The small compensation Fartun Abdi Ahmed, 25, takes from having her genitalia ritually excised with a knife used on six other girls is that the procedure took place in a rural part of Somalia, where the risk of infection, from HIV, for example, was relatively low.

"One cannot imagine the pain, the fear and the stress I went through; thank God it was a rural area and so we did not get some of the infections that are common nowadays," Ahmed, a refugee, said on 23 November at the launch of a 16-day campaign against gender violence in the Kenyan capital, Nairobi. "FGM [female genital mutilation/cutting] is the number-one form of gender-based violence for women in Somalia."

Ahmed, now a Nairobi-based community outreach worker and Somali translator with GTZ, the German aid agency, was addressing a press conference called by the UN Office for the Coordination of Humanitarian Affairs (OCHA) to mark 25 November, the International Day for the Elimination of Violence against Women.

Detailing the FGM/C phases that an estimated 90 percent of Somali women experience as teenagers, Ahmed said depending on the type of excision made - cutting the tip of the clitoris or removal of the clitoris as well as the minor and major labia - women end up suffering complications during their menstrual period, during marriage and at childbirth.

"As the stitching done during FGM leaves only a small opening, this often results in complications that can lead to infections during the menstrual period and at times a woman has to undergo surgery upon marriage to re-open the [vagina]," she said. "Even during childbirth, surgery must be performed and this can lead to the baby's or woman's death where surgery is not easily available."

The consequences of FGM/C include stress, fear, extreme shock, heavy bleeding and sometimes death, Ahmed said. Community elders and religious leaders had to be identified and trained about the dangers of FGM/C as they had the greatest influence on the community, she added.

"If these elders are not trained, the practice will continue with its devastating effects; we should also develop women’s support groups, comprising survivors of FGM and other gender-based violence to help each other," Ahmed said. "The creation of special centres where women can confidentially seek counselling and medical treatment as well as compassionate care is also very important."

Eddie Gedalof, the acting representative of the UN Refugee Agency (UNHCR), said boys and men had to be involved in efforts to end rape, assault, domestic violence, FGM/C and other abuses against girls and women.

"Boys and men are often the main problem in the fight against gender-based violence but they are also part of the solution; they must be engaged at the grassroots level in order to come up with community-based solutions," he said.

He added that UNHCR was committed to joint efforts to end gender-based violence (GBV) as it had witnessed the "despair, horrors, terrible sadness and loss of community structures for protection" caused by violence against women.

Besida Tonwe, the head of OCHA's regional support office in Nairobi, said the 2007 theme of the 16-day campaign against gender violence is Demanding Implementation, Challenging Obstacles: End Violence Against Women.

The campaign ends on 10 December, International Human Rights Day, reinforcing the message that violence against women and girls, "from rape as a weapon of warfare to female genital mutilation", was a human rights abuse.

"Sexual violence is widespread in central and eastern Africa; in conflict areas such as eastern [Democratic Republic of] Congo, it has reached almost grotesque proportions," Tonwe said. "Sexual and gender-based violence should be addressed robustly on several fronts simultaneously, not least because the violence does not end when armed conflict ends - it must be addressed also in post-conflict settings."

She said humanitarian actors and development partners in east and central Africa were urging all governments participating in the International Conference on the Great Lakes Region (IC/GLR) - an African Union-UN initiative - to ratify and translate into national law a protocol for the prevention and suppression of sexual violence against women and children.

The IC/GLR adopted the protocol in 2006 as part of its pact on security, stability and development. The pact is expected be enforced once ratified by at least eight of the 11 signatory countries in east and central Africa. So far, only Burundi, Central African Republic, Democratic Republic of Congo, Rwanda and Uganda have done so while Kenya's parliament has endorsed it. Angola, Republic of Congo, Sudan, Tanzania and Zambia have yet to ratify it.

In his message for 25 November, UN Secretary-General Ban Ki-moon said despite considerable progress by many countries in changing laws, policies, practices and attitudes, which in the past had helped create a "patchwork of impunity for this despicable offence", there was so much left to do to "tear down the veil of tolerance which still sometimes surrounds it.

"Violence against women is always a violation of human rights; it is always a crime; and it is always unacceptable," Ban said in a statement issued in New York. "Let us take this issue with the deadly seriousness that it deserves - not only on this International Day, but every day."

He said the UN family was stepping up its activities at all levels - from new initiatives by regional commissions to better coordination and programming at country level. He added that efforts were under way to raise public awareness, build political will and provide effective responses.