Acid attack

An acid attack,[1] also called acid throwing, vitriol attack, or vitriolage, is a form of violent assault[2][3][4] involving the act of throwing acid or a similarly corrosive substance onto the body of another "with the intention to disfigure, maim, torture, or kill".[5] Perpetrators of these attacks throw corrosive liquids at their victims, usually at their faces, burning them, and damaging skin tissue, often exposing and sometimes dissolving the bones. Acid attacks can often lead to permanent blindness.[6]

An Iranian acid-attacked woman under treatment in Tehran, pictured on April 2018.

The most common types of acid used in these attacks are sulfuric and nitric acid. Hydrochloric acid is sometimes used, but is much less damaging.[7] Aqueous solutions of strongly alkaline materials, such as caustic soda (sodium hydroxide), are used as well, particularly in areas where strong acids are controlled substances.[8][9]

The long term consequences of these attacks may include blindness, as well as eye burns, with severe permanent scarring of the face and body,[10][11][12] along with far-reaching social, psychological, and economic difficulties.[5]

Today, acid attacks are reported in many parts of the world, though more commonly in developing countries. Between 1999 and 2013, a total of 3,512 Bangladeshi people were acid attacked[13][14][15] with the rate of cases declining by 15%-20% every year since 2002 based on strict legislation against perpetrators and regulation of acid sales.[16][17] In India acid attacks are at an all-time high and increasing every year with 250-300 reported incidents every year while the "actual number could exceed 1,000, according to Acid Survivors' Trust International".[18][19]

Although acid attacks occur all over the world, this type of violence is most common in South Asia.[20] The UK has one of the highest rates of acid attacks per capita in the world,[21] according to Acid Survivors Trust International (ASTI).[22] In 2016 there were over 601 acid attacks in the UK based on ASTI figures, and 67% of the victims were male, but statistics from ASTI suggest that 80% of victims worldwide are women.[23] Over 1,200 cases were recorded over the past five years. From 2011 to 2016 there were 1,464 crimes involving acid or corrosive substance in London alone.

Motivation of perpetrators

The intention of the attacker is often to humiliate rather than to kill the victim. In Britain such attacks, particularly those against men, are believed to be underreported, and as a result many of them do not show up in official statistics.[24] Some of the most common motivations of perpetrators include:

Personal conflict regarding intimate relationships, and sexual rejection[25][26]
Racial motivations
Sexual related jealousy and lust[27]
Social, political and religious motivations
Gang violence and rivalry
Anti-minority discrimination
Conflicts over land ownership, farm animals, housing and property[12]
Revenge for refusal of sexual advances, proposals of marriage and demands for dowry[10]

Acid attacks often occur as revenge against a woman who rejects a proposal of marriage or a sexual advance.[28][29] Gender inequality and women's position in the society, in relation to men, plays a significant role in these types of attacks.[30]

Attacks against individuals based on their religious beliefs or social or political activities also occur. These attacks may be targeted against a specific individual, due to their activities, or may be perpetrated against random persons merely because they are part of a social group or community. In Europe, Konstantina Kouneva, currently a member of the European Parliament, had acid thrown on her in 2008, in what was described as "the most severe assault on a trade unionist in Greece for 50 years."[31] Female students have had acid thrown in their faces as a punishment for attending school.[32] Acid attacks due to religious conflicts have been also reported.[33][34] Both males and females have been victims of acid attacks for refusing to convert to another religion.[35]

Conflicts regarding property issues, land disputes, and inheritance have also been reported as motivations of acid attacks.[36][37] Acid attacks related to conflicts between criminal gangs occur in many places, including the UK, Greece, and Indonesia.[38][24]

Epidemiology

According to researchers and activists, countries typically associated with acid assault include Bangladesh,[39] India,[40][41] Nepal, Cambodia,[42] Vietnam, Laos, United Kingdom, Kenya, South Africa, Uganda, Pakistan,[43] and Afghanistan. However, acid attacks have been reported in countries around the world, including:[7][44]

Additionally, anecdotal evidence for acid attacks exists in other regions of the world such as South America, Central and North Africa, the Middle East, and Central Asia.[7] However, South Asian countries maintain the highest incidence of acid attacks.[16]

Police in the United Kingdom have noted that many victims are afraid to come forward to report attacks, meaning the true scale of the problem may be unknown.[74]

Gender

An accurate estimate of the gender ratio of victims and perpetrators is difficult to establish because many acid attacks are not reported or recorded by authorities. According to a 2010 study in The Lancet, there are "no reliable statistics" on the prevalence of acid attacks in Pakistan.[25]

A 2007 literature review analyzed 24 studies in 13 countries over the past 40 years, covering 771 cases.[15] According to the London-based charity Acid Survivors Trust International, 80% of acid attacks are on women, and acid assaults are grossly under-estimated. In some regions, assaults perpetrated on female victims by males are often driven by the mentality "If I can't have you, no one shall."[75]

In Bangladesh, throwing acid has been labeled as a "gender crime", as there is a dominance of female victims who are assaulted by males, for the reason of refusing to marry, or refusing sexual advances from male perpetrators.[76] In Jamaica, women throwing acid on other women in relation to fights over male partners is a common cause.[76] In the UK, the majority of victims are men, and many of these attacks are related to gang violence.[24]

Another factor that puts victims at increased risk for an acid assault is their socioeconomic status, as those living in poverty are more likely to be attacked.[77][16] As of 2013, the three nations with the most noted incidence of acid attacks – Bangladesh, India, and Cambodia – were ranked 75th, 101st, and 104th, respectively, out of 136 countries on the Global Gender Gap Index, a scale that measures equality in opportunities between men and women in nations.[78]

By country

Afghanistan

Such attacks or threats against women who failed to wear hijab, dress "modestly" or otherwise threaten traditional norms have been reported in Afghanistan.[79] In November 2008, extremists subjected girls to acid attacks for attending school.[45][80]

Africa

High incidence of acid assaults have been reported in some African countries, including Nigeria,[61] Uganda,[26] and South Africa.[15] Unlike occurrences in South Asia, acid attacks in these countries show less gender discrimination. In Uganda, 57% of acid assault victims were female and 43% were male.[26] A study focusing on chemical burns in Nigeria revealed a reversal in findings–60% of the acid attack patients were male while 40% were female.[61] In both nations, younger individuals were more likely to suffer from an acid attack: the average age in the Nigeria study was 20.6 years,[61] while Ugandan analysis shows 59% of survivors were 19–34 years of age.[26]

Motivation for acid assault in these African countries is similar to that of Cambodia. Relationship conflicts caused 35% of acid attacks in Uganda in 1985–2011, followed by property conflicts at 8%, and business conflicts at 5%.[26] Disaggregated data was not available in the Nigeria study, but they reported that 71% of acid assaults resulted from an argument with either a jilted lover, family member, or business partner.[61] As with the other nations, researchers believe these statistics to be under-representative of the actual scope and magnitude of acid attacks in African nations.[26]

In August 2013, two Jewish women volunteer teachers—Katie Gee and Kirstie Trup from the UK—were injured by an acid attack by men on a moped near Stone Town in Tanzania.[81]

A few cases also occurred in Ethiopia [82] and Nigeria.[61]

The Balkans

There has recently been a surge in high-profile, public acid attacks in Bulgaria[83] and Greece.[83][83]

Bangladesh

Acid attack victims in Bangladesh.

According to the Acid Survivors Foundation in Bangladesh, the country has reported 3000 acid attack victims since 1999, peaking at 262 victims for the year of 2002.[16][39] [15] Rates have been steadily decreasing by 15% to 20% since 2002, with the amount of acid attack victims reported at 91 in Bangladesh as recently as 2011.[17] Bangladesh acid attacks shows the most gendered discrimination, with one study citing a male to female victim ratio of 0.15:1[15] and another reporting that 82% of acid attack survivors in Bangladesh are women.[77] Younger women were especially prone to attack, with a recent study reporting that 60% of acid assault survivors are between the ages of 10 and 19.[16] According to Mridula Bandyopadhyay and Mahmuda Rahman Khan, it is a form of violence primarily targeted at women. They describe it as a relatively recent form of violence, with the earliest record in Bangladesh from 1983.[10]

Acid attacks are often referred to as a "crime of passion", fueled by jealousy and revenge.[15] Actual cases though, show that they are usually the result of rage at a woman who rebuffs the advances of a male. For the country of Bangladesh, such passion is often rooted in marriage and relationships. One study showed that refusal of marriage proposals accounted for 55% of acid assaults, with abuse from a husband or other family member (18%), property disputes (11%) and refusal of sexual or romantic advances (2%) as other leading causes.[29] Additionally, the use of acid attacks in dowry arguments has been reported in Bangladesh,[77] with 15% of cases studied by the Acid Survivors Foundation citing dowry disputes as the motive.[16] The chemical agents most commonly used to commit these attacks are hydrochloric acid and sulfuric acid.[84]

Cambodia

Acid attack victim in Cambodia.

Recent studies on acid attacks in Cambodia found the victims were almost equally likely to be men or women (48.4% men, 51.6% women).[16] As with India, rates of acid attacks in Cambodia have generally increased in the past decades, with a high rate of 40 cases reported for 2000 that started the increasing trend.[16] According to the Cambodian Acid Survivors Charity, 216 acid attacks were reported from 1985 to 2009, with 236 reported victims.[5] Jealousy and hate is the biggest motivator for acid attacks in Cambodia, as 28% of attacks reported those emotions as the cause. Such assaults were not only perpetrated by men—some reports suggest women attack other women occur more frequently than men do.[5] Such incidents usually occur between a husband's wife and mistress to attain power and socioeconomic security.[16][85]

A particularly high-profile case of this nature was the attack on Cambodian teenager Tat Marina in 1999, allegedly carried out by the jealous wife of a government official (the incident prompted a rash of copycat crimes that year, raising the number from seven in 1998 to 40 in 1999). One third of the victims are bystanders.[86] In Cambodia, there is only one support center that is aiming to help acid attack survivors. There they can receive medical and legal support.[87]

Hong Kong

The Mong Kok acid attacks were incidents in 2008, 2009, and 2010 where plastic bottles filled with corrosive liquid (drain cleaner) were thrown onto shoppers on Sai Yeung Choi Street South, Hong Kong, a pedestrian street and popular shopping area. A reward, originally HK$100,000, for information about the perpetrator or perpetrators, was raised to HK$300,000 following the second incident, and cameras were to be installed in the area following the December incident. The third incident occurred the very day the cameras were turned on. The fifth incident happened after Hong Kong government announced its new strategies against the incident. 130 people were injured in these attacks.[88]

India

Acid attacks in India, like Bangladesh, have a gendered aspect to them: analyses of news reports revealed at least 72% of reported attacks included at least one female victim.[89] However, unlike Bangladesh, India's incidence rate of chemical assault has been increasing in the past decade, with a high 27 reported cases in 2010.[89] Altogether, from January 2002 to October 2010, 153 cases of acid assault were reported in Indian print media[89] while 174 judicial cases were reported for the year of 2000.[90]

The motivation behind acid attacks in India mirrors those in Bangladesh: a study of Indian news reports from January 2002 to October 2010 uncovered that victims’ rejected sex or marriage proposals motivated attacks in 35% of the 110 news stories providing a motive for the attack.[89] Notable cases of acid attacks are Sonali Mukherjee's case of 2003 and Laxmi Agarwal in 2005.

Police in India are also known to use acid on individuals, particularly on their eyes, causing blindness to the victims. A well known such case is the Bhagalpur blindings, where police blinded 31 individuals under trial (or convicted criminals, according to some versions) by pouring acid into their eyes. The incident was widely discussed, debated and acutely criticized by several human rights organizations. The Bhagalpur blinding case had made criminal jurisprudence history by becoming the first in which the Indian Supreme Court ordered compensation for violation of basic human rights.[91]

Iran

According to Afshin Molavi, in the early years of the revolution and following the mandating of the covering of hair by women in Iran, some women were threatened with acid attacks by Islamic vigilantes for failing to wear hijab.[92]

Recently, acid assault in Iran has been met with increased sanctions. The Sharia code of qisas, or equivalence justice, required a caught perpetrator of acid violence to pay a fine and may be blinded with acid in both eyes.[7] Under Iranian law, victims or their families can ask a court's permission to enact "qisas" either by taking the perpetrator's life in murder cases or afflicting an equal injury to his or her body.[93] One victim, Ameneh Bahrami, sentenced her attacker to be blinded in 2008. However, as of July 31, 2011, she pardoned her attacker, thereby absolving Majid Movahedi of his crime and halting the retributive justice of Qisas.[94][95]

In October 2014, a series of acid attacks on women occurred in the city of Isfahan, resulting in demonstrations and arrests of journalists who had covered the attacks. The attacks were thought by many Iranians to be the work of conservative Islamist vigilantes, but the Iranian government denies this.[96][97]

Israel, West Bank and Gaza Strip

In 1983 acid attacks were reported to be carried out by Mujama al-Islamiya against men and woman who spoke out against the Mujama in the Islamic University of Gaza.[98] Additional attacks by Mujama al-Islamiya were reported through 1986.[99] During the First Intifada, Hamas and other Islamist factions conducted an organized intimidation of women to dress "modestly" or wear the hijab. Circulars were distributed specifying proper modest dress and behavior. Women who did not conform to these expectations, or to "morality expectations" of secular factions, were vulnerable to attacks which included pouring acid on their bodies, rock pelting, threats, and even rape.[100][101][98][102] B'Tselem has also documented additional attacks with acid in specific attacks involving women in a collaboration context.[102]

In 2006–07, as part of a wider campaign to enforce Islamist moral conduct, the al-Qaida affiliated "Suyuf al-Haq" (Swords of Righteousness) claimed to have thrown acid on the faces of "immodestly" dressed woman in Gaza as well as engaging in intimidation via threats.[103][104][105][106] Following 2014 Israel–Gaza conflict Amnesty International has claimed that Hamas used acid during interrogations as a torture technique. Hamas denies this claim.[107][108][109] In 2016, during a teacher's strike, unknown assailants hurled acid in the face of a striking Palestinian teacher in Hebron.[110]

There have also been recorded incidents of acid use against Israelis. In December 2014, a Palestinian hurled acid (concentrated vinegar which contains a high percentage of acetic acid and can cause burns) into a car containing a Jewish family of six and a hitchhiker at a checkpoint between Beitar Illit and Husan in the West Bank, causing serious face injuries to the father and lightly injuring other occupants, including children.[111][112][113] In September 2008 a Palestinian woman carried out two separate acid attacks against soldiers at Huwwara checkpoint, blinding one soldier.[114][115][116]

Moshe Hirsch was the leader of the anti-Zionist Neturei Karta group in Jerusalem. Hirsch had one glass eye due to an injury sustained when someone threw acid in his face. According to his cousin, journalist Abraham Rabinovich, the incident had no link with Hirsch's political activities but was connected to a real estate dispute.[117]

Mexico

Drug cartels such as the Los Zetas are known to use acid on civilians. For example, In the 2011 San Fernando massacre, Los Zetas members took away children from their mothers, and shot the rest of the civilians in a bus. The women were taken to a warehouse where many other women were held captive. Inside a dark room, the women were reportedly raped and beaten. Screams of the women and of the children being put in acid were also heard.[118]

Pakistan

According to The New York Times reporter Nicholas D. Kristof, acid attacks are at an all-time high in Pakistan. The Pakistani attacks are typically the work of husbands against their wives who have "dishonored them."[18] Statistics compiled by the Human Rights Commission of Pakistan (HRCP) show that 46 acid attacks occurred in Pakistan during 2004 and decreased with only 33 acid assaults reported for 2007.[7] According to a The New York Times article, in 2011 there were 150 acid attacks in Pakistan, up from 65 in 2010.[119] However, estimates by the Human Rights Watch and the HRCP cite the number of acid attack victims to be as high 40–70 per year.[7] Motivation behind acid assaults range from marriage proposal rejections to religious fundamentalism.[7] Acid attacks have been dropped by half in 2019[120]

Acid attacks in Pakistan came to international attention after the release of a documentary by Sharmeen Obaid-Chinoy called Saving Face (2012).[121] According to Shahnaz Bukhari, the majority of these attacks occur in the summer when acid is used extensively to soak certain seeds to induce germination.[122] Various reasons have been given for such attacks, such as a woman dressing inappropriately or rejecting a proposal of marriage. The first known instance of an acid attack occurred in East Pakistan in 1967.[123] According to the Acid Survivors Foundation, up to 150 attacks occur every year. The foundation reports that the attacks are often the result in an escalation of domestic abuse, and the majority of victims are female.[121]

In 2019, the Acid Survivors Foundation Pakistan (ASFP) have said that the reported cases of acid attacks on women have dropped by around 50 per cent compared to the last five years.[124]

Russia

On January 17, 2013, Russian ballet dancer Sergei Filin was attacked with acid by an unknown assailant, who cornered him outside of his home in Moscow. He suffered third-degree burns to his face and neck. While it was initially reported that he was in danger of losing his eyesight, his physicians stated on January 21, 2013 that he would retain eyesight in one eye.[125]

South America

Natalia Ponce de León (right), survivor of a 2014 acid attack, receiving an award for her activism for other survivors

Though comprehensive statistics on acid attacks in South America are sparse, a recent study investigating acid assault in Bogota, Colombia, provides some insight for this region. According to the article, the first identified survivor of acid violence in Bogota was attacked in 1998. Since then reported cases have been increasing with time. The study also cited the Colombian Forensics Institute, which reported that 56 women complained of aggression by acid in 2010, 46 in 2011, and 16 during the first trimester of 2012. The average age of survivors was about 23 years old, but ranged from 13 to 41 years.[53]

The study reported a male:female victim ratio of 1:30 for acid assault in Bogota, Colombia, although recent reports show the ratio is closer to 1:1.[126] Reasons behind these attacks usually stemmed from poor interpersonal relationships and domestic intolerance toward women. Moreover, female victims usually came from low socioeconomic classes and had low education. The authors state that the prevalence of acid attacks in other areas of South America remains unknown due to significant underreporting.[53]

On March 27, 2014, a woman named Natalia Ponce de León was assaulted by Jonathan Vega, who threw a liter of sulphuric acid on her face and body. Vega, a former neighbor, was reported to have been "obsessed" with Ponce de León and had been making death threats against her after she turned down his proposal for a relationship.[52] 24% of her body was severely burned as a result of the attack.[127] Ponce de León has undergone 15 reconstruction surgeries on her face and body since the attack.[54][128]

Three years before the attack took place, Colombia reported one of the highest rates of acid attacks per capita in the world.[129] However, there was not an effective law in place until Ponce de León's campaign took off in the months after her attack. The new law, which is named after her, defines acid attacks as a specific crime and increases maximum sentences to 50 years in jail for convicted offenders.[54] The law also aims to provide victims with better state medical care including reconstructive surgery and psychological therapy. Ponce de León expressed hope that the new law would act as a deterrent against future attacks.[54]

South Asia

In South Asia, acid attacks have been used as a form of revenge for refusal of sexual advances, proposals of marriage and demands for dowry.[10] Scholars Taru Bahl and M.H. Syed say that land/property disputes are another leading cause.[12]

Ukraine

On July 31, 2018, Kateryna Handziuk, an anti-corruption activist and political advisor from the southern Ukrainian city of Kherson, was attacked with sulfuric acid outside her home by an unknown attacker. She died of her injuries on November 3, 2018. She was 33 years old.[130][131]

Vietnam

Acid attacks are common in Vietnam although not to the level of countries such as Pakistan and India. An example of an acid attack in Vietnam is the Ho Chi Minh City acid attack where four people were injured.[132] Most of Vietnam's acid attack victims spend their lives isolated and ignored and also blamed for their agony.[133]

United Kingdom

NHS hospital figures record 144 assaults in 2011-2012 involving corrosive substances, which can include petrol, bleach and kerosene. Six years earlier, 56 such episodes were noted.[134][135][136]

The official records for 2017-2018 shows 150 patients in the UK admitted to hospital for "Assault by corrosive substance".[137]

In 2016, the Metropolitan Police in London recorded 454 attacks involving corrosive fluids in the city, with 261 in the previous year, indicating a rise of 36%. A rise of 30% was also recorded in the UK as a whole.[138][139] Between 2005-2006 and 2011-2012 the number of assaults involving acid throwing and other corrosive substances tripled in England, official records show.

According to London's Metropolitan Police, 2017 was the worst year for acid attacks in London, with 465 attacks recorded, up from 395 the previous year and 255 in 2015.[140] Acid attacks in London continued to rise in 2017.[141] In July 2017, the BBC's George Mann reported that police statistics showed that: "Assaults involving corrosive substances have more than doubled in England since 2012. The vast majority of cases were in London."[142] According to Time magazine, motives included organized crime, revenge, and domestic violence. According to Newham police there is no trend of using acid in hate crimes.[143][144]

According to data from London's Metropolitan Police,[145][146] a demographic breakdown of known suspects in London attacks for the period (2002–2016) showed White Europeans comprising 32% of suspects, African Caribbeans 38% and Asian 6%. Victims for the same period were 45% White Europeans, 25% African Caribbeans and 19% Asian. Of the total population, whites constitute 60%, blacks 13% and Asians 18% as per the 2011 census of London.[147] Known suspects were overwhelmingly male, 77% of known suspects were male and just 2% of suspects female. Four out of five victims in 2016 were male in contrast to other countries where women are most frequently victimized by men.[144]

Mark van Dongen chose to undergo euthanasia months after he was attacked by his ex-girlfriend Berlinah Wallace during the early hours of 23 September 2015.[148][68][149] He was left paralysed, scarred, had his lower left leg amputated and lost the sight in his left eye, as well as most of the sight in his right eye, following the incident.[150][151]

On April 2017, a man named Arthur Collins, the ex-boyfriend of Ferne McCann, threw acid inside a nightclub across terrified clubbers in east London forcing a mass evacuation of 600 partygoers flooding into the street. 22 people were injured in the attack. Collins was sentenced to 20 years for the attack.[152] Another similar attack is the 2017 Beckton acid attack.[153] Katie Piper was also attacked in 2008 with acid by her ex-boyfriend Daniel Lynch and an accomplice Stefan Sylvestre.

On 3 October 2017, the UK government announced that sales of acids to under 18s would be banned.[154]

In January 2018, CNN reported that acid attacks in London increased six-fold between 2012 and 2017 and that 71% of attackers and 72% of victims were male.[155]

In April 2019, a teenage girl, 13, and a woman, 63, were attacked by a man driving a white car, who poured sulfuric acid on them in Thornton Heath, South London.[156]

United States

Victor Riesel was a broadcast journalist, specializing in labor issues, who was attacked while leaving Lindy's restaurant in midtown Manhattan in the early morning of 5 April 1956.[157][158] Riesel was left blind as a result.[157] The attack was motivated by Riesel's reporting on the influence of organized crime on certain corrupt labor unions.[157]

In 1959, American attorney Burt Pugach hired a man to throw lye in the face of his ex-girlfriend Linda Riss. Riss suffered blindness and permanent scarring. Pugach served 14 years in prison for the incident.[159]

Gabrielle White, a 22-year-old single mother living in Detroit, was attacked on 26 August 2006 by a stranger.[160] She was left with third and fourth degree burns on her face, throat, and arms, leaving her blind and without one ear.[160] She also miscarried her unborn child.[160] A 25-year-old nursing student at Merritt College was the victim of an acid attack.[161]

Esperanza Medina walked out of her Logan Square apartment in Chicago, Illinois, on a July morning in 2008, heading to her job as a social worker. Three teenagers poured cups of battery acid on the head of Medina, a 48-year-old mother of four.[162][163]

In 2017, a 17-year-old girl was permanently scarred by an acid attack in Dallas.[164] In November 2019, a man in Milwaukee was attacked and sustained multiple burns.[165]

Health effects

The most notable effect of an acid attack is the lifelong bodily disfigurement. According to the Acid Survivors Foundation in Pakistan, there is a high survival rate amongst victims of acid attacks. Consequently, the victim is faced with physical challenges, which require long-term surgical treatment, as well as psychological challenges, which require in-depth intervention from psychologists and counselors at each stage of physical recovery.[166] These far-reaching effects on their lives impact their psychological, social and economic viability in communities.[5]

Medical

The medical effects of acid attacks are extensive. As a majority of acid attacks are aimed at the face,[15] several articles thoroughly reviewed the medical implications for these victims. The severity of the damage depends on the concentration of the acid and the time before the acid is thoroughly washed off with water or neutralized with a neutralizing agent. The acid can rapidly eat away skin, the layer of fat beneath the skin, and in some cases even the underlying bone. Eyelids and lips may be completely destroyed and the nose and ears severely damaged.[167] Though not exhaustive, Acid Survivors Foundation Uganda findings included:[26]

The skull is partly destroyed/deformed and hair lost.
Ear cartilage is usually partly or totally destroyed; deafness may occur.
Eyelids may be burned off or deformed, leaving the eyes extremely dry and prone to blindness. Acid directly in the eye also damages sight, sometimes causing blindness in both eyes.
The nose can become shrunken and deformed; the nostrils may close off completely due to destroyed cartilage.
The mouth becomes shrunken and narrow, and it may lose its full range of motion. Sometimes, the lips may be partly or totally destroyed, exposing the teeth. Eating and speaking can become difficult.
Scars can run down from the chin to neck area, shrinking the chin and extremely limiting range of motion in the neck.
Inhalation of acid vapors usually creates respiratory problems, exacerbated restricted airway pathways (the esophagus and nostrils) in acid patients.

In addition to these above-mentioned medical effects, acid attack victims face the possibility of sepsis, kidney failure, skin depigmentation, and even death.[61]

A 2015 attack that involved throwing sulfuric acid on a man's face and body while he lay in bed caused him, among other serious injuries, to become paralyzed from the neck down.[168]

Psychological

Acid assault survivors face many mental health issues upon recovery. One study showed that when compared to published Western norms for psychological well-being, non-Caucasian acid attack victims reported higher levels of anxiety, depression, and scored higher on the Derriford appearance scale, which measures psychological distress due to one's concern for their appearance. Additionally, female victims reported lowered self-esteem according to the Rosenberg scale and increased self-consciousness, both in general and in the social sphere.[29]

In addition to medical and psychological effects, many social implications exist for acid survivors, especially women.[26] For example, such attacks usually leave victims handicapped in some way, rendering them dependent on either their spouse or family for everyday activities, such as eating and running errands. These dependencies are increased by the fact that many acid survivors are not able to find suitable work, due to impaired vision and physical handicap. This negatively impacts their economic viability, causing hardships on the families/spouses that care for them. As a result, divorce rates are high, with abandonment by husbands found in 25% of acid assault cases in Uganda (compared to only 3% of wives abandoning their disfigured husbands).[26] Moreover, acid survivors who are single when attacked almost certainly become ostracized from society, effectively ruining marriage prospects.[77] Some media outlets overwhelmingly avoid reporting acid attack violence, or the description of the attack is laconic or often implies that the act was inevitable or even justified.[169]

Treatment

Treatment for burn victims remains inadequate in many developing nations where incidence is high. Medical underfunding has resulted in very few burn centers available for victims in countries such as Uganda,[26] Bangladesh,[170] and Cambodia.[5] For example, Uganda has one specialized burn center in the entire nation, which opened in 2003;[26] likewise, Cambodia has only one burn facility for victims,[5] and scholars estimate that only 30% of the Bangladeshi community has access to health care.[170]

In addition to inadequate medical capabilities, many acid assault victims fail to report to the police due to a lack of trust in the force, a sense of hopelessness due to the attackers' impunity, and a fear of male brutality in dealing with their cases.[77] Most of the female victims suffer more because of police apathy in dealing with cases of harassment as safety issues as victims refused to register a police case despite being attacked thrice before meriting police aid after an acid attack.[171]

These problems are exacerbated by a lack of knowledge of how to treat burns: many victims applied oil to the acid, rather than rinsing thoroughly and completely with water for 30 minutes or longer to neutralize the acid. Such home remedies only serve to increase the severity of damage, as they do not counteract the acidity.[61]

When acids contact the skin, response time is crucial. If washed away with water or neutralized promptly, burns to skin can be minimized or avoided entirely, although areas unprotected by skin, like the cornea of the eye or the lips, can be burned immediately on contact. However, many victims are attacked in an area without immediate access to water, or unable to see due to being blinded or forced to keep their eyes closed to prevent additional burns to the eye.

Prevention

Research has prompted many solutions to the increasing incidence of acid attacks in the world. Many countries look to Bangladesh, whose rates of attack have been decreasing, as a model, following their lead in many legislative reforms.[16] However, several reports highlighted the need for an increased, legal role of NGOs to offer rehabilitation support to acid survivors.[5] Additionally, nearly all research stressed the need for stricter regulation of acid sales to combat this social issue.[5][26][16]

Role of NGOs

Many non-governmental organizations (NGOs) have been formed in the areas with the highest occurrence of acid attacks to combat such attacks. Bangladesh has its Acid Survivors Foundation, which offers acid victims legal, medical, counseling, and monetary assistance in rebuilding their lives.[16] Similar institutions exist in Uganda, which has its own Acid Survivors Foundation,[26] and in Cambodia which uses the help of Cambodian Acid Survivors Charity.[5] NGOs provide rehabilitation services for survivors while acting as advocates for social reform, hoping to increase support and awareness for acid assault.

In Bangladesh, the Acid Survivors Foundation, Nairpokkho, Action Aid, and the Bangladesh Rural Advancement Committee's Community Empowerment & Strengthening Local Institutions Programme assist survivors.[172] The Depilex Smileagain Foundation and The Acid Survivors Foundation in Pakistan operates in Islamabad, offering medical, psychological and rehabilitation support.[173] The Acid Survivors Foundation in Uganda operates in Kampala and provides counseling and rehabilitation treatment to victims, as well as their families.[174] The LICADHO, the Association of the Blind in Cambodia, and the Cambodian Acid Survivors Charity assist survivors of acid attacks. The Acid Survivors Foundation India operates from different centres with national headquarters at Kolkata and chapters at Delhi and Mumbai.

Acid Survivors Trust International (UK registered charity no. 1079290) provides specialist support to its sister organizations in Africa and Asia.[175][176] Acid Survivors Trust International is the only international organisation whose sole purpose is to end acid violence. The organisation was founded in 2002 and now works with a network of six Acid Survivors Foundations in Bangladesh, Cambodia, India, Nepal, Pakistan and Uganda that it has helped to form. Acid Survivors Trust International has helped to provide medical expertise and training to partners, raised valuable funds to support survivors of acid attacks and helped change laws. A key role for ASTI is to raise awareness of acid violence to an international audience so that increased pressure can be applied to governments to introduce stricter controls on the sale and purchase of acid.[177]

Indian acid attack survivor Shirin Juwaley founded the Palash Foundation[178] to help other survivors with psychosocial rehabilitation. She also spearheads research into social norms of beauty and speaks publicly as an advocate for the empowerment of all victims of disfigurement and discrimination.[179] In 2011, the principal of an Indian college refused to have Juwaley speak at her school for fear that Juwaley's story of being attacked by her husband would make students "become scared of marriage".[180]

Regulation of acid sales

A positive correlation has been observed between acid attacks and ease of acid purchase.[16] Sulfuric, nitric, and hydrochloric acid are most commonly used and are all cheap and readily available in many instances. For example, often acid throwers can purchase a liter of concentrated sulfuric acid at motorbike mechanic shops for about 40 U.S. cents. Nitric acid costs around $1.50 per liter and is available for purchase at gold or jewelry shops, as polishers generally use it to purify gold and metals. Hydrochloric acid is also used for polishing jewelry, as well as for making soy sauce, cosmetics, and traditional medicine/amphetamine drugs.[7]

Due to such ease of access, many organizations call for a stricter regulation on the acid economy. Specific actions include required licenses for all acid traders, a ban on concentrated acid in certain areas, and an enhanced system of monitoring for acid sales, such as the need to document all transactions involving acid.[5] However, some scholars have warned that such stringent regulation may result in black market trading of acid, which law enforcements must keep in mind.[5]

History

Acid has been used in metallurgy and for etching since ancient times. The rhetorical and theatrical term "La Vitrioleuse" was coined in France after a "wave of vitriolage" occurred according to the popular press where, in 1879, 16 cases of vitriol attacks were widely reported as crimes of passion perpetrated predominantly by women against other women.[7] Much was made of the idea that women, no matter how few, had employed such violent means to an end. On October 17, 1915, acid was fatally thrown on Prince Leopold Clement of Saxe-Coburg and Gotha, heir to the House of Koháry, by his distraught mistress, Camilla Rybicka, who then killed herself. Sensationalizing such incidents made for lucrative newspaper sales.[181]

The use of acid as a weapon began to rise in many developing nations, specifically those in South Asia.[170] The first recorded acid attacks in South Asia occurred in Bangladesh in 1967,[16] India in 1982, and Cambodia in 1993.[7] Since then, research has witnessed an increase in the quantity and severity of acid attacks in the region. However, this can be traced to significant underreporting in the 1980s and 1990s, along with a general lack of research on this phenomenon during that period.[77]

Research shows acid attacks increasing in many developing nations, with the exception of Bangladesh which has observed a decrease in incidence in the past few years.[16]

Legislation

Many countries have begun pushing for legislation addressing acid attacks, and a few have recently employed new laws against this crime.[16] Under the Qisas law of Pakistan, the perpetrator may suffer the same fate as the victim, and may be punished by having drops of acid placed in their eyes.[182] This law is not binding and is rarely enforced according to a report in The New York Times.[18] In Pakistan, the Lower House of Parliament unanimously passed the Acid Control and Acid Crime Prevention Bill on May 10, 2011. As punishment, according to the bill individuals held responsible for acid attacks face harsh fines and life in prison. However, the country with the most specific, effective legislation against acid attacks is Bangladesh, and such legal action has resulted in a steady 20–30% decrease in acid violence for the past few years.[16] In 2013, India introduced an amendment to the Indian Penal Code through the Criminal Law (Amendment) Act, 2013, making acid attacks a specific offence with a punishment of imprisonment not less than 10 years and which can extend to life imprisonment and with fine.[183]

India

India's top court ruled that authorities must regulate the sale of acid. The Supreme Court's ruling on July 16, 2013, came after an incident in which four sisters suffered severe burns after being attacked with acid by two men on a motorbike. Acid which is designed to clean rusted tools is often used in the attacks can be bought across the counter. But the judges said the buyer of such acids should in future have to provide a photo identity card to any retailer when they make a purchase. The retailers must register the name and address of the buyer.[184] In 2013, section 326 A of Indian Penal Code was enacted by the Indian Parliament to ensure enhanced punishment for acid throwing.