Amidst conflict a fistula survivor embraces life again

Marwa* is 22 years old, and lives in Al Hudaydah, Yemen. At the age of 17, which makes her a child bride, Marwa got married, and soon after the wedding, she became an expectant mother.

“I was almost 17 years old, and happy with my new life. I was a new bride and I got pregnant fast. I thought life was smiling at me.”

After a prolonged and obstructed labour, Marwa gave birth to a baby boy at home. A few weeks after delivery, she noticed something strange and shocking.

“I had sudden diarrhea and faeces coming out of my birth canal. I started to ask myself why was this happening? I could not comprehend it.” she recounted to UNFPA. She searched for answers to her condition. She came to know that she had an obstetric fistula - a hole between the birth canal and bladder and/or rectum, which is caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. It was a traumatic experience.

A month after delivery, Marwa had to face another traumatic experience as a new mother. The husband divorced her, abandoning her and their new born in a very vulnerable state. Once again, Marwa was shocked, “He told me that I was no longer a woman whom he wanted to live with, because I had become what he described as ‘ruined’.”

After her divorce, she sought the family’s help, but they could not provide much assistance. The family suffers the same fate as millions of other families across the country. The ongoing conflict makes Yemen the largest humanitarian crisis in the world. “They told me to be patient and accept my fate, and they couldn’t force him to live with me again. I was told that my life is over.” she explained.

During her interview, Marwa cried nonstop and held her baby close to sooth the pain. She explained how she had come to accept her situation, “I was devastated. I felt so sorry for myself, my youth and my newborn baby who would grow up without a father. I felt my whole life had been taken away from me. What did I do to deserve such fate? I asked that myself repeatedly,” she told UNFPA.

Marwa began to search for a cure and visited many hospitals, but all in vain. “It was useless. I knocked on many doors. I spent a lot of money going to these hospitals and on medications they prescribed. I had no results,” she said.

A midwife saves the day

She was becoming more accepting of the condition and the fact that there was no treatment. She had given up all kinds of hope to find a cure or treatment. It was not until she went to the midwife in her area to seek advice to cope and live with her condition. “she was my last resort and my only hope.”

Fortunately, the midwife, Na’ama, in Marwa’s village had received support and training from one of the UNFPA funded programmes. Na’ama had undertaken a special community care programme that trains midwives on detecting and preventing obstetric fistula during pregnancy and childbirth.

The midwife, Na’ama, knew through training of an existing support mechanism funded by UNFPA and managed by the National Midwives Association, which treats obstetric fistula. Na’ama refers cases to the Association.

“Na’ama gave me hope to live life again. She showed me that I was not the only one who suffered from this condition. She told me that my condition was treatable and I could undergo surgery for fistula in Yemen.”

Upon confirming the diagnosis, Na’ama contacted the National Midwives Association and placed Marwa on the waiting list to undergo surgery.

“I was in continuous communication with the Association. One day they called me and asked me to travel to Sana’a within a week.”.

It was not an easy task to make it to Sana’a from Al Hudaydah. It was not a trip Marwa could afford; she had spent her savings searching for treatment. She received no financial backing from the family or former husband.

“I was not able to borrow money from anyone. People could hardly make ends meet because of the war.”

The number of fistula cases continue to rise in Yemen; five years of conflict has bought the health system to the verge of collapse, skilled birth attendants are limited, levels of malnutrition are rising, particulalry among pregnant women, and alarming rates of child marriage as means to cope with the economic hardships brought about by the conflict all contribute to increased cases of fistula.

UNFPA has supported the establishment of three fistula units across the country. Between 2018 and 2019, more than 100 fistula surgeries were successfully treated free of charge. UNFPA is also helping to build skills of health personnel in treating obstetric fistulas with advanced training. In addition, UNFPA has created and strengthened a network between community volunteers, community midwives, reproductive health and fistula experts countrywide to help women suffering from fistula get the services they need, including providing free transportation from rural areas.

The UNFPA-supported fistula programme covered all of Marwa’s travel expenses.

On the way to Sana’a, Marwa was accompanied by her sister to look after her and the baby; she was also accompanied by her male cousin, since women often need a male guardian to travel within the country.

At the obstetric fistula centres at Al Thawra Hospital, Marwa found many other women who were suffering the same fate. She stayed in the hospital for more than a week, and underwent a successful surgery. Since then, Marwa returned home in Al Hudaydah and resumed her normal life.

For the first time since his birth, Marwa is able to embrace her baby and life again with joy. “I forgot all the pain I had gone through. I just felt joy and happiness,” she said with a smile.

*Name changed to protect privacy