VZCZCXRO2938
OO RUEHPA
DE RUEHUJA #0203/01 0351633
ZNY SSSSS ZZH
O 041633Z FEB 09
FM AMEMBASSY ABUJA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 5177
INFO RUEHZK/ECOWAS COLLECTIVE PRIORITY
RUEHSA/AMEMBASSY PRETORIA PRIORITY 1640
RUEHYD/AMEMBASSY YAOUNDE PRIORITY 0614
RUEHOS/AMCONSUL LAGOS PRIORITY 0750
RHMFISS/HQ USAFRICOM STUTTGART GE PRIORITY
RHEBAAA/DEPT OF ENERGY WASHDC PRIORITY
RHEHNSC/NSC WASHINGTON DC PRIORITY
RUEAIIA/CIA WASHINGTON DC PRIORITY
RUEKDIA/DIA WASHDC PRIORITY
RHMFISS/HQ USEUCOM VAIHINGEN GE PRIORITY
RUZEJAA/JAC MOLESWORTH RAF MOLESWORTH UK PRIORITY

S E C R E T SECTION 01 OF 06 ABUJA 000203

NOFORN
SIPDIS

DEPT FOR AF/W, INR/AA
DOE FOR GEORGE PERSON

E.O. 12958: DECL: 01/26/2034
TAGS: PGOV PREL PINR NI
SUBJECT: NIGERIA: UPDATED HEALTH INFORMATION ON PRESIDENT
YAR'ADUA (C-AL8-02520)

REF: A. STATE 6401
¶B. 08 ABUJA 2525
¶C. 08 ABUJA 2517
¶D. 08 ABUJA 2222
¶E. 08 ABUJA 2165
¶F. 08 ABUJA 2147
¶G. 08 ABUJA 2141
¶H. 08 ABUJA 2123
¶I. 08 ABUJA 2104
¶J. 08 ABUJA 2065
¶K. 08 ABUJA 1822
¶L. 08 ABUJA 1016
¶M. 08 ABUJA 962

Classified By: Ambassador Robin Renee Sanders for reasons 1.4. (b & d).

¶1. (S/NF) INTRODUCTION. Ref A requested updated information
about the health of Nigerian President Umaru Musa Yar'Adua.
We note that our GON and private contacts continue to state
that President Yar'Adua is managing his known health issues
-- chronic kidney problems -- and is not suffering from
something more serious. The Villa also continues to keep a
tight hold on any information concerning his health and has
been cautious about any indications on travel outside of
Nigeria, to avoid additional concerns. As a result, attempts
to gain specific and/or verifiable information on his
condition, prognoses, medication, treatment options are
limited. The Ambassador's last personal dialogue with him
(Ref. C), in which she observed him up close, noted that he
was extremely frail, more soft spoken than usual, his skin
was extremely drawn, teeth were extremely tarred and his
involuntary cough had increased. He was, however alert and
could carry on a sophisticated conversation. We have also
reported, ref. B, recent extensive critical comments by a
Villa staff member on the impact of the President's health on
the country's governance. What is clear is that the
President's health is a matter of growing concern,
particularly on the minds of the northern Nigerian elite. We
have noted a considerable up-tick in what appears to be
behind-the-scenes machinations and backroom dealing, most
notably the recent reconciliation meeting between former
President Obasanjo and former VP Atiku and Atiku's pending
official return in March to the ruling PDP, former President
Babangida's sudden return to the political scene with a
string of public pronouncements, and Kwara Governor Saraki's
machinations to possibly be a PDP candidate in 2011.

¶2. (S/NF) If Yar'Adua were closer to "death's door," we would
expect more of a political power struggle publicly to break
out drawing in these traditional "Godfathers" of Nigerian
politics, as well as newer groupings including Kwara State
Governor Saraki (and Governors' Forum chairman), some of the
other Governors (e.g. Niger and Kaduna), and some members of
the "Katsina clique" who have gathered around Yar'Adua. All
these groups have a shared interest either in maneuvering VP
Goodluck Jonathan out of assuming the presidency, or in
assuring that his power as President was strictly
circumscribed and that he appointed a strong Northerner as
his VP. (We note there has been a speculation of a Yar'Adua
demise in February 2009. Thus, this has not happened and he
may either not be suffering from a terminal disease or could
-- as other leaders have done in the past -- hang on longer
than we anticipate.)

¶3. (S/NF) Yar'Adua began a two-week vacation on January 26
(to date he still remains in Abuja and his vacation is
scheduled to end on Monday, February 9). However, official
statements from the Presidential Spokesman indicated that he
would pass the two weeks in Lagos, Cross River State (at the
Obudu Cattle Ranch) and at his home state of Katsina. There
is widespread speculation, however, that the Villa may be
using the guise of a "vacation" to hide medical treatment.
On January 27, Kwara State Governor Saraki insisted to
Ambassador that Yar'Adua will not/not leave Nigeria during
his vacation; however, we believe that he is most likely
receiving clandestine medical treatment in Nigeria during
this period. Ambassador was told by two key contacts, Shell

Abuja 00000203 002 of 006


VP for Africa on January 27 and Information Minister Akunyili
on February 2, that experts from Germany have been brought in
to oversee the President's treatment. END INTRODUCTION.

¶4. (S/NF) Information below on the health of President
Yar'Adua is keyed to Ref. A questions:

¶A. (c) overall health

A 1. (S/NF) DIAGNOSES: Despite continued statements by the
Villa spokesperson that the President is not in poor health,
several individuals xxxxxxxxxxxx and First Lady Turai Yar'Adua) have
admitted privately to the Ambassador that he suffers from
acute kidney disease (Refs. C, G, H and others). We continue
to hear press and blog reports that Yar'Adua suffers from
lung cancer, although this is generally from sources further
removed from the Presidency. xxxxxxxxxxxx is the only credible source who confirmed
that he heard reports of lung cancer. xxxxxxxxxxxx is
not close to the President and has access to tertiary
information at best.) On October 27, First Lady Turai
Yar'Adua told Ambassador that Yar'Adua did not have lung
cancer, but admitted that he suffered from long-term kidney
disease and from asthma (Ref. G). On January 27, Kwara State
Governor Saraki, a medical doctor by training, told
Ambassador that Yar'Adua is "not at death's door" and that he
is learning to cope and manage his energy levels better,
leading to an improvement in his energy and breathing since
the September 2008 timeframe. xxxxxxxxxxxx a contact xxxxxxxxxxxx at
the German Julius Berger company said that Yar'Adua is
steadily weakening and going downhill, noting that although
he is "not in danger of dying soon," his ailments were
serious and chronic. Other media outlets, such as the online
news site "Sahara Reporters" have reported several
conditions: Churg Strauss Syndrome and/or lung cancer along
with kidney disease.

In a follow-up meeting with Information Minister Akunyili on
February 2, xxxxxxxxxxxx told the Ambassador that Yar'Adua remained
extremely weak. xxxxxxxxxxxxx noted that when xxxxxxxxxxxx last met with him it
was at the residence and not the office as he has
substantially reduced his office hours to conserve his
energy. xxxxxxxxxxxx said Yar'Adua told xxxxxxxxxxxx that he really
wanted to go out of Nigeria for "a rest" but given the uproar
over his September 2008 trip to Saudi, he was compelled to
stay in Nigeria to avoid more speculation on his health. xxxxxxxxxxxx
added that Yar'Adua's current strategy is to have meetings
planned well in advance so he can rest up in order to be able
to have enough energy to complete the session.

xxxxxxxxxxxx

A 2. (C) PAIN: Most of Post's information concerns his lack
of energy and fatigue; however, information exists in other
channels regarding pain management.

A 3. (s/nf) health improved/worsened, changes in appearance:
We believe that Yar'Adua still remains weak and as physically
fragile as he was in November-December 2008. Ref. C contains
Ambassador's observations during her meeting with Yar'Adua on
the margins of the December 19, 2008 ECOWAS meetings.
Ambassador noted: he coughed more extensively as he delivered
his speech on becoming ECOWAS Chair, he appeared to weigh no
more than 130-140 pounds, his skin was very taunt, his
handshake was weak, voice was fainter than on previous

Abuja 00000203 003 of 006


meetings, his eyes were deep set with dark circles
underneath, and his teeth were also very badly tarred. Over
the past several weeks, Yar'Adua has made few public
appearances. Despite this, he was able to carry on a
sophisticated conversation. His most recent appearance was
at his daughter's marriage on January 25, 2008, to Bauchi
State Governor Yuguda. Although we believe these appearances
were meant to calm public anxiety, they actually tended to
renew suspicions about his health. Based on pictures and TV
coverage of these events he appears pale and weak. He
continues to lose weight and he coughs and appears at times
to have difficulty breathing when he talks. U.K. diplomats
told us January 28 that they have seen reports that Yar'Adua
wears make-up for public appearances and padding to hide his
weight loss.

A 4. (S/NF) RESTRICTIONS TO ACTIVITY/SCHEDULE: Yar'Adua's
schedule, since assuming office in May 2007, has never
included long days or late night appointments (Ref. M);
however, it has clearly been severely restricted since late
Summer and appears to be more so since late December 2008.
President Yar'Adua has made few international trips since
assuming office, including missing the September 2008 UN
General Assembly meetings. xxxxxxxxxxxx
contact of the Mission shared his risk-analysis paper with us
in late 2008 (Ref. B, q.v.), in which he complained that
Yar'Adua's restricted office hours are "taking a heavy toll
on governance." He also noted then that the President "works
for limited hours, often can't keep scheduled appointments,
and cannot undertake rigorous national tours." On xxxxxxxxxxxx told PolCouns that Yar'Adua's
health has improved "a bit" since last fall; however, there
has been no positive impact on his ability to meet the
demands of the presidency. (This comment dove tails with
Saraki's, who also indicated that Yar'Adua has had a slight
improvement.)

A 5. (s/nf) yar'adua aware of his diagnoses/prognoses:
Although the spokesman for the Villa continues to maintain
that Yar'Adua has no serious health problems that hinder his
ability to carry out his executive functions, the President's
wife admitted his serious kidney ailment to the Ambassador.
We do believe that those around him may be jeopardizing his
well-being for their own political gain. We note that, in
conversations with other foreign diplomats, the First Lady
has indicated she is looking forward to Yar'Adua running for
a second term in 2011.

A 6. (C) NAMES AND SPECIALTIES OF PHYSICIANS: Adamu Banye
Barau serves as Chief Physician to the President. Barau
applied for a U.S. visa in April 2008. xxxxxxxxxxxx Barau planned to travel to the U.S. to
purchase medical equipment. In addition, we know Hussaini
Yakasai Munir serves as a Villa medical officer. (NOTE:
Munir applied for a visa in mid-January to attend medical
training in North Carolina from February 2-14. Specifically,
he will attend Advanced Cardiac Life Support, Cardiac Stress
Testing, Overview of Cardiac Catheterization, Non-Invasive
Management of Myocardial Infarction, and Advances of
Echocardiography at Ladan Medical Center, North Carolina
under Dr. Mohammad Lawal Garba.) We also know from several
sources that German specialists do come in and out of Nigeria
as they are, xxxxxxxxxxxx, transported by the
German Julius Berger company.

A 7-8. (c) who provides yar'adua with reports on health and
IS HE FOLLOWING DOCTOR'S ADVICE: We have no specific
information, but we believe that his wife and other members
of the "Katsina clique," such as Agriculture Minister Ruma,
and possibly Kwara Governor Saraki (who is a medical doctor),
are managing Yar'Adua's health strictly for political
reasons, which seems to overshadow any advice he may be
receiving from medical experts.

¶B. Procedures and treatments

B 1. (C) MEDICATIONS AND CHANGES IN MEDICATION: Information

Abuja 00000203 004 of 006


exists in other channels that provides suggestions on what
Yar'Adua may be taking.

B 2. (s/nf) medical procedures/surgeries in the past year:
Yar'Adua had a range of medical tests in Saudi Arabia in late
August 2008, about which there is reporting in other
channels. According to Leadership newspaper, between August
20 and August 31, 2008 he was at the King Abdulaziz Hospital
in Jeddah. We understand that, in 2001 or 2002, while he was
Governor of Katsina State, Yar'Adua had a kidney transplant.
The Ambassador was told on November 1, 2008 that Minister of
Agriculture Ruma was the donor for Yar'Adua's transplant, but
that the kidney now appeared to be failing. The individuals
(lunch attendees at a Central Bank luncheon) maintained that
Ruma's brother had traveled to Germany to determine if he was
a potential match for a second transplant (Ref. E).

B 3. (C) ADVISED TO SEEK TREATMENT IN LAST MONTH: We
understand that travel to Germany was being heavily
considered by the Villa in December 2008, but given that it
sparked renewed public concern about Yar'Adua's ability to
govern, the President remained in Nigeria. This has been
confirmed by xxxxxxxxxxxx

B 4. (S/NF) CANCELED OR POSTPONED ANY PLANNED TREATMENT:xxxxxxxxxxxx told Ambassador on
December 22 that First Lady Turai Yar'Adua confided xxxxxxxxxxxx
that Yar'Adua would travel to Germany for a second renal
transplant between December 16 and January 1 (Ref. C).
Yar'Adua did not take this planned trip given public reaction
to rumors about travel and concerns about his ability to
govern. We have no information on whether this trip may be
rescheduled.

¶C. Medical equipment

C 1. (C) EQUIPMENT ACCESSIBLE IN ABUJA: We understand that
the Villa maintains a dialysis machine for the President's
use in Abuja and from a credible source at Shell Oil Company
that some additional medical equipment for the President
arrived in December-January 2009. xxxxxxxxxxxx
 was more specific in a xxxxxxxxxxxx meeting with
Ambassador, saying that Yar'Adua is on dialysis three times a
week in the afternoons.

C 2. (s/nf) access to equipment to treat lung cancer: u.s.
medical personnel operating in Nigeria believe it may be
possible to bring chemotherapy drugs into Nigeria to receive
chemotherapy; however, the only hospital which may/may have
radiation equipment is Lagos Teaching Hospital. In all,
however, the American physician with whom we spoke on January
29 noted that both chemo and radiation therapy require a
large cadre of trained specialists (from oncologists, to
nurses and equipment technicians). However, Nigeria has
little to no specialists in these areas. Due to the lack of
local specialists, our medical source believed it would not
be possible to receive reasonably adequate treatment in
Nigeria.

C 3. (s/nf) access to equipment for surgery related to renal
FAILURE OR LUNG CANCER: St. Nicholas Hospital in Lagos
recently began performing minimally invasive transplants
(including both removal -- important as all donors in Nigeria
are "living donors" -- and transplantation) using equipment
from South Africa.

C 4. (S/NF) NEW MEDICAL EQUIPMENT BROUGHT TO ABUJA: Press
reports have circulated periodically that new equipment was
being purchased (dialysis machines mainly) and online news
site Sahara Reporters reported on January 22 that a contract
had been awarded previously to one of Yar'Adua's brothers to
build a 10 billion Naira ($64 million) "State House Clinic"
at the Villa (advertised in the SUN newspaper on July 5,
2008). Sahara Reporters maintained that the clinic was never
completed, but that dialysis equipment and equipment for a
complete Intensive Care Unit (ICU) was purchased. As noted
in A6 above, Chief Physician to the President Amadu Barau is

Abuja 00000203 005 of 006


believed to have traveled to the U.S. in May 2008 to purchase
medical equipment. The specific type of equipment is unknown.

C 5. (s/nf) surgical equipment and specialists in nigeria to
PERFORM KIDNEY TRANSPLANTS: The St. Nicholas Hospital in
Lagos has a full transplant team. St. Nicholas has been
performing renal transplants for approximately ten years,
performing more than 80 of the 100 or so transplants that
have been done in Nigeria. To date, there remains no
capacity in Nigeria to do HLA (human leukocyte antigen)
tissue matching, although samples can be taken in Nigeria and
sent abroad for testing.

¶D. Mental health

D 1. (s/nf) does yar'adua seem sad, detached, distracted,
IRRITABLE OR CONFUSED: xxxxxxxxxxxx both reported to
Ambassador in December that the President was exhausted, but
still very intellectually competent, and that the political
haggling and pressure of putting together a new cabinet drove
him to push for a vacation outside of Nigeria. The political
pressures of the cabinet reshuffle reportedly took a further
toll on his physical wellness. At Ambassador's last meeting
with him, he did not seem sad, detached, irritable or
confused.

D 2. (s/nf) does yar'adua conduct meetings/ is he alert and
FOCUSED: Yar'Adua has delivered remarks recently at the
January 12 Armed Forces Remembrance Day and the January 16
presentation of the 2006 Census to the National Assembly, as
well as attended the highly visible wedding of his daughter
to Bauchi Governor Yuguda on January 24. In these public
appearances, he appeared physically fragile. Ambassador
noted in her December 19 discussions with Yar'Adua and
observations of him at ECOWAS that he "remained focused and
still showed intelligence, understanding and awareness in his
dialogue." Others, from the Foreign, Petroleum and
Information Ministers to the Central Bank Governor, have
confirmed the same.

D 3. (s/nf) does yar'adua use prepared notes/ do aides prompt
HIM OR ANSWER FOR HIM: Yar'Adua spoke at the January 12
Remembrance Day events in Abuja without notes. In his
December 19 interactions with Ambassador, he spoke without
notes and without prompting from aides. We believe that he
is still intellectually fit, even if we don't agree with his
style of governance. However, his physical weakness adds to
the inability of his administration to do more on top of his
slow leadership style. We judge that even if his health were
not an issue, his governance and leadership style would
likely remain slow and largely ineffective as a result of his
personality, his lack of a political network of his own, and
the fact that he chooses not to dictate decisions to his
Ministers, even when necessary and/or expected. Although he
may not be up for days beforehand, he still chairs his weekly
Cabinet meetings, which we still understand can run 3-4
hours.

¶E. Spread of health information

E 1. (s/nf) why are yar'adua/family/advisors reluctant to
DISCLOSE HEALTH INFORMATION: While we have heard the
argument that Yar'Adua's quiet personality and his northern
Nigerian culture are the reasons for his unwillingness to
discuss health information, we believe that those close to
him are motivated more by a desire to retain power. His wife
and several special advisors, such as Economic Advisor Tanimu
Yakubu, we would put high on this list as they only have
influence so long as he is President.

E 2.xxxxxxxxxxxx

Abuja 00000203 006 of 006


stage is missed. (This is a point the Mission raises
regularly with GON interlocutors.)

E 3. (c) reasons or motivations for those close to yar'adua
TO LIE ABOUT HIS HEALTH: We would characterize the behavior
of those close to Yar'Adua more as avoidance, secrecy and
disregard for what is ultimately medically best for the
Nigerian President. We would add that the closed-mouth
nature of both Yar'Adua and his wife, plus the influence of
their religion are also factors. In Yar'Adua's May 15, 2008
interview with the Financial Times, he admitted he is "a
normal human being, who can fall sick," hinting at his
medical condition. His wife admitted his kidney and asthma
ailments to the Ambassador on October 27, 2008 without
hesitation. So, his handlers do not directly lie, but just
go to great lengths to avoid talking about it.

#. (U) This cable was coordinated with Consulate Lagos.
SANDERS