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I think the kidney thing was overblown. There are two things that hit people in the Arab world hard--kidney problems and eye problems. Both are due to the heat and, in the case of eyes, bright light and sand in the region.
I think Bin Ladin got excessively dehydrated (it happens), and had kidney problems that were reversed with hospitalization.
Now, if you look at the video, you see a couple of interesting things. His face looks a LITTLE different, but it IS him, most definitely. His left shoulder (right if you are looking at him) slants lower than the other one. He moved his left arm slightly, but not much.
I think he took a BAD HIT on his left side in the area of his shoulder at TORA BORA, that probably blasted him on the face slightly. I think he was hospitalized, had a great deal of surgery, and spent a good many months mending, eating well, doing light exercise, and taking it easy. I also think he did this in a comfortable environment, with fresh air, sunshine, good food, and clean sheets--not in a cave. I think that when they made the "Osama by the stream" video, his face had mended, but the shoulder was still fucked up. He did not move his arm at all in that video.
The question is, where is he? Afghanistan? Pakistan? IRAN? Who knows, he could be commuting between Iran and the warm bosom of his extended family in Saudi Arabia on a regular basis--how would we know?
No one really thought the revolutionary guard in Iran had anything to do with anything, until it was discovered that Chalabi had been working with them. Who's to say that Iran isn't playing in this game in a big way? They are very sophisticated people, they understand their geopolitical role, and they have a long history. They also know how to be very subtle. No one plays a better game of chess, and I would put nothing past them.
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