SUDANESE JOURNAL OF PAEDIATRICS

2023; Vol 23, Issue No. 2

HISTORICAL PERSPECTIVES

The story of the Sudanese conjoined twins, Hassan and Hussein

Yousif Eshag Omer Elhaj (1)

(1) Chairman Academic Activities Committee, Council of Paediatrics and Child Health, Sudan Medical Specialization Board, Khartoum, Sudan

Correspondence to:

Yousif Eshag Omer Elhaj

Chairman Academic Activities Committee, Council of Paediatrics and Child Health, Sudan Medical Specialization Board, Khartoum, Sudan.

Email: elhagy1952 [at] gmail.com

Received: 23 December 2020 | Accepted: 24 December 2023

How to cite this article:

Elhaj YEO. The story of the Sudanese conjoined twins, Hassan and Hussein. Sudan J Paediatr. 2023;23(2):248–251.

https://doi.org/10.24911/SJP.106-1703364387

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Conjoined twins have fascinated people for centuries and their surgical separation constitutes one of the most unique and rewarding experiences [1–5]. It is a very rare phenomenon that is estimated to occur between one in 50,000 births to 190,000 births. The incidence is said to be higher in Asia and Africa and it affects girls more at a ratio of 3:1. About half are stillborn and about a third die within 24 hours.

The story of Hassan and Hussein, also known as the ‘Siamese Sudanese twins,’ born August 21st 1986 is one of triumph as it demonstrates the generosity of humanity and the miracle of modern medicine. This article will outline their story.

Fayza and Mohammed Salih were teachers who lived in Kosti, a town on the White Nile, 259 km south of Sudan’s capital Khartoum, with their three healthy children. Apart from a large abdomen, there was nothing unusual about Fayza’s 4th pregnancy. Like most women in her situation at the time, there was no expectation for any prenatal imaging so she did not see any reason to do so.

Labour began at term and Fayza was assisted by the local midwife who came to the house. It was immediately apparent that this was far from a normal pregnancy as it was the breech presentation. As the labour became too prolonged, Dr. Maawia Elsadig Hummeida, obstetrician, was consulted at the local hospital in Kosti. The first baby emerged as a footling breech presentation. Fayza, who was now haemorrhaging, needed an emergency caesarean section. She was transferred to Rabak hospital, about one hour away, since the operating room in Kosti was not equipped to deal with the complexity of the case, and was closed for sterilization that day.

The mode of transport was a Toyota pick-up truck hired by Dr. Maawia and there was heavy rainfall. To make matters worse, there was a shortage of water and power cuts were frequent in Rabak. Water was sought from the neighbours and the operation was done using handheld light torches. The twins were born via caesarean section in good condition apart from their birth defect: they were conjoined chest to hip, with the adjacent legs forming a deformed third leg (Figure 1). Fayza was in a critical condition. She had a severe haemorrhage, which was further complicated by disseminated intravascular coagulation. She remained in an induced coma for 5 days while she received life-saving treatment.

After that, the twins were presented to her. She was given solace that she was young and would have more children since her uterus was intact. Everyone prepared the parents for the worst. How could such a dire case possibly survive? The twins were transferred to Soba University Hospital in Khartoum for further care and investigations, under the care of late paediatric surgeon Mr. Ibrahim Abdel Aziz. Fayza continued her recovery at Rabak Hospital and joined them when they were 37 days old.

By then the news of their birth had reached the international media and American as well as German organisations offered to adopt the twins. Both parents declined the offer, insisting that live or die, the twins would remain with them. The staff at Soba University Hospital made it clear that for the twins to be discharged, the family would have to relocate to Khartoum. Therefore, Fayza and Mohammed Salih rented a home in Umm Ombada, Omdurman, and left Kosti behind.

The twins came home and survived despite their physical challenges. Fayza sent a photo of the twins to me, Dr. Yousif Eshag, a paediatrician (her brother) living and working in Saudi Arabia (King Saud Medical City, also known as Shemaisi Hospital, Riyadh). I sent the photo and request to the Kingdom of Saudi Arabia (KSA) monarch, His Majesty King Fahd bin Abdul Alaziz. This resulted in the humane and generous Royal Decree to sponsor the treatment of the twins in London. Fayza and Mohammed Salih received a telegram from me, informing them that they were to fly to England, where the team at the Great Ormond Street Hospital for Sick Children (GOSH) would conduct the surgery.

The 3-month-old twins and their parents flew to the UK, supported by me to communicate on their behalf and handle their affairs. We arrived at Heathrow Airport on 8th December 1986 and went to the Saudi Arabian Embassy, where they were then driven to GOSH. They were greeted by the surgical team of Professor Lewis Spitz, the pioneering paediatric surgeon and international expert on conjoined twins, and Mr. Edward Kiely, Consultant Neonatal and Paediatric Surgeon. A series of surgeries subsequently followed in preparation for the main separation procedure. Fayza and Mohammed Salih were warned of the risks: there was an 80% chance that Hassan would not survive the separation. They were torn but decided that they owed it to the twins to give them a chance to lead normal lives.

On Monday 26th April 1987 (age 7/12 months old), on the first day of the holy month of Ramadan, a huge team of surgeons and nurses worked for 17 hours to conduct the difficult procedure. Despite complications, to Fayza and Mohammed’s relief, the surgery was a success and both twins survived (Figure 2). In the recovery room, the twins’ blood pressure elevated and only settled when they were placed close to each other. This is a known phenomenon and is seen frequently when conjoined twins are separated. It is thought that this is due to separation anxiety and is often managed by bringing both twins in close proximity.

Figure 1. The conjoined twins’ initial photo.

Figure 2. Hassan and Hussein cradled in the surgeon’s arms (Professor Lewis Spitz); their story rejoiced in newspapers.

Figure 3. At the age of 10 years the twins Hassan and Hussein were received, accompanied by their father Mohammed Salih, by the late His Majesty King Fahd bin Abdul Alaziz at Al-Safa Palace in Makkah. They expressed their sincere gratitude and that they are forever grateful to His Majesty.

Figure 4. During the graduation day of Hassan (second from right) with his mother Fayza Eshag (middle) and twin Hussein (first from left). Hassan graduated from Roehampton University with a BA (Hons) in Media and Photography, and Hussein graduated from Kingston University with a BA (Hons) in English Language and Communication with Creative Writing.

Hassan and Hussein remained in hospital for 8 months where they underwent subsequent surgeries and received additional therapies to aid them in their recovery. At age 9 months, they went home for the first time. Fayza and Mohammed Salih moved the other siblings to the UK, where they have resided since. The twins continued to receive regular check-ups and surgeries. Continued support was offered from the Saudi Embassy in the UK.

At the age of 10 years, they were invited to KSA and were received by the late His Majesty King Fahd bin Abdul Alaziz at Al-Safa Palace in Makkah (Figure 3). They expressed their sincere gratitude. They also performed Umrah and visited Medina.

Today the twins are 37 years old and are still living together and have a deep connection [6]. They periodically need new artificial limbs (each twin has one leg as the deformed ‘third’ leg was amputated), which they receive from the team at Roehampton Hospital. While they do make use of their artificial leg, they are most comfortable getting around on their crutches. They both have university degrees and have ambitions for the future. Hassan graduated from Roehampton University with a BA (Hons) in Media and Photography (Figure 4), and Hussein graduated from Kingston University with a BA (Hons) in English Language and Communication with Creative Writing.

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CONFLICT OF INTEREST

There are no conflicts of interest stated by the author.

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FUNDING

None.

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ETHICS APPROVAL

Consent to participate and photography was taken from Hassan and Hussain, and their parents.

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REFERENCES

1. Salih MA, Satti SA, Swar MO. Managing the common and rare in paediatrics. Sudan J Paediatr. 2012;12(2):4–6.
2. Kheir AE, Dunaway DJ, Jeelani ON, Osman NM, Omer IM, Imam AM, et al. Successful separation of craniopagus conjoined twins. Sudan J Paediatr. 2012;12(2):73–6.
3. BBC News Health: conjoined twins separated by Great Ormond street doctors. [cited 2023 Dec 22]. Available from: http://www.bbc.co.uk/news/uk-14963265
4. Winter GF. The ethics of separating conjoined twins. Bull R Coll Surg Engl. 2017 Jan;99(1):24–6.
5. Taha IAA, Helali MAH, Taha SMA, Hamad AHM, Alaraby SOMA, Dafallah AE, et al. Experience of the Sudanese doctors in surgery of conjoined twins. J Surg Case Rep. 2023 Jun 5;2023(6):rjad293. https://doi.org/10.1093/jscr/rjad293.
6. Sue Reid for the Daily Mail. [cited 2023 Dec 22]. Available from: https://www.dailymail.co.uk/news/article-11086125/The-conjoined-twins-separated-UK-reveal-share-close-bond.html