DAKAR (Thomson Reuters Foundation) - The death of a teenage girl during an operation to illegally perform female genital mutilation (FGM) on her in Egypt raises questions about the north African nation’s efforts to end the practice, anti-FGM campaigners said on Tuesday.

Mayar Mohamed Mousa, 17, died of heavy bleeding in a hospital in Suez province on Sunday while under anesthesia, according to the Egyptian Initiative for Personal Rights (EIPR), Cairo-based rights group.

The private El Canal Hospital, where Mousa’s twin sister also underwent the procedure but survived, was yesterday shut down and Egyptian prosecutors are investigating the death, said Sedkhi Sidhom, an official from Egypt’s health ministry.

“Not all cases of female circumcision are reported across Egypt. There are cases of circumcision where the women die and are then buried without a word being mentioned,” Sidhom said.

More than nine in 10 women and girls aged between 15 and 49 in Egypt have undergone FGM, and around 80 percent of these procedures are carried out by medical professionals, despite the practice being banned in 2008, according to U.N. estimates.

The teenager’s death comes more than a year after doctor Raslan Fadl was convicted of manslaughter in Egypt’s first FGM trial after a 13-year-old girl died in a botched procedure.

While Fadl was sentenced to more than two years in prison, he has not yet been imprisoned, said Suad Abu-Dayyeh, Middle East and North Africa consultant at rights group Equality Now.

“It is incredible that the Egyptian police are not taking a tough line on ending FGM in a country where over 27 million have been affected,” she said in a statement. “The death of the 17-year-old should be yet another shocking wake up call for Egypt.”

ENFORCING THE LAW

FGM affects an estimated 140 million girls and women across a swathe of Africa and parts of the Middle East and Asia, and is seen as a gateway to marriage and a way of preserving a girl’s purity. It causes numerous health problems that can be fatal.

The practice is punishable in Egypt by up to two years in prison under a 2008 law, which was enacted after an 11-year-old girl died following an FGM procedure in Minya province.

Yet rights groups say the law has not been enforced and that Egyptian society is permissive of FGM, which is widely practised among Muslims as well as Christians in the mostly Muslim nation.

“It’s a catastrophe that these cases are still happening. The doctors are actually not performing operations, but crimes,” said Dalia Abd El-Hameed, gender and women’s rights officer at the EIPR.

“Criminalization alone is not enough,” she said. “The state must focus on changing individuals’ beliefs ... that cannot be done using only medical and religious discourse,” she told the Thomson Reuters Foundation by email from Cairo.

Magdy Khaled, head of the United Nations Population Fund (UNFPA), said she was deeply saddened by Mousa’s death in light of the progress Egypt had made in combating FGM in recent years.

Around six in 10 girls aged 15 to 17 had been cut in Egypt in 2014, down from three quarters of girls in 2008, the UNFPA said.