Despite sustained efforts to stop the practice, Somali doctors and rights activists say two sisters bled to death after undergoing female genital mutilation (FGM) last week in Ethiopia's Somali region.
Doctors and activist confirmed that the girls died in Bur Salah village about 75 kilometers west of Galkayo town, but the mutilation took place near Galladi town across the border in the Somali region of Ethiopia. Galkayo hospital is the closest main health facility used by the Somali nomads who live in the area bordering Somalia and Ethiopia.
Dr. Mohamed Hussein Aden, who interviewed relatives who tried to save the girls, said the mutilation took place either September 10 or 11.
The victims were ages 10 and 11, Aden said, adding about the procedure: "There is no other way to describe it. It's brutal."
News of the incident is "heartbreaking," Aden said. He noted another emergency call came in Sunday for a young girl who had been circumcised. She was also being brought to Galkayo hospital.
Rights activists Hawa Aden Mohamed is the founder and director of the Galkayo Education Center for Peace and Development, which educates about 400 young girls in Galkayo.
Mohamed said she sent staffers to visit the girls' village but was told it would take days to locate parents. The family may be avoiding contact, fearing prosecution, she said.
Aden said Somali society is conservative and even the mother who lost the children may not tell the whole story.
He also said not all incidents are reported.
"It's shocking. This month, we heard [of] five cases, including these two deaths," he said. "Sometimes a month passes without hearing [about] any incident, but it actually happens at homes. We just don't hear of it."
Mohamed said incidents of female genital mutilation occur often, but people avoid talking about it because "it's like a taboo. They often use traditional midwifes. Sometimes people who perform are not midwives at all because they believe it's a tradition they have to do it. It's a deadly tradition."
Mohamed said some mothers ask her to grant daughters time off from school so they can undergo cutting.
"They ask for a week's holiday, saying they want to circumcise," she said. Mothers "argue, 'If I don't circumcise, she is going to chase men.'"
Mohamed said she tries to dissuade them, even shouting "no!" But, she added, "when you push them, they threaten to remove girls out of the school."
Mohamed said in a patriarchal society like Somalia, the bulk of responsibility to stop this practice rests with male family members.
"This can be stopped and it should be stopped," she said. "Mothers have learned this custom from their mothers and foremothers, or they are in remote areas and they have not heard a different opinion.
"If the father stands up, or the brother, and uncles, and say, 'Our daughters cannot be touched,' this will change."
FGM involves removing part or all of the clitoris and labia for non-medical reasons. The World Health Organization (WHO) says cutting, often performed on girls 15 and younger, can result in bleeding, infection, problems with urination and complications with childbearing.
Somalia is among the top three countries for FGM violations, according to the WHO.