Science, religion and conjoined twins: a knotty question for tradition-bound Egypt

CAIRO, Egypt - Assured that Egyptian twins conjoined at the head could be separated, Dr. Nasser Abdel Al convened 30 doctors and nurses at the Abu el-Reesh Hospital a few weeks ago and asked if they favored going ahead with the surgery.

Although there was a danger one or both might die, the medical staff voted yes. But there was another hurdle to overcome: getting the Islamic clergy's approval.

While the world watches the medical saga unfolding in Los Angeles with the separation of the Alvarez twins of Guatemala, Egypt is transfixed by a similar drama that highlights the dilemmas faced by a Muslim society that wants to embrace the latest in medical technology without forsaking deeply held beliefs.

It's because of advances in Egypt's health system that Ahmed and Mohammed Ibrahim are still alive 14 months after being born to a laborer's family in rural southern Egypt, and have a chance — however risky — to lead normal lives.

Even so, last month, after a nationally broadcast program on the twins, state television was deluged with 30,000 letters and calls, most saying the twins' condition was God's will and they should not be separated, according to program host Tarek Allam. While not a scientific survey of opinion, the response showed how the case has gripped the nation.

Specialists cannot predict the chances for successful surgery because small parts of the twins' brains overlap.

In June, the boys were sent to North Texas Hospital for Children in Dallas for evaluation, and their father, 30-year-old Ibrahim Mohammed Ibrahim, has since decided the operation should go ahead. It has not yet been scheduled.

For Islamic scholars such as Abd Al Moati Bauomy, the case poses a quandary.

"Ah, life is impossible like this," said Bauomy, retired dean of the Faculty of Islamic Jurisprudence at Cairo's Al Azhar University, the premier scholarly institution in the Sunni Muslim world, as he studied a sketch of the twins' heads and the delicately interconnected blood vessels and brain matter.

He knew it would be hard for the twins to live a proper life conjoined, but said the dangers of surgery also had to be taken into account.

In the end he refused to come down firmly for or against, saying those closest to Ahmed and Mohammed should seek a solution that, as an Islamic tenet decrees, does "the least harm."

"There are general Islamic commands that guide everyone here," he said. "If there are two points of view from two religious authorities, a person goes with the one that makes most sense to him. It's a personal decision."

After consulting the staff, Abdel Al, head of Abu el-Reesh Hospital's neonatal surgical intensive care unit, consulted Grand Mufti Sheik Mohamed Ahmed el-Tayeb, Egypt's top government-appointed cleric. El-Tayeb gave written approval for separation provided doctors believed at least one twin would survive and as long as the surgery wasn't "experimental."

It was inevitable that the question would be put to clerics in a country where any issue worth an opinion or two is seen as having an Islamic aspect.

Newspaper and Internet columns, telephone hot lines and TV call-in shows dispensing Islamic advice have led many to expect religion to provide easy answers. Some clerics use their power to make their fatwa, or religious opinion, seem like an order. A few have called for attacks on those who disobey or disagree.

Despite the degree of opposition to the operation suggested by the response to the TV program, no cleric of importance is known to have demanded an outright ban on separating the twins.

Meanwhile, the Dallas-based World Craniofacial Foundation is overseeing and helping fund the twins' stay in Texas and doctors and the hospital are donating services.

Abdel Al, the doctor, says he wants to make a special effort to make sure the country understands any decision made about the twins' future. Interviewed in a cramped hospital changing room, he comes across as both intense and friendly, his speech fast, his voice soft.

"I personally believe, first of all, in the will of God. Secondly, I believe in medical facts," he said.

"We have to acknowledge that the only hope for these babies to have a normal life is to have separation. The alternative is infirmity, is being crippled for life."