Saving Faces in Pakistan- Looking Forward from the Oscar

Shameem Akhtar, a Pakistani victim of an acid attack. Photo courtesy of Associated Press, Reporter India

I had the privilege of attending a private screening of Saving Face, the winner of Sunday night's Oscar for Best Documentary (Short Subject), followed by a Q & A with one of the directors, Daniel Junge, and one of the documentary's protagonists, Dr. Mohammad Jawad, a British-Pakistani plastic surgeon whose work the film revolves around. On a quick side note, Dr. Jawad was the also the surgeon who operated on British model and acid victim Katie Piper who recently had her eye sight restored through stem cell therapy. In short, Saving Face is about Dr. Jawad's journey back to his home land of Pakistan where he works to reconstruct the faces of women who have suffered acid attacks by their husbands, other males of close relation, and sometimes even other women. The reasons cited by attackers in many of the countries where acid violence is an issue are multifold- refusal by the women to accept unwanted marriage proposals, basic petty arguments in the house over minor issues, and even attempts to simply pursue education as a woman. The film interviews several survivors of these attacks, mostly women from rural areas, and focuses on two main characters, Zakia and Rukhsana, who are both victims. One of the sub-plots includes Zakia's court case against her husband which she eventually wins through the application of a recently passed Pakistani bill that sentences between 14 years and life in prison, as well as a $14,000 fine for men who are perpetrators of acid attacks. Throughout the documentary, several women's faces are shown, most of which are gruesomely deformed from the attacks and consistently elicited waves of shocked gasps from the audience. I whole-heartedly applaud Daniel Junge and Sharmeen Obaid-Chinoy (the other director) for giving these women a voice to the rest of the world, and to Dr. Jawad for using his plastic surgery skills for something other than breast implants (which he says he also does quite well in the documentary). The government of Pakistan, elated at the indirect receipt of an Oscar, has also declared that Ms. Chinoy will be presented with Pakistan's highest civil award upon her return.

As always, the question remains: what next? As became more apparent to me at the Q and A, there are far more questions that are still left unanswered. As with all global health and human rights issues, the hope is that these women will still be helped systematically and sustainably after the current publicity has died down. To this extent, Chinoy has announced an anti-acid awareness campaign to begin soon in Pakistan. While I felt that the documentary was great for "awareness," I still felt immobilized in my seat in an amphitheater in America because of the dire complexity of the issue at hand. Throwing acid on a woman's face is a symptom of a much larger, more pervasive, more culturally ingrained problem of misogyny and patriarchy in South Asia and the Middle East. While these forces still exist globally, they are more prevalent in the aforementioned regions. At one point, Dr. Jawad characterized the problem as being "local and focal" and unrelated to religion, culture, or the society at large because most people would not condone acid attacks. Sure, if asked directly, most people would probably denounce attacking someone else with acid, but I disagree that society, culture, and as culture's corollary, religion, are not to blame (I argue not against religion itself but men's attempts to irrationally apply it to defend culture). I believe the three are closely intertwined and reinforce one another.

In the film, Rukhsana, who is pregnant, prays that her child is a boy and not a girl for she knows that society looks differently upon the two- a male is "worth" more in people's eyes than a female. She worried that her potential daughter would suffer the same brutality that she has. In the discussion afterward, Mr. Jawad himself pointed out that one of the biggest impediments had to do with the Pakistani society's response to many of these cases, with many people convincing themselves that it was probably the woman's fault. This opinion seems to reflect both the educated and uneducated, the rich and the poor, the Muslim and the non-Muslim. This thought process is societal and stems from a patriarchal culture which is falsely justified in the name of religion. Women who are less subject to this sexism, such as wealthy women from the cities, perhaps don't see the benefit of risking their own liberty to defend women in rural areas (obviously besides for extraordinary individuals like Sharmeen who are doing something now), and thus the culture of gendered oppression remains slow-changing.

Dr. Jawad examining a patient. Photo credit- Asad Faruqi

Many questions regarding the practicality of the legal system for these women arise in my mind, but Mr. Junge and Dr. Jawad alluded to the fact that it is hard to address these questions. Has the implementation of the new anti-acid bill worked in practice? Are there fewer cases of acid attacks or perhaps more reports of them? Most attacks, unsurprisingly, go unreported so it is difficult to actually know how the rate of attacks has been affected. How practical is it for a poor Pakistani woman to actually access a lawyer without her husband knowing, afford paying for the legal services, wait for a conviction which could take many months, and also avoid the imminent violence that the man's family will likely attempt on the woman if she were to win the case? And, how much value does a formerly married woman who put her husband in jail have in the Pakistani society's eyes? Would her life actually be better? She would perhaps endure less physical abuse, but she would be ostracized from her community at the same time, essentially remaining faceless either way. It would be beneficial to examine past movements against acid violence to address the logistical ease of this particular crime. In 2002, Bangladesh passed the Acid Control Act which outlawed the unlicensed production, import, transport, storage, sale, and use of acid or even the possession of chemicals and equipment that could be used for the unlicensed production of acid. Bangladesh has also created tribunals specifically for victims of acid attacks which demand that investigations be completed in 30 days and trials finalized in 90.

Sulfuric acid is commonly used in these attacks.

The Indian media has recently written about the need for more strict and separate legislation in the Indian legal system regarding acid attacks. Furthermore, the Pakistani branch of the Acid Survivors Foundation (ASF), a collaborator on the film, has mentioned that legislation is currently in the works that will hopefully create more regulation of acid sale and create stronger rehabilitation/reintegration programs for the victims. Still, acid violence has continued steadily years after Bangladesh passed its laws. And the two main characters, Zakia and Rukhsana, run the risk of their own familial repercussions for their participation in the documentary. Zakia's in-laws and brothers have expressed discontent at her role in the film and Rukhsana's husband does not yet know. Ultimately, it is clear that from a societal point of view, Pakistan and the rest of South Asia still has a long way to go. Furthermore, I had many questions about the medical and political side of the issue. Dr. Jawad travels from England every few weeks to do a few surgeries in a government run hospital that provides free healthcare for the poor. However, he seemed to be one of the few people with the qualifications to do the reconstructive procedures for these women. After all, how many advanced plastic surgeons would remain in Pakistan (the classic brain drain issue), and for those who do, how many would choose to work in a government hospital for free? How do we incentivize or mandate Pakistani physicians to work with these types of patients with limited reimbursement, at least temporarily? Moreover, In India and Pakistan, government hospitals are rife with their own problems and given that the poor are usually unable to afford or access private institutions, it is clear that this will pose as an obstacle for women in need of reconstructive surgeries. Moreover, Dr. Jawad explained that many of the extremely expensive surgical tools and plastic molds that he used were brought from the UK as unused extras from the hospital where he works and would be extremely expensive if purchased from the market. For instance, a plastic face mask/mold that was used for one of the women costs 600 pounds. Will the Pakistani government invest money into providing free care consisting of expensive and complex surgeries for a few hundred, poor, uneducated women with little political sway? Will this documentary be enough to convince the government to do so? Would these funds perhaps be better used for prevention programs that might address the cultural issues I've mentioned above? This all remains to be seen.
Matriderm is a collagen-elastin matrix that is used in skin reconstruction. The A4 sized sheet used on Katie Piper cost 2000 pounds.
During the Q and A, I presented an idea which I hope to pursue in the future in my own global health work, which is based on creating a more interconnected framework between the medical and legal systems in developing countries. One of the issues is that women are afraid to report that they are even victims of this abuse. Examining the healthcare sector, we can study the way that certain stigmatized issues such as HIV have been dealt with. Community health worker (CHW) programs are one way to address stigma and silence in rural locations. Creating a system of local CHWs that can bring these victims to the clinic or hospital for support will be critical from a healthcare perspective. But, what if we utilized this route of access to then also bring women into contact with the legal system and lawyers/legal advocates who are interested in helping women pro bono with such cases? This network of lawyers and physicians would then collaborate to ensure that the court cases are actually seen through to the end. Moreover, these professionals are the ideal platform through which to begin changing the culture of patriarchalism because of the extreme influence that they hold in South Asian countries. In acknowledging and declaring that health is a human right, medicine and law have the potential for combined greatness in this situation and many others in global health. These are but a few ideas towards progress, and Dr. Jawad acknowledged that this is an area that they hadn't thought of before but would definitely start exploring.
In general, the sense of social awareness and urgency to act for the prevention of human rights abuses seems to emerge from countries where people have the privilege to worry about people in other countries. I personally think that Pakistani-Americans are going to care about this issue more than most people in Pakistan will. This is because the latter view it with a very different pair of eyes. People in Pakistan and India most likely have heard about acid attacks, along with the long list of other atrocities that happen to poor people, and most have probably turned a cold shoulder as they do to the abject poverty to which they have become unfortunately immune. This has at least been my personal experience talking to several people in India over the course of my half-dozen visits in recent years, and after discussions with some of my friends who currently live in Pakistan.

Sharmeen and Daniel accepting their awards and represent ing the many women who they acknowledge as the real heroes.

I think that to take informative documentaries such as this to the next level, screenings such as the one I attended must do a better job of informing viewers how we can actually impact such a complex issue. Bringing along Pakistani policy makers, academics, activists in the field, and others who have a more practical sense of where the need is, where we can play a role, and how to address these issues from their roots would be highly beneficial. The Acid Survivors Foundation website does have a list of how-you-can-helps, but addressing crowds at large social events in a more directed way would be great. Saving Face is undoubtedly important. It has opened and will continue to open thousands of eyes to just one of hundreds of horrific abuses that women in South Asia continue to face because of a culture of archaic sexism that still remains in slums and palaces alike. I encourage you to watch the documentary, but to not just feel sympathy or pity for these women. I encourage you to think, for that is why they have risked their lives to share their stories with us.

4 thoughts on “Saving Faces in Pakistan- Looking Forward from the Oscar

  1. Pingback: Are You Adopting a Raju? | Swasthya Mundial

  2. What is happening in these countries is unacceptable. Congratulations to these women for being courageous enough to share their stories live and actually try and make a difference by helping others facing alike issues.

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