Despite sustained efforts to stop the practice, Somali doctors and rights activists say two sisters bled to death after undergoing female genital mutilation (FGM) last week in central Somalia.
Dr. Mohamed Hussein Aden said the victims were aged 10 and 11, adding, "There is no other way to describe it, it's brutal."
Aden says the news of the incident is "heartbreaking" and said another emergency call came in Sunday.
Rights activists Hawa Aden Mohamed is the founder and director of the Galkayo Education Center for Peace and Development, which educates about 400 young girls in Galkayo.
She said she sent staffers to visit the girl's village but was told it will take days to locate parents. Mohamed fears the family may be avoiding contact for fear of prosecution.
Aden said Somali society is conservative and even the mother who lost the children may not tell the whole story.
He also said not all incidents are reported.
"It's shocking, this month we heard five cases including these two deaths," he said. "Sometimes a month passes without hearing any incident, but it actually happens at homes, we just don't hear it."
Mohamed says incidents of female genital mutilation occur often, but people avoid talking about it because "it's like a taboo. They often use traditional midwifes, sometimes people who perform are not midwives at all because they believe it's a tradition they have to do it. It's a deadly tradition."
Mohamed says some mothers at her center ask her to give their daughters time off from school in order for them to be circumcised.
"They ask for a week's holiday saying they want to circumcise, they (mothers) argue 'If I don't circumcise she is going to chase men," Mohamed says. "I try to explain to them, 'No', I shout, but when you push them they threaten to remove girls out of the school."
Mohamed says in a patriarchal society like Somalia, the bulk of responsibility to stop this practice rests with male family members.
"Mothers have learned this custom from their mothers and foremothers, or they are in remote areas and they have not heard a different opinion," she said. "If the father stands up, or the brother, and uncles, and say our daughters cannot be touched' this will change."
FGM involves removing part or all of the clitoris and labia for non-medical reasons. The World Health Organization (WHO) says cutting, often performed on girls 15 and younger, can result in bleeding, infection, problems with urination and complications with childbearing.
Somalia is in the top three countries in the world for FGM violations, according to the WHO.