118 GENDER PERSPECTIVES ON TORTURE: Law and Practice as the Special Rapporteur affirmed46, States’ failures to properly screen migrants and refugees, identify victims of torture, including victims of FGM, and provide appropriate care and support can re-traumatize victims and inflict additional mistreatment. Given that women with FGM are considered vulnerable, and that States have a heightened obligation to protect vulnerable and mar­ ginalized individuals from torture47, subjecting women and girls to humiliating, discriminating, or judgmental attitudes in the health setting prohibits them from enjoying the right to the highest attainable standard of health, and can amount to torture or ill-treatment. The Istanbul Convention requires States Parties to ensure that public welfare services have the professional expertise and capacity to identify and address women’s and girls’ uniquely difficult situations and traumas (arti­ cle 20), and to provide such services to all women and girls, irrespective of their legal status in the country (article 4, §3). With regard to FGM, the Special Rapporteur’s report on Gender Perspectives could include a recommendation that urges States to undertake appropriate training and introduce community-level gender and diversity sensitisation campaigns that address underlying discrimi­ natory attitudes in the provision of health care services to women and girls with FGM. A growing concern regarding FGM is the expanding trend of medicalising the practice48. This is particularly relevant in countries such as Egypt, Nigeria, Malaysia, Mali, Kenya, Yemen49, Northern Sudan50, and Indonesia51. In Indonesia, where over 50% of women are excised, health professionals perform one-third of the excisions. In Egypt, where over 90% are subjected to FGM, this amounts to 77%. Various organisations and scholars have argued that medicalising FGM negates the long-term gynecological and obstetric effects of cutting the genitalia, as well as the impact on the emotional, psychological, and sexual wellbeing of the woman, and that it remains a violation of the right to bodily integrity, even if performed by medical professionals52. However, a number of other effects of medicalization can be noted, including the perception that medicalising FGM is a safer procedure, which raises concerns about the institutionalizing and legitimizing effects of medicalization. Moreover, the medicalising trend might equally have a negative impact on women and girls seeking asylum. Given the current issues related to obtaining asylum on the grounds of fear of persecution related to FGM (see discussion above), the fact that FGM is performed in a medical setting could allow it to be considered a minor procedure, and hence undermine the request for asylum–not only because of a lack of explicit grounds but also because of a lack of well-founded fear of persecution53. In his 2013 report on torture in health care settings, the Special Rapporteur expressed concern about the failure to detect abusive and mistreating practices in health care settings that amount to torture or ill-treatment due to the fact that the practices exceed the scope of violating the right to health but are justified because they are described as medical necessities, or “healthcare treat­ A/HRC/31/57 §31. Inter-American Court of Human Rights, Ximenes-Lopez v. Brazil, judgment of 4 July 2006, in A/HRC/31/57. 48 The medicalisation of FGM refers to situations in which the procedure (including re-infibulation) is practiced by any category of health care provider, whether in a public or a private clinic, at home or elsewhere, at any point in time in a woman’s life (WHO, 2016, op cit). 49 Robertson L, Szaraz M. 2016. The medicalization of FGM. 28 Too Many. 50 UNICEF, 2013. Female Genital Mutilation/Cutting : A statistical overview and exploration of the dynamics of change. 51 G.I. Serour. Medicalisation of female genital mutilation/cutting. African Journal of Urology, Vol. 19, September 2013. 52 See for example: Global Strategy to stop health care providers from performing female genital mutilation, 2010, available at: http://www.who.int/reproductivehealth/publications/fgm/rhr_10_9/en/. 53 Foldès P, Martz F. The medicalisation of female genital mutilation FGM and asylum in Europe, Forced Migration Review, May 2015. 46 47