“A doctor is coming to vaccinate you against Covid-19,” a father told his three daughters as a doctor paid them an unexpected visit two weeks ago during the current coronavirus lockdown and school closures. The young girls, all aged under 18, had the injection and soon fell into a deep sleep. They woke up to severe pain and to the shock of finding their legs had been fettered. Unable to grasp what had happened, the girls rushed to their divorced mother for an explanation. The shocked mother hastened to report what had happened to the authorities when she discovered that her daughters had been subjected to illegal female genital mutilation (FGM). The father and the doctor were then arrested and referred to the prosecutor-general for investigation. FGM has always happened behind closed doors, and it seems to have spread under the current coronavirus lockdown in some parts of the world, including Egypt which marked the National Anti-FGM Day on 14 June. The illegal practice, which involves the partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons, has been undergone by an estimated 200 million girls around the world. Women's organisations and activists around the world are worried that more women could have been forced to undergo the illegal practice due to coronavirus lockdowns and the halt of anti-FGM efforts. A recent report by the UN population fund and children's fund UNFPA and UNICEF speculates that “there could be two million FGM cases over the next decade that could otherwise have been averted” due to “the disruptions caused by Covid-19” since “the efforts of many prevention programmes have had to be halted.” The report, produced by the UNFPA-UNICEF Joint Programme on the Elimination of Female Genital Mutilation, bases its predictions on estimates produced in collaboration with partners Avenir Health, John Hopkins University in the United States, and Victoria University in Australia. The projections, the UNFPA said, “offer an alarming view of the future that could confront women and girls if efforts are not urgently made.” The UN is not the only one ringing alarm bells. According to the US network ABC news, women's rights groups fear the lockdowns to stem the spread of Covid-19 “will see a spike in cases of FGM worldwide, with Australian activists concerned the practice could be on the rise behind closed doors.” “In Somalia, aid groups have seen an alarming spike in demand for FGM services as cutters are going door-to-door during coronavirus lockdowns and school closures,” Plan International Australia, an NGO, has warned. African-Australian activist Khadia Gbla told ABC news that she no longer received any of the average half a dozen calls she used to get every month from concerned teaches, social workers, or girls themselves at risk of FGM in Australia. She speculated that “the restrictions in place have created a breeding ground for this [FGM] to take place. “Kids are stuck at home with parents and can't actually reach out for help,” Gbla told ABC news. “The problem is that we won't actually see the damage until this is all over, and then we're going to have a whole range of children who have been cut or mutilated.” ALARMING FACTS: According to figures from the World Health Organisation (WHO), “more than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated.” Another 68 million women and young girls are at risk of undergoing FGM by 2030, a figure activists fear could increase threefold due to the current coronavirus lockdowns. Even before the Covid-19 pandemic hit the world, UNICEF had expected that four million girls could get mutilated in 2020 alone. FGM is widely defined as a human rights violation and a form of violence against women and girls. It is a cultural norm deeply enshrined in gender inequality, along with religious misinterpretations and cultural misbeliefs in some parts of world. It can have long-lasting physical and psychological implications or lead to injury and death. The desire for social acceptance and avoidance of social stigma remains the single largest factor influencing FGM. The practice has no health benefits for girls or women, but is rather a cause of direct harm to girls and a violation of women's human rights. According to the WHO, “FGM can cause severe bleeding and problems urinating, and later cysts, infections, as well as complications in childbirth and increased risk of newborn deaths.” It is mostly carried out on young girls from infancy to 15 and sometimes 18 years old. There are rare cases when it is also carried out during adulthood. “The practice is mainly concentrated in the Western, Eastern, and North-Eastern regions of Africa, in some countries of the Middle East and Asia, as well as among migrants from these areas,” wrote the WHO. “FGM is therefore a global concern.” Egypt has a long history of FGM, which remains embedded in areas of its culture. The practice seems to have declined over the past few decades due to efforts to curb it and criminalise it, but recent data indicate that the banned practice persists due to cultural barriers, religious misconceptions, and the lax application of laws. More alarmingly, perhaps, is the fact that the practice has been increasingly medicalised in Egypt, which has been ranked first in that respect. According to UNICEF, “Egypt has the highest rate of medicalised FGM compared to other countries,” as “78 per cent of girls aged 1-14 were cut by medical professionals,” the Egypt Health Issues Survey said in 2015. “Although the prevalence of FGM has decreased, efforts need to be accelerated, seeing as more than seven million girls are at risk of undergoing FGM between 2015 and 2030,” warned a 2019 UNICEF report. Statistics regarding the prevalence of the practice in Egypt vary according to sources. In 2014, UNICEF warned that Egypt was among the top countries in the world in terms of the prevalence of FGM, with an estimated 92 per cent of girls undergoing the operation, down from around 97 per cent in the 1990s. The practice was found to be mainly concentrated in Upper and rural Egypt. Egypt has adopted strict anti-FGM policies and measures to curb the practice, and these have paid off in bringing about a decline in the prevalence of FGM. But the practice has persisted despite the efforts. “While there has been a decline in the practice's prevalence in the age group of 15-17 years old by more than 13 per cent from 2008 to 2014, efforts to abandon FGM should be accelerated, as a matter of urgency,” said a UNICEF report. “Almost seven out of 10 Egyptian women aged 15-19 have undergone FGM, according to the latest national data. The proportion goes up to nine out of 10 among ever married women aged 15-49,” it warned. “FGM is more prevalent in rural Upper Egypt than in urban governorates.” UNICEF reported that in 2016 Egypt ranked sixth out of 29 countries in terms of the prevalence of FGM. Only Somalia, Guinea, Djibouti, Sierra Leone and Mali have higher prevalence rates. One UNICEF survey in 2016 estimated that 87 per cent of women and girls aged 15-49 had undergone the procedure. Variable estimates aside, the consensus remains that Egypt ranks first in the medicalisation of FGM. According to the country's Demographic Health Survey in 2014, “eight out of ten girls who were cut were cut by medical personnel.” “When comparing mothers and daughters, trends of medicalisation appear to be increasing sharply, whereby 37.9 per cent of mothers had the procedure performed by a medical professional, compared to 81.9 per cent of daughters,” UNICEF said. HEALTH HAZARDS: There are four types of FGM that range from the partial to total mutilation of the female genitalia. According to assistant professor of gynaecology at Cairo University's Qasr Al-Aini Hospital Amr Hassan, “all types are harmful and have serious health hazards that may lead to death, even when performed by a medical professional.” Hassan, also a former member of the Egyptian Population Council, insists that “there is absolutely no need for such an operation.” He said that “calls that young girls should undergo medical check-ups just in case they need to be circumcised are totally unjustified since it is only in very rare cases that girls would have an abnormality. This can be easily detected during infancy and could be treated with drugs or other medical interventions,” Hassan told Al-Ahram Weekly. Type 1 and 2 of FGM are the most common in Egypt, according to UNICEF. But, as Hassan insists, it is a misconception that some types are safer than others. “All forms of circumcision involve health risks that could lead to death and that have long-term complications and cause psychological trauma,” he said. Studies indicate that immediate hazards can include severe pain, bleeding, infections, fever, tetanus, urinary problems, trauma or death. Long-term hazards include having sexual problems like low libido and decreased satisfaction, urinary tract infections, and an increased risk of childbirth complications including difficult delivery and excessive bleeding, as well as newborn complications and death. Yet, FGM is still sometimes embedded in cultural and religious misconceptions that are born in Africa and some parts of Asia and have spread to Europe and the United States by immigration. In Britain, for instance, immigration has proved to be the number one reason why more young girls have recently undergone the practice during infancy. The UK-based National FGM Centre has warned that many parents may circumcise their daughters during early childhood and infancy to avoid the legal implications of the process. Girls cannot report the operation or call for help at an early age, and wounds heal faster, making it more difficult for the authorities to detect the crime, the centre explained. A 2015 report by the London-based City University showed that 137,000 girls and women in the UK had already undergone FGM. “The main reason for FGM is to control a girl's body,” said Azza Kamel, chair of Egypt's Appropriate Communication Techniques for Development Centre, an NGO. “Ideas of purity, cleanliness, controlling a girl's sexual desire, avoiding stigma, preserving a girl's chastity and family honour are the driving forces behind the spread of the phenomenon,” Kamel said. According to a report issued by the WHO last February, FGM is sometimes also viewed as increasing a girl's “marriageability” in cultures that also believe that cutting a woman's genitalia can reduce her libido and thus protect her against extra-marital affairs. The same report showed how FGM is also associated “with cultural ideals of femininity and modesty, which include the notion that girls are clean and beautiful after the removal of body parts that are considered unclean, unfeminine, or male.” Kamel explained that FGM is “a norm, a tradition and a cultural legacy that has nothing to do with religion. Both Christian and Muslim girls undergo the process, which remains rampant in many Nile Basin countries,” Kamel lamented. Yet, Shaimaa Said, a resident of the popular area of Dar Al-Salam in Cairo and a former FGM victim, insists that “circumcision is the basis of honour.” She said that there are “three things we need to guard in our lives: our religion, our children, and our honour.” Although undergoing FGM was “a difficult moment” for Said, she remains convinced that “it is a price that every girl has to pay.” Said said she would not think twice about doing the same thing to her daughter when “it is the right time. If I had a 10 per cent doubt about it in the past, now I don't in the light of the current widespread immorality and lack of decency,” Said said matter-of-factly. “After all, I'm protecting my daughter from herself rather than from anybody else.” Said is not the only one to think this way. The presumed link between FGM and a girl's chastity is among the main driving forces that keep the phenomenon alive despite efforts to curb it. Said is only one of an estimated 27.2 million FGM victims in Egypt, where the practice remains rampant. Some estimates suggest even larger numbers, claiming that one in four of every FGM case in the world is located in Egypt due to a tangle of sociocultural reasons. “This misconception and inferior view of a woman's honour as only linked to her genitalia is one main reason the practice persists in a blatant challenge to the legal ban,” Kamel said. CRIMINALISED AND FORBIDDEN: In 2008, Egypt criminalised FGM and imposed prison terms on its perpetrators. These can range between three months and two years, according to Law 126/2008, which was designed after 11-year-old Bodour Shaker lost her life due to an excessive dose of anesthesia while undergoing FGM in a private clinic in Upper Egypt. Egypt's former grand mufti, Ali Gomaa, the country's highest Muslim religious authority, issued a strong statement at the time making it clear that female genital mutilation was “forbidden by Islam.” The mufti's decree was the strongest made against the practice, but it was not the first as former grand sheikh of Al-Azhar, Mohamed Sayed Tantawi, had previously reiterated statements insisting that FGM is “a social norm” that has nothing to do with religion. In 2016, the government further toughened up anti-FGM penalties, imposing prison terms of up to seven years and a minimum of five years on doctors and parents involved in the illegal practice. Tougher penalties of up to 15 years in prison can be imposed on those involved in FGM if the victim dies or is left with a permanent disability. But FGM remains widespread, nonetheless. Rights groups suggest the ban has not been widely enforced and that much of society remains permissive of FGM, which is widely practised by both Christians and Muslims and mostly carried out by doctors and nurses. Only a few months ago, 12-year-old Nada Hussein died after undergoing FGM at a private clinic in the village of Al-Hawatka in the Assiut governorate in January. Nada's father and the physician who performed the procedure were arrested and referred to the public prosecution. The incident provoked global concerns as the world was preparing to mark International Day of FGM Zero-Tolerance on 6 February. Nada is probably not the last FGM victim in Egypt, and Bodour, who lost her life on the same day as a success at primary school, is still remembered as an icon of change. Many other innocent victims who have lost their lives due to the criminal practice are also still remembered. “On National Anti-FGM Day, we recall Bodour, Iman, Soheir, and Mayar, who lost their lives because of circumcision, along with other girls we do not know, but do know their pain and suffering,” Maya Morsy, head of Egypt's National Council for Women, said during a seminar last year. Thirteen-year-old Soheir Al-Betar died in 2013 after she had undergone genital cutting by a doctor at the Aga Centre in the Daqahliya governorate. Three years later, Mayar Moussa faced the same destiny at the hands of doctors in a hospital in Suez. These victims died at the hands of doctors who performed the illegal operation in violation of the law and in defiance of Al-Azhar's fatwa, or religious ruling. “FGM medicalisation is, in fact, a catastrophe as Egypt ranks first in that respect, with 82 per cent of all procedures done at the hands of medical personnel,” Hassan lamented. He referred to a study carried out by the International Population Council, which found that heath service providers, especially doctors, play a major part in the practice since families resort to them for medical advice. “Many doctors succumb to the wishes of parents and carry out the operation under the name of a ‘cosmetic procedure',” Hassan said. “Many medical service-providers lack awareness of the health risks of FGM.” Both Hassan and Kamel agreed that eliminating the practice would need raising awareness among both parents and medical service-providers alike about its many misconceptions. AWARENESS CAMPAIGNS: The loss of Nada's life while undergoing FGM at the hands of a doctor has provoked medical professionals in Egypt to take further action. In February, doctors in Egypt launched a new anti-FGM campaign to raise awareness of the health risks of the process and express their refusal to carry out the harmful practice. The campaign was titled “white coats” to indicate that many doctors refuse to have their white coats stained with the blood of innocent FGM victims. They staged a demonstration at a Cairo underground station, carrying posters saying “No to FGM” and “FGM is a crime” and handed out leaflets explaining the dangers of the process to passengers. Organiser Randa Fakhreddin, head of the NGO Union Against Harmful Practices on Women and Children, told the news agency Reuters at the time that the campaign was meant “to send a message to other doctors that we do not want our white coats to be stained with blood as well as to citizens that medicine refuses this practice. “Some ultraconservatives were not convinced by what we were saying, but we opened a discussion with them, responded to their arguments, and answered all their questions,” Fakhreddin added. In the meantime, Egypt's highest Muslim religious authority, the Dar Al-Iftaa, has reiterated statements confirming that FGM is religiously forbidden. “This act has no religious origin. It dates back to inherited traditions and customs, and the biggest evidence for its not being a religious duty for women is the fact that the Prophet Mohamed did not circumcise his daughters,” the statement said. *A version of this article appears in print in the 18 June, 2020 edition of Al-Ahram Weekly
