A woman receives treatment for burns. Photograph: Ivan Flores

The self-immolation cases seen at the country’s only burns unit are a symptom of a bigger problem in the country, where violence against women is rife

Her incessant screams echoed in the dimly-lit hallways of the hospital – long, hard and full of pain. “Oh God, please let me die!” she gasped, pausing briefly between wails. The nurses dutifully administered shots of morphine, and applied antiseptic on her wounds. Aisha*, 19, had been brought in with 70% burns to her hands, legs and torso, allegedly in a domestic gas explosion from two weeks ago that her aunt said was accidental.

“We do not believe it was an accident. Based on our experience and the nature of her burns, this is an attempted suicide,” Zahidullah Zia, the head nurse at Afghanistan’s first and only burns unit, said.

“But she has everything; there is no reason for her to kill herself,” her 55-year-old aunt insisted, as she stood next to Aisha. No other family member, not even Aisha’s husband had come to visit her in the 12 days that she lay writhing in pain in her hospital bed.

The 35-bed unit Aisha is in could be easily missed in the vast sprawling campus of the state-run hospital in Herat province, but it is the only dedicated space in the country for women like her who have gone to drastic lengths to escape forced marriages and domestic abuse. Set up in 2007 with the aid of the US government and a French charity, it’s based in Herat because self-immolation rates are higher here and in western Afghanistan than any other part of the country.

Nurse Zia has grown used to recognising the patterns that help him identify cases of self-immolation: the burns of women injured in gas explosions are different, often times there are wounds apart from burns; also, women in accident cases are nearly always accompanied by their husbands.

“Survival rates in such cases are very low,” he adds, as the team describe the case of the woman we’d originally travelled here to meet, but who passed away the night before.

“Her family told us her name was Habiba*, but later when she could muster the strength to talk, she told us her real name and confessed she had tried to kill herself, contrary to what her family claimed,” Dr Hasina Ersad, who was on duty the evening she was brought in, said. Habiba had suffered third degree burns to 85% of her body.

Amidst cries of pain, Habiba blamed her family for her fate, who had forced her into a marriage with a man who treated her badly. He had a record of criminal convictions and while he was in jail, his family would beat her. “She told me that she tried to seek help, and had even registered a complaint with the local police against her brother-in-law who often beat her too, but no action was taken against them,” Ersad explained.

The need for a burns unit where women are the majority of patients is a symptom of a bigger problem in Afghanistan, where violence against women in rife. Around 87% of Afghan women are believed to have experienced domestic abuse at least once.

Women are also admitted to the Herat unit who have been burnt by a family member. Fifty-year-old Laila* from Ghor province was set on fire by her husband. “I was sleeping, after a fight where he accused me of being disloyal, when he poured kerosene over me and set me on fire; I woke up with this intense sensation of pain.”

Laila, 50, is married and has five children. Her husband set her on fire using kerosene while she was sleeping Photograph: Ivan Flores

Her brother-in-law poured water on her as she wailed in agony. Even though they managed to put the fire out, Laila had suffered severe burns on the lower half of her body.

“They didn’t even take her to a hospital,” her brother added. “When I got to her place she was in a very bad state. I took her to a local clinic; they kept her for 20 days but her wounds weren’t healing,” he said, describing how he then reached out to the governor of the province for a referral to the burns unit.

“We are very poor. But I am going to pursue a legal case against him and his family who have treated me very badly,” added Laila, who after two months of treatment, is on her way to recovery, and has no intention of returning to her husband.

The staff at the unit have seen it all. “The women of Afghanistan are treated worse than animals. This is the only reason I chose to work in this ward; I want to help these women,” Ersad told us, choking back tears.

The cases of self-immolation at the hospital are far fewer than when they started the unit in 2008, adds Dr Shirzad, describing how cases have dropped by 40% – so far they’ve only had nine cases this year.

But these falling numbers aren’t seen as a positive development. “Domestic violence in Afghanistan is still very, very high; as are the cases of suicide among women facing abuse,” Dr Hadi Rasooli, a practicing psychiatrist from Herat, said. “Women are still killing themselves, they’re just doing it differently.”

There are no official figures available on suicide, but the topic was openly discussed at a group therapy session conducted by the psychological health unit at the same hospital. At least two of the 16 women attending the session admitted to having attempted suicide to escape domestic violence.

One of them, 28-year-old Farah*, agreed to speak to us, much to the displeasure of her husband who accompanied her.

As we waited for Farah in the office, a doctor explained her situation. Farah has been married for 17 years, a forced child marriage at the age of 11, to a man several times older than her. Whenever Farah refused to have sex with her husband it was seen not only as defiance, but also a sign of disloyalty – and she’d be beaten by her husband and his family for insubordination.

Farah was calm and composed when she arrived, lifting her sleeves to show us her scars from a few weeks earlier when she has tried to slit her wrists. “I got very depressed; things at home were not very good,” she explained.

“I was married too young so it was difficult for me to understand about being a wife,” she said. “But when it reaches a point and I can’t take it any more, I threaten to kill myself. He then apologises.”

While for Habiba, suicide was a desperate attempt to escape from her abusers, for Farah it is a dangerous gamble to try to gain control of her situation. Because walking out of a bad marriage is not an option for most women in Afghanistan.

Divorces in the country are not only rare, but looked upon unfavourably, especially if it’s a woman seeking it. Few women, like Laila, find support within their close families if they choose to leave their husband, despite the atrocities they’ve suffered.

At the time of writing, Aisha has been through one operation and continues to fight for her life. Nurse Zia is hopeful that she might possibly make it through and recover. However, for Aisha, even if she does make a physical recovery, the battles are only just beginning.

*Names have been changed.