Hazam's risky circumcision practices back with vengeance as deaths in hospitals spark concern

According to doctors, the unscientific methods used during these procedures, lacking proper training, often lead to accidents

The recent deaths of two children during circumcision have brought the procedure into the spotlight, which traditional practitioners known as "Hazam” have been performing for centuries in Bangladesh.

While medical advancements have led doctors to also perform this traditional manhood ritual on Muslim children, the recent deaths during such minor surgical procedures in hospitals have raised health concerns.

According to doctors, a significant number of male children undergo circumcision by Hazam or Khalifa - traditional surgeons - each year.

However, the unscientific methods used during these procedures, lacking proper training, often lead to horrific cases of rotting penises, septicaemia and inadvertent castrations - many of which go unreported in the media.

CURRENT CHILD CIRCUMCISION COMPLICATIONS

bdnews24.com, in collaboration with the Bangladesh Doctors Foundation or BDF, has identified at least 30 children who underwent circumcision by non-medical practitioners in recent days.

Among them, 14 children sought treatment at Dhaka Medical College Hospital or DMCH within February 2024 for complications arising from the procedure.

Doctors believe the actual number of cases is higher as many affected children do not go to government hospitals. Even those who do, outpatient cases may not be documented.

Two 6-year-old boys, Mohammad Saeed from Kamrangirchar and Farhan Khan from Faridpur, were admitted to the DMCH on Feb 28 after experiencing severe complications from circumcision performed by Hazam at home.

Saeed experienced profuse bleeding, while Farhan suffered extensive damage to the skin surrounding his genital area.

At the hospital, Farhan's grandfather Shafiqul Islam told bdnews24.com that he repeatedly warned the circumciser not to cut too much, but his pleas were ignored.

"My grandson screamed and almost fainted from the pain. Even with four or five of us holding him down, he couldn't be restrained.

“After quickly applying a bandage and giving an injection, the circumciser left. Three days later, when we removed the bandage, it was badly infected. When we took him to the doctor, we were told to rush him to Dhaka Medical College Hospital."

Shafiqul said the deaths of two children during circumcision in hospitals aroused fear in the family, prompting them to call the circumciser instead of taking Farhan to a medical practitioner for the procedure.

"Out of fear, I thought it was their profession and allowed the circumciser to proceed. But the circumciser ruined my grandson's life."

The doctor who attended to Farhan after the surgery revealed that most of the foreskin from his penis had been removed, affecting his ability to have a normal sex life in the future.

From Jan 20 to Feb 28 of this year, 14 children were treated in the paediatric surgery ward for similar issues.

However, data regarding children who were discharged after immediate treatment was not recorded.

A doctor from the ward informed bdnews24.com that, on average, a child with such problems visits the ward every day.

Rajon, a 6-year-old son of Jamal Uddin from Natore Sadar Upazila, was admitted to Rajshahi Medical College Hospital in late February due to excessive bleeding after circumcision by a Hazam.

Doctors found that the bleeding was caused by cutting a blood vessel in the child's genital area during the circumcision.

The boy's father recounted, “He seemed fine after the circumcision, but he started bleeding heavily during the night. The bleeding was severe, so doctors had to perform surgery on him.”

Professor Dr Md Nowshad Ali, the head of the Department of Paediatric Surgery at RMCH, explained: "Circumcisers like Hazam often lack knowledge about blood vessel anatomy and how to properly handle bleeding. They may have applied pressure to stop bleeding, but in this case, it didn't work, so we had to perform surgery to address the issue."

"We typically encounter one or two such cases every week during the winter season.”

These circumcisers lack training and medical expertise, leading to more complications during the procedure, Nowshad emphasised.

In another incident in February, a Hazam removed most of the skin from a 7-year-old boy named Siam, who was known by a single name, in Narayanganj's Araihazar area.

The child developed an infection and was admitted to Araihazar General Hospital, where physician Dr MM Mahfuzur treated him.

After two weeks of treatment, there has been some improvement, but skin grafting will be required for the child's penis, said the doctor.

Seven-year-old Jobayer Hossain Noman, from Savar’s Kabirpur, underwent circumcision by a local circumciser.

However, the child began bleeding, prompting his parents to take him to Savar's Gonoshasthaya Samaj Vittik Medical College Hospital the following day where Assistant Registrar Md Rasheduzzaman treated him.

The doctor explained that after the child's penis skin was cut, it was tied with a cloth. However, upon removing the cloth, the bleeding resumed.

The child's father Abul Kalam Azad mentioned that the circumciser suggested using coconut oil to stop the bleeding, but they decided to bring the child to the hospital instead.

Rasheduzzaman emphasised that if the bleeding had continued, the child could have gone into shock. “Such cases are not uncommon at the hospital.”

bdnews24.com spoke to Hazam Sohel Khalifa regarding the issue.

He stated that circumcision has been a tradition passed down through generations in his family.

"My grandfather and father practised circumcision, and so do my brother and I. I administer injections to the children before performing the procedure.

“The child seemed fine after the circumcision. As the situation worsened slightly, I advised the father to stay at home while I visited. However, they decided to go to the hospital without heeding my advice."

Rashedul Alam, an associate professor at Dhaka Shishu Hospital (children's hospital), shared details of a recent incident where a 5-year-old boy had his penis amputated during circumcision.

However, the doctor requested not to publish any photos or additional information.

Alam explained, "The boy's penis was bandaged. Upon removing the bandage, we found that about a centimetre of the penis, along with the urinary tract, had been severed.

“Fortunately, a relative brought the severed portion to us, and we performed successful plastic surgery."

"We encounter these cases regularly, so we typically don't maintain records," said Alam.

Kamrul Hasan, a resident doctor in the paediatric surgery department at Mymensingh Medical College Hospital, mentioned that children with circumcision-related issues frequently seek treatment at their facility, noting a particularly severe case on Feb 19 involving a child from Tarakanda.

"The circumciser removed excessive skin from the penis, resulting in severe bleeding that couldn't be stopped. The child was brought to the hospital using a piece of cloth to stem the bleeding. After receiving treatment, he was discharged on Feb 22."

On Mar 6, another 6-year-old child Sadid, also known by a single name, was taken to the hospital's paediatric surgery ward, where doctors discovered that most of his foreskin had been removed during circumcision.

Doctors say the blood flow to the penis is maintained by the frenular artery and dorsal vein At the bottom of the penis are veins, at the top are arteries and also many small capillaries or branches of blood vessels.

These arteries and veins are cut during circumcision. With skills, it is possible to perform circumcision without cutting arteries and veins. To stop the bleeding, doctors use stitches and electrocautery or diathermy. But Hazams do not have this technology.

IS IT POSSIBLE TO CONDUCT ALL CIRCUMCISIONS IN HOSPITALS?

According to the government, 3.2 million babies are born every year in Bangladesh, 90 percent of whom are born in Muslim families.

Half of the 2.88 Muslim children, or 1.44 million, are boys who have circumcision every year.

Paediatric surgeons say that doctors perform only 10 percent of the circumcisions in Bangladesh. The rest are performed by Hazams, medical technologists, health assistants, village doctors and various drug sellers.

Ashraf Ul Haque, head of paediatric surgery department of Dhaka Medical College Hospital, told bdnews24.com: “Circumcision is a type of surgery even if it is small. Any surgery requires a clean, sterile environment. Besides, Hazams do not have anatomical education. Hazams are not supposed to know where the artery or vein is and how much of the skin should be cut.”

“Many boys suffer infections due to impure circumcision. Doctors make markings with a surgical pen before circumcising, as the incision is made. But because the matters are not known, the Hazams cut more, or less. The purpose of circumcision is to keep the area clean. If cut less, after urinating, urine and dirt accumulate in that place.”

The doctor said that after the deaths of two children while undergoing circumcision in Dhaka, there has been a kind of 'negative publicity' about the issue. This risks further reducing the willingness to go to doctors for circumcision. If that happens, the damage will be long-term.

The deaths of two children following circumcision procedures within a span of two months have caused a stir in the country. On Jan 20, 10-year-old Ahnaf Tahmin Ayham died after undergoing circumcision at the JS Diagnostic Center in Malibagh's Chowdhury Para.

Previously, on Dec 31, another child, Ayan Ahmed, did not regain consciousness after receiving anaesthesia for circumcision at United Medical College Hospital in Satarkul. Ayan was placed on life support and later died on Jan 7 at United Hospital in Gulshan.

Health Minister Samanta Lal Sen said that as a doctor he is against the practice of circumcision performed by Hazams.

He claimed Bangladesh has a sufficient number of doctors to perform all the circumcisions.

“Circumcisions should be performed by trained doctors in a good facility. This service is available in every district and Upazila hospitals. I don’t think they will have problems performing circumcisions.”

Sen also said he was unaware if there were efforts to prevent circumcision by Hazams, or train them. “I’ll look into the matter,” he said.

[Writing in English by Arshi Fatiha Quazi; editing by Osham-ul-Sufian Talukder]