TWINS Ritaj and Rital Gaboura may look alike but, together, they are unique – having beaten a one in a million chance of survival.
The 13-year-olds were born conjoined at the head and British surgeons from Great Ormond Street Hospital saved their lives by performing the incredible separation – a medical rarity in 2011.
The sisters – who only learned about the pioneering surgeries when they were six – are now thriving as they enter their teenage years.
Speaking at her home in Cavan, Ireland, Ritaj tells The Sun: “My dad says I should be proud to have been conjoined and I just think I’m me. It doesn’t change who I am.”
When Ritaj and Rital were born in Sudan in August 2011, they were connected at the head, a condition known as Craniopagus, and while their brains were separate, they shared one scalp, one skull and one blood supply.
Simply by being born, they had beaten all the odds. Approximately 28 per cent of conjoined twins die during pregnancy or are stillborn, and around 54 per cent will die within 24 hours of being born or shortly after.
Doctor David Dunaway raised the funds to bring the girls to the UK for the groundbreaking surgery.
Before they turned one, his team at Great Ormond Street carried out four gruelling operations to separate the girls – allowing them to face each other for the first time.
Ritaj jokes: “I suppose it’s nice being able to see my sister.”
Ritaj has arrived home from school about half an hour before her twin.
Rital has autism and other learning difficulties, meaning she attends a special needs school. Her parents, who are both doctors, moved from Sudan to Ireland in 2016 when they realised she would need specialist support that was difficult to secure in their home country.
Death warnings
Reflecting on the separation of the daughters 12 years ago, mum Enas, admits it was “hard” for them to watch it all take place.
She says: “We knew that if we left them conjoined, they wouldn’t have a chance at a normal life.
“We knew it was better to just try to separate them to give them a chance, no matter what happened.”
Her husband added: “We knew that they may not live at all if they didn’t have the surgery.”
On the pioneering operations, Mr Dunaway said: “I can’t say what a joy it’s been for all of us. It is so hard to say what it feels like.
“For them to survive this process, completely neurologically intact and to be a few weeks later smiling, developing, acting appropriately, has been wonderful for us.”
Parents Enas and Abdelmagid found out they were having conjoined twins six months into pregnancy.
Within three days of the girls being born, Abdelmagid had phoned and found seven clinics that would take the girls – if the family had funding.
We knew it was better to just try to separate them to give them a chance, no matter what happened.
Enas Gaboura
Mr Dunaway, lead clinician from the plastic surgery and craniofacial unit at Great Ormond Street, helped them get the cash they needed from facial deformities charity Facing The World.
The surgeries needed to detach the girls from each other cost £400,000 and the twins were eligible because, while they shared a membrane covering their brains, their brains weren’t fused.
It would have been even more expensive had a team of surgeons and specialists not carried out the painstaking work for free, something which the twins parents are “incredibly grateful” for.
Conjoined Twins
Conjoined twins represent one in every 500,000 live births in the UK and between 1 in 30,000 to 1 in 200,000 worldwide
Approximately 28 per cent of conjoined twins die during pregnancy or are stillborn
Around 54 per cent will die within 24 hours of being born or shortly after.
GOSH performed its first successful separation of conjoined twins in 1985 and has cared for 38 sets in total.
The phenomenon is thought to occur when a fertlised egg splits into identical twins but the separation process is incomplete.
Gruelling ops
The girls were supposed to spend a few months acclimatising to their new environment but surgeons realised that surgeries needed to take place quickly as Ritaj was going into organ failure. It meant both twins were at risk of dying.
In a series of operations – which took place over four months – surgeons had to carefully remove the membrane and sever blood vessels which were attached to Rital’s brain but oxygenated by Ritaj’s heart.
Before each surgery, the dedicated parents were gently reminded by doctors that there was a chance that things could go wrong, the girls could pass away or be partially paralysed.
Incredibly, both girls came through without any major physical side effects, and Rital’s learning difficulties were expected to happen in at least one of the twins.
The girls’ craniopagus meant they had been unable to see each other until after the surgery, despite their parents attempting to use a mirror to show them their reflections.
Enas recalls: “It didn’t really work. But the girls knew the other was there. Sometimes Rital would reach up and try to hold her sister’s face and play with her cheeks. Ritaj would try to hold her sister’s hand.”
Traditionally, separating twins had been done in one mammoth operation, but the team that separated Rital and Ritaj used a pioneering technique of several smaller operations to help them survive.
Mr Dunaway explained: “One big operation risks the brain swelling and problems in reconstruction.
“It’s lots of simple steps, is any one step impossible? No. This is sure and steady, that’s the elegance of the technique.”
Enas and Abdelmagid decided to teach the girls about their unusual history when they were around six and have a treasure trove of pictures and videos to explain their life-saving operations.
Ritaj, who thought the news was “cool”, says she and her twin have a special bond – though insists being the oldest sister comes with responsibilities.
She says: “I do feel close to my sister. She does things like fix my Nintendo or come and cheer me up when I’m sad.
“I like being a twin but it’s not easy being the oldest.”
The girls are now older sisters to their two brothers, Aziz, four, and Ahmed, two.
Now, Ritaj watches some of the videos on YouTube and has even shown little brother Aziz, who understands his sisters were “stuck together” but not the full extent of what that meant.
Despite the incredible feat of medicine, the videos are littered with vile comments, including one calling the newborn twins “potatoes” which left the teenager upset.
“I don’t read them any more,” she says, after mentioning the nasty messages.
“We were called potatoes, we’re not potatoes. My hero, my dad, replied to them saying it wasn’t nice.
“I didn’t cry, but I was upset. I just don’t read them any more when I watch the videos.
“Watching the videos makes me feel very nostalgic, although I don’t remember it.”
Watching the videos makes me feel very nostalgic, although I don’t remember it.
Ritaj Gaboura
Dad Abdelmagid adds: “It’s really hard to know that my girls are seeing these comments.
“They didn’t choose how they were born, and neither did me and my wife. The most important thing I can do in response is to educate people when they leave those comments.”
While the family marks the twins’ separation date, August 15, every year, Ritaj doesn’t always want to make a big deal of what is normal for her.
The Pioneering Operations
Ritaj and Rital had their first two operations on the 9th and 16th of May 2011 to separate their blood flow. Shared blood vessels were given to Rital and their next surgery delayed to give Ritaj time to grow new blood vessels.
Once they had fully recovered, inflatable balloons were placed under the scalp on 4th July. These were slowly inflated to stretch the scalp making it grow more skin. This extra skin would be used in the final operation to make sure there was enough to cover both their heads.
Their last surgery, on 15th August, lasted 13 hours and saw the girls fully separated from each other for the first time.
Big sisters
After the trauma of the twins’ birth, the parents were concerned about adding to their brood.
But after nine years, they decided to have another child because they thought it would help with the girls.
On the arrival of Aziz, Ritaj took to being an older sister like a duck to water, but Rital struggled at first.
Now, Aziz is a source of comfort when she is sensorily overwhelmed, offering big hugs of comfort.
“I was worried what might happen (to the girls) when Magid and I got old, I wanted there to be people near their age who cared about them,” Enas says.
“I thought the boys would be an aid for helping with the girls, but actually it’s the other way around.
“Ritaj is like another mum to the boys.”
Over the years both girls have had further surgeries; Ritaj needed work to correct some scoliosis, a curve in the spine, and another operation to correct a tilt to her head shortly after their initial operation.
The love and pride Abdelmagid and Enas have for their family is clear to see.
Despite a year of worry in 2011, the family has settled into ordinary life like nothing unusual has happened to them.
The most important thing now, the parents say, is that the girls live “full and happy lives doing what they want”.
Gemini Untwined are fundraising to ensure that every child can experience life as an individual. Donate at: www.geminiuntwined.org/donate/.
The doctors
David Dunaway
David Dunaway is a lead clinician from the plastic surgery and craniofacial unit at Great Ormond Street Hospital.
He has been practising as a surgeon since the early 1990s and specialised into Facial Deformity and Head and Neck surgery.
Mr Dunaway was awarded a CBE for services to facial surgery in 2016 and has carried out many high profile separation operations, all over the world.
His most recent high profile work was the separation of conjoined twins Safa and Marwa over 50 hours of surgery in 2019.
Dr Owase Jeelani
Dr Jeelani has been working at Great Ormond Street Hospital since 2000 and has worked on multiple twin separations.
The Pakistani-born doctor set up Gemini Untwined to help fund surgeries for conjoined twins across the world.
Each year, he undertakes 200-300 paediatric neurosurgical and craniofacial surgeries.
He has worked alongside Mr Dunaway for decades and helped separate Safa and Marwa over 50 hours of surgery in 2019.
Dr Jeelani has stayed in touch with all the families of the children he has separated to ensure they are progressing well after surgery.
Sarah Carter is a health and wellness expert residing in the UK. With a background in healthcare, she offers evidence-based advice on fitness, nutrition, and mental well-being, promoting healthier living for readers.
