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Statement by Pamela Delargy at the International Day to End Fistula Day event

3 June 2013

We are here today to talk about something which is difficult to talk about. An injury of childbirth which many people have never even heard about. An injury that is embarrassing to discuss. And yet, over two million women and girls throughout the world are suffering with this condition every day.

We are here today to talk about something which is difficult to talk about. An injury of childbirth which many people have never even heard about. An injury that is embarrassing to discuss. And yet, over two million women and girls throughout the world are suffering with this condition every day. A condition which forces them to change their wet, soiled clothes every few hours to try to hide their smell. A condition which has led to their family abandoning them or their community to shun them. A condition so stigmatized that many women feel that their lives are over. This is the reality of life for women and girls suffering from obstetric fistula.

Obstetric fistula occurs because of prolonged, obstructed labour due to lack of adequate medical care, notably timely access to a life-saving emergency Caesarean section. In most cases, the baby is still-born or dies within the first week of life. That is agony enough for any mother.

But in such a case of extended labour the woman is also left with a hole in the birth canal created by the prolonged pressure of the baby's head against the pelvis. Unless this is surgically repaired by a trained, expert fistula surgeon, she will be incontinent for the rest of her life.

Thus, victims change their clothes frequently or wear layers of clothing in the hope of hiding their condition. But all too often, they are unable to disguise what has happened. This explains why fistula often leads to wives being abandoned by their husbands or ostracized by their communities. Isolation makes it even more difficult for them to earn a living. The result is a life of poverty and shame.

Yet, while fistula is a devastating medical condition, it is also, in most cases, both preventable and treatable, which is why it has all but disappeared from wealthier countries.

Recognizing obstetric fistula as a terribly neglected health and human rights problem, UNFPA, the United Nations Population Fund, together with partners, launched a global effort to eliminate fistula ten years ago. The Campaign to End Fistula, comprising more than 80 international partner agencies, plus hundreds more at national and local levels, is now active on the ground in more than 50 countries in Africa, Asia, the Middle East and Latin America.

Over the last decade, some progress has been made. Fistula has received increased attention in national and international agendas. New resources have been invested to improve medical care, train surgeons and health workers and fund units to carry out fistula repair. Education campaigns have alerted more women, families and communities to the importance of medical care during pregnancy and childbirth as well as the specialized surgery available to help them.

Yet, despite these efforts, the fight against fistula remains critically under-resourced. While 20,000 women every year are now having surgery to repair their fistulas, it is not keeping pace with the 50,000 new cases annually.

We cannot let this grave injustice continue. This is why, to mark the 10th anniversary of the Campaign, the UN General Assembly designated May 23 as the first-ever International Day to End Obstetric Fistula, in a resolution that also underlined the importance of reproductive rights and ending exclusion, inequalities and child marriage to help eliminate fistula. The Day is intended to mobilize people from all sectors and regions to both reflect on progress so far and to galvanize national and global efforts to eliminate this terrible condition.

Sadly, thousands of Sudanese women suffer from fistula and many do not even know that they can get treatment. The causes of fistula - lack of access to Emergency obstetric care, childbearing at too early an age, poor nutrition, and even some harmful traditional practices - persist in many areas of the country. So unless we act together, there will be more cases. Yet Sudan has also been a part of this global campaign to end fistula and today we are here to show support to accelerate that campaign.

UNFPA, in collaboration with local, national and international partners,  has supported the work on fistula in Sudan for a decade. This has included supporting the National Obstetrical Fistula Prevention and Management Center (Abbo Fistula Center - and we are happy to see Dr Abbo here today with us); supporting the satellite fistula centers in Kassala, ElFashir, Zalingy, Nyala and Geneina; training of more than 200 health care providers on fistula prevention and management. We have also supported community awareness programming through media and  out reach activities, covering more than 70% of population in the targeted states.

Yet we urgently need to encourage and support more effective programs -- including better reproductive health services, universal, equitable access to those services, and improved information -- to reduce the number of fistula cases. We need this challenge to become a higher priority, too, for development assistance to help extend support to the poorest, most vulnerable and marginalized women, girls, and communities who are the hardest to reach and most at risk.

We must draw on the lessons learned from the successes over the last 10 years, particularly the increasingly important role that new technology can play. Mobile phones, for example, have proven indispensable in other countries in spreading information about the condition and improving uptake of medical care, including fistula treatment. Religious and community leaders can play a key role in helping to spread the message and, of course, tackle harmful practices such as child marriage and adolescent pregnancy. Midwives are key to identifying early danger signs of obstructed labour and helping with referrals.

In Sudan, we are here today to recognize and honor the work of all those who are committed to preventing fistula and to those who are treating those who already suffer. We have today with us people who are on the front lines of this work - from the far east of the country - Kassala on to Medani to the far west in Genina and El Fasher. And we have the staff from the world famous Abbo center here in Khartoum. And we have Dr. Attiat who heads the Violence Against Women Unit in the Ministry of Social Welfare - and make no mistake - fistula is as harmful as any other type of violence. Throughout the day, these experts will be sharing their experience and ideas on how to end this scourge. And, perhaps even more importantly, we will hear from women who have suffered from fistula and have recovered - and get their ideas on how best to help others.

I am particularly proud that the Darfur Regional Authority, in recognition of the seriousness of the issue in Darfur, has chosen this issue as a highest health and social priority. While fistula occurs throughout Sudan, it seems to be especially prevalent in Darfur, due to years of isolation, lack of access to emergency obstetric care, and to early marriage and childbearing.  I want to recognize the commitment of the Ministries of Health in the Darfur states, of the ICRC who for the past six years has supported campaigns to locate fistula sufferers and transport them for surgery and support them in recuperation, to UNAMID who built the new fistula center in Nyala, to the local organizations which are helping to raise awareness and to assist those who suffer, and also to USAID and Italian Cooperation who are supporting the training of medical staff, the equipment and supplies for fistula centers and the social and material support for women and their families.

A few days ago, I accompanied the Wali and the Minister of Health of West Darfur and the Minister of Health of the DRA to visit the fistula centre in Genina.

There were five women waiting for treatment.  One had came across the border from Chad accompanied only by her nine year old son, her husband having abandoned her.  It was heartbreaking to hear their stories of isolation and of suffering. But we also had with us a story of hope - a young woman named Awatif who had been in their place a few years ago - rejected by her family and suffering. Yet, after three surgeries she had recovered. And she went on to get training and to become a midwife, and to remarry and to have a child. She gave those women - and those of us visiting - hope that we can, together, end this sad story in Sudan.

I am convinced that the story of Awatif's recovery can be the story of Darfur's recovery. The repair of Awatif's body and health and her reintegration into the community can represent the rehabilitation of the social fabric in Darfur. The end of fistula in Sudan will be an indicator that health services are accessible to pregnant women, that women are healthier and have a stronger place in their communities.

We have the knowledge and resources to eliminate fistula. Let us all work together to lift this shadow from the lives of women and girls worldwide and in Sudan. Let us work toward the day when there is no more need to observe such an international day. When fistula will only be a memory in Sudan.