Edited/Distributed by HURINet - The Human Rights Information Network
## author : 597864@ICAN.NET
## date : 10.12.96

Egyptians Stand By Female Circumcision
Tradition Flouts Foreign Pressures To Eliminate the Risky Practice

Observer News. Dist. by HURINet. 10 December, 1996.

(Observer News): Last month, the parents of 4-year-old Amira Hassan did what they thought was their duty as good Muslims: They hired the family physician to snip off part of her genitals.

When she died a few hours later, ...as a result of complications from anesthesia, Mahmoud Hassan and his wife, Atiyat, accepted it as God's will. Now the only thing that puzzles them is why anyone thinks...the doctor, Ezzat Shehat, did anything wrong.

"He is a good doctor," said Hassan, 27, a somber grocer with a neatly trimmed mustache. "They should let him return to work." The death of the little girl -- one of two who suffered the same fate at the hands of the same doctor on the same day -- highlights the immense challenge faced by women's health advocates and some government officials in Egypt as they begin to confront the widely practiced ritual known as female circumcision.

Having ignored the issue for decades, public health authorities in Egypt this year were stunned by a national survey showing...97 percent of married Egyptian women between the ages of 15 and 49 had undergone the procedure. Among women with daughters, 87 percent reported...at least one daughter had been circumcised or would be.

"They were all surprised," said Dara Carr, a researcher with Maryland-based Macro International Inc., which conducted the survey on behalf of the Egyptian government with funding from the U.S. Agency for International Development. "I think the Egyptians felt that this was a dying custom and...this was much, much higher than they had expected."

Like other countries in Africa where female circumcision is commonplace, Egypt has come under growing international pressure to curb the practice. It has been linked to such potentially fatal health risks as bleeding, infection and complications relating to anesthesia -- and, in later life, problems in childbirth and sexual relations. That pressure led, in July, to a decree by Health Minister Ismail Sallam barring health professionals from performing the operation.

...the decree has encountered stiff resistance from Islamic fundamentalists, including many within the medical establishment, who defend the practice as necessary to protect women from the consequences of excessive sexual desire.

Judging from a visit to this rural village, hemmed in by sugar-cane fields on the west bank of the Nile 320 miles south of Cairo, the ban has yet to touch the lives of ordinary Egyptians. Many people said they had never heard of it. Others said they would ignore it. And local prosecutors acknowledged...they investigate circumcision cases with little vigor, if at all.

In the meantime, health workers say, girls as young as 3 continue to undergo painful and sometimes risky surgery at the hands of poorly trained midwives, village barbers and, in many cases, doctors who work for the same ministry that is claiming to combat the practice.

Human rights advocates are divided on the best way to combat the phenomenon. Some say Egypt's parliament should make female circumcision a criminal offense. Still others say the government should concentrate on promoting public awareness of the risks.

"People say...it is so deeply rooted that [making it a criminal offense] will just drive it underground," said Marie Assaad, who chairs a coalition of Egyptian nongovernmental organizations that is trying to combat the problem. "Many doctors still believe it is a very important protection against disease and immorality and that talking against it is a Western fad."

Among religious conservatives in Egypt, female circumcision is typically defended on the basis of sayings attributed to the prophet Muhammad. But others contend the practice has no basis in Islam. They note...it is unknown in ultraconservative Islamic countries such as Saudi Arabia and Iran, occurs widely within Egypt's Coptic Christian minority and may date to the time of the pharaohs, long before the advent of Islam.

In sub-Saharan Africa, female circumcision is a tribal custom that occurs across a broad spectrum of religions and cultures in more than 20 countries. The operation can range in severity from partial or full removal of the clitoris and surrounding tissue to a radical procedure in which the external genitals are cut away and the area closed with stitches, leaving only a small opening for urination and menstruation.

Egypt's government and official media largely ignored the subject until 1994, when CNN broadcast footage of a screaming 10-year-old Egyptian girl undergoing the procedure at the hands of a Cairo barber.

After initially accusing the network of trying to embarrass Egypt in front of foreign guests then in Cairo for a U.N. conference on population, the government promised action. ...it soon ran into opposition from the Gad Haq Ali Gad Haq, then Egypt's senior religious figure and the sheik of Cairo's Al Azhar University, who warned..."girls who are not circumcised when young have a sharp temperament and bad habits."

Ali Fattah, health minister at the time, tried to finesse the issue by declaring...public hospitals would perform the operation only one day a week. When Egyptian women's groups complained, he banned the procedure in public hospitals, but not in private ones.

Sallam, the current health minister, has tried to close that loophole, announcing in July...no licensed health professional could perform the procedure. Sallam acknowledged in an interview...the Health Ministry has suspended or revoked the licenses of doctors in just two circumcision cases, both of them involving deaths.

The government faces strong resistance from Egyptian doctors such as Munir Mur, a British-trained professor of gynecology at Cairo's Ain Shams University with a thriving private practice in the upscale suburb of Heliopolis. Although Mur condemns the more extreme varieties of circumcision -- he said his method removes a fold over the clitoris while leaving the clitoris intact -- he has sued to overturn the ministry's ban on grounds...it is contrary both to Islam and sound medical practice.

"Most of our parents, mothers, aunts, sisters and so on have been doing this for years, and no one was complaining," Mur said in an interview.

Attitudes are even more entrenched in such rural villages as this warren of mud-brick houses and narrow alleys just a few miles from the five-star tourist palaces of Luxor on the opposite bank.

"Even if the law prohibits it, people will still do this operation," said Hoda Abdelmoreed, 29, a vivacious mother of three who teaches Arabic and religion at a high school in nearby Armant.

"Europe and the United States," she added, "need it more than we do. They wouldn't have AIDs and all these other problems."

When the parents of Amira Hassan decided...she should be circumcised, they turned to Shehat, the family doctor, who worked at the shabby, two-story village clinic run by the Egyptian Health Ministry.

Shehat had arranged to perform the operation along with two other circumcisions on the morning of Oct. 13. According to Mahmoud Hassan, he injected Amira with a general anesthetic and then circumcised her in the family living room, a cramped, filthy space lined with particle-board benches.

On the same morning, Shehat performed the operation another girl, 3-year-old Warda Sayed. The two girls died several hours later, apparently as a result of complications from the anesthetic. The third girl survived. Shehat then returned to the houses of the two dead girls, where he filled out certificates listing the cause of death as "natural." Shehat declined to comment.

The Health Ministry has suspended Shehat pending the outcome of the criminal investigation. But the doctor is still living at the clinic with his wife. Sameh Bahiry, an assistant prosecutor in Armant, said he does not expect charges to be filed. "We have no evidence against him," he said in an interview. "Circumcision is not illegal in Egypt."