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The New York Times, November 17, 2010

Burning Desperation: Why Did You Burn Yourself?

Self-immolation has become a common form of suicide for Afghan women. Photographer Lynsey Addario speaks with women who survived their suicide attempts.

By ALISSA J. RUBIN

HERAT, Afghanistan — “Why did you burn yourself?” asks the doctor. “If I threw myself from a building, I’d break an arm or a leg, but I wanted to die,” Halima answers. “That’s why I set myself on fire. I thought I would die instantly.”

Najiba in hospital
Mariam weeps over her daughter, Najiba, 13. Najiba who had been married six months, claimed that her mother-in-law doused her with gasoline and set her on fire, through her mother, and other nurses in the hospital, were skeptical of her story, and suspected she might have burned herself in an attempted suicide. (Photo: Lynsey Addario / NYTimes)
More photos by Lynsey Addario

As an answer it is more how than why, but it is enough for Dr. Arif Jalali, the senior surgeon at The Burn and Plastic Surgery Center of Herat Regional Hospital, in western Afghanistan. Afghan women who arrive here have either set fire to themselves, or their families did it to them. Halima did it to herself.

But why, at just 20 years of age? Halima’s circumstances, like those of many of burn victims here, have to be painstakingly pieced together by the doctors and nurses.

Pain Everywhere

It is hard at any time to see another human being’s suffering, but the burns center is pain of a different order. There is every noise a human being can make to express pain — cries, whimpers, groans, pleadings — as bandages are removed, burns cleaned and then wrapped again to protect them from infection. The women inside grip the hands of anyone nearby, digging their fingernails into the nurses’ arms, into my hand if I offer it.

Halima, it turns out, is the second wife of an opium addict, and her desperation seems to be rooted in competition for her addict husband’s affections. His first wife uses her wages as a schoolteacher to buy him an especially pure kind of opium called crystal. Halima, who has no education, cannot match such a gift.

I had met her only a few minutes earlier when I arrived at the hospital in Herat, western Afghanistan. She was crouched at the door of the burn center, bandaged and still wearing her hospital-issued pajamas, with a couple of male relatives beside her. She moved stiffly out of the way as we stepped around her to enter the building, and as we did so she begged us to say something to the doctors to let her in.

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To let her back in, it later emerged, for Halima had already been treated here and ran away. So now she knows the treatment will be painful, but also knows it is her only chance.

Running away from the only treatment available is not unusual here. As of late August, around 20 percent of the women hospitalized for burns left without the doctors’ permission. They wait until no one is watching and shuffle out of the building supported by relatives who then bundle them into cars and take them home. They leave almost always at the behest of these relatives.

Why?

The psychology of self-burning is difficult to understand, even for the nurses and doctors who work with it every day. It can take weeks to figure out how a woman was burned, and whether she fears those tending her, or trusts them.

Through a combination of shame and fear, women lie about how they were burned. In Halima’s case, after telling me her husband was a drug addict, she begged me not write it down. Her husband brought her back to the hospital, but only reluctantly, and the woman tending Halima is the husband’s first wife. Halima falls silent each time the woman approaches her with water or juice.

“Young women especially set themselves on fire thinking that if they burn themselves then ‘everyone will be kind to me.’ What she does not realize is that setting herself on fire will disable her and deform her, the husband will think she is useless and will get another wife. Afterward, she is nothing,” says Dr. Shafiqa Eanin, one of the women doctors at the center.

Social and familial pressure also plays a huge part in their decision to abandon treatment. For the runaways, there is most likely only the most marginal care when they go home, as well as an overwhelming awareness of her family’s shame over what she has done. Sometimes the women have burned themselves. Sometimes they have been been burned by those relatives, who do not want the truth to emerge. In both cases the families have the, usually mistaken, idea that they can care better for the woman at home, and reinforce this notion with fear and deceit.

“When they burn themselves, the relatives say, ‘do not tell the doctors that you burned yourself because they will give you an injection and you will die.’“ Dr Eanin added.

The fact is that the hospital is the one place they are safe. It is one of the cleanest places in the country. No one wears their own shoes inside and everyone wears a hospital issued smock and cap. There is no way to reproduce that environment even in a well off person’s home, let alone in the poor villages where many of the patients live.

Although the patients and their families think that they can keep the wounds clean, in Afghanistan where dirt, dust and flies layer every surface even in the most privileged homes, it is near impossible to keep anything sterile outside a strictly regulated hospital environment.

Complicating matters is that it is expensive for a woman to stay in the hospital because although the treatment itself is free, families have to pay for most of the medicines after the woman is released. “They do not want to spend much money for the wife anyway, so they think, ‘why should I spend any money for her now that she is disabled’ by the burns,” said Dr. Eanin.

Future?

Halima’s body is about 35 percent burned, but many of the burns are relatively superficial and if there is no infection, the hospital staff can save her. If she stays in the hospital.

Gul Zada who committed self-immolation
Juma Gul weeps as he visits his mother, Gul Zada, about an hour before her death in the burn center of the Herat Regional Hospital in Herat, Afghanistan. (Photo: Lynsey Addario/The New York Times)
Self-immolation among Afghan Women (Photos)

At her bedside Dr. Jalali asks her, “In future — if you feel sad or disturbed — will you do this again?”

“No I will not,” says Halima. “I did not know.”

She did not know what? She did now know that she would not die? She did not know how painful it would be ? She did not know that she would be scarred? She did not know anything about all that would happen after she struck the match? There are more questions than answers here. Slowly it emerges that Halima dreams that her husband will abandon the first wife in their rural village and move with Halima to live in the city.

“My husband and I never fought, we are soulmates,” she says, as if to prove that everything is well.

Dr. Jalali shakes his head. “She left at the urging of her husband,” he says. Most of all the women here need psychological help, he explains. “There is no education for women, they can’t analyze their problems,”. “There are rules in our communities, some traditions, wrong traditions. They exchange women for sheep, women for cows; there are forced marriage, our villages sell and buy women with bags of opium.”

He dreams of starting a prevention campaign, of getting social workers to go out to the villages, of having a skin stapler which can make the truly tiny stitches that leave few scars, of a hospital with a bigger staff so that everyone was not always tired. But the main problem is addressing the cause, not better remedies.

“For women in forced marriages there is no chance,” he says.

Alissa J. Rubin is the Kabul bureau chief of The New York Times. Originally published by NY Times on November 8, 2010.

Category: Women, Healthcare/Environment - Views: 14620


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