Obstetric Fistula: Africa’s silent epidemic

While all women of reproductive age are vulnerable to suffer fistula, the underage girls who are victims of child marriages, female genital mutilation and teenage pregnancies are at highest risk.

Obstetric Fistula is a silent epidemic in Africa. It’s a hole in the birth canal caused by prolonged, obstructed labour due to lack of timely and adequate medical care. As a result of this, in most cases, the baby is stillborn or dies within the first week of life, and the woman suffers a devastating injury, which leaves her incontinent. While all women of reproductive age are vulnerable to suffer fistula, the underage girls who are victims of child marriages, female genital mutilation and teenage pregnancies are at highest risk.

It’s a deeply unpleasant condition, resulting in constant leakage of urine and feaces through the vagina. Naana Otoo-Oyortey from the diaspora charity FORWARD tells me: “It’s a health issue that’s exacerbated by social factors. Many of these girls will be excluded from community life and abandoned by their husbands and families, isolating them socially and economically.”.

Another diaspora charity, MIFUMI, sent me a number of case studies. Justus Osuku, a peasant from Gweri in Soroti district, married his wife when they were both 14, during the infamous Teso insurgency in the 1990s. They were living in the Internally Displaced Peoples Camps in Soroti when his wife developed the problem. He resisted the social pressure to send her away: “I loved her. I married her when she was normal. I did not see the reason to send her away at a time when she needed me most.”

He is unusual: the overwhelming majority of husbands send their wives away, citing reasons ranging from the unbearable smell to community stigma. FORWARD is conducting research in Sierra Leone to explore the impact on the lives of women and girls who are blighted by it. The research involves 45 women affected by fistula and their recommendations will inform policy and decision makers in Sierra Leone and beyond.

One of those women, Jamma, was 18 when she got pregnant. When the labour started, she went to the local health centre but the nurse was away so she had to wait for three days. She finally gave to a stillborn baby and developed fistula. She suffered from it for two years until her friend told her about the treatment in the town. Her friend paid for her transport but the journey was very difficult. Nobody wanted to sit with her because of the smell. She was abandoned, first by her husband and then her grandmother.

On 23 May this year the UN celebrated the first International Day to End Obstetric Fistula. There is a lack of evidence as to how many women worldwide are living with the condition, but they live mainly in Sub Saharan Africa and Asia, and number in the hundreds of thousands. In Uganda there are at least 200,000 such women and 1,900 new cases are reported annually, according the National Obstetric Fistula Strategy.

“It’s a poor person’s illness,” Evelyn Schiller of MIFUMI tells me. “The issue of transport in rural Africa makes it difficult - there are very few cars in these areas. Surgeries can be lacking basic equipment like surgical gloves, clamps and oxygen. It usually takes three or four surgeries to correct it because it’s a complex repair process. We need to improve health education and antenatal care, train doctors to repair them, and above all raise awareness.” 

Mother and son walk together near the Ethiopia-Somalia border. Photograph: Getty Images

Alan White's work has appeared in the Observer, Times, Private Eye, The National and the TLS. As John Heale, he is the author of One Blood: Inside Britain's Gang Culture.

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Shimon Peres dies: President Obama leads tributes to Israel's former president and Nobel Peace Prize winner

World leaders rushed to pay tribute to the former Israeli president and Nobel Peace Prize winner. 

Shimon Peres, the former Israeli prime minister, president and Nobel Prize winner has died aged 93.

Peres, who served as prime minister twice and later became Israel's ninth president, suffered a stroke two weeks ago and has been seriously ill at a hospital near Tel Aviv since. His condition had improved before a sudden deterioration on Tuesday led to his death.

He won the Nobel Peace Prize in 1994 for his role negotiating the Oslo Peace Accords a year earlier, which talked of an independent Palestinian state. 

His son Chemi led the tributes to his father — praising his seven decades of public service and describing him as "one of the founding fathers of the state of Israel" who "worked tirelessly" for it.

World leaders rushed to honour his memory with President Obama calling him "the essence of Israel itself".

"Perhaps because he had seen Israel surmount overwhelming odds, Shimon never gave up on the possibility of peace between Israelis, Palestinians and Israel's neighbours," Obama wrote.

Britain’s chief rabbi Rabbi Ephraim Mirvis bid farewell in an emotional statement: "There will be countless tributes to Shimon Peres over the coming days, but I fear that few, if any, will adequately capture the palpable sense of collective grief felt across the world, nor do justice to the memory of a true giant amongst men," he said.

"It is true that Shimon Peres was a great statesman. He was the noblest of soldiers, a born leader, a uniquely talented diplomat, an inspiring speaker and a relentless campaigner."

The former US president Bill Clinton called Peres a "genius with a big heart" and said he would never forget “how happy” Peres was in 1993 when the Oslo Accords were signed on the White House lawn. 

"The Middle East has lost a fervent advocate for peace and reconciliation and for a future where all the children of Abraham build a better tomorrow together," he said.

"And Hillary and I have lost a true and treasured friend.”

Peres’s former political opponent, Prime Minister Benjamin Netanyahu, said in his statement: “Along with all the citizens of Israel, the entire Jewish people and many others around the world, I bow my head in memory of our beloved Shimon Peres, who was treasured by the nation.”

UN Secretary-General Ban Ki-moon said that "even in the most difficult hours, he remained an optimist about the prospects for reconciliation and peace".

French president Francois Hollande said "Israel has lost one of its most illustrious statesmen, and peace has lost one of its most ardent defenders"

Canadian PM Justin Trudeau, Australian PM Malcolm Turnbull and Indian PM Narendra Modi have also paid tribute.

Among the world leaders expected to attend his funeral in Jerusalem on Friday are President Obama, Prince Charles and Pope Francis.