the Brave group, a loose network of activists, lawyers and detainees’ families that monitors such cases, recorded that 163 people had been secretly detained by Egyptian security forces between April and June this year. Hanish, a member of the group, said that the figure could be higher, as some families are too afraid to speak out. Another local NGO, the Egyptian Commission for Rights and Freedoms, announced in August that it had recorded 1,250 cases since January. Sometimes, the disappeared are eventually located in a jail or at a police station. Often, new arrivals at a prison will find an inmate who is expecting a visit and ask them to pass on their name, family contact details and a short message. Families can be left waiting for days, weeks or months for news of missing relatives. Discovering that they are in prison is one of the better possible outcomes: occasionally, the disappeared resurface dead.


In 2011, many Egyptians believed that revolution was a way to end such police abuses. One of those who inspired the uprising did not live to see tens of thousands of people across the country take to the streets to chant their demands for “bread, freedom and social justice”. Khaled Said was a 28-year-old man who was beaten to death by security forces after being arrested at an internet café in 2010. A Facebook group created in his honour declared “We are all Khaled Said” and gathered hundreds of thousands of online supporters in the months leading up to the 2011 protests.

Wandering around Cairo today, you might still catch a glimpse of Said’s youthful likeness memorialised in graffiti: a clean-cut, wide-eyed kid in a hoodie. It is a symbol of defiance or, perhaps, of disappointment. In February 2011, when Egypt’s then president, Hosni Mubarak, was overthrown after almost 30 years in power, the interim authorities were quick to abolish the much feared State Security Investigations Service, which was responsible for crushing dissent, replacing it with the Homeland Security agency. But in the past two years, following the popularly backed military overthrow in 2013 of Mohammed Morsi, Egypt’s elected president and a member of the Muslim Brotherhood, Homeland Security has become ever more powerful.

Following years of unrest, Egypt’s military leadership promised peace and stability – after the bloodshed. In its first few months in power, it sought to regain control over the country’s streets by launching a brutal crackdown on Muslim Brotherhood supporters, killing more than 1,000 protesters and arresting many more. In July 2014, an official from the interior ministry told the Associated Press that 22,000 people had been detained in the year since Morsi was ousted, most of them supporters of the Muslim Brotherhood or Islamists. The Egyptian Centre for Economic and Social Rights, a local group monitoring political arrests, believes that the figure is closer to 41,000. Several prominent secular activists have also been arrested.

An armed insurgency in Sinai, where jihadists have declared loyalty to the so-called Islamic State, and a steady series of terrorist attacks in the rest of the country have convinced many Egyptians that their country needs the new marque of authoritarianism offered by President Abdel Fattah al-Sisi, Egypt’s imperious leader. Al-Sisi, who led the 2013 takeover and was elected the following year with an eyebrow-raising 96 per cent of the vote, had served as head of military intelligence under Mubarak. His new interior minister, appointed in March, shares a similar pedigree: Magdy Abdel Ghaffar is a former chief of Homeland Security. “It’s like the security services are controlling everything in Egypt now,” Nada Saad, a human rights lawyer, told me.

It might seem that Egypt’s security state is simply returning to its old ways but that is not quite accurate. The feeling, often expressed by activists and lawyers here, is that this new wave of repression seems to sweep up citizens indiscriminately. Mohamed Elmessiry, an Egypt researcher at Amnesty International, told me that he had spoken to someone who had spent 11 years in detention under Mubarak and then been detained by Homeland Security. “[He] said at least under the Mubarak government, national security knew what they were doing and who they wanted. National security [operatives] now are completely random: they arrest people randomly; they charge and investigate and torture people randomly.”


On 17 June, the first day of Ramadan and 16 days after Esraa went missing, Duaa finally saw her sister. A stranger had called Duaa to say that she had spotted Esraa in al-Qanater women’s prison in Cairo. When Duaa arrived at the gate of al-Qanater, the guard on duty remembered the young woman who had arrived alone and been unable to walk, and advised Duaa to wait with him rather than go inside the prison. Though neither the family nor her lawyers had been informed, Esraa was due to be transferred to court for a hearing. A few minutes later, Duaa saw her sister being escorted into a police van. She called out her name and Esraa, fearing for Duaa’s safety, burst into tears and asked her to leave. Duaa called Halim Hanish, the lawyer acting for her sister.

Hanish and Esraa are good friends. They met during the 2011 street protests and when, on 25 January 2014, Esraa was shot at a peaceful demonstration outside the Mustafa Mahmoud Mosque, he carried her to hospital. He says that they were protesting in favour of a “third way” that rejects both the Muslim Brotherhood and the military. It’s not uncommon now for Hanish to represent old friends. “You have to comfort them, even while you know for sure that nothing good is happening any time soon,” he said. “You have to comfort the families, as well. You have to lie to their faces, look them in the eye and tell them how it seems bright, insha’Allah they will be fine, even though you know [they won’t be]. It gets to you eventually.”

After the call from Duaa on 17 June, Hanish rushed to the prosecution office but was repeatedly told that Esraa was not there. Then he saw her from a distance. He shouted out to Esraa, to tell her that she was no longer alone and he was here for her now. As a result, he says, her hearing was cancelled because the prosecution lawyer wanted to speak to her privately. According to Amnesty International’s Elmessiry, this fits a common pattern for forced disappearances: often the first, second and sometimes third court investigations are conducted while the families are still unaware of their missing relative’s location and while the defendant does not have legal representation. This allows Homeland Security more freedom to conduct the initial investigation and usually extract a confession, which will form the basis of the case against the detainee.

It was not until 27 June that Hanish was able to attend a hearing. The judge said that he needed more time to consider the case against her and postponed her session until 29 June, but that day the prosecutor general, Hisham Barakat, was killed in Cairo in a bomb attack. Esraa did not appear in court until 11 July and since then her pre-trial detention has been renewed every 15 days.

Hanish understands that Esraa has been charged with belonging to the Muslim Brotherhood, spreading false news and disturbing the public by showing footage of police brutality but he knows this only informally: his requests to see the report against her, which details the reasons for her arrest, have been refused. So, too, was a request for her to be moved closer to hospital so that she can receive treatment for her back problems. The ministry of interior did not respond to my requests for an interview, though previously officials have insisted that her detention was legal and have issued denials that forced disappearances take place. Esraa’s family and friends deny all charges against her.

The only available account of Esraa’s ­two-week disappearance is an open letter that her family smuggled out of prison, which was published on local news websites. She wrote that shortly after she and her friends left Chili’s, three men stopped them to ask for their ID cards and mobiles and then forced them into a minibus similar to those that operate as shared taxis in Cairo. Souhaib and Omar were blindfolded and one of the men – who identified himself as an “officer” – asked Esraa to use her hijab to cover her eyes. When her headscarf proved too short, Souhaib took off his T-shirt and she used that instead.

They were driven to Homeland Security headquarters, where she stayed for 15 days. Her blindfold was removed only at night, when often Esraa would ask for one light to be kept on so at least she would see something. “Day-long investigations, hearing voices and screams of tortured victims, men crying out loudly. Souhaib and Omar were taken away and I was alone. I was the only girl
there,” she wrote. On her final day at Homeland Security, before she was moved to al-Qanater, she was interrogated for 18 hours.

Esraa wrote another letter on 28 July. At times, it makes her she come across like a giddy teenager, joking that it is terrible to be stuck in an all-women’s prison as: “Everyone who knows me well knows that most of my close friends are guys. Do you know how tragic this is? J” She describes a cosy companionship with her cell mates (they eat crisps and drink chocolate milk together) but also the hardships: the cockroaches, the heat, the rationed bottled water and the tap water that smells like sewage and gives her skin infections, her worsening mobility, the boredom, the harassment from the “criminal” inmates. She seems to oscillate between dejection (“Sometimes I think, ‘Why do I eat? Why should I still survive?’”) and defiance, quoting the Egyptian activist Mahinour El-Masry: “We don’t like prisons but we’re not afraid of them.”


On 16 June – the day before Duaa caught sight of Esraa – Omar and Souhaib were spotted in Tora, a sprawling prison complex on the outskirts of Cairo. It wasn’t until 10 July, however, that their lawyer, Mohamed Elbaker, learned of the charges against them in a ministry of defence video that named Souhaib and Omar as part of “one of the most dangerous terrorist cells” of the Muslim Brotherhood and alleged that they had been arrested at their organisation’s headquarters.

Souhaib is shown confessing to purchasing a pistol later used to kill a police officer, and to giving protesters fireworks to throw at security forces. You could easily fail to recognise him. His nose and lips are swollen, he is pale and he seems confused. Elbaker says that his client was tortured for ten days before filming.

I met Elbaker in the discreet, unmarked office of Adalah, an organisation he helped set up to represent victims of torture and students in detention. It moves every few months to avoid police raids. Elbaker wore a striped polo shirt and had a long, square beard; at the top of his forehead he had a zabeeba, or “raisin”, a patch of darkened skin that is worn down by Islamic prayer. He reeled off a list of his affiliations – a group called the Costa Salafis, which holds interfaith discussions at branches of Costa Coffee, and the Strong Egypt political party, which was founded by a reformist former leader of the Brotherhood – but said that his greatest political commitment was to human rights. It was 1 August and Elbaker told me that he was trying to record officially the torture used against Souhaib and Omar. Souhaib still had marks on his body but Omar, who did not appear in the ministry of defence film, was in a worse condition. He still could not lift up one of his arms and he was suffering from urinary problems as a result of being repeatedly electrocuted.

The use of torture by national security forces in Egypt has been documented by Amnesty, Human Rights Watch and local rights groups (the Egyptian government periodically refutes their findings). New arrivals at a prison or police centre can expect what is commonly referred to as a haflat al-tashreefa (“welcoming party”), in which guards beat them up. My discussions with lawyers and rights groups suggest that the torture taking place in state security or military intelligence buildings is more systematic: detainees are often blindfolded and may be beaten, suspended from the ceiling, electrocuted, burned with cigarettes or raped to extract a recorded confession.

To be transferred from national security detention to prison is like “going to heaven”, Elbaker says, because it brings with it an end to this torture. Still, Omar’s and Souhaib’s struggle is not over. Unlike Esraa, they are facing a military trial. Their case now falls under the jurisdiction of the ministry of defence, not the justice ministry, and their judge (though fully trained) will be a military official.

A presidential decree of late 2014 has facilitated an increase in the use of military courts against civilians in Egypt. Halim Hanish, who is also representing Omar, described working on a military case as “a hundred times more difficult” than working on a national security case. Lawyers can’t bring their phones into court, so they can spend hours waiting around, unable to contact their colleagues or other clients, and are searched on their way in. Sometimes, they can’t take pens or papers inside. He ­remembers that once a lawyer was forced to take off his shoes and socks in case he was hiding paper in them.

Other than Souhaib’s filmed confession, the Egyptian ministry of defence has not made public any evidence in support of its accusations. The men’s lawyers say that they have not been allowed to see the prosecution reports. Both Souhaib’s and Omar’s fathers had affiliations with the Muslim Brotherhood – Omar’s was killed by security forces at a Brotherhood protest in August 2013 – but their lawyers and families insist that they do not share their fathers’ views and are not members of the group. Everyone I spoke to about Omar described him as fundamentally uninterested in politics – as Hanish, who knows him well, put it: “If you meet Omar for an hour, he will spend 45 minutes talking about food.”

Souhaib was different; he took to the streets to protest in 2011 and frequently after that. But his brother, Osama, told me that Souhaib worked on the presidential campaign of Strong Egypt’s leader, Abdel Moneim Abul-Fotouh. This suggests that Souhaib is critical of al-Sisi’s government but unlikely to be a member of the Brotherhood. The problem that Omar and Souhaib now face, however, is that the military video will now form the basis of the case against them. They are, in effect, guilty unless proven innocent.

When those who were forcibly disappeared emerge again, they must navigate a legal system that is already mobilised against them. The terms of their detention violate international as well as Egypt’s domestic laws. Egyptian law contains specific provisions banning the use of torture, requiring that detainees receive adequate medical attention and specifying that individuals may not be held in police custody for longer than 24 hours without charge.

Souhaib’s detention has caused him the additional complication that he ended up missing sessions of the Jazeera trial. When he finally did appear in court on 29 June, he tried to tell the judge why he had been absent, explaining that he had been held in secret detention for 15 days and tortured. The judge cut Souhaib off, saying that he could register a separate complaint if he wished but the information was irrelevant. On 29 August, Souhaib was sentenced to three years in jail in the Jazeera case – but the other charges against him are so serious that this news barely mattered to him.

Ezzat Ghoneim and Mohamed Sadek, lawyers with the Egyptian Co-ordination for Rights and Freedoms, told me that they tried to file a case at Egypt’s highest court, the court of cassation, to force the prosecutor general to investigate the disappearances. Their case has been rejected several times and they are currently appealing the decision. Neither is feeling optimistic. Those who defend the disappeared do so at great personal risk. In February, a lawyer died at a police station after being tortured. “We face harassment all the time. We always work in fear,” Halim Hanish told me. But last year, Souhaib’s bewildered and devastated father, Sa’ad, who had worked for many years as a metalworker, decided to enrol in law school. He has completed his first year of studies now and spends his evenings hunched over his books. If it’s too late to help his son, he reasons, he might yet be able to offer counsel to others.


The last time that I met Duaa el-Taweel was on 1 September, three months after Esraa’s disappearance. We chatted in Esraa’s bedroom, sitting on her floral bedspread, surrounded by her bright-coloured cuddly toys. A month earlier, Esraa’s beloved cat, Woody, had three kittens and Duaa had named them Esraa, Souhaib and Omar.

Duaa’s and her mother’s routine now revolves around their weekly visits to al-Qanater prison. They always bring her favourite foods, such as kofte and pizza – and deliver messages from Omar and Souhaib. It can take two weeks for the notes to arrive but they have helped the three friends keep up their old banter. Esraa jokes about how she, unlike the boys, has a bed. Omar writes that he can’t imagine Esraa in jail as she’s so pernickety about food and she replies that he’s not exactly tough, either.

Every week, Esraa tells her sister that this might be her last visit: perhaps next week she’ll be free. Then another seven days pass and Duaa makes the trip again.

Sophie McBain is a New Statesman contributing writer

Sophie McBain is a freelance writer based in Cairo. She was previously an assistant editor at the New Statesman.

This article first appeared in the 24 September 2015 issue of the New Statesman, Revenge of the Left