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Two countries, one injury: Obstetric fistula in Nigeria and Somalia

Countries: Nigeria, Somalia Source: Médecins Sans Frontières Obstetric fistula is a devastating yet preventable condition that continues to affect women with limited access to pre- and postnatal care. When Aisha* arrived at Jahun General Hospital in Jigawa state in northern Nigeria she was in deep physical and emotional pain: She had not only lost her child during delivery, but had sustained an injury while giving birth. On the other side of the African continent, Hodan* walked into Bay Regional Hospital in Baidoa, southwestern Somalia, after suffering for eight years from urinary incontinence caused by a difficult delivery. She had been married as a teenager in a village on the rural outskirts of Bur Hakaba. Her first delivery was prolonged and complicated; the baby was delivered with forceps but did not survive. Soon after, Hodan lost control of her bladder, and she was too ashamed to talk about her condition for years. These two women, thousands of miles apart, suffer from the same condition: obstetric fistula. This condition develops when the soft tissue between the birth canal and bladder or rectum is damaged through prolonged, obstructed labor without timely access to emergency obstetric care, creating a permanent opening through which urine or stool leaks continuously. Many of the women who reach us have lived with this condition for years before they even knew what it was. Fistula care is not only about surgery. It is about listening, counseling, and helping women rebuild their confidence. At Jahun General Hospital and at Bay Regional Hospital, teams from Doctors Without Borders/Médecins Sans Frontières (MSF) and the respective state ministries of health provide reconstructive surgery, psychological support, and rehabilitation to women living with obstetric fistula. Risk factors for obstetric fistula The risk for fistula is highest where women marry and give birth young; where childhood malnutrition is widespread; where female genital mutilation is common; and where health systems cannot guarantee an emergency cesarean section in time. In Nigeria and Somalia, these factors overlap. So do insecurity, displacement, and long distances that many women must travel to reach a functioning health facility. Beyond physical injury — which can cause chronic pain, recurring infections, and an increased risk of kidney damage — women living with fistula often face stigma, exclusion from work and community life, and even, in many cases, divorce. How MSF cares for patients with obstetric fistula The 55-bed fistula ward at the Jahun General Hospital is, by design, more than a surgical facility. Care is free. Women stay between two and three months. Each patient may need one or more reconstructive surgeries, supported by physiotherapy, mental health care, and nutrition. “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 labor,” says Dr. Raphael Kananga, MSF medical coordinator in Nigeria. “By the time they arrive at our hospital, they have already sustained an injury, often with additional infections and complications. Surgical repair is possible, but this should have been prevented from happening in the first place.” Since the project opened in 2008, the teams have performed more than 6,000 fistula surgeries in Jahun. In 2025, 295 women were admitted and 224 had reconstructive surgery. From January to March 2026, 64 more women had already been admitted to the facility, with 48 already receiving surgical care. 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 labor. By the time they arrive at our hospital, they have already sustained an injury, often with additional infections and complications. Aisha has already had two surgeries and is preparing for a third. “At first, I thought I would never be cured,” she says. “Then I came here and saw other women with the same condition. I realized I was not alone.” In southwestern Somalia, the fistula unit at Bay Regional Hospital offers free surgical repair, pre- and post-operative care, counseling, and nutrition support. Since opening in 2025, 38 women have been treated. Across the country, several thousand more women are estimated to need this care but are unable to access it. Dr. Idris Suleiman Abubakar, fistula surgeon at Jahun General Hospital Courage to come forward The most terrible thing about obstetric fistula is that women suffer it when they bring another life into this world. Here you have a woman trying to bring another life, and at the end, she suffers, she often loses the child, and she is left with this condition. We have seen women in our practice [struggle with their mental health] because of this condition. It is something even the woman herself is ashamed of. So it takes courage, and a great deal of self-confidence, for her to come forward at all. Imagine a woman who has lost all hope of ever living a normal life again, and through the work you do, she is returned to what she thought she would never reach again. That is when you see real happiness in another person. And that gives me joy. That is what keeps taking me back. ... From there, I understood why I am drawn back to fistula work. If we really want to tackle obstetric fistula, every pregnant woman must deliver in a properly equipped facility, with personnel trained in midwifery. Without that, even women who reach a health facility will continue to develop fistulas — because the skilled care needed to prevent them is not actually there. Barriers to accessing fistula care "Many of the women who reach us have lived with this condition for years before they even knew what it was, or that anything could be done about it,” says Frida Athanassiadis, MSF medical coordinator in Somalia. “Fistula care is not only about surgery. It is about listening, counseling, and helping women rebuild their confidence.” Hodan lived with the condition for eight years before a relative told her about the new service in Baidoa. “For a long time, I did not know there was a name for what was wrong with me. I did not know there was treatment,” she says. At first, I thought I would never be cured. Then I came here and saw other women with the same condition. I realized I was not alone. Jahun is the only facility with the capacity to provide vesicovaginal fistula reconstructive surgical services in Jigawa state. In Somalia, the fistula unit at Bay Regional Hospital in Baidoa is the only facility in Southwest state and one of the few facilities in the country able to offer specialized repair. The limited number of services, combined with insecurity, displacement, poverty, and long travel distances, means this care remains beyond reach for most women who need it. How to prevent obstetric fistula Fistula is completely preventable. What stops fistula from occurring in the first place is clear: prenatal care that identifies risks early, trained midwives within reach of the women they serve, a functional referral pathway, and access to emergency cesarean section before prolonged labor causes tissue damage. There is an urgent need for sustained investment in maternal and newborn care in both Somalia and Nigeria. Prenatal services, skilled birth attendants, timely emergency obstetric care, and specialized repair must be available for women who need it. * Names changed for privacy