Halimo Aden Abdalla, 27, was abandoned by her husband and left alone to care for seven children in a desolate camp for displaced people on the outskirts of Mogadishu, the Somali capital. “She divorced me because she developed a fistula during the delivery of my baby, which was long and difficult,” she explains. “As soon as she realized that she couldn’t control her urine anymore, she told me, ‘I’m going to divorce you and leave.’ Since that day, she has not contacted me again and she has not given me money or help for our children. Before we survived with the daily euro that she 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 has been almost completely sewn up.
Fistulas cause women to leak urine or stool, and can lead to chronic medical problems, as well as depression and social isolation. They are widespread in Somalia, where about 98% of women between 15 and 49 years old have been victims of FGM, according to the World Health Organization (WHO). Most girls are circumcised between the ages of five and 11 and subjected to the most severe form of FGM, known as type III infibulation, in which the vaginal opening is narrowed by cutting and sewing the labia, and the labia is often removed. clitoris.
About 98% of women in Somalia have been 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, which have few resources and are affected by decades of conflict, drought and other problems. In this East African country, the taboo associated with this disease is such that women are often ashamed 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 difficult journey to Mogadishu after their village in southern Somalia was devastated. hit by airstrikes and heavy fighting following a new government ground offensive against the Islamist militant group Al Shabab, which has controlled much of Somalia for the past 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. She broke the wall of her birth canal, probably because the birth lasted several days and she was assisted by an elderly woman who lacked medical supplies and had little experience in attending births.
In Mogadishu there are 147 health centers funded by the Ministry of Health and donor organizations that offer free maternity and child care services. However, they are located far from the camps, located 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 control her tears as she explains how the other residents of the camp reject and insult her for being a single mother and suffering from a fistula. “People walk past my house and shout that it stinks of urine. I had to build this shelter by myself out of sticks, old clothes and plastic bags after the better quality home 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 impure mother,” she laments.
There are diapers for people with fistulas, but they cost 50 euro cents, and I can’t afford them.
Halimo Aden Abdalla, 27 years old
“There are diapers for people with fistulas, but they cost 50 euro cents, and I can’t afford them,” explains Abdalla. “When I go out to look for work to earn money and be able to 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 that a relative prepares for them and leaves at the door of her shelter. She cannot walk the two kilometers to the nearest source and she depends on the kindness of the man who runs the camp to bring her water.
Thanks to a fistula awareness campaign carried out by Doctors on all continents (PAC) in collaboration with the Ministry of Health of Somalia and the Daynile Hospital in Mogadishu, not all women with fistula 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 abandon after her birth canal ruptured during childbirth.
The young women arrive at the hospital on the verge of death due to injuries suffered in the vagina by the intervention of untrained midwives
Ahmed Artan Yalahow, gynecologist and surgeon at Daynile Hospital (Somalia)
One of the hospital’s specialist surgeons is gynecologist Ahmed Artan Yalahow. He wants to convince the Ministry of Health to train and equip traditional midwives so they know how to reduce the risk of women undergoing FGM dying or developing fistulas or other complications during childbirth. “The young women arrive at the hospital on the verge of death due to injuries suffered in the vagina by the intervention of untrained midwives,” he points out.
Relatively simple procedures, such as performing surgery before delivery to widen the vaginal opening, or cutting the perineum while the woman is giving birth, help reduce the risks of circumcised women developing fistulas during childbirth.
Yalahow says that a consequence of fistulas that is more difficult to treat is their 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 experiences in childbirth, and were abandoned by their husbands and stigmatized by the community,” she says.
“I’m one of the lucky ones,” says Aden while cradling her fifth child. “My husband has supported me in everything. It was he who encouraged me to have surgery. He is my rock.” Since her operation, she has become something of an activist, encouraging other women to seek treatment for her fistulas. “I ask you not to give up,” she says. “I tell them that it can be treated and that it is not a life sentence.”
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