Since September 2009 heath clinic workers at the Djabal camp in eastern Chad started recording how many prenatal patients had been cut; for September it was 22 among 330 women. "This helps us identify at-risk pregnancies because women with closed vaginas [resulting from FGM/C] can tear while giving birth," camp health director Nassourou Drassadou told IRIN.
The Italian NGO COOPI, which employs Drassadou, provides medical services to some 17,000 refugees at Djabal, 220km south of the main eastern town of Abéché.
Obstetric tears known as fistulas can lead to painful and uncontrollable urination and can require multiple surgeries to heal. Drassadou told IRIN 10 percent of the camp's prenatal patients faced a high risk of complications, in part due to FGM/C.
Most reported FGM/C among refugees has typically been linked to medical complications, the doctor told IRIN. "In the refugee camps, the health staff generally learn of [FGM/C] only when something has gone horribly wrong,"
But aid workers are not only seeing the long-term health impact of FGM/C; girls are still being cut in the camps. Health NGOs recorded nearly 60 incidences of cutting in refugee camps in 2009.
"Despite efforts to wipe out [FGM/C] we know it is still happening," health director Drassadou told IRIN.
One young girl bled to death at camp Djabal from a botched cutting, he said.
Days prior to IRIN's visit, a five-year-old was brought to the camp health clinic for urinary tract infections. "She could not urinate. Her urinary tract was not even visible," said Drassadou, who told IRIN the problem was a result of the girl's genitalia being cut at 18 months. When IRIN visited the girl at the Goz Beida regional hospital to where she had been referred, her family was preparing to bring her home. "She is better and can urinate now," her mother, Ashta Ali Heissein, told IRIN.
Heissein and her children fled violence in Sudan in 2006 shortly after her husband was killed trying to resist men who wanted his cows, she told IRIN. "I married at 19 and we never heard in Sudan that we should not have our girls cut. All mothers did it." Upon arrival at the refugee camp, she heard from aid workers and radio spots that FGM/C is harmful and potentially deadly.
Just after the girl's arrival in Chad, doctors had to operate on her because of FGM/C complications, Heissein told IRIN. "Things were better, but then she started having problems again [in 2009]."
After the girl's recent hospital stay the doctor told IRIN the girl had a good chance of not needing new surgery.
"Thanks to God," Heissein said in prayer as her daughter sat on the hospital bed, waiting to be released. "God is good. Doctors also."