From: Nashi Brooker
Comment: Circumcision in Albania Today- Should it be Immune from the Law?

Some years ago I was invited to celebrate that a boy of five years old had “just became a man”. The close family were gathered together by the parents a week after his circumcision had taken place. The little boy was wearing a dress at that point because he had not yet healed.

There was a feast and then the music started. The “man-boy” was put in a bedsheet and all male adults were dancing with him. The little boy, though still obviously experiencing discomfort, was laughing, reacting to the affection being shown to him by people he loved and trusted. People who would never dream of doing anything to harm him.

The elderly men shared “sweet” banter with him about his now cut and still raw penis. I remember, the boy laughing nervously at being the center of such attention. I was stunned. I did not think there was anything funny about any of it. Certainly not the forced smiles and giggles of the little boy.

To me, the whole thing felt medieval and undignified. What had been done? Had the boy magically attained manhood? Nothing had changed other than a wound inflicted and a healthy piece of tissue removed. Or was it rather that a social ritual had been enacted? Adults conforming to cultural norms to avoid the disapproval of other adults. Ceremonial scarification performed on a child without the ability to protect himself from the malign attention of those charged with his protection. I remembered his mother telling her boy before the operation, not to worry, “because cutting the foreskin will take only a second”. Like she knew what it was, how long the cutting and the healing would take, and what the pain would be like.

My second account is rather more graphic. It comes from B, who happened one day to visit his uncle. and found a gathering there upon arrival. At its centre he saw a little boy, not older than five, being held down on a table. Male adults were clustered around, making crude jokes about the boy’s genitalia.

The little boy was looking around nervously, without knowing what was coming to him. Someone brought in by the family, not medically trained or qualified, but who was “known in this field”, started cutting the skin and B sees blood everywhere. The boy started screaming from the pain, horrified by the blood spilling from his body. He struggled against the grip of the men holding him down.

The men had nothing better to offer him to help him through this torture but laugh, muttering expressions like, “oooooh, no, no, men don’t cry as you do, it is really nothing, we will be finished soon”. Afterwards, the men congratulated themselves while the boy was left weeping, confused, traumatized. How brave they had been. What a cause for mutual celebration and back-slapping. Both accounts provided, it must be noted that both families and close relatives are not devout Muslims.

A final example, excerpts from the 2013 experience of an Albanian blogger, describing a visit to the hospital with his son: “As much as I dislike the experience, I found myself again at the children’s hospital. The practise of circumcision is both a culturally accepted norm and also a ‘cleanliness’ suggested surgical intervention for boys in Albania. My wife and I were both comfortable with the whole idea so we went ahead and did it.

Our son is only two and a half years old and we decided that this would be the best time for him as the older he gets the more conscious he will be about this experience which, judging from mine (at seven), was not something I felt good about.”

He goes on to explain: “Culturally, Albanians have been circumcising their sons for decades. The Muslim religious background of many in the country has been a dominant reason for this practice. … However, during communism, the practice was upheld mostly for health reasons related to general cleanliness and avoidance of potential infections. Today, it’s much the same reasons that lead many parents to have their sons circumcised.”

After describing the importance in some communities attributed to this practice and its associated celebrations by families, he includes the rather wince-inducing line, “The “lucky boy” also gets some presents (generally cash) as he tries to endure the pain!”

He concludes, “In our case, my wife and I decided to go the slightly more modern way, where it was only a family matter with just grandparents coming to attend as both of us have to work. Though we did entertain some guests who came to know about it and wanted to pay their traditional ‘respects’.” 

While one does not doubt the well-meaning attitude of the family attempting to do their best for their son, what is frightening is how a procedure that, experienced at seven and remaining something the victim did not feel good about even as an adult, was then performed on a child of two and a half.

There is no uniform age for the practice to take place and there is also no way of knowing whether age plays a part in reducing psychological or physical trauma.

As for whether there is, without the justification of an immediate medical condition, any evidence of some advisability in performing this ritual on scores of perfectly healthy young boys, the British National Health Service states, “It’s rare for circumcision to be recommended for medical reasons in boys.”

And what if medical conditions arise? “This is because other less invasive and less risky treatments are usually available.” It is, they continue, “normal for a baby boy’s foreskin not to pull back (retract) for the first few years of life” and while the foreskin can separate naturally from the head of the penis (glans) by the age of three, it can take longer. “Full separation occurs in most boys by the age of 5 years.” Finally, “For some boys, the foreskin can take longer to separate, but this does not mean there’s a problem and it will usually just detach at a later stage” 

I wanted to find out more about this practice, which is being regularly performed in hospitals across Albania, so I contacted a nurse, who spoke to me but prefers not to be named.

She confirmed that it was widespread and that doctors – who earn a fee every time the procedure is performed – regularly recommend it. I asked her about the cases which are done for no valid medical reason, what was the reason put on the file of the patient?  She confirmed that if done for purely cosmetic, religious or cultural reasons, then the reason is put down as “urine infection”.

I also approached a very well known surgeon to comment on this, but he decided to remain silent on the issue. As a culture, we defend the practice, yet our reluctance to admit its in-defensibility means that we even go so far as to falsify records to avoid scrutiny. 

Statistics for every region

Here are some statistics covering male incidence of circumcision, by region, for those aged 15-49 recorded during the period 2017-2018:

Kukës 80%; Dibër 66.7%; Shkodër 50.4%;  Dürres 53.7%; Tirana 52,8 %, Elbasan 26.3%; Korçë 21.4%; Vlorë and Berat, just over 18%; Fier 12.6%’ Lezhë and Gjirokastër 4.5% (These statistics were obtained from Albania Demographic and Health Survey 2017–18.) It should be noted that the overall figure of 36.8% is a reduction from the figures of 2008-2009 which, for the same age group, were 47.7%. 

There are hardly any statistics for boys younger than 15, which makes the incidence of circumcision larger than it appears, because the procedure takes place at all ages, and frequently takes place at people’s homes, by people who are not medically qualified. It should be added that if the operation goes wrong there is no immediate access to medical attention. 

National and international legal protection for the rights of children in Albania

I contacted a leading prosecutor to confirm whether there have been proceedings against parents who decide to circumcise their boys merely for cosmetic and religious reasons and without medical justification. She confirmed that there has been no prosecution in Albania on these grounds. She believes circumcision is both legal and unregulated in Albania.

There is no protection for children threatened by this practice within the Albanian penal code. In fact, if the results of this practice were to be certified by a doctor, without it being excused as a cultural tradition, it would most likely be categorised as having caused Grievous Bodily Harm. This what the Albanian Penal Code, Article 88/a, says about serious wounding under the conditions of strong psychic distress:

“Serious wounding, committed under the conditions of momentary strong psychic distress, caused by the victim’s violence or serious insult, shall be punished up to five years imprisonment”.

Additionally, Article 124/b Maltreatment of minors states

“Physical or psychological abuse of a minor by his or her parents, sister, brother, grandfather, grandmother, legal guardian or any person who is obliged to take care of the minor, shall be punished by imprisonment of three months to two years”.

Albania is a member of Council of Europe and has ratified The European Convention on Human Rights and Biomedicine on 30/03/2011, which came to force on 01/07/2011. This is now an instrument of international law, which has been in effect since 1 December 1999, which then became national law in Albania, and the circumcision of male children appears to violate Articles 1, 2, and 20 of this convention.

Furthermore,The Charter of Fundamental Rights of the European Union (2000) states:

“Children shall have the right to such protection and care as is necessary for their well-being. Circumcision of infants and children is incompatible with this provision”.

Further, The UNESCO General Conference adopted the Universal Declaration on Bioethics and Human Rights on 19 October 2005. Article 8 provides:

“In applying and advancing scientific knowledge, medical practice and associated technologies, human vulnerability should be taken into account. Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals respected”. 

Albania today enjoys the privilege of liberal democracy. The scrutiny of the old rituals and religious practices must be something that we must uphold. 

As for scientific opinions and recommendations on male circumcision, there are strong arguments to oppose it on the health grounds.

“Circumcision does not define your identity, you can be a Muslim, and have your genitals intact”, Professor Morten Frisch, an epidemiology researcher at the University of Copenhagen states, “when it comes to healthy under-age boys, the public should learn that exceedingly few boys – according to a Danish study, only 1 out of 250 newborn boys will need circumcision for medical reasons before they turn 18.

And then, the young man can decide for himself whether he wants to get rid of his foreskin or not. Ignorance about the harms of circumcision and bizarre myths about the dangers of having a non-modified penis is widespread. Religious groups should learn that it is perfectly possible to be a male Jew or Muslim with intact genitals. Already now, some Jews and Muslims do not circumcise their boys”.

Further, Professor Morten Frisch lists a number of potential health problems after the procedure:

“threats of haemorrhage, adverse effects of the anaesthetic, wound infection, psychological trauma and post-operative pain as potential dangers relating to circumcision, has also found that 5 to 20 per cent of circumcised boys will develop a narrowing of the urethral opening at the tip of their penis, which may cause serious urinary problems. Moreover, from a medical ethics viewpoint, and in accordance with the European Convention of Bioethics, it is an unacceptable medical practice to cut away healthy, protective, sensitive, erogenous, and non-reproducible tissue from a non-consenting individual in the absence of medical necessity”.

The UN Commission on the former Yugoslavia goes further and defines circumcision as sexual assault, and a human rights violation. In Article 24.3 of the Convention on the Rights of the Child the phrase, “traditional procedures prejudicial to the health of children,” refers to the practice of circumcision. The circumcision of male children, therefore, violates numerous provisions of various international human rights instruments and must be considered unethical medical practice. Again, Albania is one of the signatory states of this convention.

The way forward for the protection of male children, only by ensuring individual consent.

Professor Firsch calls for a ban stating, “So I think a ban on circumcision under a certain age – I suggest 18-years old – should go hand-in-hand with massive information campaigns and education targeted at people who practice circumcision ritually”.

As for the above, our children are vulnerable, and doctors have a duty under national and international law to respect their personal integrity. Non-medical reasons for circumcision in infants and children is illegal and offensive. To put a child through a distressing and painful experience for the sake of tradition is irresponsible and cruel.

From all that was said above, it’s hard to come to any conclusion other than that there is not much in place, practically, to ensure young boys’ bodily integrity and protection in Albania.

Looking at the Albanian media, the practice is considered a norm, and the focus is only on how to prepare boys psychologically to go through with it. What’s more, it is presented to the public as a minor intervention with no lasting harm.

The focus must be on the long term effects, which can be disastrous. The psychological trauma might affect the hormonal changes during puberty and can be even worse when the child will have sexual relations in later life. The casual acceptance of this injustice takes us as a society back to very dark and primitive times, and we must think of the harm that we are causing to the ones who need our protection most.

This calls for a campaign to halt this “barbaric” practice and for it to be treated as illegal before the law; for it to be treated as a practice which degrades and strips the dignity from a human being. Our campaign must be directed at the Albanian Criminal Penal Code, which should specifically address the criminal offence committed when male circumcision is done purely for religious and cosmetic reasons.

On a personal basis, we should seek to intervene where we can. I have already managed on two occasions to persuade parents against going ahead with circumcisions and only wish I could have prevented more. 

Albanian society should ensure the welfare and protection of our children. We must prevent everything done to them that we, or more importantly they, will regret in the future. What our children need from us as parents and as a community is love and security. We owe it to them.

Fighting for their freedom from unnecessary interventions is the only guarantee we can give them in attempting to protect the integrity of their minds and bodies. Can we all today, set up a direct line to help parents, children, and the community, to report when this practice is performed on young boys, for no medical reason?