In Asylum Cases Involving Female Genital Mutilation, the Medical Community Is Often Out of Reach

From Flickr Commons/ Photo by Chris Goldberg/Taken on August 13, 2011

The entire clitoris and labia is cut off, the area sewed up, and a small hole remains.

Nearly 140 million women and girls worldwide are estimated to have undergone female genital mutilation (FGM), also described as female genital cutting or circumcision, a procedure that can involve the partial or total removal of the external genitalia. The practice is viewed as a cultural right of passage in many countries.

But for women seeking refuge in the United States and Europe, they and their lawyers say the circumcisions were a form of torture that could put a woman at risk for postpartum hemorrhaging, stillbirth and neonatal death, increased susceptibility of contracting HIV if exposed to the virus, as well as lifelong problems with sexual intercourse, menstruation, and urination.

Being a woman may be a liability in and of itself in some regions, but health risks alone do not always sway western courts. Granting asylum to women with FGM-related cases rests on making a claim that a fear of future persecution exists for the women. This is a difficult argument to make when the circumcision has already occurred.

Could the medical community help make the case?

“There’s an extremely vibrant debate about FGM in the legal world,” said Sara Gorman, a student of public health at Columbia University. “But I found very little about it in the medical world…my presentation is trying to show that it is a medical and health issue and should be discussed in those circles as well.”

In findings she shared at the World Health Summit in Berlin in October, Gorman says 80 percent of the circumcised women studied in the United States continued to have flashbacks to the FGM event, 58 percent had some form of affective disorder, and 38 percent suffered anxiety disorders. Women with FGM-related Post Traumatic Stress Disorder often “re-experienced” the original trauma, she said.

Gorman reviewed more than 1,000 academic papers, 35 of which discussed where the law and medicine converged, although few discussed the long-term psychiatric effects FGM posed, information that could bolster asylum claims for women facing repatriation. In research conducted by the New York University Program for Survivors of Torture, cognitive deficits from PTSD, however, were even barriers for some women in completing the asylum application process. There are additional legal and medical issues that can make establishing these asylum cases more difficult.

For women seeking asylum in Europe, privacy laws can prevent doctors from reporting incidences. Doctor-patient confidentiality limits physicians in Germany, for example, from contacting prosecutors if FGM is suspected, although Germany does not outright ban FGM. A 2012 draft law, if enacted, would allow medical professionals to report the practice to police.

And according to the BBC, medical record-keeping was insufficient when an investigation showed Scottish doctors and midwives failed to report whether pregnant women had undergone the procedure.

Circumcision, though, is not necessarily permanent. Women who arrive to Europe and the United States often have reparative surgery through a process known as deinfibulation. Gorman says women who have had the surgery may strengthen claims of possible future persecution if sent to their country of origin, because women who have had reparative surgery can be re-circumcised, or re-infibulated.

But there is little on the likelihood that a repatriated woman will face ostracism or even death by community members when they learn that she has undergone corrective surgery.

“We just don’t know the degree of persecution after returned,” Gorman said. “What we do know is that when you are returned to the original site of the trauma, your psychological symptoms get much worse. The medical community has an obligation to assess this information.”

by Claudia Adrien

The article was originally published November 27, 2013 at berlinSCI.com.

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