Fistula: Compassionate care gives Somali mothers a new chance at life

While she healed from delivery, Faisa realized she was constantly leaking urine and losing control of her bladder. She was later diagnosed with obstetric fistula, a severe childbirth injury caused by prolonged and obstructed labor creating a hole between the birth canal and the bladder or rectum. 

Like many women with the condition, Faisa felt isolated and ashamed. She lived with the condition for years before learning treatment was an option. “My husband divorced me,” she says. “My grandmother and aunts were the only ones who stood by me.” 

In August, Doctors Without Borders/Médecins Sans Frontières (MSF) opened a 20-bed obstetric fistula unit at Bay Regional Hospital in Baidoa, a town northwest of Mogadishu, Somalia’s capital. Our team there provides sustained, comprehensive fistula care to women like Faisa, focusing on prevention, pre- and post-operative care, and timely repair, including management of severe perineal tears.

Risk factors for fistula in Somalia

Somalia has one of the world’s highest maternal mortality rates, and only about one-third of births are attended by a skilled health worker. Essential maternity care is scarce and often far from reach, forcing many to undertake long journeys that can be expensive and dangerous for women in need of immediate care.

As a result, women often give birth at home with traditional attendants who are unable to manage complications like those Faisa suffered. Long distances to health facilities, widespread poverty, and a shortage of trained midwives and doctors further limit people’s access to emergency obstetric care—raising the risk of fistula. However, for many Somali women, specialized care—including fistula repair—is a distant reality. Until recently, specialist fistula repair services were only available in the capital, Mogadishu.

Khadija Adan, a mother of eight, lived with fistula for eight years—a condition she says she did not understand before traveling to Baidoa for care.

“In my village, many women give birth at home with the help of neighbors or traditional birth attendants,” she says. “Health facilities are far away, and we must walk for hours or pay for transport that we cannot afford. Early marriage and female genital mutilation are common here, and we do not have regular prenatal care.”

Helping women with fistula regain their social life

Survivors of obstetric fistula often endure stigma, isolation, and psychological distress requiring continuous psychosocial support. That’s why our teams providing fistula care at Bay Regional Hospital prioritize social support and long-term reintegration through counseling. 

“Many of our patients have lived with a condition that has kept them apart from work, friends, and community life,” says Frida Athanassiadis, MSF medical coordinator in Somalia. “Fistula care isn’t just about repairing an injury, it is about listening to women, providing counseling, and helping them rebuild confidence. Our aim is to restore dignity and support their return to their communities.”

Maternal care is essential to preventing fistula

Women and children in Somalia bear the greatest burden of a health system stretched to its limits. As funding declines and health services shrink, access to free, lifesaving care is becoming increasingly rare in Somalia. There is an urgent need to strengthen maternal health services and ensure skilled care is available, free, and closer to the communities that need it most. 

“Maternal health care is central to preventing obstetric complications,” says Frida. “In Baidoa, we provide comprehensive maternal services to prevent complications, including fistula, and we offer full fistula management and repair for women who need it. Strengthening referral systems, training more midwives and surgeons, and ensuring functioning operating theaters are crucial steps,” she adds. “Sustained investment in prenatal care, maternity services, and community awareness is essential to make childbirth safer and prevent fistula from occurring.”