Photo essay

Photo essay: For women burns survivors in India, life can be a trial by fire

Of the 1.4 lakh deaths caused by burn injuries in India every year, 90,000 are women.

“I had set myself ablaze. I was wearing a synthetic sari; as it caught fire, the fabric melted and seared my skin underneath. I ran helter-skelter, howling in pain and before I knew I was unconscious.”

With these words, Radha described the fated moment that altered her life irreversibly. She had tried to burn herself alive with kerosene, in a fit of rage, to escape the vicious circle of physical and mental abuse her alcoholic husband had subjected her to.

Radha is just one of the lakhs of women who suffer burn injuries in India every year. In Chennai, at the Kilpauk Medical College’s burns ward alone, close to 3,000 patients were admitted in 2016. Ninety per cent of the burn survivors have resorted to self-immolation as a result of domestic violence, though most suicidal or homicidal burns in women are reported as kitchen accidents resulting from gas burst, leakage or defective burners.

The long road to recovery

Burn injuries can impair skin integrity, cause hypertrophic scarring and make one susceptible to sepsis and other neurobiological changes that can also affect functionally important body parts. The subsequent rehabilitation efforts including dressing, medication, physiotherapy, surgical debridement (removal of damaged tissue) and the wound healing processes are excruciating.

As the physical wounds begin to heal, the psychological ones become more pronounced.

“When I came here, I was devastated,” said Asma, a survivor staying at the International Foundation for Crime Prevention and Victim Care’s Recovery & Healing Centre in Chennai. “The pain of wearing these pressure garments all day apart, I kept worrying about my three-year-old daughter who was very scared of my scars and refused to speak to me. I even wondered if I could just die painlessly. But after months of treatment and counselling, I’m at peace with myself now.” The Chennai centre has helped over 2,000 female burn survivors, facilitating rehabilitation and reintegration by extending psychosocial support services that help them cope with the multitude of challenges, whether medical, psychosocial or economic.

Asma, like most burn survivors, was under a lot of pressure to report her suicide attempt as an accident. She did not have a job or parental support, which meant that she had to go back to living with her husband post-treatment. She also could not risk being separated from her children. In fact, most survivors have to go back to living in the same milieu they were in before the incident, to perform the gendered nurturing roles assigned to them, thus making them vulnerable to abuse once again.

Urgent call for attention

The stigma around scars and disfigurement, blaming and shaming by relatives, fear of ridicule and lack of legal guidance negatively influences the agency of women burn survivors. They also have to deal with an ecosystem that is impassive and unresponsive, at times even adding to the perpetuation of violence beyond the initial act.

While Kilpauk Medical College in Chennai has an exclusive burns block, most hospitals across India have very little infrastructural support. A research study titled Busting the Kitchen Accident Myth: Case of burn injuries in India says there are 70 lakh burn injuries in India annually, out of which 7 lakh require hospital admission and 1.4 lakh are fatal. Another article says that of the 1.4 lakh deaths, 90,000 of those affected are women.

Despite the huge numbers, burns injuries are still underrepresented in comparison to acid attacks, an equally horrific act of violence against women. While acid attack survivors are now included in the Persons with Disabilities Bill and are eligible for affirmative action and benefits, burn survivors are not.

The PwD Act, 2016, which replaced the PwD Act of 1995, defines a “person with disability” as “a person with long term physical, mental, intellectual or sensory impairment which, in interaction with barriers, hinders his full and effective participation in society equally with others”. It also mentions that “disability is an evolving and dynamic concept”. Given this definition and the nature of burn injuries in India, burn injuries must qualify to be included under the act.

While acid attacks are included as a non-bailable offence under sections 326A and 326B of the Criminal Law Amendment Act, 2013, the same is not true for kerosene or alcohol burns. Section 357B provides compensation for survivors of acid violence, but not burn victims. Similarly, under the Nirbhaya fund, compensation is given to victims of acid attacks once an FIR is filed, but no such provision exists for fire burn victims.

Given the women’s reluctance to describe burns as non-accidental, very few cases even make it to court. Reliance on the testimony of the survivor, lack of forensic evidence and limited circumstantial evidence also mean that very few cases lead to conviction.

Prasanna Gethu, co-founder of PCVC, said: “Understanding a burn survivor calls for an objective analysis of their lives before, during and after the surgery. However, most cases are filed as accidents and there is no historical data on burn violence, especially domestic violence, in the national burn registry. Such a record is a must so that one can do effectively investigate and prosecute perpetrators of the crime, thus bringing in justice for survivors.”

Very clearly, the gaps in infrastructural support and policies to manage trauma care need to be filled. There must be provision for the women to change their police statements when they are in an enabling environment, not just at the hospital, even before they have recovered from the trauma of the incident. There is a need for a national trauma policy, which will help strengthen the care given to patients who have suffered from these types of injuries.

Maintenance of a burn registry, inclusion in the PwD Act, education of women on their legal rights, awareness about skin donation, compensation for survivors are good places to start with. While the policy changes and macro-level interventions will empower the survivors post the injury, the key is to build a comprehensive, integrated support system for female burn survivors of domestic violence. Collaborative efforts from state and non-state stakeholders, including hospitals, healthcare institutions, police, social workers, law enforcement agencies, caregivers, counsellors is a must.

* Some names have been changed on request.

All images by Sindhuja Sarathy.

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