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File photo of a courtroom in the Criminal Courts of Justice, Dublin city. Sasko Lazarov/

FGM expert tells court it is 'not possible' that toy caused girl's injuries

The girl’s father gave evidence today, both he and his wife deny carrying out FGM on their daughter at their Dublin home in 2016.

LAST UPDATE | Nov 26th 2019, 5:09 PM

THE INJURIES SUSTAINED by a young girl at the centre of a female genital mutilation trial are consistent with FGM and could not have been caused by falling on a toy as has been claimed, a court heard today.

The practice refers to the ritual cutting or removal of some or all of the external female genitalia for non-medical reasons.

The girl’s parents, who can’t be named for legal reasons, pleaded not guilty last week to carrying out FGM on their daughter, who was almost two years old at the time, on 16 September 2016.

The man, aged in his 30s, and the woman, aged in her 20s, also pleaded not guilty to one count of child cruelty on the same day.

They claim their daughter sustained her injuries after falling on a toy, something that has been disputed by doctors who examined the girl after she presented at hospital.

The trial is continuing before Judge Elma Sheahan at the Dublin Circuit Criminal Court.

Dr Deborah Hodes, a consultant paediatrician and FGM expert based in the UK, gave evidence today. Hodes viewed DVD footage of three examinations carried out on the girl at Our Lady’s Children’s Hospital, Crumlin (OLCHC) in September and December 2016.

A still image from one of the DVDs was shown on TV screens in court and copies of three images were provided to the jury.

Describing what she saw on the first DVD – footage recorded during surgery carried out by paediatric surgeon, Professor Thambipillai Sri Paran, to stop the girl bleeding on 16 September 2016 – Hodes told the court: “The clitoral hood appeared to have been retracted, the surgeon was pulling it back to get a good view and in order to stop the bleeding.”

Hodes stated: “There was a raw bleeding area where I would have expected to see the clitoris.” She noted that the view was “obscured somewhat by blood” but that she “couldn’t see the clitoral head”. A catheter was inserted after surgery to make it easier for the girl to pass urine and “avoid pain”, she noted.

The presence of the catheter highlighted that the bleeding was “coming from above the urethra”, she noted. “You would expect to see the clitoris and the clitoral hood, but I didn’t see this, I saw lots of blood,” Hodes told the court.

The second DVD contained footage of a colposcopy examination carried out by Dr Sinéad Harty, a consultant paediatrician at OLCHC, on 19 September 2016.

“It showed a swollen [clitoral] hood but much less than previously, three days earlier,” Hodes told the court. She noted that the hood was again retracted in the video and “there was a raw area again where one would expect to see the clitoris”.

‘No glands or body visible’

Hodes explained to the jury that the clitoris has three parts – the hood, the glands and the body. She said she “couldn’t see the glands or body” in this footage, adding that there was a “raw area where the clitoris should have been”.

She said the labia minora, labia majora and the rest of the vaginal area appeared normal. Hodes said there was “no visible bruising and no other lesions present”.

While being questioned by prosecuting solicitor Shane Costelloe SC, Hodes confirmed that she asked for another examination to be carried out on the girl at a later date, when healing had occurred. She said this would confirm or contradict her findings and would not be painful for the child as the area had since healed. A further examination was carried out by Harty on 6 December 2016.

“That’s common in medicine – a diagnosis is made and the patient is reviewed in weeks or months to confirm the original finding or not, in this case it did [confirm],” Hodes told the court.

Based on what she viewed in the footage of the later examination, she concluded that the girl had undergone FGM Type 1 – partial or total removal of the clitoris, the court heard.

“In my opinion the findings are consistent with FGM,” Hodes told the court, saying tissue appeared to have been cut and removed.

‘Not possible’

Hodes said the explanation that the girl sustained her injuries after falling backwards onto a toy while not wearing a nappy “does not fit with the clinical findings of the injury”.

“It’s not possible that falling back onto this type would cause this degree of damage,” she said, adding: “It’s my opinion that there’s nothing sharp there.”

She said the fact no other injuries or bruising were evident on the girl in the examinations carried out in September 2016 backed up this view. “If a child were to fall backwards onto her buttocks, onto this [toy], I would expect quite a lot of the area to be injured, not a specific part of the area.”

The toy the girl is alleged to have fallen on has been shown in court on a number of occasions. It is an activity centre with a steering wheel and other protruding objects.

Hodes co-founded a specialised clinic in London that helps identify FGM and help those who have undergone the procedure, and has helped devise FGM training for paediatricians in the UK. Hodes has also given advice about FGM to the British Director of Public Prosecutions, the Home Office, the Department of Health and the Department of Justice, the court heard.

Both Paran and Harty gave evidence at the trial last week, stating that they believe FGM occurred.

Colman Fitzgerald SC, who is defending the male accused, told Hodes there appeared to be an inconsistency in her and Paran’s evidence as to whether the labia is located above or below the clitoris. Paran last week said the labia minora and labia majora are both above the clitoris. Hodes yesterday said in her evidence that the labia is below the clitoris.

Hodes said there “seems to be” an inconsistency but noted that “very little [academic] work” on the anatomy of the clitoris has been carried out. She added that the labia is “neither under or over the clitoris because [the lips] meet”.

Fitzgerald noted that Paran last week also told the court there was the possibility of a laceration on one side of the girl’s labia minora. When asked about this, Hodes said she did not see the girl in person but that, based on the DVDs she viewed, “didn’t see such a lesion”.

Patrick Gageby SC, who is defending the female accused, asked Hodes about how a child may be kept in one position if FGM is being carried out. Hodes confirmed that sedation or holding the child down physically may be required.

He also asked her about referrals to the FGM clinic she helps run in London, specifically those cases where, upon examination, FGM is found to have not occurred.

Hodes told the court that, for the most part, in cases where FGM is not found to have occurred, the child was referred by “concerned” teachers or nursery workers. In some instances, the child had been referred by a medical professional, she said.

‘It was an accident’

Speaking via an interpreter, the male accused this afternoon told the court that he respected the opinion of Hodes and the other two doctors who believe FGM was carried out on his daughter, but said he disagreed with them.

The man, who has lived in Ireland for over a decade but is not an Irish citizen, said he respected their “medical expertise” but added: “What happened was an accident, I can say what I saw because I was present.”

The man’s recollection of events on the day his daughter was brought to hospital were yesterday heard in court via the reading of notes compiled during interviews carried out by gardaí with him in September 2016. The man today reiterated that his daughter was injured after falling onto a toy.

He said that on the day in question, he squeezed a ball that lit up and made noise while in the kitchen with his daughter. He said this scared his daughter, who was not wearing a nappy as her mother had just changed her, and caused her to walk backwards and fall onto the toy in question.

The man told the court that his back was turned when she fell but that he turned back around when he heard her scream and start to cry.

“I picked her up and tried to calm her down, her mother came from the toilet because she heard the cries. I didn’t see anything but her mother said she saw something between the girl’s legs,” the man said, via the interpreter.

He said he initially thought his daughter may have urinated but then realised she was bleeding. “I didn’t see where the blood was coming from,” he said, becoming emotional.

The man said he and his wife cleaned their daughter but that when the blood didn’t stop he decided to call 999. The court heard that the man hung up when his wife pointed out that they would probably get to the hospital faster if they drove.

He said his wife drove him and their two daughters to OLCHC. He said he went into the hospital with his eldest daughter while his wife brought their then youngest daughter, who was only a few weeks old at the time, home. The jury was shown footage of the father and daughter in the emergency department waiting room.

The man told the court he stayed in the hospital with his daughter for 20 days, sleeping on the floor during this time.

Fitzgerald then asked his client a series of questions:

“Did you cut your daughter?” “No,” the man replied.

“Did you let anybody else cut your daughter?” “No,” he said.

“To the best of your knowledge, did anybody else cut your daughter?” “No.”

“Would you have considered cutting your daughter or letting somebody else do it?” “No.”

The day before the incident

Costelloe, prosecuting, asked the man about what he did on 15 September 2016, the day before his daughter was taken to hospital. The man said he woke up at around 4am and left the house to do some cleaning and maintenance work at a pub. He said he did not return to the house until that evening but could not remember the exact time.

He said he was not aware of anyone other than his wife and children being in the family home while he was away. “I never asked my wife, but if someone would have been there she would have told me,” he said.

The man said he, his wife and eldest daughter woke up at around 11am on 16 September 2016. When Costelloe asked if it was possible that his wife and eldest daughter, the girl who was injured, were awake earlier than this, while he was still sleeping, he said it was possible.

The man told the court he believed they all woke up at the same time as it’s a small house, stating: “If somebody wakes up you would hear that.”

The man confirmed to Costelloe that he threw away the ball that is alleged to have scared his daughter before he and his wife took her to the hospital, but not the toy she is alleged to have fallen on. “I did that to calm my wife, she was blaming me for [scaring her],” he told the court.

The man said he did not throw away the other toy after this as he was told by doctors to keep it as both they and gardaí would need to see it. The man said there was some blood on the toy after the incident. The court previously heard that no blood was found on the toy, but that the girl’s mother cleaned it after the alleged incident.

Costelloe suggested to the man that he was not telling the truth and that “an act of female genital mutilation was done to your daughter while she was in your care and that you allowed that to happen”.

Replying, the man said this was not the case, adding that he did not carry out FGM on his daughter or allow anyone else to do so.

Yesterday the court heard the content of interviews conducted by gardaí with the accused in September and December 2016. Both of the accused strongly deny carrying out FGM and told gardaí they don’t agree with the practice.

The mother of the girl said she herself was a “victim” of FGM and would not allow the same thing happen to her daughter.

The trial will continue tomorrow before Judge Sheahan and a jury of eight men and four women.

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