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Heartbreak in Helmand: U.S. medics treating children with suspicious burns

NAWA, Afghanistan -- The baby’s name was Norzai, her father said, after pausing to remember.

The reason he’d brought her to the Marine base medical clinic was her feet, he said. They weren’t healing.

Not yet 3, her hair an orange hue possibly indicating malnutrition, she lay on the examining cot in a fuzzy pink top and a black bracelet and cried.

Lt. Colin McCormack, the Navy doctor who runs the clinic at Patrol Base Jaker, looked closely under the big light at the girl’s tiny, ruined feet. Third-degree burns on both soles glowed bright red. All 10 toes were gone.

“What happened?” McCormack asked through an interpreter.

“She just dropped into the cooking fire,” her father replied. It had happened three months ago, he said, and he’d sought medical help then. She’d been in a hospital for two weeks in Lashkar Gah, he said. Then they sent her home, and her toes fell off.

There was no sign of infection, McCormack said, and so there was little more that could be done for the child than to clean her feet, apply a thick coating of antibiotic cream, bandage her up and hand her back to her father.

But McCormack and his medics weren’t happy about it.

“Once again, the mechanism of injury and the explanation doesn’t make sense,” the doctor said. “I suspect something else happened.”

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He noted that the burn went all the way around one ankle, like a sock — a “circumferential” burn strongly indicating someone had held her leg in boiling liquid and that the child had not been able to recoil from the pain.

“More likely than not,” McCormack said, “this was punishment.”

According to a 2009 U.S. State Department human rights report on Afghanistan, child abuse is “endemic” in the country, based on “cultural beliefs about child-rearing.”

“In extreme examples of child abuse,” the report said, “observers reported several instances of deliberately burned children in Paktia; the children sustained burns after their parents submerged them in boiling water.”

In the space of just three months, McCormack and his medics have treated a dozen Afghan children under 5 suffering from burns that they suspect were caused intentionally, by scalding.

“It’s a disturbing thing to see a 3- to 5-year-old that’s been abused,” McCormack said. “It’s heartbreaking.”

“I despise these people,” said a medic who declined to be named.

Local officials of this rural Helmand province town, where households typically consist of nine people — Norzai was one of nine children — said they’d never heard of such a thing. But children do accidentally fall into pots of cooking liquids or fires, they said.

Both the district governor and the district administrator also said that some parents punish their children harshly.

“The reason is that they’re uneducated,” said district governor Abdul Manaf, through an interpreter. “They don’t know how to raise their children.”

Before he deployed, McCormack was informed by the previous Jaker medical unit that they had seen a number of cases in which the stories of what happened did not match the actual burns.

McCormack brushed up on burn care--and forensics, too. Most cases of intentional scalding involve an arm or leg, he learned.

“A clear line between the burned skin and the unburned skin — that clues you in,” he said. By contrast, an exploding stove or kettle, or falling into a fire, would leave an uneven pattern, he said.

According to the medics, most of these cases are brought to the Jaker clinic at least a week after the burns are sustained, sometimes by a professed uncle or an older brother pushing a wounded toddler in a wheelbarrow.

Some of the stories are absurd, they said.

“My personal favorite was that a 2-year-old tried to drink hot water,” one medic said. In that case, the boy had severe burns on his buttocks, genitals and the backs of his legs, as though he’d been picked up and dipped bottom first into scalding liquid.

Child abuse by scalding is not unknown in the United States, although it’s relatively rare. According to the 1993 National Incidence Study study by researchers at Baylor and the University of Texas, burns accounted for 9 to 10 percent of physical abuse cases of children. From 1986 to 1992, the Shriners Burn Institute in Cincinnati counted 52 children admitted for burn and scalding abuse injuries.

But in the U.S., law enforcement and child protective services usually get involved, and children are removed from abusive parents.

Marines have no authority to detain Afghans not suspected of threatening or harming coalition forces. But both the base civil affairs and rule of law officers said they’d bring the matter of child abuse up with local authorities.

montgomeryn@estripes.osd.mil

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