Germany has opened its borders in recent years to more refugees than any other European country.

But with the sudden influx of newcomers from foreign places, German officials are grappling with new cultural practices, too.

According to doctors and activists in the country, there are now 13,000 underage girls living in Germany at risk of female genital mutilation, the practice known as “cutting” that is a cultural tradition in many parts of the world, according to The Washington Post.

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The practice is often believed to show that a girl is pure before marriage, or believed to bring health benefits for a lifetime, though there is no science supporting that claim.

In fact, cutting is often a risky surgery that can lead to infection and lifelong complications for girls as they age, have sex, and become pregnant. It can also make sense painful and unenjoyable for women for their entire lives — by design — as well as causing pain during urination and menstruation.  

In Germany, an influx of refugees from the Middle East and North Africa has increased the girls at risk of FGM by 4,000 in just one year, according to The Washington Post. Many of the girls hail from Iraq, Somalia, Eritrea, and Ethiopia.

The number of girls who have already suffered FGM has risen about 20% in the country, though many of the surgeries take place when families go home to visit their relatives, according to the report.

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FGM is also on the rise in countries including France, the United Kingdom, and the United States, the latter of which saw its first federal criminal FGM case earlier this year. And Global Citizen and CHIME FOR CHANGE campaigns to bring about an end to FGM everywhere in the world, including countries where it is still a legal, common practice, with our #LeveltheLaw campaign.

In Germany, FGM is illegal in the country and if it’s carried out abroad. Parents can lose their passports if they are suspected of planning a trip abroad for the purposes of ceremonial cutting.

Female genital mutilation “is a serious breach of a person’s human rights," Ralf Kleindiek, a state secretary in the Family Affairs Ministry, said in February. "It causes unbelievable physical pain and psychological damage.”