Reshma Qureshi, who was the victim of acid attack, walked on the runway during New York Fashion Week in 2016.
Introduction
Acid attacks, also known as vitriolage are deliberate acts of violence that are potentially lethal and may result in significant burns to the surface area of the victim’s body. Acid attacks, characterised by the deliberate throwing of corrosive substances on individuals, are among the most brutal forms of violence. These attacks cause severe physical and psychological damage to victims, often with life-altering consequences. Recently Faisal Halim, a Malaysian professional footballer also known as Mickey, suffered severe burns from an acid attack. This has brought renewed attention to this vicious form of assault. While such attacks impact both genders, they are predominantly aimed at women, especially in South Asia, making it a critical issue of gender-based violence.
Understanding Acid Burns Versus Thermal Burns
The nature of the injury from acid differs significantly from thermal burns. Acid burns, caused by chemicals like sulfuric or nitric acid, result in coagulation necrosis, where the acid denatures and precipitates tissue proteins, leading to cell death. This type of burn can prevent deeper penetration but causes severe surface damage. Thermal burns, on the other hand, are caused by heat sources such as fire, resulting in thermal coagulation of tissues.
The depth of the burn can vary depending on the type and concentration of the acid, and the duration of contact with the skin. Stronger acids like sulfuric or hydrochloric acid can cause deeper burns that may lead to more severe scarring or even damage underlying tissues. As in thermal burns, the severity of burn are classified into first, second, and third-degree burns, with third-degree being the most severe, affecting all layers of the skin and possibly even underlying tissues.
In the case of Faisal Halim, the burn as been categorised as a 4th degree burn. Fourth-degree burns are extremely serious and can result in permanent damage to the affected areas, and involves damage that extends beyond the skin into deeper tissues such as muscle, tendons, and bones.
Treatment
The treatment protocols for these burns vary. Acid burns require immediate and prolonged washing under running water to dilute and remove the acid, followed by neutralisation attempts, which can sometimes exacerbate the injury due to heat generation from the reaction. Thermal burns are managed by cooling the burn area with water to reduce the temperature and tissue damage.
Treatment for acid burns can be complex and typically involves a multi-disciplinary approach, encompassing immediate care, ongoing medical treatment, surgical intervention, and reconstructive strategies as needed. Here’s a breakdown of these treatment modalities:
1. Medical Treatment
Immediate Care: The first step in treating an acid burn involves thoroughly rinsing the affected area with copious amounts of water to remove the chemical. This should continue for at least 15 to 30 minutes. Neutralizing agents are generally not recommended as they can cause a chemical reaction that might generate heat and worsen the injury.
Pain Management: Acid burns can be extremely painful. Pain relief is typically managed with analgesics and, in severe cases, may include opioids.
Infection Prevention: Burns can compromise the skin’s protective barrier, increasing the risk of infection. Topical antibiotics or antiseptic creams might be used to prevent infection, and in some cases, systemic antibiotics are prescribed.
Wound Care: Regular cleaning and dressing changes are critical. The use of appropriate wound dressings that maintain a moist environment can promote healing and reduce pain.
2. Surgical Treatment
Debridement: Surgical removal of dead, damaged, or infected tissue is crucial to prevent infection and promote healing. Debridement might be necessary periodically throughout the healing process.
Skin Grafting: In cases where the burns are deep, skin grafts (transferring skin from a healthy part of the body to cover the burned area) may be required to close wounds and reduce the severity of scarring.
Flap Surgery: For extensive burns that cannot be covered by skin grafts alone, flap surgery may be used. This involves the transplantation of a piece of tissue, along with its blood supply, from one part of the body to another.
3. Reconstructive Surgery
Scar Revision: This includes various techniques to improve the function and appearance of scar tissue, which can be unsightly or restrict movement.
Z-Plasty: A surgical technique that can help to reorient the tension lines in a scar, improving flexibility and appearance.
Laser Therapy: Can reduce scar thickness and discoloration. It can also help in blending the scar with the surrounding skin tone and improving skin texture.
Tissue Expansion: Involves the insertion of a balloon under the skin near the area of the scar. The balloon is gradually filled with saline to stretch the skin, which can then be used to reconstruct or repair the burned area.
4. Supportive Care
Physical Therapy: Early initiation of physical therapy can prevent contractures (permanent tightening of the skin, muscles, and tendons) and improve functional outcomes.
Psychological Support: Coping with the aftermath of an acid attack can be emotionally devastating. Psychological support or counselling is essential for mental health and emotional well-being.
The treatment plan for acid burns varies based on the severity and extent of the burns, and it requires careful coordination among dermatologists, surgeons, and other specialists to achieve the best possible outcomes for the patient.Despite the best medical interventions, the outcomes can be dire. Acid attack survivors often face permanent disfigurement, visual impairments, and deep psychological scars. Studies, such as the one published in the International Journal of Burns and Trauma, indicate that nearly 79% of acid attack victims suffer from some form of visual impairment, with many experiencing bilateral blindness.
Acid Violence Against Women in South Asia
Acid violence is particularly prevalent in South Asia, where it has become a distressing form of gender-based violence. The motives often relate to personal relationship disputes, rejections of romantic advances, or dowry-related issues. The demographic most at risk includes women between the ages of 18 and 30. This form of attack not only aims to physically harm but also to socially ostracize the victim, perpetuating a cycle of powerlessness and stigma.
Conclusion
Acid attacks are a severe human rights violation, reflecting deeper societal issues around gender inequality and the objectification of women. While legal frameworks in many South Asian countries have begun to address this issue with stricter penalties and regulations on acid sales, much work remains to be done in terms of support and rehabilitation for survivors, as well as education and preventive measures. Global awareness and stringent legal actions are imperative to combat this heinous crime and support its victims toward a semblance of recovery and justice.
