The London clinic fighting back against female genital mutilation

Natasha Tsangarides visits the West London African Women's Community Centre, which carries out "reversal" surgery for FGM survivors and campaigns for stronger protection for women.

Maryam* has just come out of surgery at the West London African Women’s Community Clinic. The 24-year-old Londoner was a victim of female genital mutilation (FGM) in her home country, Somalia.

The West London clinic offers a vital service for FGM survivors. Maryam has just had “reversal” surgery, a procedure to open up the vagina, which had been sewn up during FGM. “It’s amazing, I didn’t realize I wouldn’t feel pain,” she said. “My legs were shaking from fear but I didn’t feel a thing.”

Maryam was 10-years-old when she was “cut” in Somalia. “I remember the day,” she recalled. “My mum sent me to the shop to get a needle and thread. I knew what was going on. The old lady had already done it to girls on my street that day. I felt ashamed if I didn’t do it.

“Recently I got married. I suffered with sex. There’s no reason for my vagina to be closed. My husband is Somali so he expected I would be cut. When my husband realised I was closed though, he was disappointed. He said, ‘You’d better open this up’. He’s going to be happy now.”

The West London African Women’s Community Clinic, based at Charing Cross hospital, runs an FGM service every Wednesday afternoon. The clinic is a pioneering centre set up in 2010 to deliver services for women suffering the consequences of FGM. Treating women mostly from the Somali community, the clinic is breaking the taboo surrounding the procedure.

This November, several campaigns have been launched nationally in order to raise awareness and eliminate the practice of FGM in the UK. What is the scale of the problem and who is affected by it? What are the health consequences for victims of FGM? With the practice happening behind closed doors, can it really be eliminated in the UK?

FGM involves cutting female genital organs for non-medical reasons. In the UK, over 20,000 girls are at risk and 66,000 women are living with the consequences of FGM, according to a  study carried out by the anti-FGM charity, Forward.

A cultural practice, FGM developed to preserve women’s virginity and control sexuality. It is prevalent in 28 countries in Africa and in parts of Asia and the Middle East. 

97% of women in Somalia undergo the horrific procedure, typically between the ages of 5 and 9 years old, according to a 2007 study by the London School of Hygiene and Tropical Medicine. The study estimated that 15,272 Somali women aged between 15 and 49 are living with FGM in England and Wales.

Somalis comprise one of the largest ethnic groups in Hammersmith and Fulham. The 2011 census shows that 45% of the population in White City is foreign-born. The majority (636 people) come from Somalia, of which just over half are women.

With the practice so ingrained in Somali culture, migration to the UK has not stamped it out. Some second-generation girls born in the UK are being sent back to their parent’s countries of origin or, probably less commonly, having the procedure done here.

Freedom of Information requests submitted by the Evening Standard show that 2,115 FGM patients were seen at London hospitals between 2010 and summer this year.

The West London African Women’s Service provides gynaecology, maternity and sexual health care for women who have undergone FGM. It is delivered at two sites: at Chelsea and Westminster Hospital as well as the community clinic at the West London Centre for Sexual Health, Charing Cross Hospital. Between June 2011 and August 2013, 662 women with FGM have accessed the service, of whom 432 attended the community clinic.

The impact of the service has not gone unnoticed. In 2012, it won two all-party parliamentary maternity awards for most marked improvement in a service to address health inequalities and the best example of a service to address complex needs, and this year it also won the accolade of ‘Adult Sexual Health Service of the Year’ by the UK Sexual Health Awards.

Sagal Osman, an anti-FGM campaigner from White City, helps local West London women access the clinic. Originally from Somalia and a survivor of FGM, Sagal developed relationships with practitioners at Charing Cross hospital and secured regular clinics for FGM patients at the West London African Women’s Community Clinic. 

Sagal said: “At the moment I have five new patients every week and I have a waiting list of about 50 people. Most patients are Somalis. It’s probably the hardest community to reach. But over the years trust has been built.”

Women come to the clinic for a variety of reasons, typically stemming from the long-term consequences associated with FGM. These include recurrent urinary infections, painful scarring, severe menstrual cramps, wound infections, fertility problems, complications in pregnancy and even renal impairment or failure.

Dr Naomi Low-Beer, Consultant Gynaecologist at Chelsea and Westminster Hospital, and lead doctor for the FGM service at the West London clinic, performs the invaluable reversal surgery. She explained: “With the most severe type of FGM, the clitoris and labia have been totally removed, the vaginal opening closed, with a tiny passage left for urine and menstrual blood. This makes sex painful or impossible.

“Women with this type of FGM do benefit from surgery. It is often referred to as ‘reversal’, but rather than reversing the FGM the surgery opens the vagina so that women can have sex without pain. Otherwise, it can take months and months of painful attempts at penetration.  A number of women come in to have the surgery pre-marriage or before their first relationship, and others come because they are suffering from repeated urine and vaginal infections or very painful periods. The surgery can help women with these problems too. It can be safely performed under local anaesthetic in the outpatient clinic. In offering this service, you feel like you’re making a difference.”

Naomi works closely with an all-female team of committed specialists, including an obstetrician, FGM specialist midwife, doctors specialising in HIV and Sexual Health, and of course Sagal Osman, anti-FGM campaigner and health advocate. Between them they provide comprehensive specialist care for women with FGM. Between June 2011 and August 2013, of the 662 women attending the West London African Women’s Service 69 women had de-infibulations, otherwise known as reversal surgery, of whom 37 had this performed at the West London clinic.

Alia*, draped head-to-foot in black, sits nervously in the clinic’s waiting room. Having had reversal surgery four weeks ago, she is at the clinic to treat syphilis and Hepatitis B, infections commonly attributed to dirty tools used during FGM. Despite having the infections, Alia is optimistic following the successful surgery. She says, “I feel better and I feel like my life has changed.”

Tending to the needs of women suffering the after-effects of FGM is only one part of the problem. Preventing it from happening is something campaigners, frontline workers and the government have been battling with for almost thirty years. 

In July this year, Hammersmith and Fulham Council passed a special motion that proposes to raise awareness and end all forms of FGM in the borough. Councillor Helen Binmore said: “We have just set up a strategic board and hope that our coordinated multi-agency approach will help improve how agencies, services and professionals respond to this issue and offer protection to women and girls from FGM.”

Efua Dorkenoo OBE is Advocacy Director at Equality Now, an international human rights organisation.  She said: “Parents know about the health consequences but it still goes on. Parents need to know that professionals are keeping an eye on their children and that they will report FGM happening and that there can be prosecutions.”

FGM has been a criminal offence since 1985 and the 2003 Female Genital Mutilation Act made it illegal for British citizens and permanent residents to practice FGM within and outside the UK. To date, there have been no prosecutions. By comparison, France has convicted around 100 parents and practitioners.

Misplaced cultural sensitivities, a failure to see FGM as a child protection issue and a lack of accountability have so far impeded successful prosecutions taking place, Mrs Dorkenoo said. “The issue needs to be brought into the mainstream as a child abuse issue through a combination of education, protection and prosecutions.” 

Momentum is growing in the campaign to raise awareness and eliminate FGM with the government making it a national priority.  Last month, the London Metropolitan Police have, for the first time, arrested two people suspected of performing FGM on a five-week old girl. The case is under investigation and a  successful prosecution would be a landmark victory and an important step to achieving the goal of eliminating FGM.

On a local level, change is happening. Sagal Osman is optimistic. “Women suffer pain and now have a place to go. People have more trust in sexual health. Women are opening their eyes and their lives are changing.”

*Some names have been changed 

A woman walks past an anti-FGM campaign banner in Nairobi, Kenya. Photo: Getty.
Photo: Getty
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In the chaos of the Middle East, the world must stand behind the Kurds

The Kurdish people have shown themselves to be a small beacon of light in a sea of darkness.

It is one year since the lifting of the Siege of Kobanî. Many of us can recall harrowing images of the black flags of Isis flying threateningly from the surrounding hills, of car bombs being driven into the city’s defences, and of heroic citizens defending their houses and families from the despotic invaders intent on killing them. The Siege of Kobanî was the Stalingrad of the Syrian civil war – a true turning point in the battle against Isis.

Since then, we have seen a significant escalation in the involvement of the international community in Syria and Iraq. But to what end? Syria remains divided between various competing forces; Iraq is a half-governed country with declining influence over its populace. Foreign governments play power games across international boundaries which have long-since ceased to be relevant, least of all to those wishing to establish an Islamist caliphate.

Beheadings, suicide bombings, barrel bombs, religious extremism, violent intolerance, mass movements of people – these are just a few terms most associated with the Middle East today. To say the region is complex is an understatement bordering on ignorance.

In a recent PBS documentary, Inside Assad’s Syria, a television crew was sent to Damascus to cover its sectarian, religious and ideological divides. It showed us two halves to the city: one which lives in liberty and security; and another which resides in barrel-bombed apartment blocks and streets overrun with groups opposed to Bashar al-Assad.

In the southwest of Syria, pro-democratic force control pockets of land and fight Assad’s forces. In the northwest, Hezbollah works with Assad’s army to fight Islamist groups. Further north are areas ruled by groups with affiliations to Al Qaeda, such as the powerful al-Nusra Front. In the east, highways and cities have fallen to the apocalyptic regime of Isis, which stretches far across the old border into Iraq. What future does the Middle East have with such contrasting ideological and religious divides? It is near-impossible to offer a positive view for the future.

Resolving these issues will only be achieved in the long term and through a combination of local agreements (and perhaps the portioning of areas) of international oversight. In the short term, what can we do as citizens of a country with vested interests but limited power?

One of the problems of Western coverage and commentary is that we rarely view the Middle East in any way except through the prism of war. Debate is focused narrowly on the issues of intervention, extremism and migration. People are commonly talked about in derogatory terms with most mistakenly referred to as migrants, when many are fleeing from death and destruction.

These are people who, like us, desire to live in peace and security. They want to raise families and contribute to their communities. Although there are theological differences between Shias, Sunnis, Kurds, Christians, Jews and various minorities, for centuries these groups have lived alongside each other with general tolerance and respect. Churches have existed in the same cities as mosques. Yet the internecine conflicts have ruined the multiculturalism balances in Syria and Iraq. Communities have been divided against each other, sometimes on pain of death. The region is overrun with regressive forces.

Here in the UK, our view of foreign policy is shaped by the forming of alliances with progressive forces – that is those countries, governments and parties committed to values similar to our own. With the conflicts in Syria and Iraq as they are, dominated by regressive forces, our foreign policy is in disrepute. Who should we support in Syria? How can we continue to support Iraq’s army if it is being led on the ground by Iranian generals?

There is one force within the region that is progressive. They share our commitment to democracy, the rule of law and liberty. They have cohesive, well-led armed forces which not only protect their peoples, but also others in fear of persecution. Their women fight alongside their men, often in leadership positions. They have been the bulwark against Isis advances in both Iraq and Syria. They liberated Kobanî from oppression in tandem with US forces.

The Kurdish fighters of the People’s Protection Units (YPG) in Syria and the Peshmerga in Iraq have proved their strength and longevity in the face of enormous challenges. Lacking the weaponry appropriated by Isis, they have fought bravely and slowly liberated areas from tyranny. In doing so, they have treated non-Kurdish citizens well and protected them as they would wish to be protected by others. They have put their lives on the line for the common good, such as the taking of towns and cities outside of Kurdish areas. In doing so, they have refrained from declaring an expansion of Kurdish territory, instead stating that such lands will be handed over to local progressive groups when it is ready to do so.

Perversely, Western governments depend on Peshmerga and YPG forces to fight without adequately arming them. In Turkey, the same Kurdish citizens who would fight for the YPG against Isis are prosecuted and sometimes killed during clashes for protesting in favour of devolution. Turkey’s Kurdish populations in towns like Sur, Cizre, Nusaybin and many others are living under curfew. Yet we do nothing to raise this an issue.

Yet is it the Kurdish people that will be the first army to defeat the ideology of Isis. And because of this they are the biggest target. Their men and women are free. They live in lands governed by democracy, social justice and equality. They hold values in direct opposition to Isis but living in cities just miles apart. The Kurds are the only progressive force in the region which shares our values, has a commitment to democracy and has armies strong enough to protect its peoples.

If we believe in supporting those who share our values, we must show them our solidarity. Our support must go to Kurds as a whole not just those who fight for our interests, because the challenges Kurds face go beyond the borders set by the UK and France in 1920. These borders have been disregarded not only by Isis and al-Qaeda but also by Turkey, Iran, Saudi Arabia and Qatar, which have each ignored international boundaries in pursuit of their interests.

It is fair to say that this simple notion of solidarity leads us to certain complications. Kurdistan is an ancient region divided up by imperial powers between Turkey, Syria, Iraq and Iran. How do we support the Kurds without alienating our allies in Ankara and Baghdad?

During the 1991 Gulf War, the US, UK and France established a no-fly zone over Iraqi Kurdistan to protect Kurds from Saddam Hussein’s air force. A year later, the first free and fair elections were held in Kurdistan. It was also the first such election in the whole of Iraq. A decade on, whatever the merits of the conflict, the Peshmerga were allies of the Coalition during the 2003 invasion of Iraq. Since then, Kurdistan has remained steadfast in its commitment to a democratic future.

In Iraq, there is already a functioning Kurdish state in all but name. It is a pioneering force for democracy in the Middle East. In Iraqi Kurdistan there is a core set of values based on tolerance, respect and freedom of expression. Inclusiveness is enshrined in law. Women are recognised as equal citizens, with a law requiring that a minimum of 30 per cent of National Assembly seats must be taken by women. Furthermore, seats are also reserved for minority communities, with the Christian and Turkmen communities guaranteed at least five seats each. These values mirror our values.

We should adequately arm the Kurdish forces of the YPG and Peshmerga to adequately protect their lands. We must do whatever it takes to ensure Isis is restricted from further post-liberation resurgences, as was seen in the Kobanî region following the redeployment of Kurdish forces to Iraq. Over 350 were killed or injured in that resurgence, simply because YPG and Peshmerga forces are overstretched.

We should also seriously consider supporting Iraqi Kurdistan in its long-term ambition to be an independent state – when the time is right. No other people deserves it as do the Kurds. It is the largest homogenous nation on earth not represented by a unified state. They have a right to determine their own future. True, there are major issues to contend with – most notably corruption, political infighting and the continued presidency of Masoud Barzani beyond his legal mandate – however these issues can be overcome with the close help and guidance of the international community.

Outside of Kurdish controlled-areas lie lands ridden with conflict. We have seen our fellow citizens, friends and trading partners have their lives ruined by the twisted and hate-filled soldiers of Isis. In Syria, close to Kurdish cities, pro-democratic forces have been wiped out by Isis or other Islamist groups linked to Al-Qaeda. The rest of Syria is pock-marked with the barrel bombs dropped by Assad’s forces. Even within Kurdish-controlled areas, bombs have been dropped from Turkish planes on Kurdish YPG soldiers fighting for values which we would call our own. The region is highly complex and constantly changing.

Turkey is therefore a key player. Yet in recent years President Erdogan’s administration has escalated the conflict with the Kurdish citizens it represents. Peace talks between Abdullah Ocalan, the leader of the Kurdistan Workers Party (PKK), the People’s Democratic Party (HDP) and the Turkish government ended unsuccessfully in 2015. Erdogan appears determined to militarily crush the PKK before any negotiations around a lasting peace can recommence.

Turkey has refused to recognise either the YPG or the PYD – the main political party of Kurds in Syria – as a legitimate force on the ground, due to its concerns that any Kurdish autonomy in Syria may motivate Kurds in Turkey to demand similar rights. Before the Syrian civil war there were thought to be between 16-20 million Kurds resident in Turkey, in contrast to just two million in Syria.

For Erdogan, this issue is of greater importance than what is occurring in Syria and Iraq. During the Siege of Kobanî, Ankara refused Kurdish YPG fighters the right to travel across the border into Kobanî to fight Isis forces. Rather than allow them to protect their families and friends, Turkey sprayed them with tear gas and removed their weapons. Significant international pressure belatedly led to Ankara allowing Peshmerga Forces to travel from Iraqi Kurdistan and enter Kobanî through Turkey – and just in time to save the city from Isis. In the interim period, Isis recruits routinely crossed over the border with ease.

The Erdogan administration’s conflict with its own Kurdish citizens is undoubtedly complex. Many Kurds in Turkey want some level of recognition and autonomy but it is not known how many desire outright independence. A free and fair poll has never been carried out and would not be tolerated by Ankara. President Erdogan prefers to suppress opinion rather than encourage it. Where is our solidarity for people demanding human rights?

While Turkey’s air forces have been bombing the Kurdish-controlled Kandil mountainous areas in Iraq, often missing Kurdish forces, Ankara has remained a strong ally of the government in Iraqi Kurdistan, which it sees as a correcting force against the regional influences of Riyadh and Tehran. However, Ankara fears an independent Kurdistan and the effects this may have on the Kurdish populations of Turkey and Syria. Ankara fears the establishment of a Greater Kurdistan, an option which is not on the table and most Kurds do not think is achievable.

Each of these issues is interconnected. Though Kurds in Iraq may carry different passports to those in Syria and Turkey, they similarly identify as Kurdish peoples. They share a culture, a religion and a language. The challenges faced by Kurds in Syria are of utmost concern to Kurds in neighbouring countries. There is a fraternity that must not be dismissed.

The Kurdish question in Turkey is obviously complicated. Turkey remains a critical member for the NATO alliance with its landing strips used to carry out bombing raids on Isis. Therefore, keeping Ankara on side is important to Washington. This is why we in the West have been relatively silent on the Kurdish issue. Meanwhile, the international and national boundaries of Iraq and Syria are now so distorted to be almost beyond repair. Kurds control areas beyond that of Kurdistan, with no other force strong enough to protect people in those areas. In our determination not to ‘put boots on the ground’, we ask Peshmerga and YPG forces to do the heavy lifting and endure the casualties of a conflict we in part caused. This is unfair to the Kurdish people.

We must encourage Turkey to end the Kurdish conflict within its borders. Ankara must resume peace talks with Abdullah Ocalan and the HDP – now the third biggest group in the grand assembly of Turkey. Ankara should accept that the Kurdish question cannot be resolved by militarily means. The overarching issues of inequality, equal citizenship and minority rights are beyond the control of even the strongest of strongmen.

The UK can help resolve the Kurdish question. We have long been a supporter of Turkey’s aspiration to become an EU member. We should agree to accelerate that process in return for allowing the EU to broker a peace. We have a duty to the citizens of any state which harbours ambition to join us. We have a duty to protect people’s human rights.

At the same time, we should support the Peshmerga and YPG as they fight a common foe. Defeating Isis forces in Iraq and Syria would reduce the Islamists’ ability to train home-grown jihadists and send them back to European cities. We should support them with weapons and finances in return for guarantees over human rights and post-conflict governance of the areas they retake from Isis.

The Kurdish people have shown themselves to be a small beacon of light in a sea of darkness. If we believe in the values of democracy, tolerance and freedom of expression – we must support those peoples that practice them. There are small steps we can take to show them our solidarity. We must do what we can to support them.

Ibrahim Dogus is the Director of the Centre for Turkey Studies (www.ceftus.org) and the Director of the Centre for Kurdish Progress (www.kurdishprogress.org).