Medina performed the deep infibulation procedure, traditional in Somalia, for more than 30 years, before settling at Ethiopia's Hartisheik refugee camp after fleeing her native Gebile. The practice involves cutting off the clitoris, cutting the vulva and then sewing the two sides together to leave a small channel through which urine and the monthly menstruation can pass. Sometimes mistakes are made and the wound seals entirely, necessitating a repeat of the operation. Frequently, infection sets in, and sometimes the girl dies.

In 1993, UNHCR, together with the National Committee on Traditional Practices in Ethiopia (NCTPE), instituted a training and information campaign in Hartisheik that focused on female genital mutilation. The campaign targeted circumcisors, traditional birth attendants, religious leaders and community elders. The programme explained to women participants that the urinary, kidney and menstruation discomfort and complications most of them experience throughout their lives are a direct result of the rite of passage they suffered as children - a rite that ended with clumsy stitches smeared with egg to cover their bleeding wounds.

Thanks in part to that training program, and an emotional video that has been widely shown both to men and women, Hartisheik and other refugee camps have seen the custom of infibulation change. Since Medina Hassan first took part in the workshops, perhaps hundreds of girls have been spared deep infibulation. Amina Sharif, NCTPE's project co-ordinator, says the three main female circumcisors in Hartisheik camp - Medina Hassan among them - have ceased the brutal old practice. But they do continue to practice a modified version of female genital mutilation. "Before, I used to get a lot of money, 100 birr ($15) for an infibulation," Medina Hassan said. "Nowadays , I am getting 40 to 50 birr for a little cut."  These days, Medina Hassan pricks a girl's clitoris enough to draw blood. Mothers must provide new razor blades for each child (thus preventing some unnecessary infections). This modified form of female Genital mutilation is known as suna among the Somalis, and NCTPE (as well as UNHCR) hopes it too will stop. "We want to destroy completely the culture of mutilating women," said NCTPE's Amina Sharif. Hassan says she decided to stop inflicting deep infibulation on young children when she reflected on the suffering she herself had undergone. She says that she is still sometimes asked to perform infibulation by mothers in the camp. She refuses. "There are still traditionalists in the camp. When they want me to make the deep cut and I refuse, they get angry," she said. But ending mutilation altogether will take some time, Medina Hassan says. "It is our tradition," Hassan said noting that she recently performed the simplified procedure on her granddaughter. "I have never seen a woman saying, 'I don't want my child touched."

The NCTPE's Amina Sharif believes that education is the way to halt mutilation, but she says workshops and posters are not enough. The circumcisors must have something else to do, and Medina Hassan, although advanced in years, agrees. "I tell you frankly, the circumcisor earns money. We can only change if we have another job," she said. "That and education - then you can eradicate circumcision." Women who practice genital mutilation earn vast sums by Somali standards, whether at home or in refugee camps. Although Somali culture is clearly flexible enough to adapt to less brutal practices - and may one day be ready to stop mutilating young girls altogether - it may be hard to find replacement activities that can generate the same income for the circumcisors.

Meanwhile, deep infibulation is still practiced among Hartisheik's refugees, Medina Hassan says. Traditionalists will always find circumcisors willing to perform the old procedure. Despite the best efforts of field staff and NGOs, young refugee children in UNHCR's care will continue to be mutilated, and sometimes even killed.