SOMALIA From silence to healing: New fistula care in Baidoa offers hope for Somali women
When Faisa Idow went into labour with her first child, she sensed something was terribly wrong. The 23-year-old from a rural village in Somalia’s Bay region endured several agonising days of obstructed labour before being taken to a nearby town for an emergency caesarean section. After the delivery, Faisa noticed an unusual injury that caused her to constantly leak urine and lose control of her bladder. The condition, which she would later get diagnosed as obstetric fistula, left Faisa feeling isolated and ashamed.
“My husband divorced me,” she recalls. “My grandmother and aunts were the only ones who stood by me.”
Years later, a relative told Faisa about a new fistula repair service at Bay Regional hospital in Baidoa. There, Faisa was informed about obstetric fistula — a severe childbirth injury caused by prolonged, obstructed, labour that creates a hole between the birth canal and the bladder or rectum, leading to chronic incontinence. After living with the condition for years, she discovered that it could be treated.
Obstetric fistula develops when prolonged, difficult labour cuts off blood flow to the tissue between the birth canal and the rectum, creating a hole that causes continuous leakage. In Somalia, the risk of women developing the condition is higher than in most parts of the world. Only about one-third of births are attended by a skilled health worker, and the country’s maternal mortality rate remains among the highest globally. Women often give birth at home with traditional attendants who are unable to manage complications, like those Faisa suffered. Long distances to health facilities, widespread poverty, and a shortage of trained midwives and doctors further limit people’s access to emergency obstetric care.
In a context where basic healthcare is often out of reach, comprehensive and specialised care for Somali women remains a distant reality. Until recently, specialist fistula repair services were only available in the capital, Mogadishu.
About 250 kilometres (155 miles) northwest of Mogadishu, Médecins Sans Frontières (MSF), in collaboration with the Ministry of Health, opened a 20-bed obstetric fistula unit at Bay Regional hospital in Baidoa, in August 2025. The team now provides a sustained, comprehensive fistula service that focuses on prevention, timely repair—including management of severe perineal tears—pre- and post-operative care, and long-term reintegration through counselling, social support, and nutritional assistance.
By the end of October, 20 women had undergone surgery, with many more registered for upcoming rounds. The unit will continue to expand, with physiotherapy services planned for early 2026 to support full recovery.
“Many of our patients have lived with a condition that has kept them apart from work, friends, and community life,” says Frida Athanassiadis, MSF’s medical coordinator in Somalia. “Fistula care isn’t just about repairing an injury, it is about listening to women, providing counselling, and helping them rebuild confidence. Our aim is to restore dignity and support their return to their communities.”
Word of mouth has been vital, as patients continue to come from within Southwest state and beyond. Khadija Adan, a mother of eight, lived with obstetric fistula for eight years, a condition she says she did not understand before travelling to Baidoa for care.
“In my village many women give birth at home with the help of neighbours or traditional birth attendants,” she says. “Health facilities are far away, and we must walk for hours or pay for transport that we cannot afford. Early marriage, and female genital mutilation are common here, and we do not have regular antenatal care.”
Women and children in Somalia continue to bear the greatest burden of a health system stretched to its limits. Essential maternity care is scarce and often far from reach, forcing many to undertake long journeys that can be expensive, and dangerous for women in need of immediate care.
As funding declines and health services shrink, access to free, lifesaving care is becoming increasingly rare. Specialised obstetric services including emergency surgery and fistula repair remain beyond reach for most women. There is an urgent need to strengthen maternal health services, ensure skilled care is available, free, and closer to the communities who need it most.
“Maternal healthcare is central to preventing obstetric complications. In Baidoa, we provide comprehensive maternal services to prevent complications, including fistula, and we offer full fistula management and repair for women who need it,” says Frida.
“Strengthening referral systems, training more midwives and surgeons, and ensuring functioning operating theatres are crucial steps. Sustained investment in antenatal care, maternity services, and community awareness is essential to make childbirth safer and prevent fistula from occurring.”
Hannah Hoexter