President Umaru Musa Yar'Adua was flown to King Faisal Specialist Hospital in Jeddah on the night of 23 November 2009 for treatment of acute pericarditis, complicating an underlying renal failure. He was never seen in public again. For 78 days no formal transmission of power was made to Vice-President Goodluck Jonathan as required by Section 145 of the 1999 Constitution. Aso Rock cabinet meetings were chaired by Vice-President Jonathan in an ambiguous capacity; the Nigerian Armed Forces took orders from a chain of command that had no constitutional principal.
The small circle that controlled access to the President included his wife Hajiya Turai Umaru Musa Yar'Adua, his cousin and former National Security Adviser General Aliyu Mohammed Gusau (rtd), Chief of Staff General Abdullahi Sarki Mukhtar (rtd), Attorney-General Michael Aondoakaa (SAN), and Special Adviser on Media Olusegun Adeniyi. The Senate Leader Senator Teslim Folarin and Speaker Dimeji Bankole shared the parliamentary leadership. The press collectively named this circle 'the cabal'.
On 12 January 2010 the BBC Hausa Service broadcast a short interview with President Yar'Adua, recorded in Jeddah; the lifeless quality of the recording fueled rather than calmed national anxiety. On 9 February 2010 the National Assembly, acting on a Senate motion led by Senator Suleiman Nazif, adopted the 'Doctrine of Necessity' — declaring that the constitutional reference to a written letter from the President had been satisfied by the BBC Hausa interview — and empowered Goodluck Jonathan as Acting President. The Doctrine was approved by the House the same day. Attorney-General Aondoakaa publicly opposed it; he was subsequently removed.
On the night of 24 February 2010 a presidential air ambulance landed at Nnamdi Azikiwe International Airport, Abuja, in the early hours of the morning. President Yar'Adua was driven into Aso Rock under the management of his wife Hajiya Turai. Neither Acting President Jonathan nor the Service Chiefs were informed in advance. The Senate emergency session of the following day demanded — and was refused — access to the President. Acting President Jonathan was not granted access for several weeks.
Yar'Adua died at Aso Rock on the evening of 5 May 2010. The 'cabal' episode is the founding example in the Fourth Republic of an extra-constitutional centre of power; the 2010 First Alteration to the 1999 Constitution (signed January 2011) attempted to close some of the procedural gaps Section 145 had left open. Hajiya Turai has never publicly responded to the substance of the 'cabal' allegations.