“It is child abuse, plain and simple”

Genital mutilation of girls

Many girls from countries like Sudan, Sierra Leone and Somalia are genitally mutilated at a very young age. It seems very hard to do something against this. “It is tradition and then people will say: 'it is our culture'.”

By H.S. Barre and Manja Ressler

Amal Liban (27) is a bubbly woman from Rotterdam, with a contagious smile. In her daily life she is a social worker and studying to be a probation officer. She describes herself as an emancipated woman who enjoys life to the full. That was not always the case. She tells us about her struggle to heal her physical and emotional wounds after being genitally mutilated as a young child. She speaks with ease and confidence, but her tone of voice changes when she tells us about the state of confusion she found herself in for a very long time.  

Liban was born in Djibouti, Somalia and arrived in The Netherlands when she was seven. The percentage of women who are genitally mutilated in her country of origin is the highest in the world: 98 per cent. She does not remember being mutilated: she must have been a toddler. As a young adult, she wondered what was wrong with her, she had no idea she was 'circumcised'. “I remember,” she tells us, “when I started asking my mother questions, how she responded with 'No, you are alright, nothing happened' or sometimes 'Oh, but that wasn't a bad one, they only did the sunnah on you'; and I wondered what in the world that sunnah could be.”

What is colloquially called 'sunnah', especially in the Somali community, is 'type 1 genital mutilation' in the description of the World Health Organization, and consists of partly or completely cutting away the clitoris.

Other relatives also couldn't or wouldn't explain. The subject is taboo in the Somali community. Liban: “I felt something was wrong, but I couldn't get confirmation. It does something to your mind if no one is willing to tell you what happened or even that something happened.”

The sunnah is a type of genital mutilation which is hard to discover for the untrained eye; even doctors who are not specialized find it hard to determine. Let alone a teenager who couldn't remember anything of what happened when she was very young. But Liban was determined to find out and so she talked with her girlfriends at school. “I just had to know... I remember I asked my best friend and she said, you have to look at it, I have no idea.”  

“I used Google to find pictures of vaginas and compared them to mine”

There are many women like Liban: genitally mutilated without knowing this is the case, or how bad it is. Moreover, many doctors and midwives do not recognize the physical signs of the mutilation. They also hesitate to discuss the subject, as our conversations with circumcised women show; especially family doctors appear to avoid the subject or are hardly aware of the problem.

Jolande Schoonenberg is a doctor who works for Safe at Home ('Veilig Thuis'), a hotline for domestic abuse, in the Amsterdam-Amstelland region. She confirms it can be hard to recognize traces and signs of genital mutilation. “You only want to do the physical examination once on a child,” she says, “so you want it excluded or confirmed with one hundred per cent certainty. There are light versions, which are very hard to see. Look, anyone can recognize the crude version, but if there really is something visible, the law comes in play... in that case you want a good description of the injury.”

Midwife Marina, not her real name, told us about a case in the northern part of the country, where a Somali couple visited the local health center to get vaccinated for a trip to Somalia. They told the nurse on duty bluntly they would undertake the trip to have their young daughters circumcised. “The nurse didn't take action, she only recorded it,” Marina told us. “In the big city they have experience with cases like this, but at a local health center in the middle of nowhere they think 'never mind.'”  

Worried

Liban only found out the truth when her twin sister Ayaan – they were separated as babies – eventually arrived in The Netherlands. Ayaan could remember what happened to her and shared the story of her own mutilation with her sister. She was 'cut' two years later, when Liban was already in The Netherlands. Ayaan's mutilation was very visible because she underwent infibulation – type 3 in the categorization of the WHO. In this type, not only the clitoris is removed, but also the labia minora and maiora, after which the wound is sewn up, leaving only a small opening for urine and menstrual blood.

Even as Liban understood she had been 'lucky' in comparison with her sister, she wasn't any closer to understanding what happened to her. She started looking on the internet for something that looked like her own body. “I used Google to find pictures of vaginas and compared them to mine. And I searched 'genital mutilation' to find something that looked like my clitoris.”

The two sisters looked for answers together and supported each other. Liban became increasingly worried about the serious mutilation of her sister Ayaan. “You hear about women who underwent type 3, and who died in childbirth, or who needed major surgery before they could have a child.”

***

Midwife Marina works in a working class area in a big city. She sees many women in her practice who are genitally mutilated, about sixty a month, of whom one or two are born in The Netherlands, “they are circumcised in the country of origin, sometimes in England.” The majority of these women are from Eritrea, Egypt, Somalia, and Kurdish Iraq.

It is not an easy subject to bring up. “They don't talk about it, we have to ask. I had to cut open a woman twice, just before they gave birth. The husband of one of them said I should sew it up afterwards. I told him that we don't do that, that it is illegal here. Once I asked how a woman like that gets pregnant, because the hole is so small. The man cuts it open during the wedding night and afterwards it is sewn up again or it closes up by itself.”

Liban kept struggling with questions about herself, about her womanhood, having a partner, her own body. “I was sad most of the time. It is shocking to realize your body is not like that of other women.”

And then the sisters heard about reconstructive surgery, which would restore their vaginas, including the clitoris. Together they decided to see Dr. Karim, a plastic surgeon who does reconstructive surgery on genitally mutilated women; he is the only one in The Netherlands. “Thinking about the surgery was exciting, but also scary. It was confusing, I wondered if I would really change, if it would make everything all right. Or that I would somehow always feel like this.”  

The worst had yet to come: the battle to finance the surgery. Her health insurance company refused to pay for the surgery, because 'this does not affect your life'. Liban was livid. “They pay for breast enlargements and clitoris reductions... but 'this we don't do, except if the vagina has to be opened because the baby can't come out'.”

“I had to cut open a woman twice, just before they gave birth. The husband of one of them said I should sew it up afterwards”

Reimbursement for reconstructive surgery has been a bone of contention for many years. Members of Parliament like Lilianne Ploumen (Dutch Labour) have tried time and again to get this both physically and emotionally important surgery included in the basic health insurance plan. Until today without success: a majority in parliament does not consider the matter important enough. Our first article in De Groene Amsterdammer prompted a hearing this Spring of the regular Parliamentary Committee for Justice and Security, in which the invited organizations and experts again urged including reconstructive surgery in the basic health insurance plan.

Libans surgery went better than she expected. “After six hours I was home. I healed very quickly. Dr. Karim said I had been lucky that the clitoris was only damaged in the mutilation and not completely removed. He said that the person who had performed the mutilation apparently had no idea what she was doing.”

The surgery changed her life completely. “My sexuality went from zero to hundred. I gained more confidence and became curious about what my body could do. It will never be like it was at birth, of course, but it is good enough.”

Plastic surgeon Dr. Karim fiercely opposes genital mutilation and in his opinion, doctors or other health professionals have to file a police report when they find out that a Dutch-born child has been genitally mutilated. “It is child abuse, plain and simple,” he says. “It is a no-brainer for me that you have to intervene.”

He explains what he does in reconstructive surgery. “In all types of genital mutilation, the external part of the clitoris is removed. What I do, is freeing up the part of the clitoris that lies under the skin. This is possible because the largest part of the organ is not visible, it continues inward. I remove all scar tissue, cut it loose, and bring it outside the body. That way you could experience more stimulation. I  am always tentative when I say this.”

“I am angry that children who were born here, still undergo this mutilation,” Liban says. “No one tries to reach out to them. I grew up here and I know that eighty per cent of Somali women here are mutilated. Nobody does anything about it, our family doctor never said anything, I have never seen an awareness campaign.”

***

Istahil Abdulahi (48) arrived in The Netherlands twenty-nine years ago. She was genitally mutilated in Somalia when she was six. At this very young age, she underwent the most extreme kind of genital mutilation, the 'pharaonic', type 3 according to the WHO. Her mother and grandmother held her while her clitoris was cut off, after which her labia were sewn together. She is also angry that Dutch-born children of Somali parents aren't protected more. Because she wanted to do something against it, she became a so-called 'key-person', a volunteer who raises awareness of the dangers of genital mutilation in her own community.

She was trained by the Federation of Somali Associations in The Netherlands (FSAN), an NGO which received a government subsidy of two hundred thousand euros in 2019. The concept is simple: new immigrants and refugees from countries where genital mutilation is practiced, need information. Not just that it is illegal in The Netherlands, but also about the physical and psychological damage it causes. The volunteers spread this information in asylum seekers centers, community centers, in women's groups, and lately increasingly also to groups of men. The key persons are coached by health experts from regional health services ('GGD').

This whole system is coordinated by resource center Pharos, which is financed by the Ministry of Health, last year they received 328,716 euros. Project manager Diana Geraci says: “In this field we are a spider in the web in The Netherlands.” She confirms, answering our question about this issue, that children disappear from view after the age when they are regularly seen at the Child Healthcare Centers, at least that the ‘moments of contact are a lot less intensive'. From age four, children in elementary school only see a pediatrician twice, and then again in high school also twice. And this despite the fact that the age when most girls are genitally mutilated is between four and ten.

An important link in the chain of prevention is Safe at Home ('Veilig Thuis'), a hotline that can refer cases to Child Protection or decide that the police should be involved. Doctor Schoonenberg tells us that protection from child abuse is their most important mission. When it comes to genital mutilation, examinations are often required. “But also safety measures, together with the relevant authorities. Those measures range from light to strong. Speaking with a key person can give protection, but it can also be a much too light measure,” she says.

These protection measures fall under the authority of the Council for Child Protection and vary from temporary family supervision orders to custodial placement and are meant to prevent children from being taken to countries where they can be genitally mutilated. “This is if we see strong indications that a girl will actually be circumcised,” Schoonenberg explains. “We can also do a medical examination if there is a suspicion that the girl will be circumcised. The parents have to give permission and agree that the girl will be examined again when the family returns from their trip.”  

Voluntarily

Genital mutilation is classified as severe form of child abuse in Dutch law. Therefore it is strange to find out that the Child Protection protocol, which was drafted in cooperation with Pharos, contains a stipulation which makes it possible to circumvent prosecution of the parents. In the words of the protocol: “(There is) no measure indicated if parents cooperate voluntarily with psychological assistance and/or reconstructive surgery after FGM.” In their response to our question about this stipulation, Child Protection said it will not get involved if parents cooperate voluntarily.

Key-person Abdulahi is not happy with the results of the information campaign; she meets many women in her own Somali community who deny or downplay the severity of genital mutilation. She speaks passionately about her solution: she wants women like herself to visit schools to raise awareness. “I want to tell kids in schools about what happened to me, that is the only way I can think of that would really work.” She stresses how important it is to speak with children and to listen to them. “Somali parents don't listen to their children. I think it would help if someone would really listen to them.” This project is her own idea and she wants to plan and deploy it independently from Pharos. “I am not going to ask permission for visiting schools. I will do my own thing.”  

***

Not all key-persons are disappointed in the effects of their volunteer work. In the eastern part of The Netherlands, an enthusiastic group of key-persons works with the regional health service ('GGD'). One evening, we speak with four men and three women, in the presence of medical anthropologist Marthine Bos, who coordinates the work of the volunteers for the regional health service in the region IJsselland. The regional health services receive an annual subsidy of 78,000 euros to combat genital mutilation.  

We get a warm welcome in a community center in a provincial town. The volunteers, who want to remain anonymous, are seated around a large table and speak candidly about their experiences. It is a mixed company of people from different countries in Africa: Somalia, Sudan, Eritrea, Sierra Leone and Congo.

Abraham, a 36 years old man from Eritrea, who just started his volunteer work as a key-person, tells us that genital mutilation has been illegal in his country since 2014, but that the practice still continues outside the cities. “Among Christians, the circumcision of girls takes place before they are baptized, so during the first forty days. Among Muslims, who live in the lowlands near the border with Sudan, it happens later, but there it is done in the most extreme way, the 'faroun'.” In The Netherlands, he works with an Eritrean priest who openly states that female circumcision is not in the Bible, and therefore is not an obligation.

There also is an imam who accompanies key-persons to centers for asylum seekers, to explain that female circumcision is not a religious obligation; there is nothing about it in Quran and the meaning of the Hadith (oral tradition) that purportedly refers to it, is extremely dubious. Regional health service coordinator Marthine Bos and the volunteers took classes with Professor Dr. Hidir of the Islamic University of Rotterdam. He made short shrift with the so-called obligation: if it is not in the Quran, there is no question of religious obligation – whatever a Hadith might possibly say.

But that doesn't solve the problem, Abdullah from Sudan tells us. “People go to the mosque, like the one in The Hague, and those people listen to the imam. That imam says 'it is an obligation' and no one listens to the professor.” Victor, a journalist from Congo, who is also a key-person, adds: “It will still be difficult, even if you say it is not a religious obligation. It is in people's heads. It is tradition and people will say: it is our culture.”

Women's Rights activist Shirin Musa who works for the organization Femmes for Freedom, filed an official complaint against the As Sunnah mosque in The Hague after she saw a video online in which a preacher from this mosque recommended genital mutilation for girls. She filed complaints against several people, but eventually the Public Prosecution decided to prosecute only one person, the man who recommended genital mutilation in the video because – according to him – it is a religious obligation. “He was prosecuted,” Musa says. “Not the Board of the mosque, but the man who recommended it. That was an important step and I am happy with it. It was a kind of test-case in which the judge decides whether it is allowed to recommend genital mutilation.” The preacher was convicted to eighty hours of community service.

***

The four male volunteers we speak with, stress the difference in approach of raising awareness between men and women, or mixed groups.

Driss, who is from Sierra Leone and has lived in The Netherlands for twenty years already, is focused on his own gender, because the role of men in female genital mutilation is very important in his culture. He tries to convince men that female circumcision is extremely damaging and completely different from male circumcision. “Men have no idea what is involved. So I explain that with women, a part of the organ is removed and with men only a little bit of skin. They are shocked when they hear this, especially when I ask how they would feel if their finger was cut off.”

Abdullah from Sudan has lived in The Netherlands for 25 years and got involved in the work of the key-persons through his wife Layla. He is a cheerful man and speaks about his volunteer work with a sense of humor. But he is a fierce opponent of genital mutilation. His approach is a bit different. “Sometimes it is better to be very direct about it. Their first reaction is surprise.”

“Many marriages are ruined because of it. If he can't open the woman during the wedding night, he feels he is not a man”

He tells them it is illegal in The Netherlands and why that is the case, and what the consequences are of genital mutilation. “Many marriages are ruined because of it. If he can't open the woman during the wedding night, he feels he is not a man. He has to do it with his penis, or he is considered a wimp. And after the wedding night the mother or grandmother checks if he succeeded. But even if he succeeded and his wife gets pregnant, he could lose his wife during birth. Or the child. It happens often, people don't talk about it, but it is the truth. And after giving birth, the woman is sown up again. She stays in bed for forty days to heal. And after those forty days the man is allowed to be with her again and make another child...”

His wife Layla and Fatima from Somalia, who has lived in The Netherlands for 25 years, started a women's group where women can share their experiences. In the first meeting Marthine Bos provides the necessary information, showing models of mutilated and normal vaginas. During the next meetings, emotional stories are told about the participants' own circumcisions, which forges a bond between them because of the shared awareness that their physical and emotional issues are the result of what was done to them. Layla: “When you tell them you were circumcised yourself, they trust you.” Bos adds: “They stimulate one another to get help. In my experience, good aftercare is the best prevention. Reconstructive surgery makes women think.” Women who understand that their lives would have been very different without genital mutilation, are more likely to want to spare their daughters such unnecessary suffering, as the experiences of these women groups show.  

Maryam from Somalia has lived in The Netherlands for twelve years and has four children. “During my first pregnancy – here in The Netherlands – I visited a midwife, who asked me if I was circumcised. Yes, I have been circumcised. Then she asked if she could have a look, to see what kind of circumcision it was. She told me how much I was closed up and said she would have to wait until the actual delivery to see if she would have to do an episiotomy. She asked if I had any objections to keeping it open after the baby was born. And because I had no idea of what it looked like, I said 'keep it like it was'. Then she explained that this would be illegal, that a midwife who does this, will go to jail. At the time I had no idea what genital mutilation exactly was.”

The volunteers work together with the regional health service in awareness meetings at asylum seekers centers. They obviously tell that genital mutilation is illegal in The Netherlands, but they also try to make people aware of the dangers and damage it causes. Some asylum seekers who receive refugee status will remain contactable because they stay in touch with the volunteers via women's groups and community centers. According to the key persons, they often succeed in convincing people in this group to leave their daughters intact. But many immigrants stay away from this sphere of influence, and are therefore vulnerable to pressure from relatives in their country of origin or social pressure from their community in The Netherlands, and thus continue having their daughters mutilated, especially during vacations.

Too lax

The volunteers and involved regional health experts are not to blame for this. But we noticed in all our conversations that both medical professionals and volunteers are extremely reluctant to notify Safe at Home when they suspect a girl will be circumcised. “We are afraid to risk our confidential relationship, and that our clients won't return,” midwife Marina explains. “That is not what we want and this makes it more difficult. And everyone hopes it won't be that bad, that they won't do it after all. Care professionals always assume the best in people.” But at the same time she thinks her professional organization, the Royal Dutch Organization of Midwives ('KNOV'), is 'too lax'. Doctors and other health professionals never report their suspicions either and that is why no parents in The Netherlands were ever prosecuted for mutilating their daughters.

The relevant authorities – Safe at Home and Child Protection – still consider genital mutilation of girls too much a 'regular' type of child abuse. It seems there is hardly any awareness of the life-long damage of this mutilation. A Child Protection field worker, who wants to remain anonymous, told us: “As a researcher, as a field worker, I think: this is also a type of child abuse, even though a very serious one,” but she still feels she should take a 'broad view' when she is notified of a case of genital mutilation. “Eventually we will focus on the mutilation, or the risk of mutilation, and then we, as the Council for Child Protection, will have to decide if we will order family supervision or not. And also targeted assistance which focuses on diminishing the risk to zero. That is the goal of the family supervision order.”  

But she evades the question if there ever has been such a family supervision order. “I am happy if I can conclude a notification with the least severe measure. Because we forge a very good relationship with the parents, building a whole network that can take over as soon as we have come up with a good safety plan.”

At the hearing of the Parliamentary Committee for Justice and Security, we heard promising statements from several political parties: it seems there is an increasing awareness that voluntary 'notification codes' for medical and other professions are insufficient and that a legal obligation to notify the authorities when genital mutilation is observed, is the only way to ensure that doctors and other care professionals will actually involve the police when they see that Dutch-born girls have been genitally mutilated.

Photo: UNAMID / Flickr

The is the second article about genital mutilation of girls. Read the first article, ‘Vacation’ in Kenya – circumcision of Dutch-born girls abroad, here. The names of the volunteers are aliases – except that of  Istahil Abdullahi – as is the name of the midwife. They want to remain anonymous in order to be able to continue their work as best as possible.

This publication was made possible with financial support of  the Fonds Bijzondere Journalistieke Projecten (www.fondsbjp.nl)


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