Islamabad – For years, thousands of Pakistani women and hundreds of men suffered one of the most cruel forms of violence imaginable – acid attacks.
The acid, thrown at the faces and bodies of human beings, melted skin, disfigured limbs, and dehumanised individuals. Acid attacks left survivours with physical and psychological scars that lasted a lifetime.
Often these attacks were the barbaric continuation of less severe, but by no means acceptable, forms of domestic abuse perpetrated against women. Sometimes jilted lovers committed these despicable acts. Sometimes, former partners. In all instances, lives were ruined in mere seconds.
Then, something shifted. Relentless advocacy, social pressure, and a political will to bring justice to the many survivors resulted in meaningful action. Deterrents were put in place. Help provided.
Now evidence shows that steps taken to curb Pakistan’s acid violence problem have been successful in bringing down the number of attacks significantly.
Still, challenges remain.
Doctors and an activist who spoke with Media for Transparency suggest Pakistan needs stronger laws, more healthcare facilities, and more social support to eradicate acid violence from society and help survivours heal physically and psychologically.
But it would have been difficult to think about these future challenges if the number of new incidents had not been reduced.
An unprecedented decrease
Acid burning incidents across the country have decreased by more than half over a three-year period, according to a 2017 report published by the Acid Survivors Foundation (ASF) Pakistan.
“Pakistan is the only country in the world which has decreased any form of violence against women in the past 10 years,” said Valerie Khan, Chairperson ASF Pakistan, referring to the decline in acid attacks.
The ASF Pakistan, a non-profit organisation, has worked since 2006 to support survivors of acid attacks with medical and legal help. It has also actively lobbied for legislation to prevent acid attacks. Many believe the ASF has the most comprehensive database on acid violence in Pakistan.
According to the ASF report, acid attacks in the country fell down to 73 in 2016 from 153 in 2014 – a 52% reduction. The number of incidents in 2016 is also considerably lower than the annual average of 111 acid attacks over a 10-year period, according to the ASF database.
Women have been most affected by acid violence in Pakistan.
Around 56% of the 1,375 victims of acid attacks reported between 2007 and 2016 were women, the ASF data shows. Since the ASF relies on a number of sources to confirm reports of acid violence in the country, the gender of victims remains unknown in some incidents due to lack of identifying details. There are 168 such victims in the ASF’s 10-year database. If it is assumed that most of these victims were women, the number of women affected by acid violence could be as high as around 68% overall.
In the 73 acid attacks in 2016, nearly 7 in 10 victims were women.
The ASF data also indicates transgender persons are beginning to be targeted with acid violence. The 2016 data shows at least one transgender individual in Pakistan was injured in an acid attack.
“We have noticed an increase in the number of (acid) attacks in the transgender community,” Ms. Khan said.
The ASF report states most acid attacks took place Punjab, especially South Punjab, between 2007 and 2016. In fact, the South Punjab region accounts for just over half of all incidents of acid violence during the 10-year period, according to ASF data.
The report identified the South Punjab districts of Multan, Bahawalpur, Rahim Yar Khan, and Muzaffargarh as having the highest rates of acid burn violence.
It is unsurprising then that Dr. Naheed Ahmad, who heads the burn unit at Multan’s largest public hospital, has not noticed any decrease in acid attacks. The Nishtar Hospital burn unit deals with the emergency and long-term treatment of acid burn violence victims.
“I haven’t seen any positive change in the number of acid victims,” Dr. Ahmad said. “They are about the same as before in Multan.”
Ms. Khan also said Multan is one of the districts with most acid attack incidents. The claim is further corroborated by data provided by the Punjab Commission of the Status of Women (PCSW). The PCSW data shows Multan had the highest number of police cases registered for acid burn violence between 2014 and 2016. Already this year, a man threw acid on his wife in Multan after a domestic dispute in January.
Despite South Punjab, the ASF report suggests the number of acid attacks has been on the decline since 2014. This is remarkable given that the same data shows the number of attacks gradually rising each year before 2015.
Such a quick and significant decrease is perhaps a result of successful awareness campaigns and the introduction of an important legislation.
A law that worked
The conviction rate of acid burn violence cases in 2016 was 9.58%, which “is largely superior to the average national conviction rate for violence against women” of 0.6% for cases between 2008 and 2014, according to the ASF report.
Ms. Khan said the passage and enactment of The Acid Control and Acid Crime Prevention Act 2011, which criminalized acid burn violence, was the major reason for decrease in acid attacks.
In accordance with the Act, convicts can face fines of minimum Rs. 1 million along with minimum 14 years imprisonment.
“Due to the legislation, the crime is non compoundable and non bailable,” Ms. Khan said. “The prosecution is better and strong thus impunity is not prevalent (like before).”
The Punjab government in 2012 ordered its police and prosecution departments to charge perpertrators of acid violence under the Anti-Terrorism Act. Following this development, several acid violence cases in Punjab were swiftly tried in anti-terrorism courts and the accused were given life imprisonment sentences, setting a strong precedent againt acid burn violence.
In 2014, Pakistan Muslim League-Nawaz politician Marvi Memon brought forward the Acid and Burn Crime Bill in the National Assembly. This bill, which is now ready to be introduced for voting, criminalizes not just acid burning but all burn attacks, including burning by fire and hot substances. It also includes provisions for speedy trials and severe punishments.
The original law and follow-up policies have set a strong foundation for acid crime deterrence in Pakistan. However, acid attacks have not been eradicated completely and those who face this form of violence have to struggle through a lengthy ordeal.
Medical care through burn units
In Punjab, where the problem of acid burn violence is concentrated, there is a severe shortage of burn centres that can provide immediate and long-term care for survivours.
There are only five third-tier hospitals in Punjab with functional burn units, according to doctors who spoke with Media for Transparency.
Dr Hasnain Khan runs one such tertiary burn unit at the Holy Family Hospital in Rawalpindi. He said most of the patients the unit treats are from the lower economic class who cannot afford treatment so the government supports them.
However, Dr. Khan said treating burn injuries, such as those received in acid attacks, is expensive.
“If the average cost of non-burn treatment is Rs. 2,500 to 3,000, then for burn injuries it is approximately Rs. 30,000,” he said.
Dr. Khan said reconstructive surgery is a distant idea for most survivours because of the expensive cost of such procedures.
“Patients simply thank God that they have survived,” he said, suggesting that even survival and regular recovery from acid burns is a major achievement.
The expensive cost of facilities and treatment might be one reason the government has not established many burn units, Dr. Khan said.
A recent advertisement published by the Punjab Primary and Secondary Healthcare Department in national newspapers claimed the department had set up 25 district burn centres. Efforts were made to contact Additional Secretary Health Dr. Asim Altaf to get details about these centres, but he was unavailable for comment.
Recommendations for the System
On 25 June 2017, a fuel tanker overturned on a road near the Ahmedpur Sharqia tehsil of Bahawalpur district and started spilling motor gasoline, some 50,000 litres of which were stored in the tanker. People from nearby villages saw this as an opportunity and started collecting the oil in buckets. When the tanker caught fire suddenly, over 200 people died in the blaze.
Dr. Hasnain Khan, head of the Holy Family Hospital burn unit in Rawalpindi, said the Lahore High Court in its probe of the incident requested medical specialists for recommendations for providing better burn treatment facilities in Punjab.
Dr. Khan said his recommendation to the court was for the government to set up a multi-level burn care system. This would include burn facilities with 20 beds at the union council level, the lowest tier of the system. Up in the order, there would be burn units with 25-50 beds at the tehsil level and finally a burn centre with 80 or more beds at the district level. The burn centre would only treat severe burn cases while the facilities and units would take care of the majority of the patients.
This system could be piloted in Rawalpindi and Bahawalpur districts, he said, to cover North and South Punjab regions respectively.
The patient care necessary for acid burn survivours is more intensive, too.
Dressing the wounds of a burn survivour could take hours but the nurses who are tasked with this job are not paid accordingly, Dr. Khan said. He was of the opinion that the government needs to incentivize the work of doctors and nurses in the burn units to encourage more healthcare professionals to take up this career path.
ASF Chairperson Ms. Khan the first response to acid burn violence has become more effective now compared to when ASF first started its advocacy.
“We have been successful in getting the victims to the hospital,” she said. “We have met people who have not been to a hospital even after years of the incident.”
According to the ASF, all acid attack victims in 2016 reached hospitals within the critical first seven hours and received the necessary treatment.
Ms. Khan said after the incident and treatment, the most important thing is the emotional and psychological rehabilitation to help survivors integrate back into society.
“You look the same but you are never the same,” Ms. Khan said.
The long road to rehabilitation
An acid attack survivour faces an uphill battle in recovery.
“You are suddenly telling the women survivours to make a plan for their lives,” Ms. Khan said. “Now they have to think about something they never thought about before.”
She said there is a need to make a process to empower the survivours and redesign their lives.
Such a process is familiar to Dr. Ahmed, the Multan doctor who earlier noticed no decrease in acid burn violence incidents in his district. His burn center at the Nishtar Hospital also has a rehabilitation centre for acid burn survivours.
Dr. Ahmed said they initiate needs assessment at the center for survivours who have received initial medical treatment.
“We determine whether the patient needs psychotherapy, physiotherapy or socio-economic support,” Dr. Ahmed said. “We also facilitate in restoring of a body part lost (due to burn) and give makeup training on how to cover scars.”
The Multan rehab center also gives legal assistance to burn victims.
“We have a lawyers panel which takes up cases of the victims,” said Dr. Ahmed.
He said they also assist the acid attack survivours to restore and reinstate their social status by providing them with vocational skills trainings.
Dr. Ahmed said that the rehab is functioning partially and they are in process of recruiting.
“Even if we don’t have a certain facility here, our partners step in to assist,” he said.
Dr. Ahmed said not much attention is given to proactively stopping acid and burn violence. He said the rehab center was working to prevent the acid attacks more comprehensively.
“We, along with its partners, are aiming at door prevention, stopping the violence before it occurs or else the burden will only increase,” he said.