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Obstetric fistula remains a significant public health and human rights concern globally, disproportionately affecting women and girls in low-resource and humanitarian settings. An estimated 500,000 women worldwide are living with fistula, with thousands of new cases occurring annually, particularly in sub-Saharan Africa. The condition is primarily caused by prolonged and obstructed labour in the absence of timely access to quality emergency obstetric and newborn care (EmONC), resulting in chronic physical morbidity, psychosocial distress, stigma, and social exclusion.
In Somalia, the burden of obstetric fistula is exacerbated by prolonged conflict, weak health system capacity, limited access to skilled birth attendance, and socio-cultural barriers that delay care-seeking. While comprehensive national data remain limited, available estimates suggest that between 3,953 and 13,337 women are living with fistula, with prevalence ranging from 1.17 to 4.05 per 1,000 women of reproductive age. These challenges are further compounded by a high maternal mortality ratio and low coverage of facility-based deliveries, underscoring persistent inequities in access to life-saving maternal health services.
Since 2014, Physicians Across Continents (PAC), with financial and technical support from the United Nations Population Fund (UNFPA) and in close collaboration with the Federal Ministry of Health (FMoH), has contributed to the national response to obstetric fistula in Somalia. Through periodic surgical repair campaigns, more than 1,400 women have accessed free, high-quality fistula repair services. Complementing these campaigns, PAC and UNFPA have supported health system strengthening interventions, including the establishment of the National Fistula Center at Daynile General Hospital and the development of the National Obstetric Fistula Strategy, standard operating procedures, and operational tools to guide coordinated and sustainable service delivery.
Building on these efforts, PAC and UNFPA successfully implemented the 12th Obstetric Fistula Repair Camp at the National Fistula Center, Daynile General Hospital, from 27 September to 5 October 2025. The campaign provided free, high-quality surgical repair and comprehensive pre- and post-operative care to 78 women living with obstetric fistula.
An additional 40 women who were not eligible for fistula surgery received appropriate gynecological assessment and management. The campaign also incorporated health awareness sessions for patients and community members, as well as hands-on capacity building for local medical professionals to promote sustainable service delivery beyond the campaign period.
The campaign was implemented through a multi-sectoral partnership involving UNFPA Somalia, the Federal Ministry of Health, PAC, and EL ALI Group International. UNFPA provided critical financial and technical support for international specialist deployment, medical supplies, patient care, and operational logistics. PAC led clinical service delivery, coordination, and monitoring, while the Ministry of Health ensured policy alignment, facility access, and referral coordination across federal member states.
High-level advocacy and visibility were reinforced through a visit by the UNFPA Somalia Representative and Members of Parliament, demonstrating strong national commitment to ending obstetric fistula and advancing women’s health and dignity.
Despite notable progress, the campaign highlighted that the scale of current interventions remains insufficient to address both the existing backlog of fistula cases and the ongoing incidence of new cases. Achieving the elimination of obstetric fistula in Somalia will require sustained investment in prevention, including expanded access to quality EmONC, skilled birth attendance, strengthened referral and transport systems, and community engagement to address harmful practices and delayed care-seeking. In parallel, the institutionalization of continuous fistula treatment services, expansion of rehabilitation and reintegration support, improved data and surveillance systems, and strengthened coordination across humanitarian and development actors remain critical.
The 12th Obstetric Fistula Repair Camp demonstrates the effectiveness of coordinated, survivor-centred, and systems-oriented interventions in restoring dignity and advancing the sexual and reproductive health and rights of women and girls. Continued partnership, political commitment, and resource mobilization are essential to accelerate progress toward the elimination of obstetric fistula in Somalia, in line with national priorities and global commitments to leave no one behind.
This intervention was made possible through strong national leadership and multi-partner collaboration. Physicians Across Continents (PAC) acknowledges the leadership of the Federal Government of Somalia, through the Ministry of Health and Human Services, and the sustained financial and technical support of UNFPA, which has been instrumental in advancing access to life-saving obstetric fistula services. PAC further recognizes the support provided by King Salman Humanitarian Aid and Relief Centre (Ksrelief) and Korea International Cooperation Agency ( KOICA) to the 12th Obstetric Fistula Repair Camp, whose contributions to maternal health services and emergency obstetric and newborn care enabled the successful implementation of this campaign and the delivery of quality, survivor-centred care to women affected by obstetric fistula in Somalia.