Hidden Wounds Across Borders: Thousands of Women in Nigeria, Somalia Suffer in Silence as Obstetric Fistula Crisis Deepens

Michael Olugbode in Abuja

Thousands of women in Nigeria and Somalia are battling one of the world’s most devastating childbirth injuries — obstetric fistula — amid poverty, weak healthcare systems, insecurity and limited access to emergency maternal care, according to humanitarian medical workers.

A statement yesterday by Médecins Sans Frontières (MSF), stated that from northern Nigeria to South-western Somalia, women who survived prolonged and obstructed labour are now living with chronic pain, incontinence, stigma and social isolation after losing control of their bladder or bowel following traumatic childbirth complications.

At Jahun General Hospital in northern Nigeria and Bay Regional Hospital in Somalia, according to the statement, teams from Médecins Sans Frontières (MSF) and local health authorities are struggling to provide life-changing reconstructive surgery and rehabilitation services to affected women whose lives have been shattered by the condition.

For many of the patients, the injury came after days of labour without access to emergency caesarean sections or skilled medical care — a reality that continues to endanger women in fragile and conflict-affected regions.

The statement said Aisha (not her real name), a young Nigerian woman from Yobe State, arrived at Jahun General Hospital emotionally broken after losing her baby during childbirth and suffering severe internal injuries that left her incontinent.

On the other side of the continent, Hodan (equally not her real name), a Somali woman married off as a teenager, endured eight years of silence and humiliation after a prolonged labour during her first pregnancy left her with the same condition.

“I did not know there was treatment,” Hodan said after finally reaching the fistula unit in Baidoa.

According to MSF, obstetric fistula occurs when prolonged obstructed labour damages tissues between the birth canal and the bladder or rectum, leaving women leaking urine or stool continuously. In about 90 per cent of cases, the baby does not survive.

Medical experts said the condition is closely linked to child marriage, teenage pregnancy, malnutrition, female genital mutilation and the collapse or absence of emergency obstetric services.

In both Nigeria and Somalia, those risk factors are compounded by insecurity, displacement, poor transportation and overstretched health systems, forcing many women to attempt childbirth at home or in poorly equipped facilities.

Dr. Raphael Kananga said many patients arrive at hospitals only after suffering irreversible injuries.

“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,” he said.

“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.”

The 55-bed fistula ward at Jahun General Hospital has become a critical lifeline for women across northern Nigeria. Since its establishment in 2008, more than 6,000 reconstructive surgeries have been carried out there.

In 2025 alone, 295 women were admitted, while 224 underwent surgery. Between January and March 2026, another 64 women were admitted, with 48 already receiving surgical treatment.

Care at the facility includes free surgery, physiotherapy, psychological counselling, nutrition support and long-term rehabilitation, with many patients spending up to three months recovering.

Aisha, who has already undergone two surgeries and is awaiting a third procedure, said meeting other survivors gave her hope.

“At first, I thought I would never be cured,” she said. “Then I came here and saw other women with the same condition. I realised I was not alone.”

In Somalia, the fistula unit at Bay Regional Hospital, opened in 2025 with support from MSF and Somalia’s Ministry of Health, remains one of the few specialised centres in the country capable of handling such cases.

Since its launch, only 38 women have received treatment there, even though several thousand more are estimated to require urgent care nationwide.

Frida Athanassiadis said many women live with fistula for years before learning that treatment exists.

“Fistula care is not only about surgery,” she said. “It is about listening, counselling, and helping women rebuild their confidence.”

Healthcare workers warn that demand for fistula care in both countries far exceeds available capacity.

Jahun General Hospital remains the only facility in Jigawa State capable of performing vesicovaginal fistula reconstructive surgery, while Bay Regional Hospital is the only specialised centre in Somalia’s Southwest State.

Humanitarian organisations said the persistence of obstetric fistula reflects deeper failures in maternal healthcare systems across parts of Africa, where preventable childbirth complications continue to claim lives and destroy futures.

Medical experts insisted that fistula is entirely preventable through proper antenatal care, access to trained midwives, timely referrals and emergency caesarean sections before prolonged labour causes permanent tissue damage.

MSF and health officials are now calling for urgent investments in maternal and newborn healthcare services, including skilled birth attendance, emergency obstetric care and expanded fistula treatment programmes for women already living with the condition.

For survivors like Aisha and Hodan, however, the struggle goes beyond physical healing — it is also about reclaiming dignity after years of pain, silence and exclusion.