A fistula is a permanent abnormal passageway between two organs in the body or between an organ and the exterior of the body. According to WHO, there are an estimated two million women in the world living with fistulas.86 They can be classified into two categories: obstetric fistulas and traumatic fistulas. Obstetric fistulas are childbirth injuries caused by prolonged obstructed labour and account for the majority of fistula cases. Traumatic fistulas are caused by violent sex, rape or vaginal/rectal torture, and are part of the grim reality facing many women who live in militia-controlled conflict areas and war zones.
The immediate physical consequences of fistulas are urinary incontinence and/or faecal incontinence. Fistulas impact negatively on hygiene and greatly increase the potential for infections. Furthermore, if nerves to the lower limbs are damaged, women may suffer from paralysis of the lower half of the body. Due to physical immaturity and increased risk of obstructed labour, adolescent girls are more likely to suffer from fistula than older women.
As well as the physical and health consequences, the social ramifications for those who suffer from fistula are also severe. In some areas, a high percentage of fistulae occur during the first pregnancy and restrict a woman’s ability to have future children. In a society where childbearing is so highly valued this gravely affects the woman's future. If the fistula is not repaired, and the woman remains incontinent and childless, she is likely to be abandoned by her husband, whom she is economically dependent. In addition, she may be ostracised by society as being considered to have brought shame on her family.