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Ομιλία σε εκδήλωση της Loreal με τίτλο Saving Face
Ημερομηνία: 28-06-2012

I would firstly like to express appreciation for the kind invitation to participate in this conference.

I would also like to congratulate L'Oreal for this admirable initiative they have taken, in order to publicize an almost hidden crime and to raise awareness of this extreme form of violence against women and human nature.

The destruction of a person's face, either because of criminal action or by accident, creates a very complicated, and in most cases, irresolvable medical problem.

A grave mutilation of the body and the soul.

I can offer little from a medical perspective, because the plastic reconstruction of the face, nape and head is outside my area of expertise.

I can, nevertheless, analyse the political aspects of this social phenomenon Acid throwing, or acid attack or vitriolage, is a form of extreme violent assault. It is defined as the act of throwing acid onto the body of a person, mainly a woman, “with the intention of injuring or disfiguring her, out of jealousy or revenge". Perpetrators of these attacks throw acid at their victims, usually at their faces, burning them, and damaging soft tissues. In many cases exposing and dissolving the bones.

The long term consequences of these attacks include blindness and permanent scarring of the face, the body and mainly the soul.

 These attacks are most common in Cambodia, Afghanistan, India, Bangladesh, and Pakistan and other nearby countries. At least 1000 people in 15 countries are reported to have been attacked so far this year. Most of them are female and by majority under the age of 18.

The first contact I ever had with this particular issue was related to Afghanistan, when in 1996 Médecins du Monde organized a photo exhibition across major European cities, including Nicosia. The exhibition  was titled "Raise the Veil from the Afghan Women". The impact this exhibition had,  for raising awareness,  was immense, although at the time we did not know the extent to which the veil,  covered physical or   psychological scars.

I personally believe that it is a woman's right to wear the veil, scarf or burqa, if this is her own decision and is not imposed upon her by anyone.

To my knowledge and experience an uncovered woman feels naked, and this feeling is a fundamental component of the culture of various nations.

It is believed that the fact that women live in the darkness, is accorded solely to the difficult conditions and social exclusion, women face but also to the lack of access to education, whereas food is an impossibility when there is no male figure within the household.

Following two humanitarian missions in Afghanistan with MdM, in November 2001 and March 2002, during the invasion and subsequent war by the Allied forces, we found that this issue reflects a much greater secret. It often hides physical disfigurations, blindness, and the inability to commit oral functions or a synergy of the muscles of mastication, the non-convergence of the eyelids, ectropion, extensive scarring, development of ugly keloids and severe deformations. And of course all subsequent psychological effects, which are caused by external violence.

In certain Asian countries, the throwing of acid has been used as a form of revenge, for refusal of sexual advances, proposals of marriage, and demands for dowry but also over land disputes.

The chemical agents most commonly used to commit these attacks are hydrochloric acid and sulfuric acid, better known as vitriol or battery acid, which can easily be found in any household.  

Reports on sporadic episodes are being published about extremist groups acting against girls in Pakistan, Afghanistan and the Gaza Strip, for attending school or for not being dressed “modestly". The extremists aim to warn other women to wear the hijab or the burqa.  

In Bangladesh, such attacks are common and are considered to be a form of domestic violence, primarily targeted at women. Sociologists describe this phenomenon as a contemporary form of violence.

On the contrary, in Cambodia, it was reported that this form of violence is mostly carried out by wives against their husbands' lovers.

India is the fourth most dangerous place in the world for women.  Women from any religion, cast or tribe, can be victims to this pre-meditated crime intended to kill or permanently maim and punish.  There, acid attacks on women who dared to refuse a man's proposal of marriage or asked for a divorce are a common form of revenge. Acid is cheap and easily accessible and is the fastest way to destroy a woman's life. Most victims suffer not only as a result of the attack but also because of police apathy, ignorance, social exclusion and corruption.  In most cases, the perpetrators can easily get away, by bribing the police and, of course, never being tried for their actions.

Acid attacks are also common  in Pakistan and increase every year. The Pakistani attacks are typically the harassment by husbands against their wives who have "dishonoured them".

This form of violence also occurs in Europe, and over the past few years, has been recognized by many countries as one of the latest and most horrible forms of violence committed against women. This could easily be connected to another crime committed against the female gender: the termination of pregnancies if the embryo is female and the killing of millions of newborn female babies.

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. The acid can rapidly cause erosion of the skin,   the subcutaneous layer of fat, the mastication, expression and eye movement’s muscles, the nose muscles and cartilage, and in some cases even the underlying bone. Eyelids and lips may be completely destroyed and the nose and ears severely damaged.  Over 50% of burn injuries of the face involve the head and neck region, in addition to the hands when the victim raises them in order to protect herself.

The objective for reconstruction following a facial burn includes comfort, appearance and the restoration of functions such as airway patency, protection of the cornea, oral continence, and neck mobility. Appearance is altered by contractures, scarring, and changes of skin colour. The goal of the reconstructive surgeon is to minimize final deformity by restoring the patient to a near-normal appearance.

Next Section: Anatomy

The survival rate amongst victims of acid attacks is high. Consequently the victim requires long term surgical treatment and faces psychological challenges, which require in-depth help at each stage of physical recovery.

It was with great relief that we were informed of the progress of medical science that has reached the extremity of carrying out a face transplant, but we cannot speak of such options to all women, and especially in the case of these aforementioned girls.

In 2002, Bangladesh introduced the death penalty for throwing acid. Whereas according to the principle of Qisas under Sharia law in Pakistan, the perpetrator may suffer the same fate as the victim, and may be punished by having drops of acid placed in the criminal‘s eyes.

Iran has had several laws against acid attacks which are treated as a capital offence. In a case in 2008, a perpetrator was sentenced to be blinded.

In the case of Afghanistan following the ten years of war we realize that the situation has not changed despite the efforts of the international community for the implementation of human rights and fighting terrorism. Men in Afghanistan remain prisoners of the primitive instincts of revenge, violence, sexual harassment and possession. They remain prisoners of their ideological and religious fanaticism. In Afghanistan, the Taliban remain the Taliban and the women still bear the burqa.

Attitude cannot be imposed. It is, instead, a graduate evolution of culture and education. In order to change the attitudes to eliminate discrimination it is necessary that women themselves realize this. If appropriate education is provided to both sexes it would contribute to a culture of equality as it will effectively aid in shaping personalities.

I have volunteered as a paediatric surgeon and traumatologist in 7 countries of the Middle East, including Gaza, Lebanon, Iraq, Iran, and other countries of Central Asia, but never have I seen similar phenomena as those in Afghanistan. In Southern Lebanon, in the summer of 2006, during the war I had the experience of children suffering general burns including the face from the caustic effect of chemicals and phosphorus bombs. Dealing with victims of attacks by chemical weapons is a tragic experience. I lost at least 2 children and I had myself burned in the hands for just touching the skin of children affected. This is a crime against humanity. This is a burn on the face of the International Community and Dignity, under the guise of fighting terrorism.

 As a member of the Joint Parliamentary Committee of EU-Turkey, we are frequently contacted by women's NGOs in Turkey, regarding incidents of human rights violations and extreme violence against women in certain parts of the country including the throwing of acid. However I have personally never encountered it as a doctor there.

 The actual numbers of the crime remain unknown. The data currently available is only based upon the formal complaints that are made. The fear unfortunately still leaves many women in silence and so the crime remains silent.

 This is why I congratulate L'Oreal for raising the veil from over this silence.

This can only take place through long-term planning, democratic institutions and the development of education because nothing can change from one day to the other.

 

 
 
 
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