Thousands of women in Nigeria and Somalia are living with obstetric fistula, a preventable childbirth injury, amid poverty, weak health systems, insecurity, and limited access to emergency maternal care, Médecins Sans Frontières (MSF) said Friday.
The condition occurs when prolonged obstructed labour damages tissue between the birth canal and bladder or rectum, causing continuous leakage of urine or stool. In about 90% of cases, the baby does not survive.
From northern Nigeria to southwestern Somalia, women who survived difficult labours are left with chronic pain, incontinence, stigma, and social isolation. Many endured days of labour without access to caesarean sections or skilled care.
At Jahun General Hospital in northern Nigeria and Bay Regional Hospital in Somalia, MSF teams and local health authorities provide reconstructive surgery and rehabilitation for women affected.
Aisha, a young woman from Yobe State, arrived at Jahun emotionally broken after losing her baby and sustaining severe internal injuries. Hodan, a Somali woman married as a teenager, lived eight years in silence after a prolonged first labour left her with fistula.
“I did not know there was treatment,” Hodan said after reaching the fistula unit in Baidoa.
Medical experts link the condition to child marriage, teenage pregnancy, malnutrition, female genital mutilation, and the collapse of emergency obstetric services. Insecurity, displacement, poor transport, and overstretched health systems worsen the problem, forcing many women to deliver at home or in poorly equipped facilities.
“Most of the women who reach us have already given birth somewhere else or tried to, often at home, and often after several days of labour,” said Dr. Raphael Kananga. “By the time they arrive, they have already sustained an injury, often with additional infections and complications. Surgical repair is possible, but this should have been prevented.”
*Treatment capacity vs. need*
Jahun General Hospital’s 55-bed fistula ward has been a lifeline since 2008, with over 6,000 reconstructive surgeries performed. In 2025, 295 women were admitted and 224 had surgery. Between January and March 2026, 64 were admitted and 48 treated.
Care includes free surgery, physiotherapy, counselling, nutrition support, and rehabilitation, with stays up to three months. Aisha, who has had two surgeries and awaits a third, said meeting other survivors gave her hope.
“It first, I thought I would never be cured. Then I came here and saw other women with the same condition. I realised I was not alone.”
Somalia’s fistula unit at Bay Regional Hospital opened in 2025 with support from MSF and the Ministry of Health. It has treated 38 women so far, though thousands more are estimated to need care nationwide.
“Fistula care is not only about surgery,” said Frida Athanassiadis. “It is about listening, counselling, and helping women rebuild their confidence.”
*Calls for prevention and investment*
Healthcare workers say demand far exceeds capacity. Jahun is the only facility in Jigawa State performing vesicovaginal fistula surgery. Bay Regional Hospital is the only specialised centre in Somalia’s Southwest State.
MSF and health officials are calling for urgent investment in maternal and newborn care: skilled birth attendance, emergency obstetric services, and expanded treatment programmes.
Experts say fistula is preventable through antenatal care, trained midwives, timely referrals, and caesarean sections before prolonged labour causes permanent damage.
For survivors like Aisha and Hodan, recovery is about more than physical healing. It’s about reclaiming dignity after years of pain, silence, and exclusion.
