The operating table for FGM reversal surgery at the Chelsea and Westminster Hospital, London. All photos by Matteo Congregalli

Meet the FGM Survivors Fighting Against the 'Organized Crime Against Gender'

Almost 140,000 women in the UK live with the shame and devastating side effects of female genital mutilation. But some survivors are starting to fight back.

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Jan 19 2016, 3:00pm

The operating table for FGM reversal surgery at the Chelsea and Westminster Hospital, London. All photos by Matteo Congregalli

When the day came, Hoda Ali and her sister got their hair and nails done. Relatives had organized a party and brought gifts. The festive atmosphere suddenly faded when the woman, dressed all in black, came to Ali's house in Mogadishu, Somalia.

"She spoke to me first," Ali remembers."She said my younger sister—who was six at the time—had to go first. That I, at the age of seven, had to be a woman. I had to be strong and not cry to keep my sister calm."

Ali's turn came. Her family could afford a local anesthetic. "I didn't cry. I didn't feel anything, just the needle going in." When the procedure was over, both sisters had their ankles joined together by a short string restraining their movements. Running or even making big steps could cause the stitches to come off. The effect of the anesthetic vanished and the burning started. A mild painkiller was enough to ease the pain.

The complications came a few years later. "When my period was not coming and I had strong abdominal pains, I started getting worried," Ali recalls. "There was an Italian hospital in Mogadishu. The scanner revealed a shadow. They said it was a cyst."

Read More: Female Genital Mutilation and the Women Who Practice It

The surgeons decided to operate on her. They expected to find a cyst, not menstrual blood stagnating as result of the "cutting," also known as female genital mutilation. Hoda's stitched labia were reopened after a first surgery. But she still couldn't have her period.

At that time, Somalia was rapidly descending into a bloody civil war with several rebel factions fighting against the Somali government.

"I remember running through a football pitch, towards the small airplane that would evacuate us," Ali says. "I was keeping my head down not to get shot. I had my hand on my belly. I was afraid the stitches would come off."

Anti-FGM activist Hoda Ali underwent the procedure at the age of seven in Mogadishu, Somalia. All photos by Matteo Congregalli

Ali and her father fled Somalia. They flew to neighboring Djibouti and then to Milan, Italy, where a medical team was ready to operate. The morning after surgery she woke up; the sheets soaked in blood. The nurses were smiling. "At 17, I finally had my period."

Ali eventually filed for asylum in Holland. Then, she moved to London in 2001, where she became a nurse. There, she found she was not the only one who had undergone the procedure.

FGM is practised in several regions across the world: Africa, the Middle East and some parts of Asia. In Africa alone, three million girls are at risk every year. According to the World Health Organization, between 100 million and 140 million girls and women worldwide have been mutilated in this way.

The cutting consists of the complete or partial removal of female external genitalia for non-medical reasons. The most severe type of female genital mutilation—infibulation, also known as Type III FGM—involves the total removal of the clitoris and the labia. The raw edges are then stitched together and almost completely sealed.

But the "cutting" doesn't happen only in foreign lands. According to a report issued by Equality Now in collaboration with City University London, there are 137,000 women who have undergone FGM living in England and Wales. It's estimated that there are likely to be people affected by FGM in every constituency.

London has the highest number of FGM survivors. In the northwest borough of Brent, 3.9 percent of female residents have been cut; that figure rises to 4.7 percent in the south London borough of Southwark. The African diaspora brought new cultures and customs to London; female genital mutilation, unfortunately, came with it.

A patient leaflet at the Chelsea and Westminster Hospital, London, showing the parts of Africa were FGM is endemic.

FGM is also a reality for the generations of girls who were born and brought up in London and other parts of England. The cutting seasons begins when the school summer holidays start. Six weeks: Enough to allow a trip to the country of origin for the cutting and let wounds heal before children go back to school. It is estimated that some 500 British girls are at risk of FGM every summer.

Last July, a British court issued a travel ban for three girls of Nigerian descent, aged between six and twelve. Their mother had reportedly been put under pressure by her husband to make the girls undergo FGM. When she received ceremonial robes in the mail, she alerted the authorities.

The barrister for the children's mother stated that "there is a real risk that the girls may be cut in this jurisdiction or in Nigeria or may go missing." In the case of the Nigerian girls, authorities could do something. Others simply slip through the net.

Nimko Alì (no relation to Hoda) was seven when she was cut. She was born and raised in Manchester. Her parents took her to Djibouti for the procedure; she didn't know what to expect. There was a party. There were gifts. Now, in her 30s, she can lucidly analyze what happened to her when she was cut.

"There's coercion in the process. The point is creating confusion for the child," she says. "You bring your daughter to a foreign land, there is a party, so she doesn't realize what she is about to go through."

London is not just England's FGM capital. It is also the stronghold of anti-FGM campaigners and survivors who are confronting this practice on the battlefield of tradition, culture, and awareness.

Female genital mutilation is organized crime against gender. It's torture.

The life of a "closeted" FGM survivor living in London can be unbearable. While required to be strong mothers and reliable wives, health complications will take their toll on any woman. In most of the cases, genital mutilation brings urinary infections, as well as menstrual and abdominal pains.

A survivor hardly links her mutilation with pain. So do some general practitioners. "A big part of the problem is the lack of awareness, " says Ali, now an health practitioner working in a West London hospital and a trustee for the anti-FGM charity 28 Too Many. "Survivors can't link FGM to its fallout, to the painful consequence. For them, culturally, FGM was a blessing, a reason to celebrate."

A common justification for FGM in practicing communities is to attenuate the sexual desire of girls. FGM is always believed necessary to help girls to find a husband. Those who are not cut often face discrimination and threats from family and community members. In the African diasporic community, FGM is then seen as a way of preserving cultural identity and prolonging tradition.

Sagal Osman from Good Efforts for Health and Well-Being in her office in West London. Sagal is an FGM survivor and grassroots activist.

"Female genital mutilation is organized crime against gender," Nimko told me when I met her in a cafe in east London. She co-founded Daughters of Eve, a charity on the forefront of the fight against FGM in UK. "It's torture. It is not part of your culture. It doesn't define you. It doesn't define you what you should do or how you should behave."

The link between identity, culture and FGM is arguable the hardest to break. As outlined in the Equality Now report, there is a concrete risk that mothers, grandmothers or aunts impose FGM on daughters, granddaughters or nieces.

Sagal Osman, FGM survivor and community activist, recalls the case of a young woman who was cut in London. "I spoke to her mother and she said her daughter had to feel the same pain she had to go through herself, years earlier."

"It's internalized misogyny," Nimko says. "It's ultimately fear of change and fear of possibility, freedom and beauty."

The only way to end FGM is really talking about it. We have to learn to talk about our bodies.

The only solution to stop FGM is breaking the circle of abuse and introducing the notion that cultural change is possible and is not wrong. When Nimko met the Gender Equality Minister of Burkina Faso, where the incidence of FGM in women between 15 and 49 is 76 percent, she gave her the best explanation possible on the relationship between genital mutilation and culture.

"Banning the cutting is like tearing the pages out of a book," she remembers."Even if there are a few missing links, you will be able to find the hook, you'll still understand what a chapter is about. Your culture without mutilation is still recognizable. You will still identify with your mother and you will also be different."

For Nimko, part of the debate taking place in the West is not helping. It only takes a quick Google search to find material advocating the use of the term "female genital cutting" rather than FGM, a term some activists and scholars consider ethnocentric and racist.

"This is what I call the SOAS effect," Nimko says, referring to the politically right-on School of African and Oriental Studies in London. "FGM has been made illegal in many African countries. There is a UN universal ban on cutting girls. But, here, we have these intellectual masturbation sessions on whether outlawing FGM is cultural imperialism."

Leaflets and material on FGM at the Chelsea and Westminster Hospital. According to a recent report, England has a staggering number of FGM survivors.

At the Chelsea and Westminster Hospital in west London, specialist midwife Deborah Alcayde, runs a clinic that offers support and solace for FGM survivor. There are two rooms, in the neonatal unit of the hospital: one for consulting, on for de-infibulation surgery. On the wall, colorful flowers painted on the wall ease the worrying presence of the gynecological examination table. Alcayde starts with one simple question: Have you had FGM?

"Some of them don't understand the question. Some are not able to connect the cutting with its health implications," she recounts. On her desk, a bundle of laminated paper sheets show pictures of female genitalia, before and after FGM. "But when they link the symptoms they came to see me for, very few of them look at FGM in the same way."

The clinic became first operational in 2011. Since then, Alcayde has been able to witness all the stages ranging from the first visit to reversal surgery. It is not just a physical path. Genital mutilation takes a psychological toll.


The common thread that links all the cases is the pressure families put on their girls, the anticipation before FGM, and the sense of betrayal after they realize what they have been forced into. "The question they ask themselves is, How could they do this to me? How could you do this to somebody you love?"

In the most severe cases of infibulation, only a tiny hole is left open for urine and menstrual blood to exit the body. De-infibulation surgery can be the cut that heals. Alcayde re-opens the labia, cutting through the scar tissue. "FGM can have devastating effects on a woman. But when they leave after surgery, they are happy women," she says with a smile.

Female genital mutilation has been outlawed in Britain since 1985. The Prohibition of Female Circumcision Act 1985 was then replaced by the Female Genital Mutilation Act 2003, which outlawed the cutting and created extra-territorial offences [crimes committed overseas for which a UK resident or national could be prosecuted] to deter people to bring girls abroad for mutilation. Offenders face up to 15 years in prison.

Police actively liaise with health institutions to intercept cases of FGM in the UK. In 2015, it became mandatory for health professionals to report cases of female genital mutilation in girls under the age of 18 to the police. The British government is taking steps to treat FGM as a matter of child abuse.

But this may drive survivors away from looking for help. "Imagine the strength that a 16 year old needs to seek help, when her family wants her to stay circumcised despite the incredible menstrual problems and infections," says Alcayde. "Imagine that. By law, as a practitioner, you will have to report it to the police. That girl is going to stay away from accessing health services."

Deborah Alcayde's clinic wall at the hospital where she treats FGM survivors.

Alcayde is not the only one ambivalent on the relationship between policing and providing genuine support for victims. Sagal Osman runs a community-based charity, Good Effort for Health and Well Being. She is an FGM survivor from Somalia. "When we support survivors, it is always hard to convince them to seek help," she says. Once, she had to convince a Muslim survivor that the sign reading "Sexual Health" on a London clinic's door was nothing haram (Arabic for "forbidden").

"Seeking help is shameful, worrisome, embarrassing," she says. "If you add police to the mix, people are going to run away."

"The only way to end FGM is really talking about it," Nimko Ali tells me. "We have to learn to talk about our bodies."

Nimko tried to speak to her teacher at school shortly after she was cut. The only answer she got was, "That happens to girls like you." Being a survivor others you.

In 2006, she visited a school in England. Out of 14 girls, thirteen had had FGM. A few years later, she co-founded Daughters of Eve. When Nimko finally spoke out in 2010, she began receiving threats. Those harassing her were mainly men.

"At the end of the day, FGM is just about power," she says. "Those who threatened me were the ones who were afraid. They felt their power being eroded as a female was empowering herself through talking about her genitalia."

Ali, Nimko, Osman, and many others who decided to stand up and raise their voices are gaining power and setting an example for younger generations—examples of strength and courage that can break the cycle that helped FGM to survive.

At the time of writing, Ali had just returned from a trip to Somalia, the country where she left almost twenty years ago. It was the first time she had been back since she fled with her father.

"I am going to adopt my kids," she tells me, smiling. She can't have children. The long series of surgeries exacted their toll on her body. "One day, I am going to have a football team, I swear."

She repeats what she once said at an anti-FGM conference in front of hundreds of people; her voice breaks and she almost bursts into tears."My mother was a victim, my grandmother before her was a victim. But FGM has ended with my sister and me."

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