When “Deeqa” opened her eyes, she had been unconscious for 15 days. She was only 14 years old.
She had spent eight days in labour in a rural area without access to a skilled birth attendant. Eventually, her family took her to Baidoa in an old pickup truck. She survived, but her first two children, born when she was 14 and 15, died.
When Deeqa regained consciousness, she discovered that she could no longer control her urine.
She had developed obstetric fistula, a childbirth injury that can result from prolonged or obstructed labour. From that day, continuous urine leakage became part of her life. She lived with the condition for 17 years.
She also lived with fear, shame, and isolation.
At one point, after hearing that fistula could be treated through surgery, Deeqa travelled to Daynile in Mogadishu. But when she saw women who had undergone surgery, she became frightened and returned home without treatment. She feared she would die in the operating room.
Eventually, she sought help at a fistula service in Baidoa, still afraid of the surgery.
After receiving treatment, she learned something she had not known for most of her life: fistula could be treated.
Today, Deeqa urges families not to marry off girls at 13 or 14, saying girls that young are not physically ready for pregnancy and childbirth.
A condition that affects more than the body
The exact number of women living with fistula in Somalia is unknown because the country has not conducted an accurate national survey. A 2020 Islamic Development Bank study estimated that between 3,300 and 4,000 women were living with fistula.
In August 2025, MSF and Somalia’s Ministry of Health established a fistula treatment service at Bay Regional Hospital in Baidoa, providing women with treatment and surgery.
But fistula is not only a physical injury.
Sana Sadiq, MSF Mental Health Activity Manager for Somalia, says women living with fistula can experience persistent sadness, excessive worry, low self-esteem, loss of confidence, shame, and embarrassment.
Continuous leakage, wetness, and fear of smell can make women reluctant to leave their homes or interact with others. Some withdraw from social activities and relationships, while others experience anger, helplessness, and frustration. The condition can also create a financial burden through costs such as diapers.
Hodan: Finding a way to get treatment
“Hodan,” a name changed to protect her privacy, was 20 when she reached the fistula unit in Baidoa. Her condition had begun six years earlier, when she was 14.
During her first pregnancy, she experienced a difficult delivery at a local health facility. Her baby was born prematurely at seven months, and forceps were used during the delivery. Afterwards, Hodan lost control of her bladder.
She kept the condition hidden from most people, with only her household knowing about it. Her marriage ended within days.
Later, she remarried and had more children, but none survived.
Her father sold livestock and farmland while searching for treatment. When surgery was recommended, fear and uncertainty prevented her from going ahead. He died before she received treatment.
After his death, Hodan’s husband, who was working in another city, refused to pay for her journey. With no other option, Hodan borrowed money through an ayuuto, a community-based rotating savings group, and travelled to Baidoa.
At Bay Regional Hospital, she underwent two successful procedures.
Her story reflects some of the barriers many women face: long journeys from rural areas, transportation costs, limited specialised services and a shortage of facilities equipped to provide fistula care.
Alongside medical treatment, MSF provides mental health support, including individual counselling, group sessions, psychoeducation, and psychosocial support. These services can help women cope with stigma, reduce feelings of isolation, and regain a sense of control.
Treatment and prevention
Fistula can be treated, but preventing it requires better maternal healthcare.
Skilled midwives, accessible health facilities, functioning referral systems, and timely emergency caesarean sections are important in preventing injuries caused by prolonged or obstructed labour. Expanding affordable maternal care, fistula repair services, and psychosocial support is also essential.
For women like Deeqa, recovery is about more than surgery.
It can mean rebuilding confidence, reconnecting with family, and returning to everyday life without the shame and fear that once kept them isolated.
Deeqa spent 17 years living with a condition she believed had no solution.
Now, she knows there is one.
And for her, treatment has brought something she had been missing for years: hope that life can begin again.
Written by Fatima Ahmed
