What is Fistula?

Although the world is full of suffering, it is full also of overcoming it
— Good old Helen Keller

Obstetric Fistula is a birth injury condition defined by the Fistula Foundation as

“a hole between the vagina and/or rectum and the bladder. This is caused by prolonged obstructed labor, leaving a woman with no control over their urination or bowels permanently. For women with obstructed labor, labor that goes unattended, the labor can last up to six or seven days. The labor produces contractions that push the baby’s head against the mother’s pelvic bone. The soft tissues between the baby’s head and the pelvic bone are compressed and do not receive adequate blood flow. The lack of blood flow causes this delicate tissue to die, and where it dies holes are created between the laboring mother’s bladder and vagina and/or between the rectum and vagina. This is what produces incontinence in a fistula patient.”

The surgeons who perform the operations are restoring dignity to women (often mere girls) who’ve borne dead babies, lost husbands, friends and family. An estimated 1,000,000 girls worldwide were married as children, impregnated as teens and, due to a lack of available maternal health care, labor at home for days before finally being brought to a doctor who is usually miles away. They travel by foot, wheelbarrow or in the arms of a loved one only to deliver a stillborn and then be told that they are now so damaged “down there” that they will leak urine and/or feces from their vaginas for the rest of their lives.

We know that one million women in this world suffer from untreated obstetric fistula. And for every woman who receives treatment, another 50 go without.



Fatima's Story, Dr. Abbo's Fistula Center, Sudan: One young woman’s journey from heartbreak to healing

Fatima is an 18-year-old woman from the western region of Sudan. She suffered from obstetric fistula resulting from an obstructed labor at the age of 16. Since she lives in a nomadic community, she was unable to attend an antenatal clinic and was far away from a health facility when she went into labor. Her mother and aunts reassured her that labor and delivery is a natural, innate process for all females, but when her labor pains started, it was anything but natural.

“After three agonizing days, there was no sign that the delivery was imminent. At that time my husband and my father decided that it was high time to seek medical assistance. I was taken to the nearest hospital (which was about half a day’s travel away) on a camel.”

By the time they reached the hospital, the baby was already dead and the doctors performed a Caesarian section to remove the stillborn. Fatima was kept in the hospital for a few days to recover, at which point she noticed that, in addition to not being able to walk due to pain and numbness in her left leg, she was leaking urine continuously. Her doctor informed her that she had developed an obstetric fistula as a result of the difficult labor and she would need an operation to close the hole between her bladder and birth canal.

Less than a month after returning home, her husband divorced her because he could not stand the smell, leaving Fatima shattered by the loss of her husband and first born. Her parents brought her to Dr. Abbo’s Fistula Center to be treated for her fistula and the pain and weakness in her leg. Fatima received a successful surgery and physiotherapy exercises for her numb leg.

Today, she is completing her rehabilitation at Dr. Abbo’s Fistula Center in Khartoum, Sudan, funded by Fistula Foundation and our partner, Women and Health Alliance International. In addition to the physical rehabilitation exercises to help her leg, Fatima has also gone to psychological rehabilitation sessions to help her overcome her depression and regain her self-confidence and self-esteem. She has also learned income generating activities, such as knitting and baking cakes, through a vocational training program.

When she returns to her community, Fatima will be a healthy, empowered woman, running her own small business and advocating for antenatal care during pregnancy and medical assistance during childbirth to prevent fistulas from occurring to other women in her community. She hopes to remarry and start a family, which will be possible if she follows her doctor’s instructions for pregnancy after fistula operations. She will return to the fistula hospital for a follow up in six months and looks forward to a bright future ahead of her.

Fatima was lucky. Somebody or somebodies decided she mattered. That she deserved a chance just like our daughters, mothers, sisters, and aunts to live her life with dignity and without despair. Let us be the somebodies for another girl to receive the gift of a second chance at being whole. A chance to be an asset to her community rather than a liability and an object of scorn.


VERVE has and will continue to be part of the solution to this, and to all the other inequities and struggles women and girls endure in our deeply patriarchal world.

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Article by Anna Quick-Palmer