Fatima Ali Hussein was in labour for almost a week before she gave birth to her seventh child. She needed specialist medical care but there was none available where she lives in Waqle IDP camp on the outskirts of Mogadishu.
The reason she needed extra care is because she is suffering from a fistula caused during the birth of her previous children.
A fistula is a hole between the birth canal and the bladder and/ or the rectum, often caused by prolonged labour. It is prevalent in communities where FGM is practiced because it is difficult to push babies out when vaginas have been sewn up.
Fistulas leave women leaking urine, faeces or both and can lead to chronic medical problems, depression and social isolation. They are widespread in Somalia where 98 to 99 percent of women have undergone FGM. Fistulas can be repaired by specially trained surgeons but far more are needed to meet demand.
“I was in severe pain during my long labour,” says Fatima who arrived at the IDP camp four months ago after drought and conflict forced her to flee with her family from her home in rural Lower Shabelle.
“I didn’t expect childbirth to be so difficult,” she says. “I thought it would be normal as I have already given birth to six other children.”
Fatima did not have the money to pay for specialist medical care or even for transport to reach a health centre.
“My ex-husband is a rural man. He does not have the skills to make a life in the city,” says Fatima. She cannot work because she has seven children to care for and chronic health problems caused by her fistula.
Fatima would dearly love to find a specialist surgeon to repair her fistula. Her condition prevents her from leading a normal life and has led to social isolation as she is shunned by others in the camp.
“People tell me I should stay at home because I can’t control my urine flow,” she says.
“My husband divorced me because of my fistula. I am incontinent. Urine and faeces leak from my body. Now I have to try to fend for myself and my children. I used to work but my current health condition prevents me from doing so.”
Most of Waqle’s residents lived as nomads or settled farmers before they fled to the camp. The women have little or no knowledge of fistulas or other medical problems arising from childbirth. As there are no health workers in the camp, there is no awareness about fistulas or treatment available for women who have them.
“Displaced women are not aware that they can get free health care at some maternity clinics in the city,” says Dr Amina Hussein who works at Banadir Maternity and Children’s Hospital in Mogadishu. “This exposes them to dangerous conditions during labour including fistulas and bleeding which can lead to death.”
Dr Hussein says some women with fistulas are operated on but that there is such a severe lack of equipment and trained medical personnel in Somalia that most have no chance of ever receiving treatment, especially those displaced from rural areas.
Another camp resident, Batulo Mohamed, will soon deliver her baby. She is terrified.
“There is no health centre here. When I lived in the countryside, traditional midwives helped us through childbirth. I have witnessed women dying in this camp as a result of bleeding during labour.”
“I hear there are places where we can deliver babies for free but they are far from here. We can’t even afford the bus fares to get there.”
A traditional midwife, Salado Aden Nur, sometimes volunteers in Waqle camp although she lacks medical equipment and has no idea how to assist women with fistulas during childbirth.
“I use a knife and a piece of string to cut and tie the baby’s umbilical cord, she says. Sometimes I use the knife to cut open the vaginal area, which has been sewn up during FGM, to allow the baby to pass through. The knife is all I have.”
The midwife says many women in the camp have died during childbirth. Mothers die from bleeding and other complications arising from fistula. Babies die from lack of oxygen.
“Fistulas are common in this camp because there are no doctors here,” she says. “Only God is here to help.”
By Naciima Saed Salah, Mogadishu