It is summertime in Nigeria. A young woman sits alone on a bus cradling her belongings to her lap and hiding her face beneath a shawl - she is embarrassed, because people are staring at her. Urine leaks down her leg and onto the floor; her dress is sodden and the smell is pungent. She hears the comments and sees the appalled faces as she clutches her hands over her abdomen; the pain increases and her face grimaces with discomfort. A tear rolls down her cheek as she remembers her dead baby. People are revolted by her appearance and she is sickened by herself - but she is helpless. She is incapable of stopping her own faeces excrete from her body because she is chronically incontinent. Her body is raw and tender from the genital ulcerations caused by constant wetness; it is destroying her life and has forced her to become a social outcast. She used to have a husband but he shunned her. She has now been ostracised from her village and her only hope is to undertake a long journey to reach Addis Ababa Hospital where she may be cured. However, the harsh reality is that she is not alone, albeit isolated by her condition. Countless numbers of women suffer like this, yet the world is ignorant of their plight. Welcome to the nightmare of living with Obstetric Fistula.

Pregnancy and childbirth should be a magical time for women and their families. For many, however, it is a time of great danger; half a million women die from complications during pregnancy and childbirth every year. And a shocking amount of women suffer from one of the gravest of pregnancy related disabilities: Obstetric Fistula.

A fistula occurs when a woman endures obstructed labour: when her birth canal does not allow the baby to fit through. The baby's head becomes wedged in the mother's pelvis and, as a result, cuts off the blood supply to the soft tissues of the bladder, rectum and vagina. Without medical assistance, the labour can continue for as several days. In simple terms, a fistula is a hole that can develop between the vagina, the bladder or the rectum. The condition creates many physical problems but the emotional implications are life-shattering. The baby usually dies and the mother is left without any control over her urine or bowel movements; forcing her to endure terrible physical discomfort.

Genital ulcerations, frequent infections and an unfortunate odour are all part of the condition, which imposes shame and social stigma on its sufferers. Abandonment is common, with many women being driven away by their husbands and families because they are deemed 'unclean'. This stigmatisation forces the woman into a life of poverty and malnutrition; some are still adolescents who have their entire lives in front of them. The tragedy of their situation is that due to poverty in these countries and inherent lack of obstetric care, affected women are not treated properly. And without treatment, the prospects for these women to work and have a family life are dim.

The World Health Organisation estimates that more than 2 million women in developing countries are living with Obstetric Fistula; the condition is more common in sub- Saharan Africa and South Asia, where access to obstetric care is very limited. Studies show that Nigeria may have one of the highest fistula prevalence rates in Africa with an estimated 400,000 to 800,000 Nigerian women living with the illness.

There are other factors that contribute to the occurrence of Obstetric Fistula: early marriage and childbearing, lack of skilled or timely assistance during labour and harmful cultural practises, such as the circumcision of girls when they are born. The absence of education and health education is another, underlying cause.

In Eritrea, demographic and health Surveys show that maternal mortality and morbidity are both high, with skilled attendance below 30%. As a result, birth related complications are, regrettably, expected. But it is the socio-economic and cultural inequalities in places like Eritrea that truly entrench disease. Women are expected to take on heavy workloads, yet nutritional intake for girls and women is substantially lower than boys and men - and the result is micronutrient deficiencies such as anaemia.

It is estimated that 90% of women forced into an arranged marriage are under 20; while 78% of women in Africa will be between 16 and 20 when they first become pregnant. Girls are urged to procreate before their bodies have fully developed; and as a result, pregnancy and labour are extremely painful. Most Eritrean families live 20km from the nearest health station and only 28% of women deliver babies with medical assistance. The other 72% give birth to their babies at home, without any trained assistance, relying on the male members in the family to decide on the utilization of antenatal, delivery and postnatal care.

A 21-year old woman from the Tigre group in Eritrea explains her battle with Obstetric Fistula. Her account illustrates just how urgently help is required:

"If my mother had been alive I would never have had the problem that I have today. My mother died 12 years ago while she was giving birth. She stayed in labour for two whole days then she died- and her baby too. But I needed her when I got pregnant myself…

I got married in 1997 with a Christian man. Before that I was serving in teashops and got to know my husband that way. When we got married I was a virgin but my husband never managed to penetrate and 'de-virgin' me. Somehow I got pregnant anyway. I think he was sick because he could not 'do it' and it made me dissatisfied. So, after three months, I went to live with my father again, even when I was pregnant. During the pregnancy I went for check-ups in the clinic nearby and they told me everything was as expected. When the labour started my father brought an Eritrean midwife and I asked her at that time: "I am a virgin, how can they deliver my baby? I have not been opened up. Please take me to the hospital so that they can get the baby out by operation.

"I did go to the maternity hospital. There the nurse put in her hands by force because my opening was too small and I had enormous pain. After two hours, the contractions started and the doctor came and said: "her opening is much too narrow; her parents must have arranged her marriage when she was too young." But it is true; I got married when I was 16 because my father arranged it so. The labour pains started to get worse and the doctor pulled the baby out by force- but she was alive. I had a big tear and they sewed it together but, right away, I had a big problem: I could not control my faeces anymore. The doctor did an operation after six months to fix it but, one month after that operation, the same problem returned.

"Still I cannot work nor do anything at all and when my baby was one year and three months, I gave her to the father because I could not financially support her. I never heard anything about her afterwards but when she was two years old, they sent me a message saying that she had died- they did not tell me how or why. My second husband and I have known each other for three years and because the faeces problem is not continuous, we can have a normal sex life. But I have been living together with him for only a year. Two years ago I even got pregnant again. I went for check- ups and delivered while living with some relatives. During this time of labour and delivery, the labour pains started on Friday, but the baby only came out at midnight on Saturday in the maternity hospital. Again, I had a very big tear and they had to sew it shut again. This time the outside stitches healed but the inside ones did not and the faeces started to come out by itself- things haven't changed since then.

"My husband accepts my condition but I can only move around a little as the faeces continue to happen for most of the day. My big hope for the future is that my problem is fixed and I can live a life and have more children rather than facing the same embarrassment each day of my life."

However, there is hope: in 2003, the United Nations Population Fund launched a global campaign to 'End Fistula'. The campaign seeks to raise awareness of Obstetric Fistula at all levels, from communities to policy makers, determining the needs and supporting implementation of national strategies to prevent and treat Obstetric Fistula. In association with its partnerships, namely health care providers, UN agencies and international companies such as Virgin, the campaign is striving to ensure the fulfilment of a woman's right to deliver babies safely and live a life of dignity. Richard Branson, Virgin's head, said: "Fistula is both preventable and treatable, yet millions of women still suffer from this tragic condition. Fistula is not an easy subject to talk about but let's start talking openly and try and put an end, together, to this needless suffering."

The campaign comprises over 30 countries in sub-Saharan Africa, South Asia and the Arab states, and seeks to address three key issues. First, the role of prevention in nipping the disease in the bud. Interventions to prevent. Fistula can and will save many lives. These intercessions include skilled medical care for all women in labour; access to appropriate emergency obstetric care for complications that may develop; plus family planning services to prevent unplanned pregnancies. Secondly, it aims to spread the message that fistula is treatable. Reconstructive surgery can mend the injury, with success rates as high as 90 per cent. However, as fistula surgery is a specialised skill, requiring training and committed surgeons and staff. The average cost of an operation to cure one woman costs only $300, which includes surgery, post-operative care and rehabilitation support. But most women who suffer from fistula are either unaware of the treatment or too poor to travel to the special hospitals.

Despite this, the campaign is starting to heal wounds already, with four fistula centres in northern Nigeria renovated and equipped with surgical supplies, and a fistula repair centre launched in Bangladesh. But the campaign is still urging as many people as possible to support the cause; there is still a long way to go. Thoraya Ahmed Obaid, Executive Director at UNFPA, said: "together we can end fistula. We must strengthen maternal health systems, bring this to the attention of policy makers and communities and ensure that women living with fistula receive the care they need."

Finally, the campaign aims to renew hope. Most women, once treated for Fistula are free and able to resume a normal life but there are some - especially those who have had to endure the illness and associated ostracism for many years - who may need emotional and social support to recover fully. In Chad, hundreds of women have already received small grants following surgery to support skills training at a local income-generation cooperative.

In January 2005, Natalie Imbruglia - singer and face of L'Oreal - became spokesperson for the Campaign to End Fistula and is now helping to raise awareness of, and funds for, the cause. She visited Ethiopia and Nigeria with representatives from UNFPA last year and, upon returning, felt compelled to act. She said: "I don't want to be part of the silence. I want to do everything I can to make a difference in these women's lives." She has been a strong advocate for the campaign: since her appointment as spokesperson, not only has awareness increased, but many Australian and American magazines have printed articles about her visits to Ethiopia, helping to spread the word about the disease. "For so long these women suffered in silence, before it was a household issue, only discussed in the home. Now it is a public issue and people know about it," said Aliyu Yakubu, UNFPA Programme advisor in Sokoto State. Nevertheless, further awareness is essential in Britain - the sooner this happens, the sooner these women can get better.

Last year the campaign ran a very successful 'Fistula Fortnight' (21 February- 6 March). This was an innovative treatment and training project tackling Obstetric Fistula in Nigeria. National and international volunteer doctors joined forces to treat hundreds of women suffering from fistula, as well as training in fistula surgery. Four fistula centres were renovated and equipped with surgical supplies. Amazingly, 545 women were operated on during the fortnight. Mustafa Lawai, one of the trainee surgeons based at the Birnin Kebbi VVF Centre in Kebbi State, said: "if you see (the patients) when they arrive, they feel like outcasts. There is no hope. When they have their fistulas repaired, naturally they are very happy," she said.

One woman has championed the cause of fistula for many years, devoting her life to helping sufferers: the Australian gynaecologist (and Nobel Prize nominee), Dr Catherine Hamlin. Originally, Catherine came to Ethiopia to set up a midwifery school, but when she saw the plight of fistula sufferers, her plans immediately changed. She made it her life's mission to help as many fistula patients as possible and eventually moved to Ethiopia with her husband to set up the Addis Ababa Fistula Hospital, which helped thousands of women in the past thirty years reintegrate themselves back in to society. As a guest on the Oprah Winfrey show, she spoke about the link between fistula and destitution: "poverty is an enormous factor in the formation of the fistula. They are so poor; they have no hope of making a journey in a bus, unless their husband or father will sell something such as a cow or a sheep. She will then have a two-day walk to get to a main road, the bus will appear and she'll get on that and then the bus driver says: 'you're smelling', or the passengers say: 'get off!' We had two girls once that sat on a tin at the back of the bus hoping the urine would drip into the tin so they wouldn't be noticed."

Altogether, Catherine has helped to heal 24,000 women and sends each of them home in a new dress and enough change to get the bus home. The advances made have been phenomenal. However, much more can still be done, and, with the help of the developed world, fistula may soon be an illness of the past. Let's work together to end the suffering.

To support the campaign or send a donation, email fistulacampaign@unfpa.org