‘No doctor in the country will touch you’: how the NHS is failing FGM survivors
IIn May 2023, Shamsa Araweelo was in the emergency room of a London hospital in excruciating pain. It was not the first time that she sought urgent treatment for the gynecological damage caused by the female genital mutilation (FGM) or circumcision imposed on her as a six-year-old. In fact, this was one of many emergency room visits Araweelo had made in her desperate attempt to find a surgeon who could help reverse the damage done to her as a child and which had caused her so much pain and suffering as an adult. trauma has caused. .
Araweelo says she was told in the emergency room that she had severe nerve damage and that it could be reversed through reconstructive surgery. But not in Britain.
“No doctor in the country will touch you because you are an FGM survivor,” Araweelo says she was told. “I felt no compassion, no respect. It wasn't until I got to London that they told me they wished they had had the right training to help me, and it breaks my heart. We are not appreciated in Britain.”
There are thousands of FGM survivors like Araweelo across the country. The data from the Ministry of the Interior were published in 2011 an estimated 137,000 people lived there with FGM in England and Wales, but with more than 5,800 survivors re-identified by the NHS between April 2022 and March 2023, the figures could be much higher.
Current NHS rules are listed that if a doctor suspects a patient has been cut, he or she should report the matter to the police and carry out a risk assessment to determine whether a referral to social care is necessary. The GP guidelines also recommend referrals for mental health problems related to FGM or referrals to uro-gynaecology specialist clinics.
In 2014, the government and NHS England launched a £1.4 million prevention program to educate healthcare professionals about this new mandatory reporting. Yet this year, almost a decade later, an independent report was carried out by the Avengers – a London-based charity fighting FGM – it turned out that two-thirds of the 670 NHS staff surveyed reported receiving no or minimal training on how to deal with survivors.
Araweelo says that in all the years she has sought help, she has never received any form of support from medical professionals.
She was only six when she was subjected to Type III FGM in a small town in Somalia. Also known as infibulation, the cutting removed both her labia and clitoris and the remaining skin was then sutured together. For years, Araweelo thought what she was exposed to as a child was an act of cleansing, but years of pain, trauma and infection have since destroyed her life.
Question and answerFemale genital mutilation: what does it mean and what are the consequences?
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Female genital mutilation (FGM) is the removal of part or all of the external genitalia for non-medical reasons, because defined by the World Health Organization.
There are different types of cutting: removing the clitoris and/or its hood; removing the clitoris and the inner fold of the vulva (labia minora); and reducing the vaginal opening by cutting and repositioning the labia minora through stitching. This is also called infibulation and has the worst health consequences. The fourth type of cutting includes other forms of injury to the genitals, such as nicking, scraping, or cauterizing.
Because traditional practitioners use razors or blades, without anesthesia, girls experience excruciating pain and are at risk of severe bleeding and infections that can lead to sepsis. Some don't survive.
For the girls, who are often married off shortly after having their genitals cut, sex is traumatic and painful, and enjoying sex will always remain difficult unless they undergo surgical reconstruction.
During pregnancy, childbirth is often risky due to obstructed and prolonged labor. Women are at risk of developing an obstetric fistula (an abnormal opening between a woman's genitals and her urinary tract or rectum), which can cause incontinence – leading to shame, stigmatization and rejection by their partners.
- Dr. Mercy Korir is a physician and health and science editor at the Kenyan Media Organization Standard group
At age 14, when she first began experiencing tearing and infections, her mother took her to a GP who examined her, identified her as a “probable” survivor of FGM and sent her home with paracetamol, but no follow-up tests or referrals to a specialist.
“I truly believe that as a teenager I was abandoned by medical professionals, by doctors who physically examined me and did nothing about it,” Araweelo says. “I didn't know there were services that could have prevented me from ripping or helped with my mental wellbeing. I don't know if they're trying to be culturally appropriate, but they choose to turn a blind eye.”
As an adult, Araweelo has spent years trying to find options for reconstructive surgery, which for her and many other FGM survivors is the only solution to the ongoing physical, emotional, reproductive and mental health problems that can have catastrophic consequences on their lives. Yet, unlike other countries in the EU, there is no provision for reconstructive surgery in Britain.
Charities, pressure groups and FGM experts say Britain is lagging far behind in offering surgical reconstruction to survivors. There are now 26 clinics in 11 different European countries offering reconstructive surgery to victims of FGM.
Many groups believe that British doctors already have the requisite skills to perform such operations on survivors, but their injuries are simply not being considered a priority.
Dr. Aurora Almadori is an NHS plastic surgeon specializing in scar treatment and innovative therapies for the treatment of vulval scars: “From a technical and surgical point of view, it is not very difficult to perform these operations. These surgical techniques are available, clitoral reconstruction and labia reconstruction are available on the NHS, in Britain, not only for gender confirmation surgery, but also for conditions such as lichen sclerosus, but not for FGM. It is discriminatory not to provide access to certain surgical techniques.”
NHS England released a report in 2015 saying this was the case not enough international evidence to support reconstructive surgery for victims of FGM in England.
An NHS spokesperson told The Guardian: “The NHS has not commissioned reconstructive surgery for FGM, based on recommendations from doctors and due to the very limited research evidence available to safely offer this procedure. The NHS is committed to supporting survivors of FGM, including setting up specialist clinics designed in partnership with survivors and advocates so they can provide a range of support to women and their families who have suffered this terrible abuse. ”
Juliet Albert, a midwife who specializes in FGM and co-leads the UK's FGM Restore project which aims to provide reconstructive surgery to survivors, says operations performed on British citizens abroad could still become a problem for the NHS if complications arise in aftercare.
“If something goes wrong it's a burden on the NHS, and if they can't afford the operation we have to deal with the psychological consequences,” says Albert. “We must challenge the current research leaders. A plastic surgeon on our project already does labia surgery, there is a gender reassignment surgeon, it's just a matter of putting them all in the same room and having the surgery done (by policy makers).”
Research in 2019 concluded that the cost to the NHS of patient care for people who have sought plastic surgery abroad is between £862 and £10,520 per patient.
“There is a lack of justice when it comes to health inequalities,” says Albert. “Women with FGM do not shout the loudest, they are often invisible. I'm sure if it had been a different group of women who wanted the operation, we would have had it by now.”
UK FGM Restore is working on this offering reconstructive surgery to survivors while also providing psychological and psychosexual support. Albert says she hopes this will convince policymakers in the NHS to establish a national center of excellence that can offer surgery as a treatment option for survivors.
Araweelo finally underwent reconstructive surgery in Germany. She has been raising money and asking for donations to help cover costs.
From her hospital bed, Araweelo says she is finally getting closure. Her voice sounds hoarse but cheerful. “I can't feel the (pain) and irritation I used to feel, I'm numb for now,” she says. “But the big difference is that I feel safe now.”