Scora fgma manual by Ming Yong

CONTENTS What is FGM? IFMSA Policy on FGM FGM Awareness Programs FGM in other Languages: French FGM in other Languages: Arabic

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WHAT IS FGM? Female genital mutilation (FGM) comprises of all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. However, more than 18% of all FGM is performed by health care providers, and the trend towards medicalization is increasing.

Procedures Female genital mutilation is classified into four major types. 1. Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). 2. Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are “the lips” that surround the vagina). 3. Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris. 4. Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

Causes of FGM The causes of female genital mutilation include a mix of cultural, religious and social factors within families and communities. ►► Where FGM is a social convention, the social pressure to conform to what others do and have been doing is a strong motivation to perpetuate the practice. ►► FGM is often considered a necessary part of raising a girl properly, and a way to prepare her for adulthood and marriage. ►► FGM is often motivated by beliefs about what is considered proper sexual behaviour, linking procedures to premarital virginity and marital fidelity. FGM is in many communities believed to reduce a woman’s libido and therefore believed to help her resist “illicit” sexual acts. When a vaginal opening is covered or narrowed (type 3 FGM), the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage “illicit” sexual intercourse amongst women with this type of FGM. ►► FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are “clean” and “beautiful” after removal of body parts that are considered “male” or “unclean”. ►► Though no religious scripts prescribe the practice, practitioners often believe the practice has religious support. ►► Religious leaders have varying positions with regard to FGM: some promote it, some consider it irrelevant to religion, and others advocate for its elimination. ►► Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice. ►► In most societies, FGM is considered a cultural tradition, which is often used as an argument for its continuation. ►► In some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Sometimes it has started as part of a wider religious or traditional revival movement. ►► In some societies, FGM is practised by new groups when they move into areas where the local population practice FGM. 3

Who is at risk? Procedures are mostly carried out on young girls sometime between infancy and age 15, and occasionally on adult women. In Africa, more than three million girls have been estimated to be at risk for FGM annually. More than 125 million girls and women alive today have been cut in the 29 countries in Africa and Middle East where FGM is concentrated. The practice is most common in the western, eastern, and north-eastern regions of Africa, in some countries in Asia and the Middle East, and among migrants from these areas.

Complications of FGM Immediate risks of health complications from Types I, II and III Severe pain: Cutting the nerve endings and sensitive genital tissue causes extreme pain. Proper anaesthesia is rarely used and, when used, is not always effective. The healing period is also painful. Type III female genital mutilation is a more extensive procedure of longer duration (15â&#x20AC;&#x201C;20 minutes), hence the intensity and duration of pain are more severe. The healing period is extended and intensified accordingly. Shock can be caused by pain and/or haemorrhage. Excessive bleeding (haemorrhage) and septic shock have been documented. Difficulty in passing urine, and also passing of faeces, can occur due to swelling, edema and pain. Infections may spread after the use of contaminated instruments (e.g. use of same instruments in multiple genital mutilation operations), and during the healing period. Human immunodeficiency virus (HIV): Use of the same surgical instrument without sterilization could increase the risk for transmission of HIV between girls who undergo female genital mutilation together. In one study an indirect association was found , but no direct association has been documented , perhaps because of the rarity of mass genital cutting with the same instrument, and the low HIV prevalence among girls of the age at which the procedure is performed. Death can be caused by haemorrhage or infections, including tetanus and shock. Psychological consequences: The pain, shock and the use of physical force by those performing the procedure are mentioned as reasons why many women describe female genital mutilation as a traumatic event. Unintended labial fusion: Several studies have found that, in some cases, what was intended as a Type II female genital mutilation may, due to labial adhesion, result in a Type III female genital mutilation. Repeated female genital mutilation appears to be quite frequent in Type III female genital mutilation, usually due to unsuccessful healing.

Long-term health risks from Types I, II and III (occurring at any time during life) Pain: Chronic pain can be due to trapped or unprotected nerve endings. Infections: Dermoid cysts, abscesses and genital ulcers can develop, with superficial loss of tissue. Chronic pelvic infections can cause chronic back and pelvic pain. Urinary tract infections can ascend to the kidneys, potentially resulting in renal failure, septicaemia and death. An increased risk for repeated urinary tract infections is well documented in both girls and adult women. Keloid: Excessive scar tissue may form at the site of the cutting. Reproductive tract infections and sexually transmitted infections: An increased frequency of certain genital infections, including bacterial vaginosis has been documented. Some studies have documented an increased risk for genital herpes, but no association has been found with other sexually transmitted infections. Human immunodeficiency virus (HIV): An increased risk for bleeding during intercourse, which is often the case when defibulation is necessary (Type III), may increase the risk for HIV transmission. The increased prevalence of herpes in women subjected to female genital mutilation may also increase the risk for HIV infection, as genital herpes is a risk factor in the transmission of HIV. Quality of sexual life: Removal of, or damage to highly sensitive genital tissue, especially the clitoris, may affect sexual sensitivity and lead to sexual problems, such as decreased sexual pleasure and pain during sex. Scar formation, pain and traumatic memories associated with the procedure can also lead to such problems. Birth complications: The incidences of caesarean section and postpartum haemorrhage are substantially increased, in addition to increased tearing and use of episiotomies. The risks increase with the severity of the female genital mutilation. Obstetric fistula is a complication of prolonged and obstructed labour, and hence may be a secondary result of birth complications caused by female genital mutilation. Studies investigating a possible association between female genital mutilation and obstetric fistulas are under way. Danger to the newborn: Higher death rates and reduced Apgar scores have been found, the severity increasing with the severity of female genital mutilation. Psychological consequences: Some studies have shown an increased likelihood of fear of sexual intercourse, post-traumatic stress disorder, anxiety, depression and memory loss. The cultural significance of the practice might not protect against psychological complications. Additional risks for complications from Type III Later surgery: Infibulations must be opened (defibulation) later in life to enable penetration during sexual intercourse and for childbirth. In some countries it is usual to follow this by re-closure (reinfibulation), and hence the need for repeated defibulation later. Re-closure is also reportedly done on other occasions. Urinary and menstrual problems: Slow and painful menstruation and urination can result from the near-complete sealing off of the vagina and urethra. Haematocolpus may need surgical intervention. Dribbling of urine is common in infibulated women, probably due to both difficulties in emptying the bladder and stagnation of urine under the hood of scar tissue. 5

Painful sexual intercourse: As the infibulation must be opened up either surgically or through penetrative sex, sexual intercourse is frequently painful during the first few weeks after sexual initiation. The male partner can also experience pain and complications. Infertility: The association between female genital mutilation and infertility is due mainly to cutting of the labia majora, as evidence suggests that the more tissue that is removed, the higher the risk for infection.

Prevalence of FGM Country Benin Burkina Faso Cameroon Central African Republic Egypt Eritrea Ethiopia Ghana Kenya Mali Nigeria Sierra Leone Sudan, northern United Republic of Tanzania Yemen

Year 2001 2005 2004 2005 2005 2002 2005 2005 2003 2001 2003 2005 2000 2004 1997

Estimated prevalence of female genital mutilation in girls and women 15 – 49 years (%) 16.8 72.5 1.4 25.7 95.8 88.7 74.3 3.8 32.2 91.6 19.0 94.0 90.0 14.6 22.6

It’s worth mentioning that FGM is present is so many countries other than these African countries. It’s also present among the immigrants in some European countries like Spain and UK.

IFMSA POLICY STATEMENT ON FGM Location: Baltimore, United States of America Date of adoption: March 13th 2013 Date of expiry: March 13th 2016 Summary Medical students, members of the International Federation of Medical Students’ Associations (IFMSA) and specifically members of the Standing Committee on Reproductive Health including AIDS (SCORA) are raising their voices against Female Genital Mutilation, a practice that is still existing in many countries, and is taking the lives of hundreds of girls and women each year and leaving irreparable consequences for the surviving ones. Introduction Female Genital Mutilation (FGM) comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons1. It has no health benefits and harms girls and women in many ways. Observing that FGM is still a common issue of daily life in a number of countries around the globe, not only in Africa, but also in Europe, due to immigration and that an estimated number of about 140 million girls and women are currently living with the consequences of this procedure worldwide2. Studies have proven that FGM has no health benefits1, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ & women’s bodies, which can result in several severe health complications2. Besides the many health complications associated with FGM is also linked with a host of sexual difficulties and psychological morbidity5 by destroying women’s ability to enjoy sexual relations. Reasons leading to Female Genital Mutilation are numerous, but most of them are cultural and financial, and though no religious scripts prescribe the practice and that it has been clearly stated by religious leaders that religion is not by any means the main motive for this practice, practitioners often believe it has religious support. FGM is in many communities believed to reduce a woman’s libido and therefore believed to help her resist ‘illicit’ sexual acts4. The IFMSA believes that this degrades and devalues women. As a result of the fact that FGM was for years addressed as a health issue, and of the growing awareness of its health consequences, people are increasingly turning to health-care providers to perform the procedure2, in the hope that it will reduce the risk of various complications and consequences, which brings us to the problem of Medicalization of FGM. “Medicalization” of FGM refers to situations in which FGM is practised by any category of healthcare provider, whether in a public or a private clinic, at home or elsewhere. It also includes the procedure of infibulation at any point in time in a woman’s life. Main Text IFMSA is a non-governmental, non-profit organization that aims to empower medical students through local action and global vision. It gathers more than one million students from 100 countries, united by the same goal of creating global health awareness. 7

We, as medical students are aware of the danger of such practice, recognize that Female Genital Mutilation is a global health issue that should be addressed properly. We recognize this practice as a violation of basic human rights and human integrity: The rights to health, security, and physical integrity; the right to life; and when performed on a child, a violation of children’s rights as it is medically not in the best interest of a child. FGM is a violation of a woman’s sexual and reproductive rights including their right for autonomy. Hereby we are making a call for governments and stakeholders to take immediate action in order to stop this on-going practice, to implement or to reactivate existing laws to forbid this, to empower girls and women in their communities and to provide easy access to information about Female Genital Mutilation for everyone, especially medical students through implementing scientific and evidence-based information in the curricula of medical schools in order to eliminate the medicalization of FGM. Through local, national, regional and international IFMSA frameworks, we commit to raise awareness among health-care providers and general public about the harms of this practice, to empower girls and women, to fight stigma and discrimination surrounding them regardless of whether they have undergone this procedure or not, to support those seeking medical care in all circumstances, in addition to supporting women who have undergone this procedure. We also commit to advocating with our governments and our local and international partners to take more serious, sustainable steps in forming and implementing a strict legal framework against female genital mutilation. As future physicians and activists promoting human rights and public health, following our Hippocratic Oath, “First Do No Harm”, we commit to fight all forms of Female Genital Mutilation no matter the reasons of performing it and by whom it is performed. References

1. WHO; Health Topics: Female Genital Mutilation (http://www.who.int/topics/female_genital_mutilation/en/) 2. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO (2008): Eliminating Female Genital Mutilation, An Interagency Statement. WHO Press. 3. UNAIDS, UNDP, UNFPA, UNHCR, UNICEF, UNIFEM, WHO, FIGO, ICN, IOM, MWIA, WCPT, WMA (2010). Global Strategy to Stop Health-Care Providers From Performing Female Genital Mutilation. WHO Press. 4. WHO Fact Sheets: Fact sheet N°241, February 2012 (http://www.who.int/mediacentre/factsheets/fs241/en/index.html) 5. Female Genital Mutilation: Cultural and Psychological Implications – Whitehorn J, Manegay S.: Sexual and Relationship Therapy, Vol. 17 No. 2, 2002. “

FGM AWARENESS PROJECT Vision To see a world free from Female Genital Mutilation, to prevent further mutilations and to protect all the girls all over the world from this inhuman act, while respecting their reproductive and human rights.

Mission To develop a basis through which medical students are sensitized and empowered to take on a significant role in preventing Female Genital Mutilation and increase the public awareness about the risks and dangers of this act. Through a joint effort, we wish to enable a friendly environment to deal with FGM and its associated problems and complications outside of the myths and related stigma.

Why a transnational project? During a discussion on the IFMSA SCORA server, a joint initiative between IFMSA-Egypt and MedSIN Sudan was taken to address FGM with the community of medical students within Standing Committee on Reproductive Health including AIDS (SCORA). As a public health issue that has a great impact on health, we had recognized that medical students do serve a role in a joint effort to address this issue in their communities. This can be done through raising awareness, holding information campaigns and peer education trainings, as well as a broader spectrum of activities involving all stakeholders while addressing this issue. Thus we found in both NMOs -and maybe a few more- a good seed to start with our project in order to help and serve our communities.

Goals and Objectives Goal I: To assess medical students’ knowledge on FGM 1. To assess medical students’ awareness on magnitude and complications of FGM through a unified survey conducted within a designated time frame. 2. To assess medical students’ knowledge regarding FGM and its complications and their will to perform FGM operations. Goal II: To educate medical students on FGM 1. To educate medical students on facts, wrong beliefs and complications of FGM– through an array of educational and information-sharing activities during the launching of a national campaign. 2. For medical students to understand the ethical and legal aspects of FGM and to refuse practicing FGM in their future careers. Goal III: To change the students’ attitudes regarding FGM 1. To change the students’ attitudes towards Female Genital Mutilation by presenting them with all of the complications and problems that happen to the mutilated females. 2. To prevent future FGM operations by making sure that future graduating doctors are aware of FGM complications and damages.

Goal IV: To assess public knowledge on FGM 1. To assess public awareness and knowledge on FGM complications through a unified survey conducted within the designated time frame. 2. To educate families and change their attitudes and beliefs towards FGM by raising the parents’ awareness about the risk factors and problems related to FGM.

Activities Activities you can do to promote for the idea in your country (other than the main activities): ►► Online Campaign to explain the situation in your country, what is FGM and its complications. ►► Make a flash-mob in your college or in a mall. ►► Make some materials that you can distribute in your campaigns like pins, bracelets or pens. ►► Organize one day events like a concert, a festival or a cultural day. ►► Organize a gallery, photo gallery or drawing gallery to promote for girls’ rights. ►► Shoot a video.

Partners and Sponsors Potential Partners and Sponsors: ►► UN agencies that work on women rights and human rights and stand against gender based violence: UNICEF, UN Women, UNFPA country head offices in your country. ►► Other national organizations that support women rights and feminism. ►► Fellow students’ organizations, you can held peer education sessions to them for raising their awareness about FGM.

How can a new NMO join the project? For National Member Organisations to join the project, they will have to fill into the Application Form for the Enrollment of the National Member Organisation in the project and submit it to the Transnational Project Coordinator and the Projects Support Division Director. Once the NMO receives a reply from the Projects Support Division that the application form has been added to the Projects Database, it can proceed with the activities of the project right away. You will be able to find the Application Form for the Enrollment of NMOs in the Transnational Project with the Transnational Project Coordinator. Contacts of the Transnational Coordinator (2013-2014) Basant El.Banna E-mail: basant.elbanna23@gmail.com Cellular: (+20) 114 50 122 60 FB: https://www.facebook.com/basant.elbanna Contacts of the National Coordinators (2013-2014) Dalia Abdel Nasser (IFMSA-Egypt) E-mail: zeina_ga45@yahoo.com Khalid Hussien (MedSIN-Sudan) E-mail : khalid.hussein.eisa@gmail.com 10

FGM IN OTHER LANGUAGES French Mutilations sexuelles féminines Les mutilations sexuelles féminines recouvrent toutes les interventions incluant l’ablation partielle ou totale des organes génitaux externes de la femme ou toute autre lésion des organes génitaux féminins qui sont pratiquées pour des raisons non médicales. Cette intervention est le plus souvent pratiquée par des circonciseurs traditionnels, qui jouent souvent un rôle central dans les communautés, notamment en tant qu’accoucheurs. Toutefois, plus de 18% des mutilations sexuelles féminines sont pratiquées par des soignants, et cette tendance à la médicalisation augmente. Les mutilations sexuelles féminines sont internationalement considérées comme une violation des droits des jeunes filles et des femmes. Elles sont le reflet d’une inégalité profondément enracinée entre les sexes et constituent une forme extrême de discrimination à l’égard des femmes. Elles sont presque toujours pratiquées sur des mineures et constituent une violation des droits de l’enfant. Ces pratiques violent également les droits à la santé, à la sécurité et à l’intégrité physique, le droit d’être à l’abri de la torture et de traitements cruels, inhumains ou dégradants, ainsi que le droit à la vie lorsqu’elles ont des conséquences mortelles. Classification Les mutilations sexuelles féminines se classent en quatre catégories: ►► La clitoridectomie: ablation partielle ou totale du clitoris (petite partie sensible et érectile des organes génitaux féminins) et, plus rarement, seulement du prépuce (repli de peau qui entoure le clitoris). ►► Excision: ablation partielle ou totale du clitoris et des petites lèvres, avec ou sans excision des grandes lèvres (qui entourent le vagin). ►► Infibulation: rétrécissement de l’orifice vaginal par la création d’une fermeture, réalisée en coupant et en repositionnant les lèvres intérieures, et parfois extérieures, avec ou sans ablation du clitoris. ►► Autres: toutes les autres interventions néfastes au niveau des organes génitaux féminins à des fins non médicales, par exemple, piquer, percer, inciser, racler et cautériser les organes génitaux. Aucun bienfait pour la santé, seulement des dangers Les mutilations sexuelles féminines ne présentent aucun avantage pour la santé et sont préjudiciables à bien des égards aux jeunes filles et aux femmes. Elles comportent l’ablation de tissus génitaux normaux et sains ou endommagent ces tissus et entravent le fonctionnement naturel de l’organisme féminin. Les complications immédiates peuvent être douleur violente, choc, hémorragie, tétanos ou septicémie (infection bactérienne), rétention d’urine, ulcération génitale et lésion des tissus génitaux adjacents. Les conséquences à long terme sont notamment: ►► infections récidivantes de la vessie et des voies urinaires; ►► kystes; ►► stérilité; ►► risque accru de complications lors de l’accouchement et de décès des nouveau-nés;

►► nécessité de pratiquer ultérieurement de nouvelles opérations chirurgicales. Par exemple, en cas de fermeture ou de rétrécissement de l’orifice vaginal (type 3 ci-dessus), il faudra procéder à une réouverture pour permettre à la femme d’avoir des rapports sexuels et d’accoucher. Ainsi, l’orifice vaginal est parfois refermé à plusieurs reprises, y compris après un accouchement, ce qui accroît et multiplie les risques immédiatement et à long terme. Quelle population est exposée? Les mutilations sexuelles sont pour la plupart pratiquées sur des jeunes filles entre l’enfance et l’âge de 15 ans et à l’occasion sur des femmes adultes. En Afrique, on estime que plus de trois millions de jeunes filles par an sont menacées par ces pratiques. Plus de 125 millions de jeunes filles et de femmes sont victimes de mutilations sexuelles pratiquées dans 29 pays africains et du Moyen Orient où ces pratiques sont concentrées. Cette pratique est la plus commune dans l’ouest, l’est et le nord-est de l’Afrique, dans certains pays d’Asie et au Moyen-orient, ainsi que dans certaines communautés d’immigrants en Amérique du Nord et en Europe. Facteurs culturels, religieux et sociaux Les mutilations sexuelles féminines sont le produit de divers facteurs culturels, religieux et sociaux au sein des familles et des communautés. ►► Là où elle relève d’une convention sociale, la pression sociale qui incite à se conformer à ce que font ou ont fait les autres constitue une forte motivation pour perpétuer cette pratique. ►► Les mutilations sexuelles féminines sont souvent considérées comme faisant partie de la nécessaire éducation d’une jeune fille et de sa préparation à l’âge adulte et au mariage. ►► Les mutilations sexuelles féminines sont souvent motivées par des croyances relatives à ce qui est considéré comme un comportement sexuel approprié, c’est-à-dire que ces pratiques ont à voir avec la virginité prénuptiale et la fidélité conjugale. Selon les croyances de nombreuses communautés, les mutilations sexuelles réduiraient la libido féminine, ce qui aiderait les femmes à résister aux actes sexuels «illicites». Lorsqu’une ouverture vaginale est obstruée ou rétrécie (type 3 ci-dessus), la crainte de douleurs en cas de réouverture, et la peur que cette réouverture soit découverte, sont censées décourager les femmes d’avoir des relations sexuelles «illicites». ►► Les mutilations sexuelles féminines sont associées à des idéaux culturels de féminité et de modestie, selon lesquels les jeunes filles sont “propres” et “belles” après l’ablation de parties de leur anatomie considérées comme “masculines” ou “malpropres”. ►► Bien qu’aucun texte religieux ne prescrive cette intervention, les praticiens pensent souvent qu’elle a un fondement religieux. ►► Les autorités religieuses adoptent des positions variables à l’égard des mutilations sexuelles féminines: certaines les préconisent, d’autres les considèrent comme étrangères à la religion et d’autres encore contribuent à leur élimination. ►► Les structures locales du pouvoir et de l’autorité, tels que les dirigeants communautaires, les chefs religieux, les circonciseurs et même certains agents de santé peuvent contribuer à conforter cette pratique. ►► Dans la plupart des sociétés, les mutilations sexuelles féminines sont considérées comme une tradition culturelle, argument souvent avancé pour les perpétuer. ►► Dans certaines sociétés l’adoption récente de cette pratique s’explique par la volonté de copier les traditions de groupes voisins. On trouve parfois à son origine un mouvement de recrudescence religieuse ou traditionnelle. ►► Dans certaines sociétés, les mutilations sexuelles féminines sont pratiquées par des groupes nouveaux lorsqu’ils arrivent dans des zones où la population locale les pratiquent.

Arabic

REFERENCES The information contained in this manual is referenced from the World Health Organisationâ&#x20AC;&#x2122;s website (www.who.int).

The SCORA 2014 Female Genital Mutilation Awareness Manual Content by: The SCORA International Team 2013 - 2014 Layout Editor: Ming Yong (ming.yong@amsa.org.au), SCORA International Publications Team 2013 - 2014 Last updated: 13th May 2014 For further information, contact Joe Cherabie (scorad@ifmsa.org), SCORA Director 2013-2014.

Albania (OMA) Algeria (Le Souk) Argentina (IFMSA-Argentina) Armenia (AMSP) Australia (AMSA) Austria (AMSA) Azerbaijan (AzerMDS) Bahrain (IFMSA-BH) Bangladesh (BMSS) Belgium (BeMSA) Bolivia (IFMSA Bolivia) Bosnia and Herzegovina (BoHeMSA) Bosnia and Herzegovina - Rep. of Srpska (SaMSIC) Brazil (DENEM) Brazil (IFMSA Brazil) Bulgaria (AMSB) Burkina Faso (AEM) Burundi (ABEM) Canada (CFMS) Canada-Quebec (IFMSA-Quebec) Catalonia - Spain (AECS) Chile (IFMSA-Chile) China (IFMSA-China) Colombia (ASCEMCOL) Costa Rica (ACEM) Croatia (CroMSIC) Czech Republic (IFMSA CZ) Denmark (IMCC) Dominican Republic (ODEM) Ecuador (IFMSA-Ecuador) Egypt (EMSA) Egypt (IFMSA-Egypt) El Salvador (IFMSA El Salvador) Estonia (EstMSA) Ethiopia (EMSA) Finland (FiMSIC) France (ANEMF) Georgia (GYMU) Germany (BVMD) Ghana (FGMSA) Greece (HelMSIC) Grenada (IFMSA-Grenada) Guatemala (ASOCEM) Haiti (AHEM) Hong Kong (AMSAHK) Hungary (HuMSIRC) Iceland (IMSIC) India (MSAI) Indonesia (CIMSA-ISMKI) Iran (IFMSA-Iran) Iraq (IFMSA-Iraq) Israel (FIMS) Italy (SISM) Jamaica (JAMSA) Japan (IFMSA-Japan) Jordan (IFMSA-Jo) Kenya (MSAKE) Korea (KMSA)

Kurdistan - Iraq (IFMSA-Iraq/Kurdistan) Kuwait (KuMSA) Kyrgyzstan (MSPA Kyrgyzstan) Latvia (LaMSA Latvia) Lebanon (LeMSIC) Libya (LMSA) Lithuania (LiMSA) Luxembourg (ALEM) Malaysia (SMMAMS) Mali (APS) Malta (MMSA) Mexico (IFMSA-Mexico) Montenegro (MoMSIC Montenegro) Morocco (IFMSA-Morocco) Mozambique (IFMSA-Mozambique) Namibia (MESANA) Nepal (NMSS) New Zealand (NZMSA) Nigeria (NiMSA) Norway (NMSA) Oman (SQU-MSG) Pakistan (IFMSA-Pakistan) Palestine (IFMSA-Palestine) Panama (IFMSA-Panama) Paraguay (IFMSA-Paraguay) Peru (APEMH) Peru (IFMSA Peru) Philippines (AMSA-Philippines) Poland (IFMSA-Poland) Portugal (PorMSIC) Romania (FASMR) Russian Federation (HCCM) Rwanda (MEDSAR) Saudi Arabia (IFMSA-Saudi Arabia) Serbia (IFMSA-Serbia) Sierra Leone (SLEMSA) Slovakia (SloMSA) Slovenia (SloMSIC) South Africa (SAMSA) Spain (IFMSA-Spain) Sri Lanka (SLMSA) St-Kitts and Nevis (IFMSA-SKN) Sudan (MedSIN-Sudan) Sweden (IFMSA-Sweden) Switzerland (SwiMSA) Taiwan (IFMSA-Taiwan) Tanzania (TAMSAz) Tatarstan-Russia (TaMSA-Tatarstan) Thailand (IFMSA-Thailand) The former Yugoslav Republic of Macedonia (MMSA-Macedonia) The Netherlands (IFMSA-The Netherlands) Tunisia (ASSOCIA-MED) Turkey (TurkMSIC) Uganda (FUMSA) United Arab Emirates (EMSS) United Kingdom of Great Britain and Northern Ireland (Medsin-UK) United States of America (AMSA-USA) Venezuela (FEVESOCEM) Zambia (ZAMSA)