In the most general sense, a fistula is an abnormal connection or passageway between two organs or body cavities that do not usually connect. In females, these include abnormal passages between the bladder and the vagina and between the rectum and the vagina. In most countries in Africa, fistulas are typically the result of difficult childbirth—or sexual violence, most conspicuously in the form of rape, gang rape, and the insertion of sharp objects into a girl’s or woman’s vagina or rectum. The most common form of this traumatic fistula is creation of a passage between the bladder and vagina.
The leakage and disposition to infection that result from traumatic fistulas are the source of immense, almost disabling shame; they often leave the victim with an extreme physical limitation of movement.
The U.S.Agency for International Development (USAID) reports that:
“Traumatic gynecologic fistula can make up a significant part of the overall genital fistula caseload in places where sexual violence has been used as a weapon of war… Survivors are at an increased risk for unwanted pregnancy and sexually transmitted infections, including HIV. Survivors live not only with chronic incontinence, but also with the psychological trauma and stigma of rape.”
Traumatic gynecologic fistula afflicts an unknown but unforgivably high percentage of the many tens of thousands of girls and women in Darfur who have been sexually assaulted over the past 18 years.
The Girls and Women of Zamzam camp for Internally Displaced Persons (IDPs)
Surgical treatment of traumatic gynecologic fistula in Darfur is urgently needed by a tremendous number of women, although again, no census is possible. The evidence from among girls and women from Zamzam camp (near El Fasher, capital of North Darfur) shows that many women do all they can to conceal their medical issue; however, with the incentive of possible reparative surgery, they will come forward. A number have already done so, speaking with the Team Zamzam counselors and each other (they have already sent a group photo).
Fistula surgery in the El Fasher clinic can cost as much as $400, and for each patient our assumption is that the full amount will be required, and that the surgery patient will need considerable assistance, both before and after the surgery. We have had our first success, and hope to find the resources to assist the many more women who desperately want this life-changing treatment.