Gender Violence:The Health Impact – Immediate Medical Care for Burn Victims

by Rishabh Raj

A report by Acid Survivor Trust International (ASTI) aptly says “acid violence rarely kills … [it] always destroys lives.” The very gruesome nature of the violence coupled with the fact that an acid attack takes only five seconds to cause superficial burn and thirty seconds to escalate into  deep burns and that India also accounts for a major share of global burn deaths makes it extremely important to discuss immediate medical care available to burn victims.

Acid attacks inevitably lead to excruciating physical ordeals for the survivors. Upon contact, the acid melts through flesh, muscle, and even bone, until thoroughly washed. Eighty percent of these attacks are directed at women and between 40 per cent and 70 per cent of them target women less than 18 years of age[1].

But acid attacks are not the only form of gendered violence that causes burn injuries. In India, several women are burned alive by their partners, or other close relatives. According to a report by Acid Survivors Foundation of India, this is the most common form of dowry deaths.[2]

In India, about 700,000 to 800,000 people per year sustain significant burns, though very few are looked after in specialist burn units. The highest rates occur in women aged 16-35 years of age[3]. Compare this to the US where annually 500,000 cases receive burn treatment with an average of about 3,300 deaths[4].

Need for appropriate medical care
The medical care available immediately after such an incident is crucial in determining the extent of damage and loss. Hence, it becomes extremely important to understand the complexities of burn injuries and rehabilitation. The most common cause of death for burn patients is infection. The burn skin is very sensitive and can be very easily infected if not taken care and cleaned properly. Hence throughout the course of treatment, strict hygiene measures have to be followed until the wounds are completely healed.

Hospitals not properly equipped
Women who are unable to access proper medical care after the attack could die. Unfortunately, hospitals in India are ill-equipped to handle such complexities. Many hospitals have no facilities to handle acid violence and burn emergencies. Some doctors are not even aware of basic first aid measures such as flushing acid out of the body immediately after the attack. The number of trained burn and plastic surgeons is less than 1100 for more than 1200 million population of India.[5] The situation becomes further grim due to the absence of organized burn care at primary and secondary health care levels, where a woman is most likely to first go after such an incident.[6]

No defined protocol for treating burn victims
In 1998, India was the only country in the world where fire (burns) was classified among the 15 leading causes of death[7].  There is no defined protocol in India for immediate medical attention to burn victims. Burn management remains a relatively new concept here. The concept of legal rights of a burn survivor and the family is also slowly emerging in India.

Under the 11th Five Year Plan, a new initiative was rolled out at the national level to leverage available resources for more effective and standardized delivery of treatment for burn victims. The National Programme for Prevention of Burn Injuries (NPPBI) was started with a goal to ensure capacity building of infrastructure and manpower at all levels of health care delivery system in order to reduce incidence, provide timely and adequate treatment to burn patients to reduce mortality, complications and provide effective rehabilitation to the survivors.

This pilot project was converted into a full-fledged national programme under the 12th Five-Year Plan providing burn management facilities in 67 State Government Medical Colleges at a cost of Rs. 407.21 crore.[8]

It is important to recognize that there is a difference between an accidental burn injury and an acid/dowry burn attack and the approach to medical care has to be based on these factors. While it may be easy for an accidental burn victim to access a health care facility, a victim of acid attack faces intense emotional and psychological fears which hinders the treatment at all the stages.

Finally, burn rehabilitation is an extremely difficult and time-consuming effort. Women have to cope with enormous physical pain and deal, at the same time, with low self-esteem and lack of motivation due to their altered looks and social rejection. Medical care available to the victim in the aftermath of an incident can play a crucial role in minimizing the extent of the loss and needs to be accelerated by the Government as well as the medical professionals in the field with due diligence.

WHO has issued guidelines on burn management broadly outlining the first-aid and a set of checks to estimate the severity of burn. The table below provides a list of Dos and Don’ts for providing immediate relief to a victim.

Do's and Don'ts

[1] Trauma Informed Care, Sourcebook, Acid Survivors Foundation India

[2] http://www.asfi.in/upload/media/SOURCE_BOOK_12_feb.pdf

[3] Burns in developing world and burn disasters – Rajeev B Ahuja

[4] Chapter 4: Prevention of Burn Injuries – Total Burn Care

[5] Arun Goel and Prabhat Srivastav, Post-burn Scars and Scar Contractures, Indian Journal of Plastic Surgery, Medknow Publications, September 2010

[6] National Programme for prevention of burn injuries – JL Gupta, LK Makhija, SP Bajaj – Department of Burns, Safdarjung Hospital, Dr RML Hospital, New Delhi

[7] Burn Mortality : recent trends and socio cultural determinants in rural India

[8] National Programme for Prevention and Management of Burn Injuries, CCEA – Press Information Bureau

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Rishabh Raj is currently a fellow with PRS Legislative Research’s Legislative Assistants to Members of Parliament programme. An engineer from IIT Kanpur, Rishabh is interested in finding technological solutions to social problems.

Gender Violence: The Health Impact – The Gendered Nature of Acid Attacks

by Vaibhav Gupta

An acid attack is a form of violence that affects women and girls disproportionately. The Law Commission of India reports that most of the acid attacks registered in India have been against women[1]. A report from the Cornell Law School[2]on combating acid violence published in January 2011 corroborates this. According to this report, 72 per cent of acid and burn attack victims in India are women, clearly indicating the gendered nature of such attacks.

Acid and burn attacks in India need to be understood in the context of the socio-cultural transformation that is taking place across the nation. This requires a study of the reasons behind such attacks and their prevalence in our society. However such a study is difficult to undertake because until recently, India did not even recognise acid attacks as a separate offence.

Trends from neighboring Bangladesh, though, point to a shocking fact: in 78 per cent of acid attacks reported in Bangladesh, the motive behind the crime is cited as the victim’s refusal to marry the perpetrator or her denial of a sexual advance[3].

The 2013 data from India’s National Crime Records Bureau lists 57 cases of acid attacks on women in 2010, 77 in 2011 and 83 in 2012.The upward trend is similar to other gender based offences in India including rape, kidnapping and abduction of women, cruelty by husbands and assault on women.  [4].

Laws against Acid Attacks

India recognised acid attacks as a criminal offence in 2013 when the Parliament passed The Criminal Law (Amendment) Act, 2013. Under the amended legislation, an attempt to throw acid can earn the perpetrator a prison term of five to seven years (Section 326B)[5], while causing permanent or partial damage or deformation can result in a jail sentence of no less than 10 years and up to a maximum of life imprisonment (Section 326A)[6]. The law also stresses that the victim should be compensated by the perpetrator[7]as well as by the respective state government.[8]However, it should be noted that while offenses under Section 326A require the fine imposed to be proportional to the medical expenses incurred by the victim, this is not the case for offences committed under Section 326B.

Implementing Laws: Impossible?

The problem is not just one of legislation, but its implementation and monitoring as well. According to the Supreme Court’s directives[9]on the regulation of acid sales:

1) A buyer must provide a government-issued identity card showing he/she is over 18 years of age
2) Every seller must maintain records of every buyer of acid

However, in practice, this does not seem to be regulated. Individuals are easily able to purchase acid for household purposes bypassing any such process. Even the government seems casual about the severity of these incidences, their investigation, compensation, and punishment; the Delhi High Court in April 2014 highlighted a case where compensation to the victim was delayed for over 6 months. This begs the question: Can the Government afford to be so casual about such a serious crime?

What can be done?

India also lags behind its neighbors in providing protection against acid offences. Bangladesh’s Acid Offences Prevention Act 2002 and the Acid Control Act 2002 banned the open sale of acids, and imposed stringent punishment (including the death penalty) and a fine on offenders. The law further outlays that investigations have to be completed within 30 days and the trial within 90 days. Dedicated Prevention Tribunals have been set up with the sole objective of looking into these crimes. In Pakistan, perpetrators of acid attacks may be punished with a maximum of life imprisonment.

The National Commission for Women prepared a draft proposal in 2008 that specifically dealt with acid attacks in India; in addition to classifying an acid attack as a separate and most heinous form of offence, the law intended to make provisions to:

1) Assist the victim of an acid attack by providing her with medical treatment services;

2) Provide social and psychological support;

3) Provide legal support to survivors;

4) Arrange rehabilitation mechanisms/schemes, taking into account the specific needs of the victim; and

5) Regulate and control acid and other corrosive substances

However, the law was never discussed. We still lack a comprehensive piece of legislation on acid attacks that deals with prevention, regulation of acid sales, punishment, medical care and rehabilitation.

This devastating form of violence continues to take place against the girls and women of this country without stirring the conscience of lawmakers and people in positions of power. As the Cornell Law School report says, ‘Acid attacks are social phenomena deeply embedded in a gender order that has historically privileged patriarchal control over women and justified the use of violence.[10] It is high time policymakers initiate steps to address the issue through advisories, amendments and legal directives.

[1] Law Commission of India Report to Supreme Court on Writ Petition 129 of 2006, Laxmi vs. Union of India

[2]‘Combating Acid Violence in Bangladesh, India and Cambodia’, Cornell Law School, 2011

[3]‘Combating Acid Violence in Bangladesh, India and Cambodia’, Cornell Law School, 2011

[4]Crime in India 2013, National Crime Records Bureau

[5]Sec 326B of IPC

[6]Sec 326A of IPC

[7]Sec 326A of IPC

[8]As per section 357B of Criminal Procedure Code

[9]Law Commission of India Report to Supreme Court on Writ Petition 129 of 2006, Laxmi vs. Union of India

[10]‘Combating Acid Violence in Bangladesh, India and Cambodia’, Cornell Law School, 2011, Foreword by Yakin Erturk

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Vaibhav Gupta is currently a fellow with PRS Legislative Research’s Legislative Assistants to Members of Parliament Programme. When he’s not volunteering with organisations that work on everything from education to disability, Vaibhav dreams of building his own start-up in the policy field.