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Baseline Survey on Acid and Burns Violence Against Women and Girls Final Report March 2015

Submitted to: BVS-N

Submitted by: Pinky Singh Rana

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Study Team

Principal Investigator/Team Leader: Pinky Singh Rana

Team Members: Kripa Shahi: Coordinator, BVS-N Priyanka Malla: Statistical Consultant Samjhana Kachhyapati: Translation and technical support Sunaina Shrestha: Research Assistant and Data Entry Abita Karki : Research Assistant and Data Entry Sadhana Shrestha: Enumerator, Kathmandu Susmriti Shrestha: Enumerator, Kathmandu Tejaswi Aryal: Enumerator, Kathmandu Susmita Paudel: Enumerator, Kathmandu Surendra Karki : Enumerator, Banke Anuja Malla : Enumerator, Banke Siya Saheli Kumari: Enumerator, Janakpur Sujit Thakur: Enumerator, Janakpur

Technical Support: Sulakshana Rana, BVS-N, Laetitia Vanderstichelen, BVS-N, Barbara Russo, ASTI Note: The Study team expresses its appreciation to all the individuals and institutions approached by the Study Team and Technical Support Team, particularly the burns/acid survivors.

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List of Acronyms ASTI Acid Survivors Trust Nepal

BVS-N Burns Victim Survivors-Nepal

CBOs Community Based Organizations

CTEVT Centre for Technical Education and Vocational Training

DAO District Administration Office

FGD Focus Groups Discussion

GoN Government of Nepal

KAPB Knowledge, Attitude, Practice and Behavior

KII Key Informant Interviews

NFE Non Formal Education

NGOs Non governmental organizations

SLC School Leaving Certificate

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Table of Contents

EXECUTIVE SUMMARY 5

CHAPTER 1: INTRODUCTION 9

1.1 INTRODUCTION 9 1.2 PROJECT OVERVIEW 9 1.3 NEED, OBJECTIVES AND SCOPE OF THE BASELINE SURVEY 10 1.4 SURVEY METHODOLOGY 11

CHAPTER 2: KEY FINDINGS 14

2.1 BURN/ACID VIOLENCE SURVIVORS 14 2.2 POTENTIAL SURVIVORS 28 2.3 COMMUNITY LEADERS 37

CHAPTER 3: ANALYSIS AND DISCUSSION 46

CHAPTER 4: RECOMMENDATIONS 51

PREVENTION AND PROTECTION BASED STRATEGY AND PROGRAMS 51 PROTECTION AND REHABILITATION BASED STRATEGY AND PROGRAMS 52 REHABILITATION AND REINTEGRATION BASED STRATEGY AND PROGRAMS 52

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Executive Summary

BVS-Nepal is implementing the project, “Strengthening Support and Services to Survivors of Acid and Burns Violence” to strengthen services and support for survivors of burns and acid violence and to prevent further attacks. The current Baseline Survey is undertaken as part of the project activities to determine the existing status of burns/acid violence survivors and relevant stakeholders in project areas, prior to the project.

Objectives 1. To determine the number of burn and acid victims in target districts from 16

December 2010 to 16 October 2013. 2. To assess the knowledge, attitude, practice and behavior (KAPB) of burn/acid victims

of violence and potential victims, with specific focus on existing physical, psychological, social and economic conditions, and confidence level within and outside the household [past (16 December 2010-16 October 2013) and current situation].

3. To assess the KAPB of community members and leaders on causes and consequences of burn/acid violence (current situation).

4. Identify services being provided by government and non government agencies and their effectiveness [past (16 December 2010 - 16 October 2013) and current situation].

5. Identify and recommend multi-sectoral support services (socio-economic, psychological, emotional, legal, counseling, media, etc.) required for acid/burn violence victims and potential victims.

6. Identify and recommend appropriate strategies and programs (training, services, etc.) targeting victims, potential victims and others.

Methodology Tools utilized for primary data collection were (i) Interview questionnaire, (ii) Focus Group Discussions, (iii) Key Informant Interviews, and (iv) Case Studies. Literature review was also undertaken. Sample groups for the individual questionnaire were (i) Burns/Acid violence survivors, (ii) Potential Survivors, and (iii) Community Leaders, living in 3 project districts of Kathmandu, Dhanusha and Banke. The total of number of respondents were as follows:

Burns/Acid violence survivors: 34

Potential Survivors: 66

Community Leaders: 66

Key Findings and Analysis (as per Baseline Survey Objectives)

Objective 1: To determine the number of burn and acid violence victims in target districts from 16 December 2010 to 16 October 2013 A total of 61 burns/acid violence victims were identified from the 3 districts during the specified timeframe. However, only 34 respondents could be interviewed for the survey, due to factors such as non availability of contact numbers, change of location, desire for invisibility by victims and their families, non-systemic data management, and inadequate follow up system were challenges faced in identifying burns/acid violence victims.

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Objective 2: To assess the knowledge, attitude, practice and behavior (KAPB) of burn/acid violence victims and potential victims, with specific focus on existing physical, psychological, social and economic conditions, and confidence level within and outside the household Major characteristics identified by sampled groups are as follow:

Acid/Violence survivors (experience based)

Potential Survivors (knowledge based)

Community Leaders (knowledge based)

Most discriminated groups in districts

Married women (59%) Widows (38%) Economically dependent

women (38%)

Economically dependent women (45%)

Married women (39%) Women and girls from male

dominted families (32%)

Economically dependent women (45%)

Widows (44%) Married women (41%)

Districts most vulnerable to acid/burns violence

Banke (29%) Sunsari (27%) Dhanusha (27%)

Most vulnerable ethnic groups

Terai /Madhesi Others Caste (26%)

Hill Chhetri (23%) Madhesi Dalit (18%)

Major cause of violence

Dowry (44%) Relation based disputes (15%) Extra-marital affairs (15%) Accusations of witchcraft

(15%)

Dowry (29%) Extra-marital affairs (29%) Relation based disputes (18%) Need to bear male child (18%)

Relation based disputes (58%) Dowry (54%) Illiteracy (33%)

Key methods of committing violence

Dousing with kerosene and setting on fire (67%)

Acid throwing (12%)

Dousing with kerosene and setting on fire (53% of 17 respondents who heard of such incidences)

Dousing with kerosene and setting on fire (81%)

Major perpetrators

Husband (56%) Father-in-law, mother-in-law

and unknown persons (18% each)

Mother-in-law (79%) Father-in-law (74%) Husband (53%)

Husband (56%) Mother-in-law (48%) Father-in-law (40%)

Key consequences

Physical disfigurement (85%) Emotional trauma (44%) Psycho-social trauma, and

(32% each)

Physical disfigurement (71%) Emotional trauma (36% each)

Physical disfigurement (80%) Emotional trauma (44%)

Social Conditions Social stigmatization (32%) Social stigmatization (35%) Social stigmatization (21%) Economic conditions

Inability to obtain employment (35%)



Confidence level Low confidence level (32%) Inability to face society (29%)

Low confidence level (20%) Inability to face society (18%) Constant fear in daily life (17%)

Low confidence level (42%) Inability to face society (21%) Constant fear in daily life (24%)

Objective 3: To assess the KAPB of community members and leaders on causes and consequences of burns/acid violence While the Community Leaders’ knowledge on causes and consequences of burns/acid violence have already been mentioned in Objective 2 Findings, findings on their attitude, practice and behavior are as follow: Community leaders identify themselves as ‘feeling discomfort’ in handling burns/acid violence cases (24%), or the tendency to ‘just get on with the job’ (15%). These perceptions are reinforced by majority of Survivors who identify Community Leaders’ knowledge on burns/acid violence (medium: 32%) and an attitude of ‘just getting on with job’ when handling burns/acid survivors cases (20%). Community Leaders attitude towards survivors is indicated as indifferent (44%) by Survivors, and are identified by the latter as some of the least involved stakeholders in prevention and service to survivors. Survivors’ further highlight the need for Community Leaders to possess improved communication skills (50%) and positive attitude towards burns/acid violence survivors (37%).

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Potential Survivors also identify Community Leaders as possessing least knowledge on potential burn/acid violence survivors (56%), and limited knowledge on burns/acid violence, its causes and consequences, and the skill and comfort in handling such cases. Their lack of knowledge on legal matters is also identified as highest among all stakeholders (68%).

Objective 4: Identify services being provided by government and non government agencies and their effectiveness Government and non government agencies are involved in providing various services to burns/acid survivors - from rescue period onwards wherein NGOs/CBOs, Human Rights Activists, community members help take the victim to the hospital and police for case registration. Survivors (94%) identified the need for immediate medical services as fulfilled. But intensive medical care, food and shelter are fulfilled only to some extent; disparity is evident in psycho-social counseling (requirement vs. received: 78% vs. 33%), safe and stable environment (requirement vs. received: 100% vs. 33%); and access to justice (requirement vs. received: 100% vs. received 29%). Potential Burns/Acid Violence Survivors also identify police (25%) and NGOs (7%) as engaged during rescue. NGOs (64%) and police (54%) are identified as involved in preventions of and service provision (NGOs: 69%; police: 41%) to survivors. Government and private hospitals are providing immediate and long medical service to survivors. Among community members, aside from family members police (50%), NGOs (20%), DAO (5%), and women’s groups (20%) are playing key roles in preventing/reducing discrimination and stigma pertaining to burns/acid violence. In all these services government and NGOs are both involved; however NGOs are identified as the most involved in prevention (75%) and protection (63%) of burns/acid violence. But the quality of these services and government and NGOs capacities must be closely looked into as only 29 percent survivors claimed health improvement. Some 71 percent Survivors indicated ‘no improvement’, primarily due to not receiving timely support and nutritious diet.

Objective 5: Identify and recommend multi-sectoral support services (socio-economic, psychological, emotional, legal, counseling, media, etc.) required for acid/burn violence victims and potential victims Major multi-sectoral services required and interventions suggested by all three sample groups are as follow:

Burns/Acid Survivors Potential Survivors Community Leaders

Identified services Medical services (68%)

Economic support (65%)

Physiotherapy support (44%)


Skill development training (62%)

Job placement (59%)

Medical support (79%)



Recommended interventions

Street dramas (68%)

Women’s group mobilization (59%)

National campaign (50%)

Teacher training (44%)

Women’s group mobilization (58%)

Job placement (53%)


Training to health service providers (44%)

Community based awareness programs (50%)

National campaign (48%)

Prevention based awareness/women’s group mobilization/training to health service providers (47% each)

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Recommendations Based on results from survey respondents, FGDs and KIIs the following long and short term strategies and programs are identified. Some may be adopted by BVS-N within the project period, while others may be undertaken as a long-term approach.

Prevention and protection based strategy and programs

Strategy 1: A transformational approach is suggested to address dowry system. It is essential BVS-N collaborate with government and other NGOs – national and local – to address this pervasive cause of burns/acid violence against girls and women. To this end, a national campaign against all forms of dowry and dowry based violence is suggested to be adopted.

Strategy 2: Baseline Survey findings indicate higher vulnerability and risk among particular ethnic and religious groups, and lower income level families. BVS-N is recommended to strategically reach out to these groups through specifically designed prevention based activities. Child marriage and illiteracy that compound their vulnerabilities must be addressed within this strategic approach.

Strategy 3: Social transformation and change in mindsets demand evidence. Currently, as evidenced during data collection processes there is limited consolidated data on the prevalence of burns/acid violence at national or district levels. An Action Research undertaking is recommended whereby systemic data management system will also be addressed.

Protection and rehabilitation based strategy and programs

Strategy 4: Coordination and collaboration with networks against domestic violence, women’s rights, and government and NGOs bodies to facilitate and speed prevention and rehabilitation processes. At present most stakeholders are engaged in isolated programs and activities, with limited knowledge of each others’ skills and capacities. Robust coordination and networking would enhance outreach and support to victims and their families - at national and district levels.

Strategy 5: Recovery from burns/acid violence is a lengthy and highly expensive medical process. Currently there is limited resources - human, infrastructure and equipment – in terms of immediate and long term recovery and rehabilitation. It is challenging for any one institution to attempt to address all of a victim’s needs. Subsequently, coordinated and collaborative efforts between GoN, NGOs, private sectors and community groups must be initiated.

Rehabilitation and reintegration based strategy and programs

Strategy 6: Survivors who have recovered, or are in the process of doing face challenges in family and community rehabilitation and reintegration. Social stigma and ostracization due to physical disfigurements, constant fear and feeling of threat, low self-confidence and increased family disputes work as potential barriers which must be addressed at different levels.

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Chapter 1: Introduction

1.1 Introduction Burns and acid violence is a brutal form of violence, committed mostly against women and girls. They cause disfigurement, long-lasting medical complications, pain, social ostracism and psychological trauma for victims. The most common reasons for attacks might be women rejecting love, marriage or sex proposals, dowry-related and other marital disputes, and land or property disputes. While burns and acid violence is not restricted to a geographical region, attacks are most common in south Asia, where there is cheap and easy availability of acid. Some 80 per cent of known acid attack victims are female and almost 70 per cent are under 18 years of age. However, though acid and burns are not the most pervasive form of violence against women, the horrific consequences has drawn significant amount of international and political attention. 1 Recent years have seen the number of Nepali girls and women increasingly become burn victims, as a result of violence against women and girls. Dowry claims, so-called ‘suicide attempts’ through kerosene dowsing, and even acid throwing have been reportedly on the rise. A couple of violence related burn cases have made headlines highlighting the plight of Nepali women. However, burns victims are a challenge for Nepal’s health sector due to limited health facilities, infrastructures and human resources and expertise to address their needs. The government of Nepal (GoN) has been addressing burns survivors through it facilities at the Bir hospital, Kathmandu, Bheri Zonal Hospital, Banke and Janakpur Zonal Hospital in Dhanusha districts. The overall support systems to burns survivors, particularly women, in the forms medical, legal, psychological, physiotherapy, surgery, rehabilitation and reintegration are also being supported by a few private health facilities such as Sushma Koirala Memorial Hospital and Kirtipur Hospital.

1.2 Project Overview

BVS Nepal The Burn Victims Survivors (BVS)-Nepal, was established in 2008, and is the first and one of the handful of organizations working specifically on prevention, protection, curative and long term recovery of burns and acid survivors. BVS-Nepal helps and supports survivors of burns, resulting from accidents, or violence, such as attempted homicide attacks using kerosene or acid, cases of self-immolation and attempted suicide, often stemming from domestic violence. As part of its commitment for addressing burns survivors, BVS-Nepal is working with survivors, family members of survivors, government and other stakeholders such as community persons, non government organizations (NGOs) and service providers at national and community levels. BVS-Nepal is working in different parts of Nepal.

Project Management and Implementation In 2013, with support from the international organization Acid Survivors Trust International (ASTI), BVS-Nepal initiated implementation of the project entitled “Strengthening Support and Services to Survivors of Acid and Burns Violence” with support from the Acid Survivors Trust International (ASTI). With a time frame of 2 years and 9 months, the project is being implemented in Nepal and Pakistan. BVS-Nepal is implementing the project to strengthen services and support for survivors of burns and acid violence and to prevent further attacks. The project aims to achieve the following outputs:

1 Source: Terms of Reference (ToR) of Principal Investigator

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Output 1: Improved access to and quality of medical responses to acid and burns violence Output 2: Increased access to justice for survivors of acid and burns violence Output 3: Improved access to rehabilitation and reintegration services for survivors of acid and burns violence Output 4: Increased awareness amongst survivors of their rights and the skills needed to organize and create change Output 5: Increased awareness of the causes of and appropriate responses to acid and burns violence at community, national and global level Output 6: Stronger evidence-base made available for a range of stakeholders (NGOs, government, media, service providers, etc.) to tackle and prevent acid and burns violence Output 7: Partners have improved capacity to respond to and prevent acid and burns violence

To achieve the above mentioned output results, the project incorporated a number of activities ranging from awareness raising, medical support to and capacity building of survivors, training to BVS-Nepal staff and focus on building close coordination and collaboration with relevant stakeholders.

1.3 Need, Objectives and Scope of the Baseline Survey

Need for the Survey The project is an innovative and challenging initiative for both BVS-Nepal and ASTI. There is relatively narrow understanding of causes, consequences, potential risks, and preventive and curative measures being undertaken in Nepal to address violence related burns survivors. The current Baseline Survey is based on the need to understand the current status of violence related burns survivors and potential survivors. Focus is laid on outputs and outcomes of project activities. Findings will be used as parameters to determine whether the project is able to address the identified indicators at the end of the project period, i.e., 2016.

Objectives The specific objectives of this survey are:

7. To determine the number of burn and acid victims in target districts from 16 December 2010 to 16 October 2013.

8. To assess the knowledge, attitude, practice and behavior (KAPB) of burn/acid victims of violence and potential victims, with specific focus on existing physical, psychological, social and economic conditions, and confidence level within and outside the household [past (16 December 2010-16 October 2013) and current situation].

9. To assess the KAPB of community members and leaders on causes and consequences of burn/acid violence (current situation).

10. Identify services being provided by government and non government agencies and their effectiveness [past (16 December 2010-16 October 2013) and current situation].

11. Identify and recommend multi-sectoral support services (socio-economic, psychological, emotional, legal, counseling, media, etc.) required for acid/burn violence victims and potential victims.

12. Identify and recommend appropriate strategies and programs (training, services, etc.) targeting victims, potential victims and others.

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Scope of the Baseline Survey The survey covers burn and acid women and girls victims of violence in target districts, from 16 December 2010 to 16 October 2013. Geographically, and as per the Terms of Reference (TOR), the survey covers the project implementation locations of Kathmandu, Dhanusha and Banke districts, with specific focus on the project implementation areas.

Limitations of the Baseline Survey Potential limitations of the assessment are:

Identifying violence related burns/acid survivors was a challenge, as despite the availability of victims’ names and addresses, at NGOs and hospitals, it was not possible to locate them due to the lack of contact number or change of location.

There exists a diverse group of stakeholders at central and district levels. But time constraints compelled purposive sampling of respondents, based on their level of engagement with the project.

The Principal Investigator has mitigated these limitations and minimized possible biases through triangulation of methods and data. Triangulation was achieved through three major approaches: findings from available respondents, validation and documentation. Findings were elicited though analysis of interviewer administered questionnaires. Validation was achieved through stakeholder meetings, key informant interviews (KIIs) and Focus Group Discussion (FGDs), and case studies. Documentation includes project-related documentation, relevant policies, strategies, researches and other external documents.

1.4 SURVEY METHODOLOGY A number of survey tools were adopted for materializing the survey objectives. Information from survivors, potential survivors and community are major information source for reaching conclusive findings, with supplementary information from FGDs and KIIs.

Sample Design The target audiences for the individual questionnaire were burns/acid violence survivors, potential survivors, and community leaders, living in 3 project districts of Kathmandu, Dhanusha and Banke. Taking into account the limited number of known burns/acid violence cases a total sample of 198 respondents (survivors: 66; potential survivors: 66; and community leaders: 66) was targeted. The characteristics of target groups were as follow:

Survivors: The survey recognizes ‘survivors’ as girls and women who were burnt or had acid thrown at in relation to acts of violence. Survivors can belong to any ethnic group and age. Survivors were identified based on information from hospitals, police, NGOs and communities. Sample selection criteria determined these were involved in incidents from within the period 16 December 2010 to 16 October 2013.

Potential Survivors: Potential survivors were identified on basis of four criteria, namely, (i) suspected cases of burns/acid violence, (ii) attempted cases of burns/acid violence victims who however did not get burnt, (iii) girls/women who have faced some form of violence, or (iv) girls/women with similar backgrounds (ethnicity, age, economic status, location) as identified acid/burn violence survivor.

Community Leaders: Community leaders comprise of social workers, teachers, political leaders, religious leaders and Female Community Health Volunteers identified from locations from which survivors are living or identified from.

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Table 1: Total number of respondents targeted and interviewed, by district and type District Burns/acid survivor Potential Survivor Community Leaders

Target respondent

Total interviewed

Target respondent

Total interviewed

Target respondent

Total interviewed

Banke 34 10 16 16 16 16 Dhanusha 16 16 16 16 16 16 Kathmanduu 16 8 34 34 34 34 Total 66 34 66 66 66 66

Tool Development and Data Collection Interview Questionnaire: The interviewer-administered questionnaire (Annex 1a, 1b and 1c) is the primary data collection tool. Separate questionnaires were developed for survivors, potential survivors and community leaders. The structure of all questionnaires involve:

Socio-demographic information

Knowledge level about causes and consequences of burns victimization and socio-cultural and economic rights

Respondents’ perception of stakeholders knowledge, attitude, behavior and practice (KABP) with survivors

Suggestions for required types of program and strategies Locations for data collection are those wherein BVS-Nepal is implementing project activities. A pre-test was undertaken in Kathmandu. This helped ensure Data Collectors were well versed with the questionnaire. Feedback was used to finetune the questionnaires. Data Collectors administered the questionnaires to identified sample groups in their respective districts.

The overall data collection process was monitored by local BVS personnel.

Focus Group Discussion: The Focus Group Discussion (FGD) checklists (Annex 2), was designed to backstop information from interviews. They gathered information on stakeholders’ understanding of burns victimization, existing situation in districts, initiatives and interventions and suggested strategies. Target group identification was based on their involvement in addressing burns victimization, either as service providers, anti-burns/acid advocates and/or prosecutors of perpetrators. FGDs were facilitated by Data Collectors.

Table 2: Total Number of FGDs conducted, by district and type

District Women Adolescent Girls Men Adolescent boys

Banke 1 1 1 1 Dhanusha 1 1 1 1 Kathmandu 1 1 1 1

Total 3 3 3 3

Key informant interviews: A series of interviews was undertaken with selected key informants and stakeholders. These included:

Hospitals: Doctors and nurses

Government of Nepal (GoN) bodies: Women and Children Development Office, Police

Non Governmental Organizations (NGOs): Saathi, Fatima Foundation, Maiti Nepal, etc.

Legal Sector: Bar Association, lawyers, etc.

Rehabilitation Centers

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KIIs elicited stakeholder opinions on existing status of survivors, potential risks and the current gaps. A generic semi-structured interview (Annex 3), shaped by survey outputs was used for this purpose.

Case Studies: Data Collectors also gathered cases studies from district level to backstop findings from the survey.

Orientation to Data Collectors The survey involved experienced Data Collectors from central and district level. Considering the sensitive nature of information being collected priority was given to women data collectors, and those with previous work experience on violence against women. A 2-day orientation at the BVS-Nepal office (2-3 November 2014) in Kathmandu ensured common understanding of survey objectives, tasks and responsibilities among team members. Thus, a team of 6 women and 2 men collected primary data through interview administration and FGDs.

Data Entry and Analysis MS. Access was used to enter the data and STAT for analysis purpose. Data entry error was prevented by manual checks, data validation and screening for outliers.

Ethical Safeguarding Ethical safeguarding of respondents remained a priority from preliminary survey phase. The questionnaire, training of survey data collectors and data collection processes warranted respondents were not compelled to respond against their wishes, and could withdraw from interview at any point. Data collectors ensured information collection did not discomfort respondents while discussing their history. Respondents were not provided any compensation, either in cash or kind. Referral service points were however advised, where necessary.

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Chapter 2: Key Findings This chapter outlines the key data collected and their analyses. In many instances multiple responses are provided, and as a result percentages are higher than the overall total of respondents. The initial segment of Chapter 2 provides the demographic and economic profiles of the three sample groups, namely, Burn/Acid Violence Survivors, Potential Burn/Acid Violence Survivors and Community Leaders.

2.1 Burn/Acid Violence Survivors

Demographic Profile A total of 34 respondents were interviewed from Banke, Dhanusha and Kathmandu districts. The number falls short of the targeted 66 respondents due to the inability to identify/locate respondents, from the period within the specified timeframe of 16 December 2010 to 16 October 2013. As interviews were also administered in hospitals, respondents are also from other districts, or were living in the target districts. Chart 1 indicates the percentage of respondents by districts. Age group The average age of respondents is 32 years. Ethnicity No particular attention was given to the ethnic 2 background of respondents during their identification. Among the total participants, Terai/Madhesi Other Caste comprise of 26 percent, followed by Hill Chhetri (23%) and Terai Madhesi Dalit (18%). Religion Majority of the respondents (85%) practiced Hinduism, followed by Islam (9%) and Kirant and Christianity (3% each), respectively. Language Some 48 percent of respondents spoke Maithili, followed by Nepali speakers (33%), and Awadhi and Hindi (6% each), respectively. Educational background

2 Categorization of caste/ethnic groups is based on Caste/Ethnic Groups with Regional Divisions (11) and Social Groups (103) from 2001 Census. 1.1 Hill

Brahman: Hill Brahman; 1.2 Hill Chhetri: Chhetri, Thakuri, Sanyasi ; 1.3 Tarai/Madhesi Brahman/Chhetri: Madhesi Brahman, Nurang, Rajput, Kayastha ; 2.1 Tarai/Madhesi Other Castes: Kewat, Mallah, Lohar, Nuniya, Kahar, Lodha, Rajbhar, Bing, Mali Kamar, Dhuniya, Yadav, Teli, Koiri, Kurmi, Sonar, Baniya, Kalwar, Thakur/Hazam, Kanu, Sudhi, Kumhar, Haluwai , Badhai, Barai, Bhediyar/ Gaderi; 3.1 Hill Dalit: Kami, Damai/Dholi, Sarki, Badi, Gaine, Unidentified

Dalits; 3.2 Tarai/Madhesi Dalit: Chamar/Harijan/Rama, Musahar, Dushad/Paswan, Tatma, Khatwe, Dhobi, Baantar, Chidimar, Dom, Halkhor ; 4 Newar: Newar; 5.1 Hill/Mountain Janajati; Tamang, Kumal, Sunuwar, Majhi, Danuwar, Thami/Thangmi, Darai, Bhote, Baramu/Bramhu, Pahari, Kusunda,

Raji, Raute, Chepang/Praja, Hayu, Magar, Chyantal, Rai, Sherpa, Bhujel/Gharti, Yakha, Thakali, Limbu, Lepcha, Bhote, Byansi, Jirel, Hyalmo, Walung, Gurung, Dura; 5.2. Tarai Janajati: Tharu, Jhangad, Dhanuk, Rajbanshi, Gangai, Santhal/Satar, Dhimal, Tajpuriya, Meche, Koche, Kisan, Munda, Kusbadiya/Patharkata, Unidentified Adibasi/Janajati; 6 Muslim: Madhesi Muslim, Churoute (Hill Muslim); 7 Other: Marwari, Bangali, Jain, Punjabi/Sikh, Unidentified Others

Series1, Banke, 29.41, 29%

Series1, Dhanusha,

26.47, 27%

Series1, Kapilbast

u, 2.94, 3%

Series1, Mahottari,

11.76, 12%

Series1, Sunsari,

29.4, 29%

Chart 1: Burns/Acid violence survivors,

by district type

Series1, Hill Chhetri, 8,

23%Series1,

Hill/Mountain Janajati,

2, 6%Series1, Tarai

Janajati, 1, 3%

Series1,

Newar, 2, 6%

Series1, Tarai/Madh

esi Other Castes, 9,

26%

Series1, Muslim, 3,

9%

Series1, Tarai/Madh

esi Brahman/C

hhetri , 3, 9%

Series1, Tarai/Madhesi Dalit, 6,

18%

Chart 2: Burns/acid violence survivors, by ethncity type

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Of the total respondents 50 percent had attended school. Amongst these 41 percent had primary education (Class 1-5), 23 percent each classes 6-8 and 9-SLC, respectively. Some 12 percent had studied 10+2 and above. The remaining was illiterate. Marital status 91 percent of respondents were married at the time of the survey. The remaining was unmarried. Amongst the married 50 percent were living with their husband, 18 percent separated, and 12 percent divorced. 3 percent was widowed. The remaining did not respond. Family status Respondents were asked about the type of family and their living condition – during their burn/acid throwing incident and at present. Responses indicate a change in living place, as well as the family type and the household heads of families where they currently live. Some 29 percent are currently living with their husband – a sharp decline from the 79 percent at the time of incidence. The number of respondents currently living on their own or with their parents has more than doubled (Chart 3). Some 44 percent of total respondents also currently live in nuclear families with their parents, in contrast to the earlier 12 percent. A sharp change is noted compared to the time of incidence where respondents lived in a nuclear family with the husband (48%) or joint family (33%) of the husband (Chart 4). For a majority of 62 percent respondents their husband was the household head at the time of the incidence. A shift is noted here - there is a decline in husbands as household heads. Currently, majority (35%) identified their father, followed by 29 percent each who identified their own self or the husband, respectively (Chart 5).

During burn/acid

incident, Own self, 6%

During burn/acid incident,

Husband, 62%


Father-in-law, 21%


Father, 12%


Mother , 0


Brother, 0

At Present, Own self,

29%

At Present, Husband,

29%

At Present, Father-in-

law, 0

At Present, Father, 35%

At Present, Mother , 3%

At Present, Brother, 3%

Chart 5: Household heads, as indicated by respondents during incidence and currently

Duringburn/acidincident

At Present

Before being

burnt/thrown acid at,

On my own …

Before being

burnt/thrown acid at, Maternal home …

Before being

burnt/thrown acid at, Husband’s

house, …

Before being

burnt/thrown acid at, Father/Mo

ther, 9%

Before being

burnt/thrown acid at, Others, 3%

At present, On my own

(independently, 21%

At present, Maternal

home (Maiti), 26%

At present, Husband’s

house, 29%

At present, Father/Moth

er, 24%

Chart 3: Living place of BVS, during incidence and currently

Beforebeingburnt/thr…

During burn/acid

incident, Alone, 3%

During burn/acid

incident, Joint Family

(husband's), 33%

During burn/acid

incident, Joint Family

(maternal), 3%


Nuclear Home (husband's),

48%

During burn/acid incident, Nuclear

Maternal Home, 12%

At Present, Alone, 3%

At Present, Joint Family (husband's),

6%

At Present, Joint Family (maternal),

22%

At Present, Nuclear Home

(husband's), 25%

At Present, Nuclear

Maternal Home, 44%

Chart 4: Type of family, as indicated by BVS during incidence and currently

During burn/acidincident

At Present

16

Economic profile Majority (32%) of respondents are from daily wage labor families. This is followed by agriculture (26%) and business (15%). No substantive change is evident in the family occupations, during the incidence and at present. Looking into respondents’ personal economic background, during the burn incidents 33 percent identified themselves as housewives, followed by daily wage laborers (27%), and agriculture (12%) as their source of income. 9 percent each identify domestic helper and business as their income source. At present, majority is still engaged in daily wage labor. There is little change in income source through business and domestic helper, but a rise in unemployment (from 6% to 25%) is notable. Currently newly identified income source include beauty parlor: 3%, periodic work in towns/cities: 6%, service: 3% and others (not indicated by respondents): 6%. Findings indicate substantial decrease in respondents and their families’ income adequacy (Table 1). Conditions are worse amongst those who earlier claimed their income as insufficient. Table 3: Adequacy of income among burns/acid survivors and their families

Burns/acid survivors Family

Income

sufficiency

During burn/acid incident Currently During burn/acid incident Currently

Yes 41% 18% 35% 12%

No 59% 82% 65% 88%

Key Findings:

The average age of respondents is currently 32 years.

Burns/acid survivors are primarily from the terai belt of the nation, namely, eastern, western, central and mid-western terai regions.

Most burns/acid violence survivors belong to the Terai/Madhesi Others Caste (26%), followed by Hill Chhetri (23%) and Madhesi Dalit (18%).

Half of the burns/acid violence survivors are illiterate; among the remaining educated respondents 41 percent had only attained class 1-5 education.

Burns/acid violence survivors come from daily wage labor (32%) and agriculture (26%) families. Burns/acid violence incidences negatively impact the economic status of victims and their family – compared to the time of incidence, currently there is income inadequacy among victims and their families.

Burns/acid violence pushes victims to change households; many move from their husband’s or father-in-law/mother-in-law’s house to their parents’ house.

Before burn/acid incident, Daily

wage labour, 27%

Before burn/acid incident,

Agriculture, 12%

Before burn/acid incident, Beauty

parlour work, 0%


Domestic helper, 9%


Business, 9%Before burn/acid incident,

Unemployed, 6%


Housewife, 33%

Before burn/acid incident, Periodic

work in town/cities, 0

Before burn/acid incident, .Service,

0

Before burn/acid incident, Others,

3%

Currently, Daily wage labour, 28%

Currently, Agriculture, 6%

Currently, Beauty parlour work, 3%

Currently, Domestic helper,

9%Currently,

Business, 9%

Currently, Unemployed, 25%

Currently, Housewife, 3%

Currently, Periodic work in town/cities, 6%

Currently, .Service, 3%

Currently, Others, 6%

Chart 6: Source of income of BVS, during incidence and currently

Before burn/acid incident

Currently

17

Perceptions on discriminations against girls and women Respondents were asked about their perceptions on women and girls most discriminated in obtaining their rights in their districts. A large 59 percent identified married women, followed by 38 percent each who indicate widows and economically dependent women. Women from particular communities (29%) are also identified. Respondents were asked about their perceptions on major factors leading to girls and women facing burn/acid violence in their respective districts. Dowry demand tops the list with 73 percent, followed by 47 percent each who identify need to bear a male child and accusations of witchcraft, respectively. 35 percent identify property dispute as the major cause. Factors such as extra-marital affair of the husband, relation based disputes, illiteracy, etc. are also indicated.

Burns/Acid violence experiences of respondents This section deals with information on respondents’ personal burns/acid violence incidents – focusing on causative factors, method used, consequences, and current status. Cause of violence Dowry is the most common (44%) cause of violence committed during the indicated period, followed by relation-based disputes, extra-marital affair of the husband, and accusations of witchcraft (15% each) respectively. These are trailed by need to bear a male child and illiteracy, by 9 percent each. Property disputes, desire to marry another woman and financial problems (6% each) are also identified. Only 3 percent indicated her rejection of a boy/man caused the burn violence. ‘Others’ (11%) include drug and alcohol abuse by husband, lack of knowledge and household disputes.

Key Findings:

Married women (59%) are perceived as the most susceptible to burns/acid violence; this is followed by widows and economically dependent women (38% each).

Dowry (73%), accusations of witchcraft (47%) and the need to bear a male child (47%) are viewed as major causative factors for burns/acid violence.

Percentage, Relation

based disputes, 21%

Percentage, Extra-marital

affairs of husbands,

23%

Percentage, Need to bear male child,

47%

Percentage, Rejection of a man/boy, 3%

Percentage, Dowry, 73%

Percentage, Property

disputes, 35%

Percentage, Accusations of

witchcraft, 47%

Percentage, Illiteracy,

18%

Percentage, Financial problems,

15%

Percentage, Desire to

marry another

women, 9%

Chart 8: Survivors' perceptions on major causes for burns/acid victimization

Series1, Young Girls,

21%

Series1, Widows, 38%

Series1, Married

Women, 59%

Series1, Economically

dependent women, 38%

Series1, Women from

nuclear families, 6%

Series1, Women from joint families,

12%

Series1, Women from

familes where men

are dominant,

5%

Series1, Women from

families where

mother/father-in-laws are

dominant, 18%

Series1, Women from

families where

women are dominant,

3%

Series1, Economically independent women, 15%

Series1, Women from

particular communities,

29%

Series1, Women from

poor economic

background, 5%

Series1, Women from

sound economic

background, 3%

Series1, Single

women, 18%

Series1, Women with disabilities,

3%

Series1, Others, 3%

Chart 7 : Survivor perception on women and girls most discriminated in obtainiing rights

18

Method of violence Majority of 67 percent respondents identified ‘doused with kerosene and set on fire’ as the method for committing the violence. 12 percent also had acid thrown at them – a surprising finding considering acid throwing is still regarded as foreign in the country. Pushed into fire, having hot water/liquid thrown at, and electrocution are also identified. Perpetrator of violence In the cases identified majority of 56 percent identified the husband as perpetrator of the violence. This is followed by father-in-law, mother-in-law and unknown persons (18% each). Neighbors and agents luring them to other places have also been identified. In one case (3%), the respondent identified her own friend as the perpetrator. Consequence of burns/acid victimization Physical disfigurement (85%) is the major consequence identified by respondents, followed by emotional (44%) and psycho-social trauma (32%) they undergo. Some 35 percent claimed inability to obtain a job, social stigmatization (32%), low confidence level (32%), and inability to face society (29%).

Percentage, Relation based violence, 15%

Percentage, Extra-marital affairs of

husband, 15%

Percentage, Need to bear male child, 9%

Percentage, Rejection of

man/boy, 3%

Percentage, Dowry, 44%

Percentage, Property disputes,

6%

Percentage, Accusations of

witchcraft, 15%

Percentage, Illiteracy, 9%

Percentage, Financial proobles

(Specify), 6%

Percentage, Desire to marry another

women, 6%

Percentage, Sexual violence, 12%

Percentage, Others, 12%

Chart 9 : Cause of burns/acid throwing violence

Percentage, Doused with

kerosene, 67%, 67%

Percentage, Thrown hot

water/liquid at, 3%, 3%

Percentage, Pushed into fire,

6%, 6%

Percentage, Electrocution,

3%, 3%

Percentage, Thrown acid at,

12%, 12%Others (doused with petrol, personally

doused kerosene)

9%

Chart 10: Method used for committing

burns/acid violence

Percentage, Brother, 3%

Percentage, Father-in-law,

18%

Percentage, Mother-in-law,

18%

Percentage, Brother-in-law,

9%

Percentage, Sister-in-law,

9%

Percentage, Husbands, 56%

Percentage, Friends, 3%

Percentage, Neighbours, 6%

Percentage, Agents luring you to other,

6%

Percentage, Unknown

persons, 18%


Chart 11: Perpetrators in respondents' incidents

Percentage, Physical

disfigurement, 85%

Percentage, Emotional

trauma, 44%

Percentage, Psychological trauma, 32%

Percentage, Constant fear in daily life, 26%

Percentage, Long periods of physiotherapy,

21%

Percentage, Economic burden on

family, 26%

Percentage, Family

disputes, 26%

Percentage, Other health

related problems, 9%

Percentage, Social

stigmatization, 32%

Percentage, Inability to get

job, 35%

Percentage, Dependency on

family members, 23%

Percentage, Low self-

esteem, 18%

Percentage, Inability to face

society, 29%

Percentage, Low confidence

level, 32%

Percentage, Inablity to

speak in public, 15%

Percentage, Inability to face the public, 6%

Percentage, Divorce, 3%


Chart 12: Consequences of burns/acid victimization

19

Rescue and support 82 percent respondents said they were rescued during the incidence. Amongst these, 77 percent said they were taken to the hospital. 3 percent claimed neighbors helped douse the fire, while another 3 percent said water was thrown at them to douse the fire. Amongst those not rescued immediately (18%; n=6), 50 percent claimed the rescue came after a week, and 33 percent after 4 days. 17 percent did not respond.

Table 4: Type support provided by different stakeholders

Taken to

hospital

Financia

l support

Putting

out fire

Called for

ambulance

Taken

action

Others

In numbers

Husband 11 - - -- -- 1

Father-in-law/Mother-in-law 1 1 2 -- -- 1

Mother/Father 7 11 -- -- -- --

Community members 3 -- 4 -- -- --

Police 2 -- -- -- 7 --

Brother -- 7 -- -- -- --

Sister -- 2 -- -- -- 1

Friends -- 5 3 2 -- 1

Community members -- 1 -- 1 -- --

NGOs -- 2 -- 1 -- --

INGOs -- 1 -- -- -- --

Brother-in-law/Sister-in-law

(Bhauju/Bhinaju)

-- -- 1 -- -- --

Others -- -- -- -- -- 3

Key Findings:

Dowry (44%) is the primary cause of burns/acid violence among burns/acid survivors. Accusations of witchcraft, extra-marital affair of the husband and relation based disputes (15% each) are also identified as key causes.

Dousing the victim with kerosene and burning (67%) is the most prevalent method of committing burns/acid violence. Acid throwing is noted amongst 12 percent respondents – surprising, as it is not viewed as common in Nepal.

The husband is the primary perpetrator (56%), as identified by burn/acid violence survivors.

Physical disfigurement is the major consequence (85%) suffered by burn/acid violence survivors. Emotional trauma (44%), inability to obtain employment (35%), social stigmatization (32%), psychological trauma (32%) and low confidence level (32%) further compounds their situation.

20

Services required and availed Findings reveal disparity in burns/acid survivors’ needs and the support they received. All respondents indicate the need for food, shelter, clothes, financial support, safe and stable environment, and access to justice - however these needs were only partially fulfilled (Chart 13). Some 94 percent who identified need for immediate medical services claimed this as fulfilled. Intensive medical care, food and shelter have also been fulfilled to some extent. Disparity is more evident in psycho-social counseling (requirement: 78%; received: 33%), safe and stable environment (requirement: 100%; received: 33%); and access to justice (requirement: 100%; received: 29%). Health services All cent percent indicate they received health support as a result of being burns/acid survivors. The number of survivors able to access various health related services were: Table 5: Number of burns/acid survivors able to access health services

Surgeries and associated procedures 29%

Regular psychosocial counseling 21%

Regular physiotherapy sessions 26%

Nutritional packages 23%

Despite the services availed only 29 percent claim improvement in health (prior to project period). Their reasons were: comfortable in undertaking tasks, comfortable in neck movement, able to move arms and limbs properly, able to walk properly, able to earn own living and walk freely in public post surgery, improved health conditions, comfortable in moving body, ear repair, physically and psychologically more fit after receiving reports, and healing of wounds and improved health. Twenty four respondents did not respond. However, 71 percent said there was no improvement, primarily due to not receiving timely support and nutritious diet. Legal rights Some 26 percent respondents claimed obtaining knowledge pertaining to their legal rights after the incidence. The remaining was ignorant. Their knowledge ranged from the rights pertaining to registration of case, fight for one’s property, citizenship, birth registration of children. They also indicate the right of survivors to access justice and support despite absence of specific law on burn/acid violence. Of the total respondents 62 percent burns/acid survivors claimed they required support, which ranged from consultation with lawyers and NGOs, to support in collecting evidence, support in visiting courts, financial support in paying legal fees and consultation with media. But as indicated by the given table the percentage receiving support is low. Table 6: Legal support required and received by respondents

Required support Support received (amongst

those requiring it)

Consultation with lawyers 41% 14%

Consultation with NGOs 50% 12%

Support to collect evidence 32% 27%

Required Support, Food,

100%

Required Support,

Shelther, 100%

Required Support,

Clothes, 100%

Required Support,

Medical care withing 24 hours, 94%

Required Support, Intensive

medical care , 88%

Required Support, Financial

support, 100%Required Support,

Psycho-social counselling,

78%

Required Support, Safe

and stable environment,

100%

Required Support, Access to

justice, 100%

Support Received, Food, 82%

Support Received,

Shelther, 67%

Support Received,

Clothes, 42%

Support Received,

Medical care withing 24 hours, 94%

Support Received, Intensive

medical care , 75%

Support Received, Financial

support, 37%

Support Received,

Psycho-social counselling,

33%

Support Received, Safe

and stable environment,

33%

Support Received, Access to

justice, 29%

Chart 13: Comparative data on support required vs. received

Required Support

Support Received

21

Support to visit courts 35% 17%

Financial support to pay legal fees 29% 10%

Consultation with media 23% 0

Rehabilitation and Reintegration Services Findings indicate the need to address rehabilitation and reintegration support to burns/acid survivors. Amongst the total survivors only 17 indicated requiring and/or receiving such support. Majority needed support in family reintegration, safe stable and secure environment, and support to attend community/family events.

22

Table 7: Rehabilitation and reintegration support required and received by respondents

Required support Support received No Response Total

Safe, stable and secure environment 41% 18% 41% 17

Support for reintegration into family 65% 29% 6% 17

Support to attend community/family

events

29% 6% 65% 17

Skills for realizing personal changes (At Present) Despite their violent experiences, 71 percent of respondents have to-date not received any awareness on rights and skills to create change due to being a burns/acid survivor. Amongst the 29 percent who indicated the need, majority identified ‘self-confidence building to interact outside the home’; self-esteem building to interact outside home, skill training for self-sufficiency and skill training to participate in public, and awareness on social and economics rights. But the support they received versus their requirement is low. Table 8: Required skills to create change, and support availed

Required support Support received Total

Awareness on social and economic rights 80% 20% 5

Non Formal Education 67% 33% 9

Self-esteem building to interact outside home 83% 17% 6

Skill training for self sufficiency 50% 50% 10

Skill training to participate in public 71% 29% 7

Change in confidence level and self-sufficiency due to services received (Pre-project period) When asked whether the services they received made them feel more confident and self-sufficient, 38 percent of total respondents affirmed it; 62 percent responded negatively. Amongst those affirming it, in a multiple response question on changes they experienced, 85 percent identified ‘feel confident going outside home’, followed by 61 percent claiming ability to interact with friends. They even feel ‘confident to go seek employment’, and are ‘no longer depressed’. They were ‘able to participate in public fora’, ‘travel on their own’, and ‘able to share personal story with other survivors’.

Series1, Feel confident going outside home,

85%

Series1, Able to interact with friends, 61%

Series1, Able to participate in public for a,

31%

Series1, Able to share personal

story with other survivors,

15%

Series1, Confident to go

seek employment,

54%

Series1, Am no longer

depressed, 38%

Series1, Able to travel on my

own, 31%

Series1, Others, 15%

Chart 14: Increase in type of confidence based on support received

23

Knowledge, Attitude, Practice and Behavior of Stakeholders in Relation to Burns/Acid Violence against Women and Girls Attitude of stakeholders When asked to rate the attitude of various stakeholders, family members from the parental side such as siblings are identified as ‘supportive’, followed by NGOs/CBOs, friends/peers and police are indicated as supportive. But the husband and family members on the husband’s side, namely, husband and brother/sister-in-laws and community leaders are indicated as being indifferent. Table 9: Attitude of relevant stakeholders

Stakeholders

Supportive Indifferent Pitying Stigma/Dis

crimination

Others Non Respondents

Husband 26% 47% 12% 0 3% 12%

Brother/Sister 79% 9% 0 0 0 12%

Brothers/Sisters-in-law

(husband side)

23% 47% 12% 0 0 18%

Brothers/Sisters-in-law (parental side)

29% 26% 23% 0 0 22%

Friends/Peer groups 59% 9% 26% 0 0 6%

Police 59% 18% 9% 3% 0 11%

Social workers 47% 29% 9% 3% 0 12%

Community based

organizations/NGOs

65% 9% 15% 3% 0 8%

Health service providers at

hospital/health service centers

47% 23% 18% 0 0 12%

Health Facilities 41% 35% 6% 0 0 18%

Community Leaders 18% 44% 6% 0 0 32%

Media 9% 6% 29% 0 0 56%

Others 0 0 0 0 0.00 3%

Key Findings:

The husband, mother and father of the victim and community are found taking the victim to the hospital. Financial support, in such instances, is generally provided by the victim’s parents, brother and sister and friends.

Victims’ siblings (79%), and NGOs/CBOs (65%) are indicated as supportive. The husband (47%), his family members (47%) and even community leaders (44%) are seen as indifferent.

Burns/acid survivors medical, food, shelter needs are generally addressed. Disparity is more evident in psycho-social counseling (requirement: 78%; received: 33%), safe and stable environment (requirement: 100%; received: 33%); and access to justice (requirement: 100%; received: 29%).

Despite the medical services received 71 percent claimed there was no improvement, primarily due to not receiving timely support and nutritious diet.

Access to justice is difficult for the burns/acid survivors as their requirement for legal support, collection of evidence and attendance of courts are not supported and they are unable to do it on their own.

While training for self-sufficiency have been received, confidence building measures to enable interaction within outside home remain inadequate. Consequently, only 38 percent of total respondents claimed the support and services received had built their confidence and made them self-sufficient.

24

Stakeholder roles in prevention and service to burns/acid violence (Pre-project and present period) Respondents identify NGOs as the most involved in both prevention and service of burns/acid violence against girls and women. They are followed by the police and women’s groups. Surprisingly, community leaders despite having major say at community levels are identified as the least involved. Stakeholder knowledge level and ability to handle burns/acid violence cases (Pre-project to present period) To assess various stakeholders knowledge level, understanding of legal matters and comfort in handling the cases respondents were asked to rate 10 different stakeholders, namely, police, lawyers, District Administration Office (DAO), Women’s groups, CBOs, NGOs, Human Rights Activists, Journalists/Media, community leaders and Health personnel. Following is their take: Table 10: Knowledge level on burns/acid throwing violence, and comfort level in handling cases

Scale Knowledge

Level

Knowledge level

on legal matters

Scale Comfort level in

handling cases

Police High 47% 53% Comfortable 41%

Medium 26% 12% Uncomfortable 23%

Low 15% 18% Just get on with

the job

23%

None 12% 17% Don't know 13%

Health Personnel High 62% 12% Comfortable 73%



the job

3%


Lawyers High 41% 59% Comfortable 41%


Low 6% 0 Just get on with

the job

9%


NGOs/CBOs High 44% 53% Comfortable 50%


Low 3% 9% Just get on with the job

0

None 9% 23% Don't know 21

Women's rights

group/activists

High 59% 47% Comfortable 65%



the job

3%


Journalists/Medi

a




the job

17%



Prevention, Police, 64%

Prevention, Lawyers, 9%

Prevention, District

Administration Office, 27%

Prevention, Women's groups,

51%

Prevention, Community

based organizations,

30%

Prevention, NGOs, 73%

Prevention, Human Rights Activists, 36%

Prevention, Journalists/Medi

a, 15%

Prevention, Community

leaders, 21%

Prevention, Health personnel,

6%

Prevention, No response, 3%

Services, Police, 65%

Services, Lawyers, 12%

Services, District Administration

Office, 26%

Services, Women's groups,

44%

Services, Community

based organizations,

35%

Services, NGOs, 65%

Services, Human Rights Activists,

44%

Services, Journalists/Medi

a, 15%

Services, Community leaders, 6%

Services, Health personnel, 18%

Services, No response, 0

Chart 15: Perception of respondents on stakeholder involvement in prevention and service

Services

Prevention

25

Community

Leaders



the job

20%


A majority of 82 percent respondents indicated the need for stakeholders to change their attitudes for increased support to survivors. Amongst these respondents, areas in which change is indicated are: Table 11: Change in stakeholders’ skills and behavior for improved support to survivors

Stakeholders Better

communication

skills

Improving

listing skills

Increased

referrals

Emotiona

l support

Positive attitude

towards

survivors

Improved

data

management systems

Police 54% 21% 11% 7% 36% 11%

Health Personnel 4% 39% 29% 18% 32% 7%

Lawyers 42% 37% 25% 12% 12% 8%

NGOs/CBOs 30% 26% 22% 37% 22% 15%

Women's right 18% 22% 37% 41% 11% 7%

Journalists/Media 33% 25% 33% 21% 17% 8%

Community Leaders 50% 25% 12% 87% 37% 12%

Prevention, protection and service based interventions When asked whether they had heard/attended any awareness programs on prevention of burns/acid violence, FM Radio is identified by the most (79%), followed by television (50%) and street drama (21%).

Percentage, Street drama,

21%

Percentage, Orientation

program, 6%

Percentage, Television show, 50%

Percentage, FM radio, 79%

Percentage, Articles, 18%

Percentage, Poster/Pamphl

ets, 15%


Chart: 16 Burns/acid throwing prevention based awareness program heard of/attended

by respondents

Key Findings:

NGOs are identified as the most involved in prevention (75%) and protection (63%) of burns/acid violence.

According to survivors knowledge on burns/acid violence survivors is highest among health personnel (62%), women’s rights activists (59%), police (47%) and NGOs (44%).

Health personnel (73%) and women’s rights groups/activists (65%) are also identified as the most comfortable in handling burns/acid violence cases.

Community leaders are identified as possessing the least knowledge (41%) and capacity/comfort (62%) in handling the cases.

The need for improving listening skills, referrals, support mechanisms have been identified for all stakeholders.

26

Among the various multi-sectoral services required by survivors medical (68%) and economic support (65%) are the primarily identified. Other areas include physiotherapy, door-to-door programs, community based awareness programs and job placement, plastic surgery, shelter homes and rehabilitation programs.

Asked about interventions that would support prevention and protection from burns/acid violence at community and family level, street dramas are identified by majority (68%), followed by women’s group mobilization (59%), and a national campaign (50%). Other identified interventions include lobbying with policy makers, research, skill development training; inclusion within school curriculum, etc.

Skill training and entrepreneurship needs A large 79 percent of total respondents stated they wanted some skill development training. Another 73 percent also claimed they would prefer to start their own enterprise. Some potential businesses envisaged are:

Beauty parlor = 8

Tailoring = 12

Small business = 2

Soap business = 1

Candle shop = 1

Hotel = 1

Clothes store with tailor = 1

Open a shop =1

Grocery store = 1 Knowledge of organizations working on burns/acid violence

Percent, National campaign, 50%

Percent, Lobbying with policy makers, 26%

Percent, Research, 26%

Percent, Community based awareness programs, 18%

Percent, Inclusion of subject within school

curriculum, 23%

Percent, Teacher training, 44%

Percent, Street drama, 68%

Percent, Women's group mobilization,

59%

Percent, Training to health service

providers, 20%

Percent, Prevention based awareness programs, 21%

Percent, IEC/BCC programs, 6%

Percent, Counselling, 18%

Percent, Shelter/Homes, 12%

Percent, .Skill development training,

26%

Percent, Income generating programs,

18%

Percent, Job Placement, 21%

Percent, Reintegration programs, 9%

Percent, No Response, 3%

Chart 18: Interventions required at family and community levels for addressing burns/acid violence

Series1, Missing, 0.03

Series1, Community

based awareness program,

35%

Series1, Door to door

awareness programs,

38%

Series1, IEC/BCC

programs, 6%

Series1, Counselling,

26%

Series1, Shelter/Hom

es, 18%

Series1, Economic

support, 65%

Series1, Medical

support, 68%

Series1, Physiotherap

y, 44%

Series1, Plastic

surgery, 23%

Series1, Skill development training, 27%

Series1, Income

generating programs,

18%

Series1, Job placement,

35%

Series1, Self-esteem

building training, 6%

Series1, Self-confidence

building programs,

9%

Series1, Rehabilitation programs,

18%

Series1, Reintegration

programs, 9%

Chart 17: Multi-sectoral services required by burns/acid survivors

27

15 respondents said they were aware of groups/organization working to end violence related to burns/acid throwing in their districts, and identified SAATHI (n=4), BVSN (n=8); Fatima Foundation (n=2) and Maiti Nepal (n=1). Three respondents claimed ignorance of such groups. The rest did not respond. Of the total 34 responders only 6 were associated with organization working to end violence related burns and acid throwing in their districts. All six of them were associated with BVSN of which two were also associated with SAATHI. Eleven survey respondents said they were not associated with any such organizations; the rest 17 did not respond.

Key Findings:

FM radio (79%), television (50%) and street dramas (21%) are the most common sources of information for survivors on burns/acid violence.

Survivors identify street dramas (68%) and women’s group mobilization (59%) as the primary means for preventing burns/acid violence at family and community levels.

Based on their own experiences, survivors believe the primary need for burns/acid survivors are medical (68%), financial (65%) and physiotherapy needs (44%).

Survivors (79%) are keen for skill training to enable them to start their own enterprise such as beauty parlor, tailoring and small shops.

Less than half (n=15) the respondents were aware of organizations working against burns/acid violence, indicating Saathi, Maiti Nepal, Fatima Foundation and BVS-Nepal. Only six were associated with NGOs.

28

2.2 Potential Survivors

Demographic Profile The target of 66 potential survivors was interviewed in this category. Potential survivors were identified on the basis of four criteria, namely, (i) suspected cases of burns/acid violence who have however not revealed it, (ii) attempted cases of burns/acid victims of violence who however did not get burnt, (iii) girls/women who have faced some form of violence, or (iv) girls/women have similar backgrounds (ethnicity, age, economic status, location) as identified acid/burn survivor. Respondents were identified based on set criteria. Respondents thus covered 6 districts, with a majority being from Kathmandu (33%) and Banke (24%) districts, respectively. Age Group The mean age of the respondents is 28.79 years. Ethnicity Majority of potential respondents are Terai/Madhesi Other Castes (26%) followed by Hill Chhetri (23%) and Terai/Madhesi Dalit (18%). Religion Respondents practice Hinduism (67%), followed by Islam (23%) and Buddhism (11%). Language Majority of respondents speak Nepali (59%), followed by Maithili (18%), Awadhi (15%) Urdu (6%) and Tamang (1%). Marital status A large 86 percent of respondents are married; 14 percent are unmarried. Amongst the married, 65 percent were living with the husband, 14 percent were separated, 5 percent widowed, and 2 percent divorced. The remaining did not share their marital status. Amongst the total respondents 62 percent were living in the husband’s house, 18 percent in their own house, 9 percent with parents, and 8 percent in their maternal home. 3 percent were also staying at shelter homes.

Series1, On my own, 18%, 18%

Series1, Maternal

home, 8%, 8%

Series1, Husband's house,

62%, 62%

Series1, Father/M

other, 9%, 9%

Series1, Rehabilit

ation home,

3%, 3%

Chart 21: Place of living of potential survivors

Series1, Hill Chhetri, 8,

23%Series1,

Hill/Mountain Janajati, 2, 6%

Series1, Tarai Janajati, 1, 3%

Series1, Newar, 2,

6%

Series1, Tarai/Madhesi Other Castes,

9, 26%

Series1, Muslim, 3,

9%

Series1, Tarai/Madhesi Brahman/Chh

etri , 3, 9%

Series1, Tarai/Madhesi

Dalit, 6, 18%

Chart 20: Burns/acid violence survivors, by ethnicity type

Banke24%

Kathmandu/Bhaktapur/Lalitp

ur33%

Chitwan1%

Dhanusha20%

Dhading6%

Dolakha1%

Mahottari5%

Makwanpur1%

Okhaldhunga1%

Ramechap2%

Sindhuli 2%

Solukhumbu2%

Sunsari2%

Chart 19: Potential survivors district of residence

29

Family status Majority was found living in a nuclear family living with the husband, followed by joint family on the husband’s side. The husband is the household head in 59 percent cases, followed by 18 percent respondents who are heading their households. Other household heads were father (14%), father-in-law (6%), and brother and mother-in-law (2% each). Educational status 58 percent of respondents attended school. The remaining 41 have no school education; 1 respondent had obtained non formal education (NFE). Amongst respondents attending school (n=38), 32 percent had attended classes 6-8, 29 percent classes 9-SLC and 1-5 each, respectively. Ten percent had studied 10+2 and above.

Economic Profile Of the 60 respondents who responded, 24 percent identified daily wage labor as their source of income, while 15 percent were domestic helpers. 11 percent each were involved in agriculture and business, respectively. 18 percent were unemployed. 19 percent of total respondents indicated their source of income as sufficient; 79 percent claimed it was insufficient. The remaining did not respond. Skilled based training Some 35 percent of total respondents had received skill-based training. The type of training included tailoring (62%), sewing (9%), CMA (4%), jewelry making (4%), and beauty parlor training (4%). The remaining 17 percent did not respond. Majority (68%) received the training in 2014. 5 percent each received the training in 2004, 2005, 2007, 2008, 2009 and 2011 respectively. Training had been imparted by Saathi Drop-in Centre (52%), Center for Technical and Vocational Training (CTEVT) (9%), while 5 percent each received it from Huda (an Islamic Centre), other NGOs (unidentified), self, family members and parents. Duration of training was 6-month (61%); others ranged from 1 month to 3 months.

Key Findings:

The mean age of potential survivors is 28.79 years.

Majority of potential respondents are Terai/Madhesi Other Castes (26%), followed by Hill Chhetri (23%) and Terai /Madhesi Dalit (18%)

86 percent of respondents are married; 14 percent are unmarried. 62 percent of total respondents are living in the husband’s house. The husband is the household head in 59 percent of respondents.

58 percent had attended school; 41 percent were illiterate.

Daily wage labor is the source of income for 27 percent of 60 respondents. 79 percent of total respondents indicate their income as inadequate.

To date, some 35 percent of respondents had received skill-based training.

0% 10% 20% 30%

Daily wage…

Skilled labor

Unemployed

24%11%

2%3%

15%11%

18%8%8%

Chart 22: Source of income of potential survivors

30

Perceptions on discriminations against girls and women According to the potential survivors, in a multiple response question, economically dependent women (45%) are most discriminated and denied of rights, followed by married women and women from poor economic backgrounds (39% each). They are followed by women/girls from male dominant families (32%).

Knowledge on burns/acid throwing incidences Knowledge of burns/acid violence cases Of the total respondents, some 65 percent had seen/heard of burns/acid violence incidences; only 26 percent had heard of such incidences in their own community/district. The remaining were ignorant (68%), or did not respond (6%). Perceived causes of burns/acid violence Some 56 percent of total respondents identify dowry as the major cause of burns/acid throwing. This is followed by 41 percent who identified illiteracy, relation based disputes (38%), extra-marital affairs of the husband (33%) and others (drug and alcohol abuse by husband, wife not being attractive, listening to others, etc.) (29%). The need to bear a male child (17%), desire to marry another woman (15%) and rejection of a man/boy (11%) have also been identified. Mode of committing violence Of the 17 who claimed to have heard of such incidences, 53 percent claimed victimization occurred through dousing with kerosene; 35 percent said victims had been pushed into the fire. 6 percent each mentioned electrocution and having acid thrown at them. Cause of violence in known burn/acid violence incidence As per their knowledge, the cause of violence is indicated as dowry and extra-marital affairs (29% each). Relation based disputes and need to bear male child (18% each), and property disputes and accusations of witchcraft are identified by 12 percent each.

0% 10% 20% 30% 40% 50%

Young girls

Married women

Women from nuclear families

Women from families where men are dominant

Women from families whre women are…

Women from particula communities

Women from medium economic background

Single mothers

Others

5%27%

39%45%

9%18%

29%26%

3%15%

9%39%

3%2%

8%3%

8%9%

Chart 23: Girls and women most discriminated in accessing their rights

0% 20% 40% 60%

Relation based disputes

Extra-marital affairs of…

Need to bear male child

Rejection of man/boy

Dowry

Property disputes

Accusations of witchcraft

Illiteracy

Financial problems

Desire to marry another…

Sexual violence

Others alcohol abose,…

38%

33%

17%

11%

56%

24%

21%

41%

5%

15%

5%

29%Chart 24: Perceived major causes of buns/acid violence

0% 10% 20% 30%



Property disputes

Illiteracy

No Response

18%29%

18%29%

12%12%

6%6%

12%

Chart 25: Cause of burns/acid victimization in cases around their district

31

Perpetrator of violence In most cases heard of/known by respondents the mother-in-law (79%) and father-in-law (74%) were the main perpetrators; They are followed by the husband (53%). Rescue and support 61 percent of respondents claim victims were rescued within a 24-hour period; the remaining 39 percent indicated otherwise. The rescue involved taking the victim to the hospital (64%), family and neighbors taking her to the hospital, pouring water to extinguish fire, etc. Amongst the 39% (n=7) who claimed rescue was not immediate, 43 percent claimed rescue occurred after one week, while 14 percent ‘indicated after 10 days’. The remaining 43 percent did not respond. Stakeholders involved in rescue Major stakeholders involved in the victims’ rescue are identified as victims’ father/mother (56%) and community members (31%). Others include friends (25%), police (25%), social workers (19%), father/mother-in-law (19%), brother (13%), brother-/sister-in-law (parental side) (13%%), husband (12%), and NGOs and INGOs (7% each), respectively. Consequence of burns/acid victimization Respondents indicate physical disfigurement (71%) as the major consequence of burns/acid survivors. This is followed by emotional trauma and social stigmatization (35% each). Some 31 percent also indicate victims’ inability to get a job.

0% 20% 40% 60% 80%

Brother

Father-in-law

Brother-in-law

Husband

5%5%

74%79%

16%11%

53%

Chart 26: Perpetrators identified by rrespondents in cases heard

Taken to the hospital

64%Family and

neighbour took her to hospital

9%

Poured water and

covered the victim's

body 9%

Husband helped

extinguish the fire9%

A blanket was used to cover and extinguish

the fire 9%

Chart 27: Mode of Rescue

0% 20% 40% 60% 80%

Physical disfigurement

Psychological trauma

Long periods of physiotherapy

Family disputes

Social stigmatization

Dependency on family members

Inability to face society

Inability to speak in public

Divorce

71%35%

24%17%

9%12%

20%9%

35%30%

15%5%

18%20%

6%3%

6%3%

Chart 28: Consequences of burns/acid violence, as identified by respondents

32

Respondents knowledge on knowledge, attitude and practice of stakeholders involved in servicing burns/acid violence survivors Stakeholder involvement in prevention of burns/acid violence When asked about stakeholders most involved in prevention of burns/acid violence, majority identified NGOs (64%) and police (54%). Others included women’s groups, HR Activists and journalists/media, CBOs, etc. Stakeholder involvement in service provision to burns/acid violence survivors Regarding stakeholders most involved in servicing burns/acid related violence survivors, NGOs (64%), followed by police (41%) are identified by majority. They are followed by women’s groups, journalists/media, DAO, and HRAs. Source of information on burn/acid violence cases Some 72 percent of respondents identified FM radio as source of information on burns/acid violence cases. This is followed by TV shows (66%), street dramas (28%), poster/pamphlets (20%) and articles (18%). Some 8 percent identified orientation programs.

Knowledge level of stakeholders Respondents identified NGOs (70%) and Women’s Rights Activists (64%) as possessing highest level of knowledge on burns/acid violence in their community. The same stakeholders were identified as possessing most knowledge on causes: NGOs (56%) and Women’s Rights Activists (50%).

Key Findings:

Some 65 percent of respondents had heard of burns/acid violence cases, but only 26 percent had heard of it occurring in their own district and communities.

Dowry is identified as the key cause of such violence (56%).

Use of kerosene to commit the violence is identified by 53 percent of the 17 respondents who claimed knowledge.

Respondents identify the mother-in-law (79%) and father-in-law (74%) as key perpetrators.

61 percent respondents were of the opinion victims were rescued immediately, with majority of the rescue being undertaken by the father/mother (56%) and community members (31%).

Physical disfigurement (71%), emotional trauma and social stigmatization (35% each) and inability to get employment are identified as major consequences (35%).

0% 20% 40% 60% 80%

Police

Womens group

Human Rights Activists

Health personnel (Doctors…

55%11%

15%33%

18%64%

32%26%

9%2%

6%

Chart 29: Stakeholders identified as most/may be involved in prevention of

burns/acid violence

0% 20% 40% 60% 80%

Police

District Administration…

Community based…


Community leaders

Others

41%11%

20%35%

14%64%

18%21%

8%14%

3%8%

Chart 30: Stakeholders most involved in providing services to burns/acid survivors

33

NGOs/CBOs (67%) are also identified as possessing the most skill/capacity in handling burns/acid survivors, followed by women’s rights activists (59%). Surprisingly, lawyers (45%) and community leaders (38%) are indicated as possessing the least skill/capacity in handling burns/acid violence cases. With regards to stakeholders’ comfort level in handling burns/acid cases NGOs/CBOs (67%), health personnel and (65%) and Women’s Rights Activists (62%) are indicated as most comfortable in handling burns/acid survivor cases. Table 12: Knowledge level of stakeholders on burns/acid violence, knowledge on causes, knowledge on consequences

Stakeholders Knowledge on burns/acid violence

Knowledge on burns/acid violence causes

Knowledge on burns/acid violence consequences

Skill/capacity level

Comfort level in handling cases

Police

High 49% 32% 24% 35% Comfortable 16%

Medium 23% 46% 26% 25% Uncomfortable 32%

Low 16% 9% 18% 17% Just get on with it 32%

None 12% 13% 32% 23% Don't know 20%

Health Personnel




None 18% 22% 31% 12% Don't know 23%

Lawyers




None 35% 41% 48% 42% Don't know 42%

NGOs/CBOs



Low 0 2% 3% 6% Just get on with it 6%

None 15% 15% 30% 21% Don't know 21%

Women's rights group/activists


Medium 9% 21% 11% 14% Uncomfortable 0

Low 1% 3% 0 4% Just get on with it 8%

None 26% 26% 38% 24% Don't know 30%

Journalists/Media




None 20% 27% 39% 24% Don't know 36%

Community Leaders



34


None 33% 36% 50% 38% Don't know 50%

Stakeholders most knowledgeable about potential burns/acid survivors Respondents indicate Women’s Rights Activists (59%) as the most knowledgeable about potential victims, followed by NGOs/CBOs (55%). Community leaders (54%), lawyers (53%) and health personnel (51%) are indicated as the least knowledgeable. Table 13: Stakeholders most knowledgeable about potential survivors

Stakeholders Level Police Health personnel

Lawyers NGOs/CBOs

Women’s Rights Groups/ Activists

Journalist/Media

Community leaders

High 49% 15% 20% 55% 58% 17% 5%

Medium 28% 25% 15% 14% 7% 17% 18%

Low 7% 9% 11% 9% 14% 16% 21%

None 16% 51% 54% 22% 21% 50% 56%

Knowledge level on law pertaining to burns/acid violence Some 67 percent respondents indicate lawyers’ knowledge as high, followed by police (66%). They are followed by Women’s Rights Activists (46%). Surprisingly community leaders (68%) are identified as possessing no knowledge. Table 14: Stakeholders most knowledgeable about existing laws, as perceived by respondents


Lawyers NGOs/CBOs


Journalist/Media

Community leaders

High 65% 9% 67% 35% 46% 12% 6%

Medium 17% 26% 7% 29% 17% 28% 9%

Low 1% 14% 6% 4% 12% 18% 17%

None 17% 51% 20% 32% 25% 42% 68%

Table 15: Respondent perception on whether increased stakeholder knowledge on burns/acid throwing will reduce the violence


Lawyers NGOs/CBOs


Journalist/Media

Community leaders

Yes 92% 59% 53% 80% 77% 67% 72%

No 3% 13% 14% 3% 8% 8% 2%

Don’t know 5% 28%% 33% 17% 15% 25% 26%

Majority of respondents stated services were being provided by the following: police (92%), NGOs/CBOs (80%), women’s Rights Activists (77%), community leaders (72%) and journalists (67%), health personnel (59%), lawyers (52%). Yet when asked on the particular area of service, respondents expressed ignorance on rescue, reintegration, physiotherapy facility, plastic surgery, nutritional support, safe and stable environment/shelter, self esteem building program, research and monitoring. Table 16: Knowledge on services currently being provided by government, NGOs and others

Res

cue

Fam

ily/c

om

mu

nit

y

rein

tegr

atio

n

Co

un

selin

g

Free

med

ical

sup

po

rt

Bu

rn r

elat

ed

trea

tmen

t

Bu

rn r

elat

ed

ph

ysio

ther

apy

Bu

rn r

elat

ed

pla

stic

su

rger

y

Fin

anci

al

sup

po

rt

Nu

trit

ion

al

sup

po

rt

Safe

/Sta

ble

envi

ron

men

t

Lega

l su

pp

ort

Self

-co

nfi

den

ce

bu

ildin

g

pro

gram

Se

lf-e

stee

m

bu

ildin

g

pro

gram

Co

mm

un

ity

bas

ed

awar

enes

s

pro

gram

Res

earc

h

Mo

nit

ori

ng

Co

mm

un

ity

sen

tin

el s

yste

m

IG p

rogr

ams

Skill

tra

inin

g

Don’t Know 39% 41% 29% 20% 26% 42% 53% 20% 42% 56% 38% 38% 38% 32% 48%

61% 62% 26% 32%

GoN 20% 15% 12% 39% 36% 24% 21% 18% 23% 13% 30% 4% 8% 9% 23%

20% 17% 11% 5%

35

GoN NGO 14% 5% 3% 8% 9% 2% 3% 15% 8% 9% 9% 14% 15% 20% 9% 9% 6% 24% 24%

NGO 27% 39% 56% 33% 29% 32% 23% 47% 27% 22% 23% 44% 39% 39% 20%

10% 15% 39% 39%

Multi-sectoral services required for burn/acid violence survivors When asked about multi-sectoral services required for burn/acid survivor support, key areas identified include economic support (70%), skill development training (62%), job placement (59%), medical support (50%) and community based awareness programs (39%). Identified interventions for prevention and tackling of burns/acid violence at family/community levels To prevent and tackle burns/violence related cases within families Potential Survivors identified the need for women’s group mobilization (58%), job placement (53%) followed by skill development (47%), training to health service providers (44%). Knowledge on organizations/groups working in their districts and support provided Majority (77%) of respondents are ignorant of any group or organization working in their district to end violence related burns/acid throwing. Only 23 percent claimed such knowledge. Amongst those responding positively, 33 percent identified Fatima Foundation, 27 percent identified Saathi, 20 percent identified BVSN, and 7 percent identified Aasaman Nepal. Thirteen percent did not indicate the organizations. Some 20 percent of respondents claimed association with such organizations, identifying Saathi’s Drop in Centre. When asked about the type of support these organizations were providing, most identified training on computer skills, beauty parlor, tailoring, etc. Respondents also identified support to domestic violence victims, counseling to women working in bars, restaurants and massage parlors.

0% 10% 20% 30% 40% 50% 60% 70%

Community based awareness…

IEC/BCC programs

Shelter/Homes

Medical support

Plastic surgery

Income generating programs

Self-esteem building training

Rehabilitation programs

Others

39%26%

9%29%

18%70%

50%21%21%

62%38%

59%9%

22%17%

12%3%

5%

Chart 31: Multi sectoral services required for burns/acid violence survivors

0% 20% 40% 60%

National campaign

Research

Inclusion of subject within school ..

Training to health service providers

IEC/BCC programs

Shelter/Homes

Income generating programs

Self esteem/confidence building pr..

Community based sentinel system

23%14%

21%39%

12%58%

44%30%

9%30%

12%47%

23%53%

35%29%

5%6%

Chart 32: Intervention identified for preventing burns/acid violence in families/communities

36

Key Findings:

NGOs are identified as the most involved and engaged in preventing (64%) acid/burns violence and service the victims (64%). They are followed by the police, in both instances.

FM radio is the primary source of information for learning about burns/acid violence.

According to respondents NGOs (70%) and Women’s Rights Activists (64%) possess highest level of knowledge about burns/acid related violence. NGOs (67%) are also identified as possessing most skill and capacity in handling burns/acid violence cases, and showing comfort in their handling.

Women’s rights Groups (59%) are identified as the most knowledgeable about potential victims, while lawyers are most knowledgeable about related laws.

There is a general consensus among respondents that increased knowledge among stakeholders will help reduce burns/acid violence.

Respondents expressed that while medical support is generally being provided by the government, NGOs are playing the key role in community based awareness, counseling, self-confidence and self-esteem building, financing support to victims and skill training.

Potential Survivors are able to identify a few NGOs providing help, namely, BVS-N, Fatima Foundation, Saathi and Aasaman.

37

2.3 Community Leaders

Demographic Profile Majority of Community Leaders participating in the survey are from Kathmandu (47%) and Banke (24%) districts.

Age A total of 66 respondents participated in the Community Leaders category. The mean age of respondents is 39 years. Ethnicity Hill Brahman (32%), Terai/Madhesi Other Castes (21%) and Hill Chhetri (15%) comprise the major respondents in this sample group. Religion Majority (89%) of respondents practice Hinduism, followed by Islam (9%) and Buddhism (1%). Language Nepali is spoken by 58 percent of respondents, followed by Maithili (23%), Awadhi (12%) and Newari (5%). One percent each spoke Tamang and Magar, respectively. Marital status 79 percent of respondents were married; the remaining 21 percent was unmarried.

Educational status Most (95%) respondents had attended school. Amongst these 65 percent had passed 10+2 and above. Others had attained class 9-SLC (27%), class 6-8 ((6%) and class 1-5 (2%). Some 14 percent of respondents had also attended NFE classes. 5 percent were illiterate.

Occupation of Community Leaders

Interviewed community leaders were mostly social workers (36%), political leaders (15%), and health workers (9%). Others included teachers, housewives, respected community members, etc.

Perceptions on discriminated groups Community leaders identified economically dependent women (45%) as the most discriminated in being denied their rights. They are followed by widows (44%), and married women (41%). Others identified by a majority were women from male dominated families (30%), and women from poor economic background (32%).

Banke24%

Kathmandu/Bhaktapur/Lalitpu

r47%

Dhanusha14%

Kavre3%

Mahottari11%

Udaypur1%

Chart 33: Community Leaders' district of residence

Hill Brahman

32%

Hill Chhetri

15%

Tarai/Madhesi

Brahman/Chhetri

1%

Hill Dalit2%

Hill/Mountain Janajati

6%

Tarai/Madhesi Other

Castes21%

Newar9%

Muslim9%

Tarai/Madhesi Dalit

5%

Chart 34: Community Leaders, by ethnicity type

Social worker

35%

Political leader14%

Religious leader

2%

Health worker

9%

Business person

3%

Others (housew

ives, teachers, respect…

Chart 35 : Occupationof Community Leaders

38

Causes and consequences of burns/acid violence Factors giving rise to burns/acid violence As in other sample groups, Community Leaders claimed dowry related disputes (74%) as a leading cause, followed by illiteracy (42%), relation based disputes (32%), property disputes and accusations of witchcraft (27% each), the need to bear a child (26%) and extra-marital affairs of the husband (24%). Knowledge of burns/acid incidence in their districts/communities (Pre-project period and current period) When asked if community leaders had seen/heard of burns/acid violence, 76 percent had heard of it; 24 percent had not heard of such incidents. But only 39 percent acknowledged hearing of it in their own communities and districts. Of those who had heard of such incidences 12 percent spoke of incidents that occurred in 2012, 20 percent of 2013, and the remaining 58 percent of identified 2014. The remaining 10 percent were unable to indicate the date.

Method of burns/acid violence

Some 81 percent identified the incident occurred through dousing with kerosene, followed by

the victim being pushed into fire and having acid thrown at (8% each respectively).

Cause of burns/acid violence

Relation based disputes (58%) is identified as the major cause for the burns/acid violence community leaders had seen or heard of, followed by dowry (54%), and illiteracy (33%). The need to bear a male child and accusations of witchcraft, as well as financial problems, desire to marry another woman, and sexual violence are also identified. Perpetrators of burns/acid violence Community leaders identified the husband (56%) as the main perpetrators of violence, followed by mother-in-law (48%) and father-in-law (40%). The victim herself was identified by 20 percent, while sister-in-law and bother-

0% 10% 20% 30% 40% 50%

Young girls

Married women

Women from nuclear families

Women from families where…

Women from families whre…

Women from particula…

Women from medium…

Single mothers

Others

23%44%

41%45%

11%15%

30%15%

5%18%

11%32%

6%3%

23%14%

3%

Chart 36 : Most discriminated women/girls, as identified by Community Leaders

0% 20% 40% 60% 80%


Extra-marital affairs of…


Rejection of man/boy

Dowry

Property disputes

Accusations of witchcraft

Illiteracy

Financial problems

Desire to marry…

Sexual violence

Others

32%

24%

26%

11%

74%

27%

27%

42%

14%

9%

18%

5%

Chart 37: Factors giving rise to burns/acid violence, as perceived

by community leaders

0% 20% 40% 60%



Property disputes

Illiteracy

Desire to marry…

Others please specify

58%

25%

13%

54%

25%

12%

33%

4%

4%

4%

8%

8%

Chart 38: Cause behing burns/acid violence

39

in-law were identified by 16 percent each respectively. The brother (8%), and the father, mother and others (1%) each respectively have also been identified. Support to burns/acid violence survivors (Pre-project period and current period) Most (92%) community leaders claimed the victims were supported within 24 hours of the incidence, while 8 percent responded negatively. According to one respondent the victim was

rescued after 1 week’s time.

The main stakeholders involved in rescue were the husband (7), mother/father (5),

brother/sister-in-law (husband’s side) (2), father/mother-in-laws (2), brother (2), and sister (1).

They mostly helped by extinguishing the fire and taking the victim to the hospital.

Consequence of burns/acid violence

According to Community Leaders

physical disfigurement (80%), emotional

trauma (44%), low confidence level

(41%), psychological trauma (39%) are

some key consequences of burns/acid

violence.

Community Leaders were of the view

family members (64%) and police (50%)

can play the major role in reducing stigma

and discrimination against victims. These

are followed by community people, peers

and media (25% each), respectively.

0% 10% 20% 30% 40% 50% 60% 70%

CBOs

Community people

Family members

Human Rigths Activits

Media

Peers

Self

No Response

8%8%

23%5%

64%26%

9%15%

23%20%

23%50%

5%20%

11%

Chart 40: Key stakeholders identified for reducing stigma/discrimination related to burns/acid violence

0% 20% 40% 60% 80%

Physical disfigurement

Psychological trauma

Long periods of physiotherapy

Family disputes

Social stigmatization

Dependency on family…

Inability to face society

Inability to speak in public

Divorce

80%44%

39%24%

14%11%

18%14%

21%29%

2%29%

21%41%

6%9%9%

2%

Chart 39: Consequences of burns/acid violence

40

Knowledge, attitude and behavior and practice of stakeholders

Knowledge and Attendance of Awareness programs Asked about respondents’ knowledge and attendance of awareness programs on prevention of violence based burns/acid victimization, 53 percent respondents identified television, followed by FM radio (48%), poster/pamphlets (38%), street dramas (33%) (no information is available on whether these were BVS conducted or otherwise) and articles (32%). Some respondents indicated they had attended orientation programs (30%) also. Stakeholders who may be involved in prevention and support to burns/acid survivors Community leaders identified NGOs (64%), police (59%) and women’s groups (54%) as those who may be most involved in prevention of burns/acid violence. CBOs, journalists/media, HR Activists and health personnel are also identified by many. Police (67%), NGOs (64%) and women’s groups (41%) are identified with most potential in providing services to burns/acid violence victims. They are followed by health personnel (doctors and nurses), CBOs, journalists/media and HR Activists.

Respondents’ perception on

stakeholder knowledge,

causes and consequences

of burns/acid violence

According to community

leaders, knowledge level on causes pertaining to burns/acid violence is highest among women’s rights groups/activists (68%), followed by NGOs (51%). Respondents also indicate knowledge level of police as high (51%).

Key Findings:

Community leaders cover 9 districts, with majority being from Kathmandu (47%) and Banke (24%).

The mean age of respondents is 39 years.

Interviewed community leaders are mostly social workers (36%), political leaders (15%), and health workers (9%).

76 percent respondents had heard of burns/acid violence incidences in their communities; 81 percent indicating kerosene was the means used for the committing burns/acid violence in cases they had heard of.

Relation based disputes (58%) and dowry (54%) were major causes for violence in identified burns/acid violence incidents. The husband was the main perpetrator (56%).

80 percent respondents understand physical disfigurement as the consequence of burns/acid violence.

Community Leaders identify family members (64%) as key stakeholders capable of reducing stigma and discrimination against victims.

0% 20% 40% 60% 80%

Police

Lawyers

District Administration Office

Womens group

Community based…

NGOs


Journalists/Media

Community leaders

Health personnel (Doctors…

Others

59%

8%

8%

55%

38%

64%

27%

32%

14%

24%

2%

67%

9%

12%

41%

32%

64%

21%

30%

17%

33%

3%

Chart 41: Potential stakeholders involved/may be involved for prevention and service provision

May be/involved inproviding services

May be/involved inprevention

41

Some community leaders also indicate health personnel (14%), community leaders (12%) and journalists/media (12%) possess no knowledge at all. Table 17: Stakeholders’ knowledge on burns/acid violence, its causes and consequences

Knowledge Causes Consequences

Police

High 51% 33% 33%

Medium 41% 55% 43%

Low 6% 12% 18%

None 2% 0 6%

Health Personnel

High 50% 50% 58%

Medium 36% 30% 23%

Low 14% 18% 15%

None 0 2% 4%

Lawyers

High 41% 35% 29%

Medium 33% 36% 30%

Low 15% 17% 24%

None 11% 12% 17%

NGOs/CBOs

High 51% 47% 50%

Medium 36% 42% 29%

Low 8% 5% 6%

None 5% 6% 15%

Women's rights group/activists

High 68% 56% 54%

Medium 24% 36% 30%

Low 3% 3% 5%

None 5% 5% 11%

Journalists/Media

High 36% 32% 27%

Medium 44% 42% 26%

Low 8% 12% 26%

None 12% 14% 21%

Community Leaders

High 23% 18% 15%

Medium 41% 48% 40%

Low 24% 20% 24%

None 12% 14% 21%

Stakeholder capacity, and comfort level in handling burns/acid violence cases Categorizing skills into a scale of 4 (high, medium, low and none), Health Personnel (61%) and Women’s Rights Groups (58%) are indicated as possessing the most skill. As for their comfort level in dealing with burns/acid violence victims Health Personnel (79%), Women’s Rights Activists (75%) and NGOs (70%) are again indicated as stakeholders most comfortable in handling these cases. Community leaders (25%), police (24%) and lawyers (23%) are identified as feeling most uncomfortable. Some 41 and 26 percent respondents respectively, indicate police and lawyers ‘just get on with their jobs’. As for knowledge about potential burns/acid victimization in their

42

own community/district, respondents identified knowledge among Women’s Rights Activists

(52%) as the highest, followed by Police (46%), and NGO/CBOs (40%). Table 18: Stakeholders’ capacity and comfort in handling burns/acid violence cases, and knowledge about potential victims in their communities/districts

Police Capacity in

handling cases

Comfort level in

handling cases

Percentage Knowledge about potential

victims in own community

High 33% Comfortable 27% 46%

Medium 41% Uncomfortable 24% 41%

Low 17% Just get on with the

job

41% 7%

None 9% Don't know 8% 6%

Health Personnel




job

8% 20%


Lawyers



Low 16% Just get on with the job

26% 28%


NGOs/CBOs




job

12% 12%


Women's rights

group/activists




job

0 4%


Journalists/Media




job

29% 18%


Community Leaders



Low 21% Just get on with the job

15% 20%


Stakeholder knowledge on existing laws

Regarding stakeholder knowledge on existing laws on burns/acid violence in their respective districts, lawyers (75%), followed by police (63%) and women’s rights Activists (40%) are identified as possessing the most knowledge. Community leaders (34%), journalists/media (21%) and health personnel (20%) are identified as possessing no knowledge. Increased knowledge of stakeholders and reduction of burns/acid violence

43

There is strong indication from Community Leaders that increased knowledge level among various stakeholders will reduce risks of violence. Amongst stakeholders, the highest is indicated for journalists/media (82%), community leaders (79%), Women’s Rights Activists (75%), Health Personnel (79%), NGOs/CBOs (69%). Table 19: Stakeholders’ perception on whether increased stakeholder knowledge on burns/acid violence will reduce it

Police Health personnel

Lawyers

NGOs/ CBOs Women's Rights Groups/Activists

Journalists/Media

Community leaders

Yes 5% 75% 53% 67% 75% 79% 76%

No 0 14% 23% 17% 16% 6% 8%

Don’t know 95% 11% 24% 16% 9% 15% 16%

Interventions and stakeholders: Ongoing and proposed Knowledge on support being provided by government and non government sectors Government and NGOs are identified as providing the most support at district levels. Government is identified as the most engaged in rescue (38%), free medical support (29%), and burn treatment (35%); NGOs, on the other hand are more involved in family/community reintegration (51%), counseling (42%), free medical support (34%), and financial support (43%). Table 20: Perception on support being provided by GoN and NGOs

Re

scu

e

Fam

ily/

Co

mm

un

ity

rein

tegr

atio

n

Co

un

selin

g

Free

me

dic

al

sup

po

rt

Bu

rns

rela

ted

tre

atm

en

t

Bu

rns

rela

ted

p

last

ic

surg

ery

Fin

anci

al

sup

po

rt

Nu

trit

ion

al

sup

po

rt

Safe

/sta

ble

en

viro

nm

en

t/s

he

lter

Lega

l Su

pp

ort

Self

con

fid

en

ce

bu

ildin

g

Self

est

eem

bu

ildin

g

Co

mm

un

ity

bas

ed

awar

en

ess

p

rogr

am

Re

sear

ch

Mo

nit

ori

ng

Don't know 17% 23% 21% 12% 21% 35% 27% 26% 27% 21% 26% 26% 26% 26% 23%

GoN 38% 9% 15% 29% 35% 20% 9% 12% 18% 29% 11% 17% 8% 24% 29%

GoN/NGO 27% 15% 20% 24% 15% 23% 21% 20% 18% 18% 21% 16% 21% 17% 21%

NGO 18% 53% 44% 35% 29% 22% 43% 42% 37% 32% 42% 41% 45% 33% 27%

Services required for burns/acid survivors

Key Findings:

Television (53%) and FM radio (48%) are popular mediums to disseminate burns/acid violence information to Community Leaders.

Community Leaders identify NGOs (64%) are/may be the most engaged in prevention based activities; service provision to burns/acid violence survivors may be/are provided by police (67%) and NGOs (64%).

Women’s Rights Groups/Activists (68%) and NGOs (51%) are perceived as most knowledgeable on burns/acid violence. They are also more knowledgeable on potential victims (WRAs: 52%; NGOs: 40%).

Health personnel are identified as possessing most skill (61%) in handling such cases, and showing comfort (79%) in dealing with them; Community leaders and are identified as feeling most discomfort in handling burns/acid violence cases (24% each).

There is general consensus that increased knowledge among all identified stakeholders on burns/acid violence will reduce victimization.

44

Community leaders highlight medical and economic support as primary needs for burns/acid

violence survivors. The need for providing skill training and ensuring job placement is also

highlighted, along with community based awareness programs.

Interventions required at family /community level for preventing and tackling burns/acid violence Most community leaders indicate community based awareness programs (50%), followed by National Campaigns (48%) as the most required interventions. These are followed by women’s group mobilization (47%), training to health service providers (47%) and prevention based awareness programs (47%). Reintegration programs (38%) and skill development training (36%) are also those identified by more respondents.

Potential key stakeholders for

ending burns/acid violence

Community leaders believe

family (62%) can play a major

role in ending burns/acid

violence.

Male members (47%) of the

society, and social and

community leaders (39%) are

also indicated, amongst others.

Knowledge of organizations and groups working on burns/acid violence prevention

Most Community Leaders were ignorant of organizations and groups working on prevention of burns/acid violence. Only 20 percent respondents confirmed knowledge of organizations working to end burns/acid violence in their district; but they were unable to identify organizations. Only 11 percent indicated BVS-Nepal, followed by Saathi (8%), and Aasman Nepal (1%).

0% 20% 40% 60% 80%

Community based awareness…

IEC/BCC programs

Shelter/Homes

Medical support

Plastic surgery

.Income generating programs

Self-esteem building training

Rehabilitation programs

53%38%

12%44%

21%77%

79%33%33%

54%44%

53%18%

26%23%

6%

Chart 42: Identified multi sectoral services required for burns/acid survivors

0% 10% 20% 30% 40% 50%

National campaign

Research

Inclusion of subject…

Training to health service…

IEC/BCC programs

Shelter/Homes

Income generating…

Self esteem/confidence…

Community based…

48%27%

39%50%

30%47%47%47%

26%30%

8%36%

11%27%

23%38%

15%

Chart 43: Required interventions for prevention and tackling of burns/acid

violence

0% 10% 20% 30% 40% 50% 60% 70%

District Administration Office

Father

Government line agencies

Husband

Male members of society

NGO workers

Political leaders

Social and community leaders

Women and Child Development Office

11%62%

20%29%

21%18%

12%17%

47%12%

36%27%

26%17%

39%33%

14%

Chart 44: Key stakeholders identified for eliminating burns/acid violence

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Some 8 percent indicated association with such organizations, with 3 percent indicating association with BVS-N, and 1 percent each with KYC, Saathi, WOREC, CASA Nepal, and women’s group. Amongst the 10 respondents indicating such associations, activities undertaken by such groups were highlighted as youth awareness, training on VAW and counseling, support to survivors, awareness programs, raising voice for women’s rights, street dramas, anti human trafficking programs, etc.

Key Findings:

Government is identified as the most engaged in rescue (38%) and burn treatment (35%); NGOs, on the other hand are more involved in family/community reintegration (51%) and counseling (44%).

Medical (79%) and economic support (77%) are identified as key support required for burns/acid survivors.

Community leaders highlight the need for community based awareness programs (50%) and national campaigns (49%) to create change at community and family levels.

They identify family (62%) and male members of society as critical stakeholders in realizing changes.

Only 20 percent respondents possessed knowledge of organizations working in their districts/communities to address burns/acid violence.

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Chapter 3: Analysis and Discussion This chapter analyses findings, outlined in Chapter 2, as per baseline survey objectives. Findings from the three sample groups are compiled within each objective, and validated by FGD and KII information to reach conclusions.

Objective 1: To determine the number of burn and acid violence victims in target districts from 16 December 2010 to 16 October 2013 A total of 61 burns/acid violence victims were identified from the 3 districts during the specified timeframe. However, only 34 respondents participated in the survey. Since a large number of victims were identified through hospitals and NGOs during the data collection period, factors such as non availability of contact numbers, change of location, desire for invisibility by victims and their families, non-systemic data management, and inadequate follow up system were challenges faced in identifying burns/acid violence victims. Moreover, many victims and families may not have disclosed the crimes owing to the need to avoid police involvement, or protection of perpetrators, children or family name. Such concerns are validated by FGDs and KII, particularly by hospital nurses, who claim victims are unwilling to disclose the true nature of the incident despite repeated queries. Looking into characteristics of burns/acid victims, women from the terai belt of country, especially Banke (29%), Sunsari (29%), Dhanusha (27%), Mahottari (12%) and Kapilbastu (3%) districts are more vulnerable to burns/acid violence. Illiterate and/or semi-literate women, particularly from Terai/Madhesi Other Caste (26%), Hill Chhetri (23%), Terai/ Madhesi Dalit (18%), Terai/Madhesi Brahmin/Chhetri (9%) and Hill/Mountain Janajati (6%) are more susceptible to victimization. Dowry system (44%) is the primary cause of burns/acid violence. This is followed by accusations of witchcraft, extra-marital affairs of husband, and need to bear male child (15% each). Perpetrators are also mostly the husband (56%) and the father-in-law/mother-in-law (18% each). Acts of violence are generally committed by dousing victims with kerosene and setting on fire (67%); acid throwing though comparatively marginal is also prevalent (12%). Findings from all three sample groups, validated by FGDs and KIIs, underline physical disfigurement (85%), as well as emotional (44%), and psychological trauma, inability to obtain employment (35%), low confidence level amongst victims (32% each) as major consequences of burns/acid violence acts.

Objective 2: To assess the knowledge, attitude, practice and behavior (KAPB) of burn/acid violence victims and potential victims, with specific focus on existing physical, psychological, social and economic conditions, and confidence level within and outside the household

47

Knowledge and perceptions: Burns/acid violence survivors identify married women (59%), followed by widows and economically dependent women (38% each) as the most discriminated in obtaining their rights in their districts and communities. Comparatively, potential victims indicate economically dependent women (45%), married women and women from poor economic backgrounds (39%) as the most discriminated in their districts and communities. Looking into survivors’ perceptions on major causes of burns/acid victimization, dowry leads the way (73%) followed by accusations of witchcraft and the need to bear male children (47% each). Potential survivors also indicate dowry (56%) as a major cause for burns/acid violence against women and girls. Other perceptions veer towards illiteracy (41%) and relation based disputes (38%). Dowry as a primary cause of burn/acid violence is reinforced by all 12 FGD findings as well. Physical conditions: Survivors identify physical disfigurement (85%) as the major consequence of burns/acid violence; Attached is the psychological and emotional trauma that impact confidence and self-esteem of victims. Long periods of physiotherapy, family disputes and economic burden are also underscored by victims (Chart 12). Similar views are expressed by potential survivors – based on knowledge of cases they’ve heard of or seen. Physical disfigurement are identified by majority (71%), followed by social stigma (35%) and inability to obtain employment (35%) (Chart 28). At personal level, victims’ constant fear, low self-esteem and confidence due to physical disfigurement and discrimination continuously challenge individual ability to come out of the consequences of the incidences. Inability to access justice further reinforces their fear. Information from KIIs highlight the limited capacity to address social and psychological needs of burns/acid survivors. Inadequacy of burns related beds, necessary human resources, and equipment, and counseling experts are detrimental to effective social and behavioral change among survivors. Moreover, FGDs with women’s groups reflect society as ‘not always supportive’ towards burns/acid violence survivors. Economic and social conditions: Poor economic condition is notably a common denominator – both as a cause and consequence, starting from denial of girls and women’s rights, unending demands for dowry from the girl’s family, and the consequences which economically impact both victim and her family. Burns/Acid survivors and their families who claimed income adequacy during the time of incidence are now claiming otherwise; Survivor and families who claimed income insufficiency are now in worse conditions (Table 3). A behavior pattern noted among survivors is burn/acid violence pushes victims to change households – many move from their husband or father-in-law/mother-in-law’s house to their parent’s house. Subsequently, a shift in household head - with a decline in husbands as household heads is noted. Currently 35 percent identified their father, compared to 62 percent who identified their husband at the time of the incident (Chart 5). Victimization is also noted to impact the family with whom victims live with, as family disputes (potential survivors: 20%; survivors: 26%) spurred on by impacts of victimization, added economic and social burden, victims’ trauma and social perceptions strain family relations and weigh down the family economically.

48

Confidence Level: Burns/acid violence leads to demoralization and low-confidence level of victims (32%). This is further compounded by social stigmatization confronting them (32%). The number of victims receiving skills and support for realizing personal changes remains low (29%). But it is notable that 38 percent of those receiving support claimed increase in confidence and self-sufficiency.

Objective 3: To assess the KAPB of community members and leaders on causes and consequences of burn/acid violence Knowledge and perceptions: Some 76 percent Community Leaders - mostly comprising of social workers (36%), political leaders (15%), and health workers (9%) - had heard of burns/acid violence incidences in their communities. Majority (81%) identified kerosene as the means used for the committing violence. Looking into causes for such violence, Community Leaders identify relation-based disputes (58%) and dowry (54%) as major causes for violence in identified incidents (Chart 40), with the husband as the main perpetrator (56%). As with survivors and potential survivors, community leaders also identify physical disfigurement (80%) as the major consequence of burns/acid violence (Chart 39). Community Leaders identify NGOs as the most engaged in prevention based activities (64%) and service provision (64%) to burns/acid violence survivors. They perceive Women’s Rights Groups/Activists (68%) and NGOs/CBOs (51%) as most knowledgeable on burns/acid violence and on potential burns/acid violence victims (52%). On the other hand, community leaders (12%) and journalists/media (12%) are indicated as possessing ‘no knowledge’ on burns/acid violence. Health personnel are identified as possessing most skill (61%) in handling such cases, and showing comfort (79%) in dealing with them (Table 18). Attitude, practice and behavior: Findings indicate television shows (53%) and FM radio (48%) as popular mediums through which community leaders learn of burns/acid violence information. Community leaders identify themselves as ‘feeling discomfort’ in handling burns/acid violence cases (24%), or the tendency to ‘just get on with the job’ (15%). These perceptions are reinforced by majority of survivors who identify community leaders’ knowledge on burns/acid violence (medium: 32%) and an attitude of ‘just getting on with job’ when handling burns/acid survivors cases (20%) (Table 10). Moreover, Community Leaders attitude towards survivors is indicated as indifferent (44%) (Table 9) by the latter, and are identified by survivors as some of the least involved stakeholders in prevention and service to survivors (Chart 15). Survivors’ response further highlight the need for Community Leaders to possess improved communication skills (50%) and positive attitude towards burns/acid violence survivors (37%) (Table 11). Looking at various stakeholders, Potential Survivors identify Community Leaders as possessing least knowledge on potential burn/acid violence survivors (56%) (Table 13), and limited knowledge on burns/acid violence, its causes and consequences, and the skill and comfort in handling such cases (Table 12). Their lack of knowledge on legal matters is also identified as highest among all stakeholders (68%) (Table 14).

49

Objective 4: Identify services being provided by government and non government agencies and their effectiveness Findings indicate government and non government agencies as involved in providing various services to burns/acid survivors. Involvement of various agencies is noted from rescue period onwards wherein NGOs/CBOs, Human Rights Activists, community members help take the victim to the hospital and police for case registration. With regards to medical services 94 percent survivors identified need for immediate medical services as fulfilled. Intensive medical care, food and shelter are also fulfilled to some extent; disparity is more evident in psycho-social counseling (requirement vs. received: 78% vs. 33%), safe and stable environment (requirement vs. received: 100% vs. 33%); and access to justice (requirement vs. received: 100% vs. received 29%). Potential Burns/Acid Violence Survivors also identify police (25%) and NGOs (7%) as engaged during rescue. NGOs (64%) and police (54%) are identified as involved in preventions of and service provision (NGOs: 69%; police: 41%) to survivors. Government and private hospitals are providing immediate and long medical service to survivors. Among community members, aside from family members police (50%), NGOs (20%), DAO (5%), and women’s groups (20%) are playing key roles in preventing/reducing discrimination and stigma pertaining to burns/acid violence. In all these services government and NGOs are both involved; however NGOs are identified as the most involved in prevention (75%) and protection (63%) of burns/acid violence. But the quality of these services and government and NGOs capacities must be closely looked into as only 29 percent survivors claimed health improvement. Some 71 percent indicated ‘no improvement’, primarily due to not receiving timely support and nutritious diet. KIIs indicate that inability to come for regular physiotherapy, laxity by survivors and their family members, inadequate nutrition provision by family, and lack of follow up are some factors that need close investigation and monitoring for better understanding the quality of services. In hospitals nurses generally serve as counselors, with or without training, due to the long hours they spend with survivors. But KIIs underscore the need for burns specific counselors to address the trauma and lack of self-confidence, self-esteem and stigmatization that overwhelm survivors. Nevertheless it is notable that of the total survivors interviewed 38 percent claimed feeling more confident and self-sufficient due to services they had received. Amongst these 85 percent identified ‘feel confident going outside home’, followed by 61 percent claiming ability to interact with friends. They even feel ‘confident to go seek employment’, and are ‘no longer depressed’. They were ‘able to participate in public fora’, ‘travel on their own’, and ‘able to share personal story with other survivors’ (Chart 13). On the legal front only 26 percent respondents claimed obtaining knowledge pertaining to their legal rights after the incidence. Very little effort towards addressing their access to justice is noted by this baseline survey. Objective 5: Identify and recommend multi-sectoral support services (socio-economic, psychological, emotional, legal, counseling, media, etc.) required for acid/burn violence victims and potential victims

“Most burns/acid patients have not received their rights; they are not aware of it and remain neglected….Burns is not even receiving 10% of what is being spent on HIV/AIDS.”

Doctor, Government Hospital

50

Findings from the three sample groups indicate the need for increased multi-sectoral support for burns/acid survivors. FGDs from three districts - with male, female, youth (male and female) groups - indicate basic awareness on causes and consequences. Yet they possess limited knowledge and skills to prevent and protect girls and women from such violence. KIIs with hospital doctors and nurse, police, WCO and rehabilitation centers and NGOs reflect more intensive and collaborative multi-sectoral approaches as essential – simultaneously addressing preventive as well as curative aspects. Moreover, considering the lengthy and expensive nature of burns/acid violence and its repercussions on victims, family and society services from one sector alone will prove inadequate. Based on their personal experiences, burns/acid violence survivors identify their primary need as medical (68%), financial (65%) and physiotherapy services (44%). Other needs such as physiotherapy, door-to-door programs, community based awareness programs and job placement, plastic surgery, shelter homes (Chart 17) are identified for prevention, protection and rehabilitation. Potential Survivors on the other hand identify economic support (70%), skill development training (62%), job placement (59%), medical support (50%) and community based awareness programs (39%) as key areas (Chart 31). Community Leaders also identify medical (79%) and economic (77%) as primary amongst multi-sectoral needs of survivors (Chart 42).

“Our hospital also provides free treatment facility to patients; but it is not always possible as burns treatment is very expensive”.

Doctor, Private Hospital

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Chapter 4: Recommendations Based on results from survey respondents, FGDs and KIIs the following long and short term strategies and programs are identified. These target Burns/Acid Violence Survivors, Potential Victims and other stakeholders. Some may be adopted by BVS-N within the project period, while others may be undertaken as a long-term approach.

Prevention and protection based strategy and programs

Strategy 1: Findings reveal burns/acid violence against girls and women as more prevalent in the terai belt bordering India, where dowry system is highly prevalent. A transformational approach is suggested to address dowry system. It is essential BVS-N collaborate with government and other NGOs – national and local – to address this pervasive cause of burns/acid violence against girls and women. To this end, a national campaign against all forms of dowry and dowry based violence is suggested to be adopted. Some suggested programs and activities are:

National campaign led by the government, with support of BVS-N. This will include mass awareness raising and behavior change campaigns.

Dowry system is culturally inter-linked. It is recommended that linkages are established with Community Leaders and Faith Leaders to facilitate behavior and practices based transformational process.

Engagement of men and youth (women and men) as catalyst to bring about change processes.

Orientation to and engagement of Community Leaders in prevention and protection measures. Currently, findings indicate them as some of the least knowledgeable when in fact they can play critical roles in behavioral and attitudinal changes at community level.

FM and TV programs and street dramas regularly targeting the high-risk areas.

Strategy 2: Baseline Survey findings indicate higher vulnerability and risk among particular ethnic and religious groups, and lower income level families. BVS-N is recommended to strategically reach out to these groups through specifically designed prevention based activities. Child marriage and illiteracy that compound their vulnerabilities must be addressed within this strategic approach. Suggested activities are:

Use of social media to reach out to diverse age and gender groups.

Orientations to youth of target groups.

IEC material specifically targeting vulnerable groups and relevant community members, especially those in decision-making and power positions such as Community Leaders, Health Service providers, Faith based leaders, teachers, etc.

Initiation of Hotline facilities and Information centres, which will also house information on available medical, counseling and rehabilitation services.

Strategy 3: Social transformation and change in mindsets demand evidence. Currently, as evidenced during data collection processes there is limited consolidated data on the prevalence of burns/acid violence at national or district levels. An Action Research undertaking is recommended whereby systemic data management system will also be addressed. Suggested activities:

Collaboration with government and non-government mechanisms – police, hospitals, NGOs, CBOs, etc.

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Establishment of National Data Management System

Research to be undertaken

Protection and rehabilitation based strategy and programs

Strategy 4: Coordination and collaboration with networks against domestic violence, women’s rights, and government and NGOs bodies to facilitate and speed prevention and rehabilitation processes. At present most stakeholders are engaged in isolated programs and activities, with limited knowledge of each others’ skills and capacities. Robust coordination and networking would enhance outreach and support to victims and their families. These should be maintained at national as well as district levels. Suggested activities:

A directory of all relevant organizations working in the sector.

Establishment of referral mechanism between police, hospitals, shelter homes, CBOs, counseling bodies, groups of former survivors, drop-in centres, skill training centers, etc.

Networks to work as pressure groups at national and district levels to prosecute perpetrators, and enhance survivors’ access to justice.

Highlight successful cases of victims’ as Role Models to encourage others to register cases and access justice.

Regular awareness and capacity building training to NGOs, community members; Technical support in the form of counselors, nutritionists, etc. at district and national level hospitals and support centres.

Media mobilization to engage and highlight media role in prevention, protection and rehabilitation processes of a burns/acid survivor.

Strategy 5: Recovery from burns/acid violence is a lengthy and highly expensive medical process. Currently there is limited resources - human, infrastructure and equipment – in terms of immediate and long term recovery and rehabilitation. It is challenging for any one institution to attempt to address all of a victim’s needs. Subsequently, the following are recommended:

Policy level lobbying to set aside emergency fund for victims of burns/acid throwing violence, at national and district levels. Specific focus to be laid on the highly prone districts.

At national and district levels, collaborate with government and non government agencies for annual programs to address short term and long term medical, economic sustenance and confidence building needs of burns/acid violence survivors.

Training and provision of trained counselors to address burns/acid victims needs at hospitals.

Linkage building with private sector organizations for facilitating job placements; lobbying with bi-and multi-lateral organizations and INGOs to support economic empowerment, nutritional support packages, long term rehabilitation, awareness to key stakeholders, etc.

Rehabilitation and reintegration based strategy and programs

Strategy 6: Findings indicate that even survivors who have recovered, or are in the process of doing face challenges in family and community rehabilitation and reintegration. Social stigma and ostracization due to physical disfigurements, constant fear and feeling of threat, low self-confidence and increased family disputes work as potential barriers. Some recommendations to address these concerns are:

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Working with Community Leaders and other stakeholders to create behavioral change for acceptance of burns/acid survivors.

Provision of skill training and seed fund to survivors for entrepreneurship establishment, and economic empowerment.

Identification of opportunities for job placement through linkage building with private sector.

In Potential Survivors cases, working with perpetrators to prevent burns/acid violence cases, by highlighting the social and economic consequences at individual, family and community levels.

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