Young girls in Sierra Leone, who were traditionally circumcised at puberty, are having their clitoris cut out by secret societies at a younger and younger age, especially in the remote north of the country.
The women who perform the crude operation with a long-bladed knife are also getting younger.
At Lunsar, a village 120 km northeast of the capital, Freetown, a group of circumcisers and their young assistants had gathered to listen to speakers from a women's rights group urge them to give up the practice.
The huddle of 30 or so women and young girls all wore white headscarves, showing that they had been circumcised themselves and initiated into the sisterhood of a 'bundu' secret society.
All of them carried their ceremonial circumcision knives held upright like short spears.
One was a small girl who looked no older than five or six. Her knife, with its 30 cm iron blade, was half as tall as she was.
Rugiatu Turay, coordinator of the Amazonian Initiative Movement (AIM), a women's rights group fighting to end female genital mutilation (FGM) in Sierra Leone, said this girl was at the early stages of her apprenticeship as a circumciser and would be required to carry the knife for an older woman, rather than hack away at human flesh herself.
"What does a girl of five know about FGM?" Turay said, pointing at the youngster standing with a group of knife-carrying circumcisers. "If you give her a knife or a blade to circumcise somebody it is just like teaching her how to kill, because, along with the clitoris, she can cut out another part of the body and damage it, leading to death."
In many African societies, the circumciser is an older woman who has passed childbearing age - but not in Sierra Leone.
One of the young women in the group at Lunsar said she had been circumcised at puberty, in the chaos of Sierra Leone's 1991-2001 civil war, and had been performing the operation on other girls.
"I was circumcised at 13 and have myself circumcised 23 girls since then," said 26-year-old Rugiatu. "This is the only way I earn a living, take care of myself and feed my children," she explained. "I was at school when my parents were killed - I had nobody to take care of me and entered the society. It is from there I got married."
Young girls in Sierra Leone were traditionally circumcised at puberty, as part of the rites of passage to adulthood. The ceremony was usually performed after they had undergone training for up to two years in household skills, such as cooking, sewing and curing illnesses with local herbs.
But today, in most cases, this period of apprenticeship has been pared down to just one or two weeks of preparation for the ritual of circumcision itself.
Age offers no protection from being circumcised. Olayinka Koso-Thomas, a gynaecologist who has been fighting against female circumcision for 30 years in Sierra Leone, said, "They even initiate babies and small children. Depending on the ethnic group, people do it at different ages: three, five, after secondary school, etc. The Sousous do it when the girls are 40 days old. The practice is more widespread in the north, where there are also more Muslims, who are more intransigent in sticking to the practice," she told IRIN.
In the face of widespread support for the practice among the country's five million people, and government indifference to international pressure to ban genital cutting, AIM is one of a handful organisations actively fighting FGM.
It was formed in Guinea at the time of Sierra Leone's civil war, when Turay and several other Sierra Leonean women, who had all been circumcised, were refugees.
"It is time for us to begin to talk to elderly women, so that they know this practice endangers the life of these young girls," Turay told IRIN.
"We want to see people dropping their knives; we want to see parents and girls becoming more open about the practice; we want the victims of the practice talking about it and ready to say 'no', so that the government will know women are ready for a change."
The organisation has been talking to people in villages throughout the West African country, and claims to have persuaded about 400 women, many of whom double as midwives, to give up inflicting FGM on others by offering them alternative ways of earning money.
Nandewa Bangura, from Rothana, a village near Lunsar, is one of those who have heeded the call, after wielding her knife between the thighs of countless young girls for the past decade - she cannot remember how many she has circumcised over the years.
Like others campaigning against FGM, she realises that the crude surgery can lead to life-long medical complications, and that accidentally severed arteries can cause young girls to bleed to death within hours.
"I have seen several girls die, and I have heard about the problems that other women are experiencing," she told IRIN. "So, if this organisation provides us with microcredit schemes, schools for the children - since we have no schools in the village - and a means for ex-practitioners, then we can practice the initiation ritual without cutting."
Female circumcision is a lucrative business for the women who perform the operation.
"Whenever I initiate young girls, the parents pay me money, give cloth, chickens, palm oil and, sometimes, goats when they have nothing else," Bangura explained.
It also brings cash into the hands of village chiefs, who charge a fee for every circumcision ceremony that takes place within their jurisdiction.
Turay, whose organisation has received a grant from the US embassy, equivalent to US $240 per woman, for putting 35 circumcisers out of business, complains that some of them simply demand too much.
"Some practitioners think we should build houses for them to make them stop," she said. "The challenge is to provide them with microcredit and income generating activities."
The Guinean branch of AIM runs a school for young girls who have escaped circumcision, with adult literacy and soap-making courses for women who have agreed to give up performing FGM.
Turay said she would like to set up a skills training centre in Sierra Leone to teach former circumcisers how to read and write, operate computers and make money from agriculture or tie-dying cloth. She would also like to set up a special school catering for girls who are determined to escape FGM and forced marriage.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions