An organisation representing family doctors told the South Eastern Health Board earlier this year it was concerned at the lack of a service at Waterford Regional Hospital for those requiring male circumcisions on religious or cultural grounds.
The Irish College of General Practitioners (ICGP) confirmed yesterday it had contacted the health board to relay its concerns after the issue was raised by a number of its members in Waterford, where there is a large population of refugees and asylum- seekers.
Dr Philip Crowley of the ICGP, who is co-ordinating training for GPs on treating patients in a multicultural society, said the South Eastern Health Board was the only one it had cause to write to.
He said male circumcisions in the State based on clinical need, usually where a boy had difficulty passing urine due to tightness around the foreskin, were "fairly uncommon". However, the demand was increasing as Islamic communities arrived in the State and required circumcision on religious grounds. The Jewish community here also believes in male circumcision.
"To the ICGP's best knowledge it is provided by the health service to these communities without any problem in most parts of the country," he said.
"Our view is if communities have a fundamental belief in the practice, they will pursue it in a risky environment if it is not provided by a hospital. They may find somebody in their own community to do it or a religious person to do it."
A spokeswoman for the health board said it provided male circumcisions on medical grounds only at Waterford hospital.
Dr Crowley said he understood some surgeons would not carry out the operation unless there was a genuine medical need because of the risks attached to all surgery. "But many surgeons accept it's a fundamental religious belief in some communities and provide the service."
He said doctors needed to adapt to a changing patient population. The death of the Waterford baby was "a drastic failure" to do that, he said.
A member of the Eastern Regional Health Authority, Dr Maurice Guéret, said he reported to the health authorities two years ago the activities of an African "surgeon" who was performing "kitchen table-top circumcisions" in Dublin for about €100 each. One Nigerian boy almost bled to death after such a procedure but was saved at Temple Street Hospital, he said.
The boy's father, writing to Dr Guéret, said: "Personally I've nothing against this man but I believe if nothing is done urgently, he will claim lives of some innocent infants."
Dr Guéret said yesterday nothing had been learned from this incident two years ago. Access to hospital circumcisions needed to be speeded up if other tragedies were to be avoided.
Temple Street Hospital could not provide figures yesterday on the number of male circumcisions it carries out on religious or cultural grounds each year.
However, its chief executive, Mr Paul Cunniffe, said they were generally carried out when the child was six months old and under general anaesthetic. The hospital's policy was to advise parents of these children that the procedure was not medically necessary.
More recently the National Treatment Purchase Fund has been arranging for boys who have been waiting some time for the procedure to have it carried out privately.
However, Dr Philip O'Connell, who opened the first health centre for asylum-seekers and refugees in St James's Hospital, Dublin, in 1999, said the problem was that a majority of Africans seek to have the operation carried out in the first six weeks after birth. "Even within our capital city access to services, it is very difficult within that very short time-frame," he said.