When a country's leader falls seriously ill, attention turns to the likely successor. In democracies, the succession process is usually straightforward. But in dictatorships or monarchies, the death of a powerful leader may produce a political crisis.
U.S. intelligence analysts right now are following the medical conditions of three ailing foreign leaders in particular. In each case, the United States has a stake in the outcome.
Saudi Arabia
The kingdom of Saudi Arabia was founded by Ibn Saud, who had 35 sons at the time of his death in 1953. The crown has been passed down among them: Each new king named his successor, a crown prince, who then took the throne when the time came.
But there's a problem now in Saudi Arabia. It's not that the current king, Abdullah, is 85 years old; it's that the man due to succeed him — Crown Prince Sultan — is himself 84 and is said to be terminally ill, perhaps with pancreatic cancer.
"We do know for a fact that the Crown Prince Sultan is ill," says Kamran Bokhari, director of Middle East analysis for Stratfor, an intelligence research firm. "And his chances of recovering are very, very slim."
Simon Henderson of the Washington Institute for Near East Policy says this is an unprecedented situation: No crown prince in Saudi Arabia has ever died before ascending to the throne.
"If the designated successor dies before the king, it throws up in the air the whole notion of who the next king is going to be," he says.
In a break with Saudi tradition, King Abdullah said in 2006 the designation of the next crown prince should be done by a so-called Allegiance Council, made up of members of the royal family.
"We could see tensions within the royal family and we could also see some power maneuvering," Henderson says. "One prince has control of the military; another prince is the interior minister and has a considerable paramilitary force under his command. Will it come to a confrontation? I don't know, but it possibly could."
Another complicating factor: The senior princes — brothers or half brothers — are all in their 70s or 80s, meaning Saudi Arabia could face a series of succession crises in the coming years. This, in a country that's the No. 1 oil exporter and the leader of the Muslim world. It's fair to say U.S. intelligence agencies are monitoring the Saudi leadership situation very closely.
North Korea
Tens of thousands of people regularly fill Kim Il Sung Square, in the North Korean capital, Pyongyang, as they did one day last month. They snapped their flags in the air and cheered their leader.
Kim Il Sung was the founder of North Korea, and his son, Kim Jong Il, is the current leader. The banners surrounding the plaza say "Long Live the Great Leader Kim Jong Il."
But how long will Kim live? He's only in his early 60s, but U.S. officials say he had a debilitating stroke this summer.
Paul Stares of the Council on Foreign Relations has written a new report, "Preparing for Sudden Change in North Korea." He researched the life expectancy of people who have had strokes: Twenty-five percent die within one year.
"What complicates it somewhat is Kim Jong Il is believed to be a diabetic, and the life expectancy, according to a large study done recently, goes down by about 15 percent," he says. "So they're not terrible odds, but they're not great odds, either."
Once again, there's a succession issue. Kim Jong Il was groomed by his father over a period of 20 years to follow in his footsteps. But the son has no designated successor, and there is no institution in North Korea that could play an obvious role in choosing his replacement.
A senior U.S. official who tracks intelligence on North Korea says it appeared that no one there was making decisions during the roughly two months Kim was incapacitated last year. And Stares says the country is now facing a range of problems, including severe food shortages.
"We're not predicting there's going to be a collapse tomorrow," he says. "We're just saying that this has to be considered as among a range of possibilities."
And this, in a country with nuclear weapons.
Cuba
Fidel Castro, who has outlasted 10 U.S. presidents, turned over most of his power a year ago — to his brother Raul. As the case of North Korea also shows, even communist countries can practice hereditary succession.
Fidel Castro disappeared from public view in 2006 after undergoing serious intestinal surgery. Last month, his friend and protege, Hugo Chavez of Venezuela, made it official: Fidel isn't coming back.
Chavez said the Cuban leader — who used to walk up and down streets at dawn like a warrior, embracing his people — will not return.
Days later, Castro himself, writing in a newspaper column, referred to the gravity of his health situation and said he would probably not make it to see the end of President Barack Obama's first term.
Under Raul Castro, there's been no evident unrest or big outflow of refugees, as some predicted. But Marifeli Perez-Stable, a Cuba analyst at the Inter-American Dialogue, says it may be too soon to conclude what will happen when Fidel finally departs the scene.
"Even if people haven't seen him in person for 2 1/2 years, his death is a big thing in Cuba," she says. "Especially if people's breakfasts, lunches and dinners are not taken care of. I mean, this is a big question: How long will the Cuban people put up with a government that is incompetent to improve their standard of living?"
Once more, there are succession issues: Over the past 2 1/2 years, Raul Castro has been able to consolidate his authority, but there could be new challenges once Fidel is truly out of the picture. And how will the country choose its next leader after Raul — who himself is 77?
As with the Saudi royal dynasty and the Kim family in North Korea, these questions are unanswered. And political instability — in a close U.S. neighbor, or in the world's top oil supplier, or in a nuclear-armed adversary — is enough of a concern that intelligence analysts will be paying close attention.
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