Fadumo Mohamed Aden underwent surgery to repair his fistula at Daynile Hospital in Mogadishu. NACIIMA SAED SALAH
Halimo Aden Abdalla, 27, was abandoned by her husband and left to care for seven children alone in an abandoned refugee camp on the outskirts of Mogadishu, the capital of Somalia. “She divorced me because I developed a fistula during the birth of my baby, which was long and difficult,” she explains. “As soon as he realized he could no longer control his urine, he said to me, ‘I’m going to divorce you and leave.’ Since that day he has not contacted me again and has not given me any money or help for our children. “We used to survive on the daily euro I earned working on the dock.”
A fistula is a hole between the birth canal and the bladder or rectum, often caused by prolonged labor. It is common in communities where female genital mutilation (FGM) is practiced because it is difficult to expel babies when the vagina is almost completely sewn shut.
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Fistulas cause women to lose urine or stool and can lead to chronic medical problems as well as depression and social isolation. According to the World Health Organization (WHO), they are widespread in Somalia, where about 98% of women between the ages of 15 and 49 have been victims of FGM. Most girls are circumcised between the ages of five and 11 and subjected to the most severe form of FGM, type III infibulation, in which the vaginal opening is narrowed by cutting and stitching the labia, and the labia are often removed.
Approximately 98% of women in Somalia are victims of female genital mutilation
Fistulas can be repaired by specially trained surgeons, but many more are needed to meet demand, especially in countries like Somalia that have few resources and have been affected by decades of conflict, droughts and other problems. In this East African country, the disease is so taboo that women are often embarrassed to seek treatment, even when it is available.
Forced to give birth under a tree
Abdalla was in the third trimester of her pregnancy in April this year when she, her husband and children were forced to make the long and arduous journey to Mogadishu after their village in southern Somalia was destroyed and by air strikes and heavy fighting following a new government was hit by a ground offensive against the militant Islamist group Al Shabab, which has controlled large parts of Somalia for 16 years.
Abdalla couldn’t afford to go to a health center, so she gave birth under a tree in the camp where she lives. The wall of her birth canal ruptured, probably because the birth took several days and she was assisted by an older woman who had no medical care and little experience in assisting in birth.
In Mogadishu, there are 147 health centers funded by the Ministry of Health and donor agencies that provide free maternity and child care. However, they are far from the camps, on the outskirts of the city and home to hundreds of thousands of displaced people, making them inaccessible to most of the people who need them most.
The stigma of smelling like urine
Abdalla cannot hold back her tears as she tells how the other residents of the camp reject and insult her because she is a single mother and suffers from fistula. “People walk past my house and shout that it smells of urine. I had to build this shelter myself out of sticks, old clothes and plastic bags after the better house I lived in with my husband was destroyed by the rain,” she says. “My children fight with other children who insult them and tell them that they have an unclean mother,” she complains.
There are diapers for people with fistulas, but they cost 50 cents and I can’t afford them.
Halimo Aden Abdalla, 27 years old
“There are diapers for people with fistulas, but they cost 50 cents and I can’t afford them,” explains Abdalla. “When I look for work to earn money and feed my children, they reject me because I smell like urine.”
Abdalla is weak, malnourished and in constant pain since the birth of her seventh baby. She and her children survive on one meal a day, which a relative prepares for them and leaves at the door of their shelter. Unable to walk the two kilometers to the nearest spring, she relies on the kindness of the man who runs the camp to bring her water.
Thanks to a fistula awareness campaign run by Doctors on All Continents (PAC) in collaboration with Somalia’s Ministry of Health and Daynile Hospital in Mogadishu, not all women with fistulas suffer the same fate as Abdalla.
Fadumo Mohamed Aden is one of the 200 women whose fistula was repaired by surgeons at Daynile, one of the capital’s largest hospitals. Now that she has fully recovered, she intends to resume the women’s clothing business that she was forced to give up after her birth canal ruptured during childbirth.
The young women arrive at the hospital on the verge of death because they sustained injuries to their vaginas as a result of the intervention of untrained midwives
Ahmed Artan Yalahow, gynecologist and surgeon at Daynile Hospital (Somalia)
One of the hospital’s specialists is gynecologist Ahmed Artan Yalahow. She wants to persuade the Ministry of Health to train and equip traditional midwives so that they know how to reduce the risk that women who undergo FGM die or develop fistulas or other complications during childbirth. “The young women arrive at the hospital on the verge of death because they have sustained injuries to their vaginas as a result of the intervention of untrained midwives,” he emphasizes.
Relatively simple procedures such as performing surgery before delivery to widen the vaginal opening or cutting the perineum during childbirth help reduce the risk of fistulas developing during childbirth in circumcised women.
According to Yalahow, one consequence of fistulas that is more difficult to treat is its impact on women’s mental health. “Even if we manage to repair the fistula, the women suffer deep trauma because they married young, had terrible birth experiences, and were abandoned by their husbands and stigmatized by the community,” she says.
“I’m one of the lucky ones,” says Aden as she holds her fifth child in her arms. “My husband supported me in everything. It was he who encouraged me to have surgery. “He’s my rock.” Since her operation, she has become something of an activist, encouraging other women to seek treatment for their fistulas. “I ask you not to give up,” he says. “I tell them it can be treated and it’s not a life sentence.”
Naciima Saed Salah is a journalist at Bilan Media, Somalia’s first media outlet written by women and for women, founded by the United Nations Development Program (UNDP) and based at the Dalsan Media Group offices in Mogadishu.
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