Eight years ago, more than a dozen men with AK-47s shot their way into Akinbode Oluwafemi’s home in Lagos, Nigeria. They killed his house guard and his brother-in-law, and briefly held a muzzle to the head of one of his year-old twins.
“I do not know why I was not killed that day,” said Mr. Oluwafemi, who as deputy director of Environmental Rights Action/Friends of the Earth Nigeria has been one of his country’s leading antismoking activists.
He was one of several tobacco control advocates at last week’s 17th World Conference on Tobacco or Health in Cape Town who in telephone conversations described violence or threats they faced as they fought the expansion of smoking in their countries.
No arrests were made in any case, and none of the victims could prove that the men assaulting or threatening them worked for the industry. But the pattern was consistent.
They were first quietly warned that they were upsetting cigarette companies, tobacco farmers or government officials connected to the industry. If the activists persisted, threats or violence escalated suddenly and unpredictably.
In 2012, Tara Singh Bam, deputy regional director of the International Union Against Tuberculosis and Lung Disease, discovered “wanted” posters with his face and those of nine other antismoking advocates — including Indonesia’s national health minister — pictured under the headline “Ten Enemies of Tobacco Farmers.”
“He grabbed my hand and said ‘You must leave my country as soon as possible,’” said Dr. Bam, who is from Nepal. “Then he blew smoke in my face. My children started crying — and he left.”
And just two years ago, he said, he received a Facebook message warning: “Do not interfere in our tobacco affairs.” It ended with “Your coming made the atmosphere not good.”
When he looked up the sender’s name, Dr. Bam said, he found an official of the Indonesia Tobacco Growers Association.
Mr. Oluwafemi said he could not prove that his attackers were linked to the tobacco industry in his country, but he strongly suspected it. They were far better dressed and better armed than typical robbers in Nigeria, he said, and his modest home was an unpromising target in a neighborhood of mansions with Mercedes-Benzes.
Also, he added, they started firing even before they cleared the outside wall. He may have survived, he said, partly because of the chaos caused by all the shooting — the police later counted 75 empty shells.
The killers fatally shot one of their own by accident, and ultimately fled in his nine-year-old minivan, ignoring his new Toyota Camry and taking only about $400, some baby clothes and food.
More telling was the fact that he was threatened both before and after the attack. The first time was in 2010, when he was on Nigerian radio criticizing the industry.
“Someone called a friend of mine and said I should shut up or be killed,” he said. Two years ago, as he was interviewed on Africa Independent Television, someone called another friend and said: “Your boy is on TV again — we have arranged that he’ll be killed.”
Mr. Oluwafemi abandoned his house after the attack. He declined an offer from a friend, a general in the Nigerian Army, to post soldiers outside his new home.
He also turned down offers from Bloomberg Philanthropies and the Bill and Melinda Gates Foundation to move him and his family to the United States.
“If I left,” he said, “I felt it would mean they have won.”
The discussion of threats was an undercurrent at what was already a contentious conference held to highlight the tobacco industry’s focus on poor and middle-income countries.
It was led by Tedros Adhanom Ghebreyesus, the new director-general of the World Health Organization; Michael R. Bloomberg, the former New York mayor who is the W.H.O.’s global ambassador for noncommunicable diseases; and South Africa’s health minister, Dr. Aaron Motsoaledi.
Dr. Tedros, the first African to head the W.H.O., called Africa “ground zero for the war on tobacco” as the industry, losing customers in the West, seeks new markets there.
Dr. Motsoaledi said he hoped South Africa would soon bar smoking in public places and mandate that cigarettes be sold in unbranded packaging with gory pictures of cancer patients.
Mr. Bloomberg announced that he was donating $20 million to create a new global watchdog agency called Stopping Tobacco Organizations and Products — or S.T.O.P. — devoted to monitoring the industry’s deceptive tactics.
In a phone call with reporters before the conference, Mr. Bloomberg named Philip Morris, the makers of Marlboro, as his prime target.
Last year, the tobacco firm created a “Foundation for a Smoke-Free World” and promised to donate nearly $1 billion to it over 12 years. Tobacco companies are now marketing electronic cigarettes and devices that heat cigarettes without burning them; critics consider the foundation a ruse intended to spread the notion that those products are less harmful than cigarettes and help reduce smoking rates.
“This is an effort by Philip Morris to confuse the public,” Mr. Bloomberg said. “It’s fake science as well as fake news. Deliberately misleading governments with misinformation is just something we should not put up with.”
André Calantzopoulos, the chief executive of Philip Morris, called Mr. Bloomberg’s announcement “simply a repetition of decades-old rhetoric now being applied to the reality of 2018 by those who don’t want men and women who would otherwise continue smoking to have access to potentially better alternatives. The ultimate result is confusion amongst adult consumers, leading us to wonder who is misleading whom.”
Last year, the W.H.O. accused the foundation of being an industry front, said the agency would not partner with it, and advised governments to shun it.
The foundation’s president, Dr. Derek Yach, a former W.H.O. official who helped write the world’s tobacco control treaty, immediately fired off a letter of protest arguing that the foundation was an independent nonprofit that “fully insulated itself from the influence of the tobacco industry.”
Even before the Cape Town conference opened, its leaders announced that Dr. Yach, a South African, would be barred from attending.
Eight years, ago, Mr. Bloomberg started a $2 million global antismoking program in partnership with the W.H.O. Shortly afterward, he and Mr. Gates announced that they would jointly spend $500 million on the cause — 25 times as much as was spent at the time.
The campaign, nicknamed Mpower, urges governments to raise tobacco taxes, prohibit smoking in public, outlaw cigarette giveaways and advertising aimed at children, and offer nicotine patches and other help to smokers trying to quit.
Mr. Bloomberg said the Mpower campaign had already cut smoking rates in some countries so much that 35 million early deaths will be prevented.
The tobacco industry has filed numerous lawsuits in poor countries trying to thwart antismoking measures.
At the conference, Dr. Loida Alzona, director of health, public safety and environmental protection at the Metropolitan Manila Development Authority in the Philippines, described how her agency was defeated in court when it tried to enforce regulations outlawing smoking on transit platforms and streets.
Two men fined for smoking sued, demanding an injunction preventing her agency from penalizing anyone. They persisted even after charges against them were dropped, Dr. Alzona said, repeatedly appearing with high-priced lawyers even though they were low-paid workers.
One said later in a television interview that he was among about 50 men recruited by tobacco industry lawyers to try to be arrested in order to provoke a test case, Dr. Alzona said.