A ground-breaking survey done by a German NGO of 40 villages in the rural Germian region of Kurdish-controlled northern Iraq has revealed that nearly 60 percent of the area's women have undergone circumcision (also known as female genital mutilation, FGM).
Of 1,544 women and girls aged over 10 interviewed by members of WADI's locally-based mobile medical team, 907 said they had undergone the operation, the so-called "Sunna" circumcision, which involves the partial excision of the clitoris; 637 said they had not.
"We knew Germian was one of the areas most affected by the practice," WADI Director Thomas von der Osten-Sacken told IRIN in Sulaymaniyah. "But these results were a real shock."
Although banned in the West, the practice of FGM is common in other Muslim countries in Asia and the Middle East, and in Africa in particular, where there are regular calls for it to be stopped. Health experts say it can cause major problems, including various forms of scarring and infertility in some cases.
The procedure, when performed without any anaesthetic, can lead to death through shock or excessive bleeding. The failure to use sterilised medical instruments can lead to infections and the spread of diseases such as HIV/AIDS.
Girls who have not been circumcised are considered "unclean" in many of the cultures where practised, and are often treated as sex workers.
Long known to exist in Iraqi Kurdistan, particularly in certain rural areas of the southern Sulaymaniyah governorate, FGM has been the object of more than a decade of campaigning by local women's organisations, as well as NGOs such as WADI.
In the total absence of statistics, though, estimates of the prevalence of the practice varied wildly. Some claimed as many as 40 percent of all women in Sulaymaniyah governorate were circumcised. Others suggest that it was around 10 percent.
WADI's small study will not be enough to put an end to that controversy. But it offers the first solid evidence that FGM is, at least locally, a major problem in Iraq.
The NGO is now planning a second, much larger survey of this practicse, which could turn out to be a lengthy process.
"You can't just go into a village and ask women if they've been circumcised," WADI mobile team doctor Suheila Hidayat Qadir told IRIN in Sarqalla, a small town in Kifri sub-district. "This is a practice that goes on in secret. Nobody talks openly about it."
In the 40 Germian villages, the surveying itself took less than two months, in October and November 2004. But members of WADI's team had been visiting locals for over a year and are known to them by providing medicine to the sick and health advice to women and children.
"These people are very poor; what they want most is money, not advice," said team leader Assi Frood Aziz. "They only began to trust us when they saw we actually intended to carry on helping them."
Dr Qadir and her colleagues include information about FGM among the health advice they gave villagers. They remind villagers of the dangers of infection immediately following the operation along with other serious health issues.
They also point out that circumcising a girl reduces her chances of experiencing a healthy and fulfilling sex life when older.
Trust or no trust, though, they have found persuading the people of Germian to give up the practice difficult for the simple reason that many are convinced it is a religious Islamic obligation, although this has been debated.
As one campaigner against FGM in Pizhdar, an eastern district of Iraqi Kurdistan, put it: "When you ask villagers why they circumcise their daughters, they tell you that if they don't, even the water she carries back from the well will be 'haram' [impure]."
No senior Sunni cleric has ever outright condemned female circumcision. In Iraqi Kurdistan, however, the fight to end the practice was made easier in 2001 when liberal clerics in Sulaymaniyah agreed to issue a "fatwa" (religious order) against it.
Members of WADI's Germian team say that clerics in the region are far more cooperative than in the past. But they add that the remoteness and backwardness of many of the villages has slowed the speed with which attitudes change.
"The Sulaymaniyah clerics have talked on TV several times about female circumcision," said Aziz. "But few of these villages have electricity, let alone radios or televisions. How are villagers supposed to hear what they say?"
He and other medical team members have taken to carrying copies of the fatwa around villages to show inhabitants. In the future, he says, they may swap that for a video and television.
"The ideal would be to interview one of the senior clerics in Sulaymaniyah about circumcision, and screen the results in each of the villages," he said.