Health effects

jpafmat

Journal of Punjab Academy of Forensic Medicine & Toxicology

0972-56870974-083X

Punjab Academy of Forensic Medicine & Toxicology

jpafmat-13-2-editorial

Editorial

Acid Throwing: a Cause of Concern

17-122013

13211211429112013251220130112014

2013

IndianJournals.com

Acid throwing, date and gang rape, sexual violence at workplace, female feticide and forced abortion, honor killing, bride burning and dowry death are a few crimes against women attracting national and international attention and focus of the modern world.

Acid throwing, also called an acid attack [1] or Vitriolage, is a form of violent assault [2] defined as the act of throwing acid or a similarly corrosive substance onto the body of another “with the intention to disfigure, maim, torture, or kill.” [3] Perpetrators of these attacks throw acid at their victims, usually at their faces, burning them, and damaging skin tissue, often exposing and sometimes dissolving the bones. [4] The most common types of acid used in these attacks are sulfuric, nitric, or hydrochloric acid. [5] The long term consequences of these attacks may include blindness, as well as permanent scarring of the face and body, [6, 7, 8] H along with far-reaching social, psychological, and economic difficulties. [3]

According to researchers and activists, countries typically associated with acid assault include Bangladesh, India,Pakistan, Cambodia, Vietnam, Laos, Hong Kong China, the United Kingdom, Kenya, South Africa, Uganda and Ethiopia. [5]

Health effects

The most notable effect of an acid attack is the lifelong bodily disfigurement. Consequently the victim is faced with physical challenges, which require long term surgical treatment, as well as psychological challenges, which require in-depth intervention from psychologists and counselors at each stage of physical recovery.[14] These far-reaching effects on their lives impact their psychological, social and economic viability in communities.[3]

Medical

The medical effects of acid attacks are extensive. As a majority of acid attacks are aimed at the face,[16] several articles thoroughly reviewed the medical implications for these victims. Severity of the damage depends on the concentration of the acid and the period of time before the acid is thoroughly washed off with water or neutralized with a neutralizing agent. The acid can rapidly eat away skin, the layer of fat beneath the skin, and in some cases even the underlying bone. Eyelids and lips may be completely destroyed, the nose and ears severely damaged. [9] & the acid attack victims also face the possibility of septicemia, renal failure, skin depigmentation, and even death. [11]

Psychological

Acid assault survivors also face many mental health issues upon recovery. One study showed that when compared to published Western norms for psychological well-being, non-Caucasian acid attack victims reported higher levels of anxiety, depression, and scored higher on the Derriford appearance scale, which measures psychological distress due to one's concern for their appearance. Additionally, the women reported lowered self-esteem according to the Rosenberg scale and increased self-consciousness, both in general and in the social sphere. [12]

Social

In addition to medical and psychological effects, many social implications exist for acid survivors, especially women. For example, such attacks usually leave victims handicapped in some way, rendering them dependent on either their spouse or family for everyday activities, such as eating and running errands. These dependencies are increased by the fact that many acid survivors are not able to find suitable work, due to impaired vision and physical handicap. This negatively impacts their economic viability, causing hardships on the families/spouses that care for them. Moreover, acid survivors who are single when attacked almost certainly become ostracized from society, effectively ruining marriage prospects. [13]

Prevention

Research has prompted many solutions to the increasing incidence of acid attacks in the world. Many countries look to Bangladesh, whose rates of attack have been decreasing, as a model, following their lead in many legislative reforms. [14] However, several reports highlighted the need for an increased, legal role of NGOs to offer rehabilitation support to acid survivors.[3] C Additionally, nearly all research stressed the need for stricter regulation of acid sales in order to combat this social issue. [3, 10, 14]

Role of NGOs

Many non-governmental organizations (NGOs) have been formed in the areas with the highest occurrence of acid attacks to combat such attacks. Bangladesh has its Acid Survivors Foundation, which offers acid victims legal, medical, counseling, and monetary assistance in rebuilding their lives. [14] Similar institutions exist in Uganda, which has its own Acid Survivors Foundation,[18] R and in Cambodia which utilizes the help of Cambodian Acid Survivors Charity. [3] NGOs provide rehabilitation services for survivors while acting as advocates for social reform, hoping to increase support and awareness for acid assault.

Indian acid attack survivor Shirin Juwaley founded the Palash Foundation [16] to help other survivors with psycho-social rehabilitation. She also spearheads research into social norms of beauty and speaks publicly as an advocate for the empowerment of all victims of disfigurement and discrimination

Regulation of Acid Sales

A positive correlation has been observed between acid attacks and ease of acid purchase. [14] Sulfuric, nitric, and hydrochloric acid are most commonly used and are all cheap and readily available in many instances.

Due to such ease of access, many organizations call for a stricter regulation on the acid economy. Specific actions include required licenses for all acid traders, a ban on concentrated acid in certain areas, and enhanced system of monitoring for acid sales, such as the need to document all transactions involving acid. [3]

Treatment

Treatment for burn victims remains inadequate in many developing nations where incidence is high. Medical underfunding has resulted in very few burn centers available for victims in countries such as Uganda, [10] Bangladesh and Cambodia. In addition to inadequate medical capabilities, many acid assault victims fail to report to the police due to a lack of trust in the force, a sense of hopelessness due to the attackers ‘impunity, and a fear of male brutality in dealing with their cases. [14] Most of the female victims suffer more because of police apathy in dealing with cases of harassment as safety issues as they refused to register a police case despite the victim being attacked thrice before meriting police aid after an acid attack.

Epidemiology

According to researchers and activists, countries typically associated with acid assault include Bangladesh, India, Pakistan, Nepal, Cambodia, Vietnam, Laos, Hong Kong, China, the United Kingdom, Kenya, South Africa, Uganda, and Ethiopia. However, acid attacks have been reported in many other countries around the world and the anecdotal evidence for acid attacks exists in various other regions of the world. However, despite such widespread occurrence South Asian countries maintain the highest incidence of acid attacks in the world. [14]

Gender

Women are at an increased risk of acid violence in certain countries, such as Bangladesh and India.[22] Another factor that puts victims at increased risk for an acid assault is their socioeconomic status, as those living in poverty are more likely to be attacked. [13] Additionally, all three nations with the most noted incidence of acid attacks - Bangladesh, India, and Cambodia - are ranked 93rd, 114th, and 104th, respectively, out of 134 countries on the Global Gender Gap Index, a scale that measures equality in opportunities between men and women in nations.[14]

Acid attacks are often referred to as a “crime of passion,” fueled by jealousy and revenge.[16] Actual cases though, show that they are usually the result of rage at a woman who dares to refuse the advances of a male. For the country of Bangladesh, such passion is often rooted in marriage and relationships. One study showed that refusal of marriage proposals accounted for 55% of acid assaults, with abuse from husband/family member (18%), property disputes (11%) and refusal of sexual or romantic advances (2%) as other leading causes.[12] Additionally, the use of acid attacks in dowry arguments has been reported in Bangladesh, [13] with 15% of cases studied by the Acid Survivors Foundation citing dowry disputes as the motive. [14] The chemical agents most commonly used to commit these attacks are hydrochloric acid and sulfuric acid. [15]

India

The Thomson Reuters Foundation survey[17] says that India is the fourth most dangerous place in the world for women to live in as women belonging to any class, caste or creed and religion can be victims of this cruel form of violence and disfigurement, a premeditated crime intended to kill or maim her permanently and act as a lesson to “put her in her place”. In India, acid attacks on women who dared to refuse a man's proposal of marriage or asked for a divorce are a form of revenge. The number of acid attacks have been rising [18] in India. There are no official figures available but it is estimated that here are, 1000 acid attacks a year in India. [19]

Acid attacks in India, like Bangladesh, have a gendered aspect to it: analyses of news reports revealed at least 72% of reported attacks involved women. [14] However, unlike Bangladesh, India's incidence rate of chemical assault has been increasing in the past decade, with a high 27 reported cases in 2010. Altogether, from January 2002 to October 2010, 153 cases of acid assault were reported in Indian print media while 174 judicial cases were reported for the year of 2000. However, scholars think that this is an underestimation, given that not all attacks are reported in the news, nor do all victims report the crime to officials.[14] Motivation for acid attacks in India mirrors those in Bangladesh. 34% of the analyzed by print media in India cited rejection of marriage or refusal by women of sexual advances as the cause of the attack and dowry disagreements have been shown to spur acid attacks. Land, property, and/or business disputes accounted for 20% of acid assaults in India from 2002 to 2010.

Legislation in India

India's top court has ruled that authorities must regulate the sale of acid used by jilted boyfriends and others to attack women. The Supreme Court's ruling on July 16, 2013 comes after a particularly notorious incident in which four sisters suffered severe burns after being attacked with acid by two men on a motorbike. An acid called “Tezaab”, which is designed to clean rusted tools but is often used in the attacks, can currently be bought across the counter. The Supreme Court has directed the states and union territories to issue licenses to retailers selling acid after the government said it will categorize acid as poison. The court said anyone under the age of 18 will not be able to purchase acids like hydrochloric, sulfuric and nitric. Shops will have to keep details like the quantity sold and the addresses of buyers, who will need to present photo identification to purchase acids.“Over the counter sale of acid is completely prohibited unless the seller maintains a log/register recording the sale of acid,” the Supreme Court said. Retailers will have to declare the amount of acid being stocked, to the police, the court said. Failure to do so would lead to undeclared stock being confiscated and a fine of up to 50,000 rupees. In its order, the Supreme Court said that acid attacks become a non-bail able offense and said survivors should receive 300,000 rupees in compensation, a third of which must be given within 15 days of the attack.

Following the gang rape of a 23-year-old student on a bus in Delhi late last year, India's Parliament approved a bill strengthening laws on assaults against women. Acid attacks were included in the bill and made a criminal offense with a minimum 10-year prison term. [20]

D. S. Bhullar

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