The Struggle for Power in Saudi Arabia

As the gerontocratic rulers of the House of Saud plot to appoint successors, the inside fight to lead the kingdom is heating up.

RIYADH — With the reign of King Abdullah in its twilight, Saudi Arabia has become consumed with speculation about the future of the ruling al-Saud brotherhood as it contends with an increasingly bloody Syrian civil war, a nuclear challenge from Iran, and doubts about U.S. steadfastness in the Middle East.

Abdullah, who has been the dominant figure in Saudi politics since 1995, is in very frail health. The king, who is roughly 90 years old, has made no public appearances for almost four months, and left at the end of May for vacation in Morocco. He only cut his holiday short this past weekend, returning to Riyadh to attend to the fallout from the increasingly bloody civil war in Syria.

Despite his age and frailty, Abdullah has been busy preparing the House of Saud for his departure from the political scene. He has appointed younger princes to key ministries and as governors to the most important provinces, made one half-brother a contender for the throne, sacked another, and weeded out the weakest aspirants among the younger al-Saud princes. Such a sweeping shakeup of the staid ruling family has even included moves to make his own son a prime contender for the throne.

The leadership turnover couldn't come at a more critical time for the kingdom. Saudi leaders have been deeply anxious about the waning of American leadership in the Middle East -- including the U.S. commitment to the kingdom's protection -- just as their confrontation with Iran is coming to a head. This Saudi-Iranian cold war is most evident in Syria, where Tehran strongly supports Bashar al-Assad's besieged regime and Riyadh is supporting the armed rebellion seeking to overthrow it.

Meanwhile, King Abdullah's remaining energies have been focused on remaking the House of Saud's own leadership. The upheaval continued right up to his departure for Morocco: On May 27, Abdullah decreed that the Saudi Royal National Guard, a powerful military force that he commanded for decades, was to become a full-fledged ministry -- and that his son, Miteb, 61, would be the new minister. These moves give Miteb more political clout to compete with other rivals for the throne from the younger generation of al-Sauds.

The whirlwind of new appointments has left Saudi citizens and veteran watchers of the House of Saud grasping for meaning in the king's zigzag maneuverings. It has also raised concerns about a destabilizing power struggle among the younger princes, and questions whether the process of king-making is about to change dramatically. But so far, the smart money is betting that he's preparing to hand the throne to one of his half-brothers, delaying the transfer of power to the "younger" generation as long as possible.

If that holds true, it isn't going to please President Barack Obama's administration, which has been pressing for younger blood to rule the kingdom and accelerate reforms. It rolled out the red carpet for the newly minted Interior Minister Prince Mohammed bin Nayef, 53, for his four-day visit to Washington in January, setting up separate meetings with Obama, Secretary of State Hillary Clinton, national security advisor Tom Donilon, and other high-ranking U.S. officials. This was taken among Saudis as a signal that Washington favored Mohammed as the next king.

Washington has good reason to look fondly on Mohammed: The prince is not only from the younger generation, but he was the architect of the highly successful Saudi campaign in the mid-2000s to crush al Qaeda inside the kingdom. He also became a family hero after an audacious terrorist attack against him inside his own palace in August 2009, in which a suicide bomber gained a meeting with the prince (after promising to surrender) and then detonated himself. Mohammed escaped miraculously with only slight injuries.

But Prince Mohammed isn't seen as the likeliest candidate to become the next crown prince. Both Abdullah and Crown Prince Salman, 77, seem ambivalent about whether the time is ripe to pass power from their generation to the next. The brotherhood of senior princes has stuck together with impressive cohesion on the right of one brother to follow another to the throne. Over the past 81 years, the crown has passed five times in this fashion. Now, however, only two of the sons of the kingdom's founder, Abdulaziz bin Saud, still appear viable.

If that trend holds -- which it has for 81 years -- the Saudi "chattering class" gives a better-than-even chance that Prince Ahmed, the youngest of the powerful "Sudairi Seven" brothers at 71 years old, will emerge the winner. That would represent a remarkable turnaround for Ahmed: The king fired him as interior minister last November, after appointing him only five months earlier. However, Ahmed still retains much support within the fractious al-Saud family, according to Saudis in both royal and diplomatic circles.

Ahmed's abrupt firing as interior minister stemmed from a dispute with the king over a plan to split off the ministry's 500,000-man security force into a separate body. In an unheard-of display of disapproval of the king, several hundred of Ahmed's supporters turned out at the airport to greet the prince upon his return to Riyadh after his dismissal. Among his supporters are some human rights activists and the liberal wing of the royal family, led by Prince Talal.

Veteran Saudi watchers of the royal family believe that decision could come down to who lives longer -- King Abdullah, who has outlived two crown princes already, or the current heir, Salman. Rumors that the crown prince suffers from Alzheimer's are untrue, but there is no doubt that Salman has been slowed down considerably by age -- he is "certainly no longer the Salman of yesterday," in the words of one Saudi who recently saw him, a judgment in which U.,S. officials concur. But if Salman does outlive Abdullah to become king, the thinking is that he will favor Ahmed because they are full brothers from the same tightly-knit Sudairi clan.

Should Abdullah miraculously outlive the far younger Salman, he has put his half-brother Muqrin in line to move up the power chain to become the next crown prince. Saudis say Muqrin is clearly campaigning for the job through constant public appearances, designed to keep himself in the limelight. Miteb has also been keeping a high profile, but most Saudi watchers doubt the king is ready to upset the whole al-Saud family by naming him heir apparent -- a move that would constitute an unprecedented kingly power play.

Abdullah's sweeping shakeup of the House of Saud's leadership hasn't been kind to the Sudairi clan. One of the king's first moves was at the Ministry of Defense and Civil Aviation, which had been the personal fiefdom of Prince Sultan, another of the Sudairi brothers, for 48 years. While minister, Sultan allegedly parlayed his grip over tens of billions of dollars in defense spending into a family fortune. He had also positioned his son, Prince Khalid, 63, to take over the ministry, and compete for the crown, by making him assistant defense minister. Khalid's fame stems from his role as co-commander of the U.S.-led coalition force that drove occupying Iraqi forces out Kuwait in 1991. Khalid's fortunes seemed on the rise after King Abdullah sacked his own half-brother, Prince Abdul Rahman, who had been deputy defense minister for 33 years, upon Sultan's death in October 2011. In his place, the king named Khalid, seemingly making him a prime contender to the throne.

But the king, in retrospect, clearly had other ideas. He also put another half-brother, Prince Salman, in charge of the Defense Ministry shortly before naming him crown prince last June, and authorized him to dismantle the Sultan family empire there. Salman did this partly by detaching the civil aviation portfolio from the Defense Ministry and stripping Khalid of any role in lucrative military procurement contracts.

In another of his bold, unexpected strokes, King Abdullah sacked Khalid in April and replaced him with the little-known former head of the Royal Saudi Navy. This leaves the once powerful Sultan branch of the al-Saud family with just one top post, the General Directorate of Intelligence. Since last July, this has been in the hands of Prince Bandar bin Sultan, the long-serving Saudi ambassador to Washington who had been the king's national security advisor.

Choosing the next king of Saudi Arabia still remains a deeply personalized decision, made by the royals at the very upper echelons of the House of Saud. This tradition had seemed set to change dramatically after King Abdullah established in 2007 an Allegiance Council, made up of Abdulaziz's sons and grandsons, and gave the 35-member body the power to approve or reject the king's choice as heir apparent.

So far, however, the Allegiance Council has remained moribund, and the king has appointed two crown princes of his own choosing. One council member, the liberal Prince Talal, resigned in disgust after Abdullah failed to consult the body when he chose the conservative Prince Nayef as his successor in October 2011. When Nayef died last June, the king immediately appointed Prince Salman as crown prince, again without any known consultation with the council.

It is a time of change for the risk-averse royals in Riyadh. In addition to the eventual handover of power to the next generation of Saudi princes and the struggle for Syria, the princes doubt whether Washington is still committed to the longstanding U.S.-Saudi security relationship. King Abdullah's moves in the next months and years will determine who leads Saudi Arabia -- and what sort of Middle East the kingdom must contend with -- for decades to come.



Aleppo Evil

Meet the flesh-eating parasite that's sweeping across Syria.

AL-SALAMA, Syria — A crowd gathers at the center of Bab al-Salam, a refugee camp on the Turkey-Syria border that is home to some 13,500 internally displaced Syrians. Children sit at their mothers' feet, playing with plastic toys in the melting mud. One boy's cheeks are pocked with small red dots; a boy next to him, wearing nothing but a diaper, has a large crusted lesion on his leg -- signs of an infectious skin disease that is spreading throughout Syria and the neighboring region.

Since war came to Syria a little more than two years ago, the country has been transformed into a public health nightmare. Gastroenteritis, which causes severe diarrhea, vomiting, and abdominal pain, is ubiquitous among displaced populations -- both inside and outside Syria -- and a measles epidemic is currently sweeping the northern portion of the country. (At least 7,000 cases of the disease have been detected since 2011, according to Doctors Without Borders.) An outbreak of water-borne diseases such as hepatitis, typhoid, cholera, and dysentery, meanwhile, is all but "inevitable," according to the World Health Organization (WHO).

But in camps like Bab al-Salam, it is a silent, flesh-eating parasite that is literally leaving its mark on the population. Cutaneous leishmaniasis, also known as the "Aleppo evil" or the "Aleppo boil," is carried by sand flies and causes painful lesions that can become secondarily infected, often resulting in disfigurement. Another form of leishmaniasis -- visceral -- affects the spleen and liver, and it is the second-largest parasitic killer in the world after malaria. Mercifully, it is only the nonlethal parasite that is coursing through the Syrian countryside, where years of fighting has made seeking medical treatment extraordinarily difficult. Still, the parasite leaves its victims scarred for life.

According to the WHO, which has set up an early-warning system to monitor the disease in all 14 of Syria's governorates, 1,047 cases of cutaneous leishmaniasis were reported between April 14 and May 18 of this year. The majority of those cases occurred in Aleppo, where the disease was endemic prior to the crisis, but an increasing number have cropped up among internally displaced people in Syria's Tartus governorate, where the disease was previously unreported. Thousands of additional cases have been reported in bordering countries in the last year.

Still, the WHO has yet to classify the increasing number of cases as an official outbreak, which would require a twofold increase in the number of reported cases among all age groups since last year. "Despite articles or videos circulating in the media talking about an 'outbreak' of cutaneous leishmaniasis, WHO has not received up to date any systematic epidemiological data to ascertain that," Jose Postigo, an expert on leishmaniasis at the WHO, told Foreign Policy in an email. "But the disease is highly endemic in parts of the country."

If one assumes the conflict hasn't depressed the rate of reporting, the numbers recorded by the WHO aren't significantly different from those in previous years (the Aleppo governorate, where the vast majority of cutaneous leishmaniasis cases occur, reported 18,603 cases in 2008, for example). But the war has increased the risk that the parasite will be carried to neighboring countries, according to Postigo. Already, the WHO has received some 1,300 reports of leishmaniasis cases in Lebanon, Jordan, Turkey, and Iraq in the past year. In all likelihood, many more cases remain unreported, whether because of poor education, lack of access to medical treatment, or logistical problems associated with mass migration.

According to the WHO's eastern Mediterranean regional office, accurate data on the number of leishmaniasis cases is difficult to gather because of the movement of Syrians inside the country and within neighboring countries. Some 1.6 million refugees have fled Syria since the violence began 27 months ago, and another 7,000 arrive daily in bordering countries, according to the United Nation's refugee agency, UNHCR. Lack of data from the clinical level also hampers efforts to map the disease's spread, according to Samantha Crago, who works on the Syria regional response team at Save the Children, which helps deliver medical and humanitarian aid inside Syria. What is clear, she says, is that the international community isn't doing enough to treat the disease.

"Overall, health facilities are overwhelmed across the country with critical shortages of staff, drugs, equipment. This can be assumed also for [cutaneous] leishmaniasis, which is non-life-threatening, so treatment options are not widely available or prioritized," says Crago. "Organizations were distributing bed nets and some were providing spraying [for sand flies], but many areas such as inner cities and other higher-conflict-intensity locations are harder to reach to provide this support."

The WHO's Postigo claims that medication for cutaneous leishmaniasis is readily available in Syria and that the WHO has sent medication to Lebanon and Turkey in preparation for the expected uptick in cases among Syrian refugees. In camps like Bab al-Salam, however, medicine shortages persist. Doctors with Medical Relief for Syria (MRFS), a nonprofit organization that runs a medical center in the camp, say they have only four types of antibiotics, all of which treat symptoms associated with gastroenteritis. As a result, they are unable to treat leishmaniasis patients with the necessary doses of sodium stibogluconate, which must be injected directly into the boil. The situation is the same in many refugee camps in bordering countries. As of August 2012, for example, the Zaatari refugee camp in Jordan -- now home to some 180,000 Syrians -- was only treating trauma patients because of a shortage of doctors. 

There is no one single aid organization providing relief in Syria or in refugee camps in bordering countries. Medical supplies for Syrians suffering from leishmaniasis both inside and outside the country come from a patchwork of local aid organizations, private donors, and international aid organizations like the WHO and UNHCR -- all of which struggle to get medicine to those in Syria who are in need.

In past years, Save the Children has teamed up with the WHO to spray chemicals in sand-fly breeding grounds, thereby reducing the chances of a leishmaniasis outbreak. But this year, according to Crago, preventive spraying was disrupted by the fighting. As a result, he expects the disease to spread more quickly than in previous years.

The lack of medical supplies and preventive spraying isn't the only obstacle to containing leishmaniasis. Poor education about what causes the Aleppo boil -- and how to treat it -- means that many children continue to suffer unnecessary pain and disfigurement. "Do you see what is happening to my child? Just look at this. It is because of that dirty water," one middle-aged woman told me as she pointed to a stream of garbage flowing between tents.

Most mothers in Bab al-Salam whose children had visible sores thought they were caused by poor camp conditions. Doctors with MRFS seemed to shrug off the disease -- and the refugees' ignorance of how it spreads.

"They always say it is from the water. They don't understand they probably got the disease before they came here," said one doctor. "I am not as worried about the leishmaniasis as I am about the possible cholera outbreak. The summer months are coming."

According to Peter Hotez, a professor of molecular virology and microbiology at Baylor College of Medicine and founding dean of its National School of Tropical Medicine, lack of preventive medicine -- like nets and spraying for sand flies -- is the main driver of leishmaniasis infections in Syria. As a result, Hotez and his team are working to develop a vaccine that prevents the ulcers from forming -- though it is still in early, pre-clinical stages.*

Treatment with sodium stibogluconate, moreover, "requires intramuscular injections" and prolonged treatment by specialized doctors, according to Hotez -- an unrealistic scenario for victims of the disease still living in war-torn areas.

Another force propelling Syria toward a devastating outbreak is the rapid deterioration of sanitary conditions within the country. Trash pickup is virtually nonexistent, and in many cities garbage has begun to collect in the streets. In places like Aleppo and the suburbs surrounding Damascus where the fighting is at its worst, there is no electricity or running water. The subsequent buildup of sewage in the streets -- combined with Syria's extreme heat -- attracts the sand flies that carry leishmaniasis, according to Crago.

"Syria has been teetering on a leishmaniasis outbreak for a while," Hotez said. "It makes sense. Anytime a war like this starts, the chances of outbreak increase."

*Correction: A previous version of this article incorrectly stated that a vaccine for Leishmaniasis won't be available for distribution for another three years. In fact, the vaccine is still in early, pre-clinical stages, so it's difficult to say how long until it reaches the market. FP regrets the error.