FLORENCE — "My first child died inside me while I was trying to give birth ..."

Hamdi Abdurahman Ahmed is 30 years old and has a marked Florentine accent as she begins to speak. In 2007, she left Somaliland and arrived in this Tuscan city where she currently works as a cultural mediator.

In Italy it is rare to meet women like Ahmed who accept to speak serenely about the scar they have had to live with since they were young: female genital mutilation (FGM), a ritual practice inflicted on 125 million women in 29 countries (27 in Africa, as well as in Yemen and Iraq).

"He was a breech birth and I was too sewn up," Ahmed recalls of the baby she lost. "My people say that a breech birth brings bad luck, so his death was seen as destiny. It didn't dawn on anyone, not even me, that the baby had been strangled by my infibulation."

An insignia of chastity and respectability that in certain societies, from Gambia to the Horn of Africa, takes the most extreme form of infibulation: the removal of all external genitalia, followed by the sewing of the vagina almost completely closed.

Until three years ago, even Hamdi was not able to talk about it: that which in her country is seen as virtue, in Italy and other Western destinations of migrants, it becomes a stigma of barbarity that creates an insurmountable rift between cultures.

"For me, infibulation was a natural condition, like breathing," explains the young woman. "Until one day, all my world turned upside down. I was taking care of a friend who was recovering from a de-infibulation surgery: she needed my help to dress the wound. One day I was late for work so I asked my Italian roommate to look after her. I came back home and found her crying, vomiting, asking me what kind of crime could a woman possibly be guilty of to deserve such torture. In that moment, my mind exploded with every single memory I had suppressed: the cut performed in my tiny room, the unbearably painful menstrual cramps, the death of my child. They teach us that it's normal, that suffering is part of your womanhood. But it's not true. Today, I try to rouse the memories of other women, speaking out against infibulation."

An elusive phenomenon

In Italy, and elsewhere in Europe, how many Somali, Egyptian, Senegalese, Ethiopian, Nigerian women are bearing the same pain as Hamdi? But above all, how many, unlike Hamdi, are still devoted to a tradition handed down from grandmothers and mothers who in turn impose it on their daughters, "cutting" them illegally here in Italy or in their country of origin while on vacation?

The figures are unclear. The latest survey promoted by the former Ministry for Equal Opportunities dates back to 2009: Of the 110,000 women who emigrated from FGM-practicing countries, it was estimated that 35,000 had been subjected to the practices and 1,100 of their daughters were at risk. Italy is currently the European country with the fourth highest prevalence level after Britain (170,000 women), France (53,000) and Sweden (42,000).

The Department for Equal Opportunities has guaranteed that on Feb. 6, the International Day of Zero Tolerance for Female Genital Mutilation, it will publish on its website all the initiatives financed to date. In fact, Italian law not only punishes whoever practices the "cut" with imprisonment from 3 to 16 years, it also allocates five million euros annually for the investigation of the phenomenon throughout Italy, public awareness campaigns to inform and sensitize communities, and training courses for educators and mediators. Still, much of the European and national funding has since dried up.

What Italy is doing against FGM?

Local initiatives are in fact numerous: It would suffice that the government coordinate them. In Perugia, in 2014, a Reference Center for the Study and Prevention of FGM was opened. In the northern region of Piedmont, the coordinating body for Regional Family Healthcare Clinics organized eight training courses within healthcare facilities, while in the Burlo Garofalo Hospital in Trieste, an 80,000-euro project involving the African migrant associations in Friuli-Venezia Giulia has just been concluded.

"We estimate that there are about 500 girls at risk in the region," explains Head of Gynecology, Salvatore Alberico. "Every year, we perform 2 or 3 de-infibulation procedures: They are carried out in day-hospital and the patient can choose between local and general anesthetic. But it's not simply a matter of restoring an anatomical normalcy in women affected by pelvic infection, chronic cysts, and in more serious cases, recto-vaginal fistulae. The emotional scar tissue must also be repaired."

Cristina Vecchiet, a psychotherapist at the hospital in Trieste, stresses the importance of the physician's attitude and behavior towards the patient: "We avoid calling it ‘mutilation,' to start with because the women don't see it that way," Vecchiet explains. "Before they migrate, it is simply their culture. If they ask for de-infibulation, they need to be made aware of the entire process, releasing them from the silent submission they were subjected to at the moment of the cut."

The motivations that prompt them to get operated are always the same: liquid stasis, painful sexual intercourse, wanting to give birth naturally without a caesarian section. The emotional preparation leading to the procedure is long and marked by inner conflicts. "They fear judgment from their families who maintain a strong influence over them," says Vecchiet. "Of the nine cases treated here in four years, seven husbands were African and they supported their wives' decisions completely."

A young woman from Burkina Faso had to resort even to a plastic surgeon: The cutter who had "fixed" her as a child had let the blade slip, lacerating her up to her bellybutton. A woman from Sudan had postponed the procedure twice in the grip of ambivalence between desire and the terror that had reawakened the shock of the infibulation she had undergone when she was nine years old.

"I have seen women with extremely tightened stitchings, almost incompatible with life," recalls Aldo Morrone, President of the Mediterranean Institute of Heamatology, who was the Director of a division for migrant healthcare at the San Gallicano Hospital in Rome. "For some women, de-infibulation in preparation for childbirth is equivalent to betraying their roots."

Morrone recalls a young university graduate who grew up in Rome, the daughter of an African diplomat, who didn't want to suffer during sexual intercourse any longer. "She made an appointment for de-infibulation seven times and she did not show up seven times," he said. "And a girl with a tumor on her vaginal labia asked us to operate without unsewing her. It's a complex cultural model that must be handled without any prejudice."

Convictions are nearly inexistent

To date, convictions for this crime in Italian courts can be counted on one hand. The first case exploded two months after the 2006 law was entered into force: A Nigerian woman, arrested in Verona as she was preparing to "operate" on a 20-day old girl, after having cut another girl, was then sentenced to one year and eight months. But the parents of the two victims were acquitted in the Court of Cassation. The most recent episode dates back to last October when the Court of Cassation confirmed the relinquishment of parental responsibility for a husband and wife from Nigeria living near the town of Teramo: They had allowed their daughters of 9 and 10 years old to undergo genital mutilation by their grandmother while on a trip to Nigeria.

In Nigeria, 27% of the women have undergone one of the types of FGM. There are 35,700 Nigerian women living in Italy, the largest community of female immigrants from an African FGM practicing country. There are also many women immigrants from Senegal (25,700), Ghana (20,200), the Ivory Coast (10,900), Burkina Faso (5,300), Ethiopia (5,000), and Eritrea (4,500). From Somalia and Somaliland, where the infibulation prevalence stands at 98%, there are about 2,300 women living in Italy.

Every African community is a world in itself: "A Nigerian woman told me in confidence that they turn up the volume of the music really loud and proceed with the cutting," reports Laila Abi Ahmed, a 49-year-old Somali, President of the Nosotras association in Florence. "In Italy, immigrants perform only Type I and II, the partial or total removal of the clitoris and the labia minora, at a cost of 300 to 500 euros. Not infibulation with the sewing: It's too complicated and dangerous."

According to Laila, this hidden suffering persists because Italy isn't doing enough: "Many doctors can't distinguish between the various types of circumcision," she explains. "Ministerial circulars are not provided at the local state-run healthcare units, and in our training courses we meet health care workers who know nothing about the law against FGM.

According Ahmed of Nosotras, the most important healthcare professionals to train are pediatricians: "When a woman who has undergone FGM gives birth, she should be given a personal medical chart that she can present to her daughter's pediatrician," she says. "This way, the pediatrician will know immediately that the girl is at risk of cut and can monitor her. Serious, responsible prevention can only truly take place this way."

*Photography: Simona Ghizzoni, Maps and graphic: Alessandro D'Alfonso, Data research: Emanuela Zuccalà, Valeria De Berardinis, Video: Emanuela Zuccalà, Simona Ghizzoni, Video editing: Paolo Turla

**This report is part of the UNCUT project on female genital mutilations (FGM). Produced with the support of the “Innovation in Development Reporting Grant Program” of the European Journalism Centre (EJC), funded by the Bill & Melinda Gates Foundation, and carried out in partnership with ActionAid NGO and the cultural association Zona.

Copyright: Emanuela Zuccalà Simona Ghizzoni - Zona.