Acid Survivors Foundation

Executive summary

In 2011 the Acid Survivor's Foundation celebrated its twelve-year anniversary. To mark this occasion ASF invited the government, its partners, donors, the media, and former patients to discuss the progress made and the challenges still necessary to face.

Since its formation, ASF has emerged as a global pioneer in combating gender based violence in the form of acid attacks. ASF has been working towards its vision by providing holistic burn-care services. ASF runs a 20-bed hospital in Banani, Dhaka fully equipped to provide standard burn care services including economic reconstructive plastic surgery. ASF's hospital provides psychological care, legal assistance, and financial support for economic rehabilitation. ASF engages in government and civic activism in order to ensure that survivors' rights are met and campaigns both nationally and locally for government policy changes. They also run national and local prevention campaigns to raise awareness on the legal and social consequences of acid attacks and disseminate relevant information on how victims and their family/friends should properly handle an acid attack.

The declining trend in acid violence in Bangladesh is an indication of ASF's success since its inception in 1999. ASF's victims' rights campaign has led to institutional and policy reforms designed to deter potential attackers. 2002 saw the highest number of acid attacks in Bangladesh: 490. This galvanized ASF's prevention campaigns. As a result, the trend has declined with only 84 incidents affecting 111 victims in 2011. However, this has not led to any slack in the efforts of the ASF.

In 2011, the Management Development Foundation (MDF) worked in conjunction with ASF to develop a ten-year strategic plan and a five-year project proposal with the objective of clarifying the future direction of ASF, to improve its effectiveness and corporation with its partners, and to articulate a logical program intervention for the next five years.

2011 was also the year that ASF's Executive Director Monira Rahman was honored with the prestigious World's Children's Prize in recognition for her struggle for the children who have been the victims of acid attacks or petrol attacks leading to permanent and disfiguring scars. ASF was also honored with the 2011 Human Rights Prize of the French Republic.

Notification and Referral Services (NRS)

Upon its establishment the ASF worked in collaboration with BRAC to develop a nationwide notification system to identify acid attacks within 24-hours. Within 48-hours the situation is to be investigated and the victim brought to the ASF hospital in Dhaka. A 24/7 hotline is also maintained, which allows attacks to be reported and victims to be transferred to the ASF hospital. The NRS also allows government agencies, NGOs, & the media to stay informed.

Acid Survivors Foundation Hospital

Acid attack victims require specialized treatments including reconstructive plastic surgery, physiotherapy, and the application of pressure garments. Patients usually need specialized treatment for the eye, ear, nose, mouth, neck, and/or other body parts. Other injuries and health conditions including fractures, diabetes, pregnancy, etc. will affect the course of treatment procedure.

October 3, 2011, Prothom Alo reports that according to the Ministry of Health and Family Welfare 64% of treatment costs in public health facilities are borne by the patient themselves. Burn treatment is expensive and complex, so given the poor socio-economic condition of most acid burn victims their families' cannot afford these costly time consuming treatments. Neither are most health facilities in Bangladesh properly equipped, nor do they have the skilled staff necessary for the treatment of complex chemical burns. As a result, burn victims face a high rate of mortality.

Upon ASF's inception in 1999, the Dhaka Medical College Hospital (DMCH), with its 8-bed burn unit, was the only hospital in Bangladesh that specialized in treating any form of burn injury. To partially rectify the situation, ASF, with the help of the British High Commission and British Women's Association started a 20-bed Burn Rehabilitation Center in November 1999, which has become known as informally as Thikana (meaning destination in Bengali).

Using the Notification and Referral Services (NRS), the ASF is able to learn about attacks and can facilitate the transport of acid victims to Thikana within 24 hours. Before the establishment of a surgical facility at the ASF hospital victims would be brought to the DMCH. After successful surgery the patients would be brought to Thikana for post surgery nursing care, physiotherapy, and trauma counseling. Given the finite facilities at DMCH and the necessity to treat other types of burns, the Kadoorie Charitable Foundation helped establish a 15-bed surgical facility and the Centre for the Rehabilitation of the Paralyzed (CRP) a.k.a. Jibontara (meaning "life stem") Hospital. In 2003, Thikana & Jibontara Hospital were merged into the 20-bed ASF Hospital at Banani, Dhaka.

ASF aims to ensure that survivors have access to the best available medical care. 7 survivors in 1998 and 8 survivors in 2000 were sent to Spain for medical treatment. Since 1999, 25 survivors have been sent to the United States and Europe for advanced medical treatment. However, due to the expensive nature of such treatments, the ASF began collaborating with international surgeons in 2001 to impart their knowledge in Bangladesh and work with local surgeons in order to develop their skill.

The ASF Hospital currently provides comprehensive services including nursing care, nutritional care, medication, pathological tests, reconstructive plastic surgery, physiotherapy and the application of pressure garments, counseling and therapeutic services, legal advice, and rehabilitation and reintegration services. These services are provided free of charge to roughly 600-700 acid victims annually.

Psychological support services

The permanently damaging nature of acid attacks and the inefficiency of the Bangladesh justice system are a serious and sometimes permanent detriment to the psychological health of survivors and their families. This can result in the development of psychiatric conditions, including post-traumatic stress disorder and suicidal tendencies, needingspecialized psychiatric care. However, DMCH is currently the only hospital in Bangladesh with a clinical psychology department.

Consequently, ASF provides bed-side and community psychological support to help victims and their families overcome the trauma of the attack. ASF currently has one clinical psychologist and two peer counselors at its hospital to provide counseling and psycho-therapeutic services. ASF also organises music and art therapy in its hospital to help patients express their emotions.

Rehabilitation and reintegration

Attacks will temporarily removes one's capacity for work or study. This capacity can be rebuilt following treatment through rehabilitation and reintegration techniques.

ASF statistics have shown that 46% of perpetrators are someone close to the victim (Husbands 26% & Other family member 20%). Therefore, many victims of acid violence are unable to return to their families; however, some are compelled to regardless due to a lack of an income source.

The Department of Social Welfare and both National and District Acid Control Councils have funds that provide interest free loans to survivors. ASF is continuously working with its partners and survivors to ensure that these funds are effectively used for benefit of acid survivors. Microfinancing is often not an option as acid survivors fall into a high risk category for investment. They initially do not have a regular source of income and do not feel confident about repayment of loans.

Rehabilitation strategy

ASF works to rehabilitate its patients through the use of the following measures:

Advocacy

ASF advocates to ensure that survivors' legal rights are met. ASF's advocacy campaigns directly involve survivors as spokespersons for change. This allows campaigns to hold more clout and give survivors more self-confidence. ASF also lobbies with the government, NGOs, business organisations, and other agencies to provide rehabilitation support for survivors.

Direct services from ASF

To ensure that survivors are in a position to act as spokespersons, they will need to have secured livelihoods. As such, ASF compliments government efforts by providing rehabilitation support to survivors through social protection and other schemes, which enable survivors to establish a secured livelihood and successfully reintegration into mainstream society.

ASF also provides emergency financial support to victim's who are the sole breadwinner of their family and provides education support to encourage survivors to continue primary and secondary schooling.

Legal support

The effective prevention of acid violence can only be ensured if all perpetrators are brought to justice and the state can effectively control the illegal use of acid.

Prior to 2002 acid related offenses were primarily dealt with using The Prevention of Oppression Against Women and Children Act of 2000. ASF along with other humans' rights organisations, social activists, and pressure groups advocated for the introduction of new laws to combat acid offenses specifically. ASF, the newspaper Prothom Alo, and BRAC on International Women's Day mobilized over 5000 people to march alongside 100 acid attack survivors as a campaign for new laws.

ASF's efforts have resulted in the creation of two laws on April 17, 2002: the Acid Crime Control Act (ACCA) and the Acid Control Act (ACA), making it the first country in the world to have specific laws against acid attacks.

ASF provides legal support for survivors by referring them to its legal partners including BRAC, Aino Salish Kendro (ASK), the Bangladesh National Women Lawyer's Association (BNWLA), and the Bangladesh Legal Aid Services and Trust (BLAST). ASF's case managers prepare case reports of each survivor as they are admitted in the ASF Hospital and then provide legal advice to both survivors and their family. While the legal partners pursue court cases for each survivor, ASF's case managers monitor the role of the police and public prosecutors to ensure the utmost concern is given.

Advocating awareness

Bangladesh has the highest reported incidence of acid violence in the world. In Bangladesh, acid violence is largely a gender-discriminatory crime against women. Since its inception, ASF has worked to create successful prevention campaigns which have led to significant reductions in acid attacks. ASF runs local and national prevention campaigns using radio, television, and print to bring the issue into public attention.

School and college campaigns

ASF has organised various school and college campaigns in order to motivate students into taking an active role in preventing of acid violence in their communities. The campaigns also help raise awareness as to the causes of acid violence, which will engender a change in attitude towards women and human relationships. The campaigns also work to sensitize youth to the social rehabilitation needs of victims and to encourage youth not to discriminate against students with scars and disfigurements. Students are also informed as to the proper procedure for dealing with acid attacks.

Community meetings

ASF's community meetings involve survivors' families, community leaders, and representatives of the local government with the purpose of making them aware of the consequences of acid violence as well as the psychosocial struggles of survivors. Plans to accelerate community acceptance of survivors, ensure social protection, and promote favorable environments for healing are also discussed.

"Use water"

ASF has taken great measures to raise awareness as to the importance of using water immediately after an attack. Information is given to do the following if any part of the body is exposed to acid or if acid is swallowed:

International Women's Day

Every year the ASF organises an open air program to express men's commitment to ending gender based violence in Bangladesh on the eve of International Women's Day.

16 Days of Activism

The Men & Boys Network arranged a mass gathering on November 25 at Rabindra Sharibor to launch the 16 Days of Activism campaign. Speakers at the event included Professor Shiekh Imtiaz of Dhaka University; Ranjan Karmaker, Executive Director of Steps Towards Development; and Monira Rahman, Executive Director of ASF. Special guests included Director Animesh Ayech; Women's rights activist Rekha Shaha; and Close-Up One singer Mizan Rajib. The cultural program included music from Shaon. The program encouraged participants to proactively pursue the end of gender-based violence.

Gender-based violence and justice in South Asia

The Cornell Law School's Avon Global Center for Women and Justice and the Jindal Global Law School in India worked in conjunction to organise the International Conference on Gender-Based Violence and Justice in South Asia on 22–23 October 2011 in New Delhi.

The conference brought together representatives of South Asian and African countries where gender-based violence is a major issue including Afghanistan, Bangladesh, India, Nepal, Pakistan, and Sri Lanka as well as other nations concerned with the progress of the conference including Canada, France, Guyana, Norway, Singapore, South Africa, the United States, the United Kingdom, and Zambia. Over the course of two days, practitioners and scholars shared their knowledge, insights, and strategies. The event also brought together judges, scholars, human rights activists, victims, health care and legal professionals, and policy makers.

The conference was closed with several major conclusions in mind. The first was the international nature of gender-based violence as well as the need for a more thorough and streamlined process to effectively prosecute perpetrators of crimes such as human trafficking and bride abandonment. The second was the need for equal representation of women in government agencies and the need for gender sensitization programs, which are essential to ensuring the effectiveness of justice and promoting meaningful protection for women.

South Asia Special Forum

ASF participated in the South Asia Social Forum, held November 18–22 at Dhaka University. The ultimate goal of the forum was to raise awareness of the poverty, hunger, and discrimination affecting Asia while advocating for a world based on a foundation of equality, freedom and justice for all.

On November 21, ASF and Manusher Jonno Foundation organised a seminar on “Effective Strategies to Combat Gender Based Violence: South Asia Perspective”. The seminar gathered experienced and committed human rights activists to exchange ideas and best measures for combating the violence against women.

Southeast Asia International Burn Care Conference

On April 3–6, 2011, Interburns and ASF organised the gathering of a group of 47 burn care experts and providers from twelve South East Asian countries in tea resort town of Srimongol to discuss the most cost effective strategies for providing proper burn care to patients with limited resources. The conference led to the creation of the Srimongol Declaration, which called for Southeast Asian governments to allocate more significant funding to burn care treatment and prevention.

Department of International Development

June 21, 2011, British Minister of State for the Department of International Development Alan Duncan visits the ASF hospital and interacts with survivors. He also met with the Prime Minister to request the securing of a plot of land where the British Government would help ASF build an "ASF Burn Complex". The reduction in the number of acid related burn c

ases has been in proportion to increasing reports of kerosene and gas attacks. Bangladesh has a single 100-bed facility for treating all these cases, which ASF and the Department of International Development both agree is not sufficient.

HRH The Princess Anne, The Princess Royal

March 1, 2011, HRH Princess Anna visits ASF for the second time (the first being in 2000), where she witnessed the rehabilitation center in action and interacted with some victims.

English Cricket Team

February 17, 2011, the English Cricket Team visits ASF, where they interacted with victims.

Human Rights Prize of the French Republic

December 10, 2011, ASF receives the prize from the French Human Rights Commission at a ceremony held at the Quai d'Orsay in Paris.

World's Children's Prize

April 28, 2011, Dr. Monira Rahman, Murhabazi Namegabe, and Cecilia Flores-Oebanda are honored as the Children's Rights Heroes for millions of children at the Gripsholm Castle in Mariefred, Sweden.