MSF's fistula camp in Boguila, CAR. First thing in the morning, fistula patients empty and rinse the buckets which hold their urine. Patients must drink large amounts of water before and after surgery so their urine is not concentrated. Approximately two million women in Africa have a fistula, which is a hole between the vagina and the bladder or rectum, through which urine or faeces leak continuously. Fistulas can be caused by prolonged obstructed labour and childbirth or sexual violence in addition to lack of medical facilities.