RUCHI KUMAR
A nurse in the burn unit of the hospital in Afghanistan's Herat province prepares a topical ointment used to treat and prevent infections in burn patients.(Photo: Ivan Flores)
At 32 years old, Dr. K is old enough to remember the first time the Taliban took control of Afghanistan in 1995.
She was 7 when girls were banned from school. "For years, my mother ensured that we continued our studies in secret classes conducted by women teachers in their homes," she says.
Inspired by her mother, who worked as a gynecologist, she enrolled to study medicine after the fall of the Taliban in 2001. By 2016, she had become a surgical resident at the country's only burn center, in the western province of Herat.
In her five years of practice, Dr. K has treated hundreds of women whose husbands set them on fire or thrown acid on them – as well as women suffering from domestic violence who chose to end their lives to escape the abuse, often opting for self-immolation.
Now she says her life is in danger because of her work.
With the Taliban back in power, Dr. K asked that she be identified only by the initial of her last name. She reports that she has been threatened by Taliban commanders acting on the wishes of an ex-husband of one of her jailed patients, now released, as well as men who blame her for their incarceration and divorce.
Spousal abuse is rarely reported — yet numbers are high
It is difficult to come up with an accurate count for the degree of domestic violence – and self-immolation — in Afghanistan. For many reasons, women rarely report spousal abuse. They're worried about the stigma of filing a complaint and often afraid of reprisals, including losing their children. Nonetheless, in this deeply patriarchal country, the numbers for reported cases are high. In 2020 alone, 7,191 cases of domestic abuse were reported by the Afghan Ministry of Women's Affairs, which was established in 2001 and has been now abolished by the Taliban. By contrast, India, which has a population of 1.38 billion compared to Afghanistan's 38 million, documented 5,297 domestic violence cases in 2020.
Then there are the self-inflicted burns that Dr. K has treated. Self-immolation "is a complex phenomenon, because this is the final message of a woman before she dies, particularly when there is little option for disclosure or seeking help,," explains Ayesha Ahmad, senior lecturer at University of London, who has extensively researched gender-based violence in Afghanistan. "There is also symbolism in the act of self-immolation — it is a form of disclosure in itself. A woman will set herself alight and run out of her house, with the surrounding community as her witness. It is her voice, it is her scream, it is her desperation and it is also her drawing a line that she is not going to endure violence anymore."
In the course of her work, Dr. K says the hospital would see at least two such cases — of self-immolation and/or burn victims — a week. Sometimes family members will say that the burns were caused by an accident – for example, the explosion of cooking gas cylinders. But, says Dr. K, in private conversation with their doctors some of these women will confess that they set themselves on fire.
"I can't forget this one case; a woman who was brought in during my shift," she says. "After setting her on fire, her husband tried to bury her in the yard. Fortunately, the sand helped put out her burns, and neighbors rushed her to the hospital," Dr. K says, recalling what the patient told her.
As the woman lay writhing in pain from her burns, her family members pressured Dr. K not to share the woman's account with the police. "They were afraid her husband would target them for revenge. But I made note of her condition and her statement that her husband had been the attacker, which was used by the police to arrest him," she says.
Threats against women — and caregivers — under the Taliban regime
However, since the Taliban takeover, Dr. K says, men like this woman's husband have been released and are hunting for the doctor. The Taliban released all prisoners when they took over provinces and recruited them for their battles.
Women she has treated have told her that they have been threatened by a husband who is among the released prisoners. Dr. K herself has been threatened over the phone as well.
"There are many such perpetrators who were convicted based on the medical reports I filed," she says.
Similar threats were also reported by social workers who provided support to women survivors of domestic violence. "The change in the administration of the country has brought our work to a grinding halt. The Taliban do not approve of our activities," Marzia, an Afghan psychologist specializing in cases of domestic violence, tells NPR. She asked that only her first name be used for the same reasons that Dr. K requested to have her identity shielded.
Marzia, who is currently in hiding because of threatening calls she received from the ex-husbands of women she helped, described one incident in the wake of the Taliban takeover. One of her patients told her that her husband was "a drug addict who would physically abuse her." She told the doctor that her husband had tried to behead her with a large knife.
"My colleagues and I intervened and filed a complaint that landed him in jail. But he has been freed now and is threatening her," Marzia says. "Last I heard she has been on the run with her kids, much like I am," she adds ruefully.
"In another case, I had helped one of my patients seek divorce from a very violent man," she says. "He never accepted the court ruling but couldn't do much. However, now with the Taliban in power he has sought their support to overrule the divorce and is threatening her as well as me, whom he blames for the divorce."
This photograph shows a patient at the Herat burn center in 2017. A mother of five, she says her husband set her on fire using kerosene while she was sleeping.(Photo: Ivan Flores)
Fears of a bleak future
As doctors, psychologists and social workers — many of them women — struggle to operate under the changed realities, there is a growing concern over the worsening violence against women.
Dr. K is not the only doctor who has stopped providing services to women who have self-immolated or been attacked by a spouse. At the same time, there is concern that violence against women has worsened since the Taliban takeover. That's what Marzia and others believe.
Ahmad also warned of a likely rise in domestic violence in the absence of agencies and in the wake of rising conflict in the country as the Taliban tries to solidify its power or some such.
"We understand from global literature that during conflict, domestic violence soars," says Ahmad, pointing to the Taliban's cutting back on protection for women as a key reason.
Marzia has been trying to provide what little support she can to the women she was working with at the time of the fall, using phone calls and messages via systems like Whatsapp.
"But I am unable to reach many of my patients. I am extremely worried about their safety," she says.
And Dr. K has been unable to return to the hospital because of the threats she has received. Patients have called her for treatment, even urging her to go back to work. But she is afraid for her life.
"I'm also mentally stressed. I am a doctor who has become a patient herself," she says.
Ruchi Kumar is a journalist who reports on conflict, politics, development and culture stories in India and Afghanistan.