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.
Olivia Acland
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The closure of small businesses in Calais is punishing entrepreneurial refugees like Wakil

We meet the Afghan refugee who purchased a plywood shelter, painted it with blue hearts and green flowers, and stocked it with basic supplies. The police have just destroyed his makeshift shop.

French police have returned to the Calais migrant camp, known as the “Jungle”, to continue dismantling the businesses there. Last Friday was the fourth consecutive day that they had been in the camp seizing stock from shops, restaurants and barbers.

They have arrested at least 13 proprietors and accused them of running illegal businesses without authorisation, sustaining an underground economy, and not having the required health and safety measures in place. The majority of the “Jungle” businesses have now been dismantled.

Many small enterprises have cropped up in the Calais camp over the last year, and a mud road lined with plywood shacks has been nicknamed “the high street”. Here you can find Afghan restaurants, Pakistani cafes, hairdressing salons and small convenience shops. 

The Mayor of Calais, Natacha Boucher, recently announced that the camp is to be demolished imminently, and closing down its micro-economy seems to be the first step in realising this plan.


The authorities enter the Calais camp. Photo: Juliette Lyons​

The makeshift town – which is home to more than 4,000 people – has been cowering under the threat of demolition since January, when attempts were made to bulldoze its southern stretch. Most of the people living here have come from war-torn Afghanistan, Sudan, Iraq and Syria, and a lot of them have been on the move for years. The shops and restaurants were bringing a degree of normality back to their lives.

The businesses were mainly run by refugees who had given up trying to cross the border into Britain and were seeking some stability within the makeshift world.

Wakil, the owner of a small convenience store, was one of these people. He left Afghanistan four years ago, where he worked first as a journalist, and then as lorry driver for the US military. He tells me that he misses his old life and job greatly: “I studied at university for four years in order to become a journalist, I am passionate about that work and I dream of doing it again.”

Forced out of his hometown after writing articles that criticised the Taliban, he moved to Kabul and found work as a lorry driver for the US Army. When the US pulled out of Afghanistan, Wakil deemed it too dangerous to stay and set off on a journey to Europe.

He travelled over land through Iran, Turkey, and Greece, and then made it to Italy in a flimsy boat. With very little money, he was forced to sleep rough until he managed to find work in a restaurant where the owner was willing to overlook the fact that he did not have the right papers.

He started to establish a life in northern Italy, taking classes to learn the language and renting. Then, when the restaurant changed hands and the new owner refused to employ anyone without a work permit, he was once again jobless and without prospects. 

“After this happened, I decided to go to England,” he says. “Back home I had met some English people and they told me that life is good over there.”

Wakil then travelled by bus through France, and ended up stuck in Calais. He says: “I tried to cross the border but a policeman caught me in the back of a lorry – he beat me and sprayed me with pepper spray. After that I was frightened and I stopped trying. I decided to stay here for a while, and I set up this business to give me something to do.”


A view of tents in the camp. Photo: Olivia Acland

After just ten days in the Jungle, Wakil managed to purchase a plywood shelter off another Afghan refugee for €370. Smuggling building supplies into the camp had become very difficult, so “property prices” within the micro-economy were on the rise.

He painted the shack with blue hearts and green flowers, and stencilled the words “Jungle Shop” onto the side in mauve. When his improvised store was ready, he borrowed a bicycle and headed into Calais to buy basic supplies from cheap supermarkets.

He filled the shelves with tomatoes, fizzy drinks, milk cartons and biscuits. Each time a customer came asking for something that he didn’t have, he’d note it down and incorporate it into his next shop. In this way, his business grew and although the profits were small (around €250 a month), Wakil was relieved to be busy and working again.

Wakil’s business wasn’t raided the first day that the police came in, but after watching other shops being emptied of stock and the owners being taken to prison, he became extremely anxious. On the evening of the first raid, he invited friends to his shop to eat or take away as much of his supplies as they wanted.

“I was too worried to eat,” he says. “But I knew that the police would come for my shop in the next days and I didn’t want everything I’d bought to be wasted.”

Fearing arrest, Wakil then went to hide in Calais and returned at the end of last week to find his shop empty. 

“The police took everything,” he tells me. “When I came back and saw it all gone I felt terrible. Many more of my friends had also disappeared – I’m told they were taken to prison.”

When I express my sympathies, he replies: “Don’t worry about me; others from the Jungle are in worse situations. This has happened to many of us.”

Most of the businesses that were providing some kind of stability for displaced people like Wakil are now just empty shells. A volunteer at Care 4 Calais (a charity distributing aid in the camp) Alexandra Simmons says, “the businesses were giving independence to refugees who had lost everything. They were extremely good for people’s mental health.”

The bare shops now serve as stark reminders that it is just a matter of time before the camp is emptied of its people too.