In the Land of Invisible Women

by Qanta Ahmed

  I learned from a quick call to the emergency room that the child indeed had been a victim of strangulation. The nine-year-old Saudi boy had been found hanging from a noose in a bathroom at his family home. Discovering the curtains to the shower closed but no water flowing, his siblings had stumbled across the child suspended from the shower head. A thin noose of plastic cord was tightening around his neck. They managed to cut him down at once and rush him to the emergency room in the back of the family car. His fourteen-year-old brother had driven him here. In the emergency room he was ashen and barely breathing. With difficulty he was placed on the respirator, the doctor struggling with a tiny tube to gain entry beyond the vocal cords swollen and engorged by the strangulation. Had his family been any later, he would have been dead at the scene. As I surveyed his frail body, I wondered if indeed he had been lucky to survive, after all.

  Deeply distressed, the nurses were whispering soothing words to the unconscious child, examining his body for bruises and cuts. We found some nondescript marks on his flank that could have been there from the tiled wall in the shower. No parents came to see him in the unit as long as he was admitted to us. I ordered some high-dose steroids and inhalational treatments to improve his breathing. Conferring with another colleague, we made careful adjustments to the ventilator so it would breathe for the tiny, sparrow-like boy.

  “I guarantee it.” Nurse Mama Mary was agitated. Her steel eyes flashed. “This child is a victim of abuse. Either he was trying to end his life to escape a horrible fate or his abuser was worried he would squeal and wanted to silence him forever. Those kids bringing him in, they were brave. But we're never going to know. Mark my words. We never do find out. This isn't the first child who has come in like this.” I looked at her, unable to conceal my shock. “Please, Dr. Qanta, when you have been here as long as I have, you get to see a lot of things. It's a disgrace.” She bustled off to finish her tasks, grumbling her anger all the way.

  I stared at the unconscious child for a long time, knowing his secret pains, the ones I couldn't see, would remain insoluble. His spirit was desolate and abandoned. I could feel a void of sadness emanating from his malnourished frame. Even sedation couldn't obliterate the horrors his short years had brought him.

  A couple of days later, we inspected his vocal cords with a fiberoptic camera. The swelling was much better; the steroids appeared to have worked. Slowly we decreased the sedative medications and the child began to breathe independently of the machine. At last, we were able to remove him from the respirator. He was weakened, but alive. Most importantly, and to our surprise, he survived without any damage to his brain. After a period of careful observation, he was returned to the pediatric ward service, and shortly thereafter, sent back to the home in which he had been hung.

  There was no investigation or recourse. Social services were limited at the time, and what comes from families remains in families for the most part. No children's homes existed, no basis existed to cast suspicion on his parents. We could never prove his abuse, merely powerlessly know that he was likely to face the same abuses in the future.

  I spoke to David. As an emergency room attending for at least a dozen years in the Kingdom, he was very familiar with my patient's case and began to share another story of his own.

  “Oh Qanta, it is heartbreaking. We do see these children from time to time, often enough that one is not surprised by it. I guess it's like any other society. We saw abuse in North America. Why wouldn't we see it here? Families have the same sicknesses wherever you go. In some common denominators, man is universally consistent, however much we don't want to see that. The Saudis are not unusual in that respect, nor are they immune from these societal diseases. It's just a lot less reported here. People are afraid, and the networks to report it in order to take action don't really exist right now.”

  “So tell me if you have seen a case of child abuse recently,” I asked, always curious to learn from my knowledgeable friend.

  “A kid was brought into the ER on a busy Thursday night some time ago. He was a scoop and run. By that I mean they had just piled him into the back of the pickup and dumped him onto a gurney in the ER. At the time we didn't have the Red Crescent ambulance services which we have now, Qanta. We worked hard for those ambulances here at the National Guard.”

  I knew this; David had been a major reformer of EMS services in Riyadh. Adequate first-responder service was one of his overarching passions.

  “Anyway, I was right there and noticed the kid looked really flat, just languid and really in a desperate condition. Nearby a Saudi man, who said he was his guardian, but probably his owner, was standing to one side looking remarkably unconcerned. He was making calls on a cell phone. Disengaged. I knew at once something was wrong.” Ken looked at me to emphasize his point. I knew exactly what he meant. His sixth sense as an experienced clinician had been alerted.

  “The kid was a ragamuffin, a little Saudi boy. I was told he was twelve but he looked more like seven years of age to me. His skin was anemic, his hair was falling out. He had lost most of his teeth. They told me he had been a camel jockey that week, you know, Qanta, those kids who are trained to ride camels in races. They have to be tiny so that they don't slow the animals down because of their weight. Anyway, they said they found him like this, in his bed at the Camel Souq (market).

  “Come to think of it, it must have been the time for the al-Jenadriyah Festival. You know, Qanta, it's every March. So that's how I just knew. I knew the kid must have been racing every day. They have camel races there specially for the festival, right outside the city.” I nodded.

  David's patient must have worked long and unpaid hours, alternately grooming and riding the camels with his tiny legs tucked up high underneath him.

  Perhaps the little boy had to shepherd and corral a flock. Maybe he felt bonded in his servitude to these creatures. The camels were likely the only beauty he had known. I was afraid to hear what Ken would say next. “So here I was,” he said, “about to examine this kid, when I realized he wasn't breathing. Literally he had just rolled in. Not even a minute had passed. I called a cardiac arrest code and started CPR but he was already dead. Actually he was cold. He had obviously been dead for some time.” He paused.

  “They said that's how they found him…” he continued.

  “But why would they bring him to the ER?” I asked, puzzled.

  “Well, Qanta, the owner or whatever he was got scared. He didn't know what to do with a child's body. The easiest thing to do was bring him to the hospital. Obviously this child had been living without his family for who knows how long. They were done with him; they didn't want to answer any awkward questions and start explaining things to the police, even if they would have investigated, which I doubt.”

  “So what did you do?”

  “Well I knew CPR was futile. But I started it because I felt compelled. I think it was just an emotional reflex on my part. Poor kid. To think he probably spent his whole life in the camel market…” David trailed off. We were left to our own thoughts for a time. After a few moments, he began again.

  “Even though he was dead, I examined him in detail and took photographs for my digital library. I figured they might be useful for a court case if this could ever be reported. I took pictures of his skin wounds. His skin was like putty, really dehydrated for a long time prior to death. On his arms I noticed marks on both wrists. He had obviously been tied up, again, for a very long time. They were encircling and pretty deep, Qanta, kind of in a spiral. Very much like ligature marks. They couldn't have been anything else. When I showed the slave owner, because that was what I decided he must be, he didn't seem to know or even care. He didn't even look like he was afraid that I had discovered the injuries. He was unmoved when I told him the kid was dead. He actually looked relieved to have me confirm this.

  “I examined the rest of his body very closely. He was covered in welts and bruises. I noticed he had a displaced fracture of a collar bone that had healed badly
. I think he also had an ankle fracture that had never been set. It was sickening.” David looked queasy even retelling the story years later.

  “How old were your sons at the time?” I asked, gently, helping David expose the source of his deep distress.

  “Well, my youngest, Frank, was the same age. He had just turned five.”

  “But you said the patient was twelve.”

  “No, Qanta, that's what the heavy said. I did a skeletal series, looking for evidence of abuse, and I deliberately X-rayed the epiphyses, his wrists actually, to determine radiographic age. The radiology techs arrived after I had pronounced him, but I had them image him posthumously anyway, again in case we could ever bring the perpetrator to justice. The films showed he had terrible osteoporosis, from his poor diet and the lack of vitamin D. It's very common here because people are so shielded from the sun, but this kid probably didn't have any type of healthy nutrition anyway.”

  “What else did the X rays show?”

  “Oh, the usual, old broken ribs that had healed, a nasty break of the forearm that seemed to have been set, but badly, certainly not by one of our surgeons. And his age, the radiologist confirmed it. He could not have been older than five, at the most. I was sick. Someone had abused this child for his whole short life and he wound up dead on a gurney on a Thursday night. We never knew his real name.” David stopped speaking. I didn't have the appetite for any more pain. I knew without asking that no one had been brought to justice and no one ever would.31

  I realized Maha spoke for all the silenced Saudi children; she was their champion.

  CHAMPION OF CHILDREN

  I WAS DEEPLY DISTURBED BY David's tale. I wanted to know what Maha thought of this story and more of her activism. We spoke a few days later.

  “Yes, Qanta, you are probably right, these children were both victims of abuse. No question. We had very limited resources then, even now, and you know like in any country there are ignorant, cruel people here too. It's our women and children who suffer most at their hands. I have seen many cases like this. I am trying to change this. Our sponsors, both of them Saudi princesses, are very concerned to improve the conditions of our country. They are really supportive.” She looked at me earnestly, willing me to understand her efforts.

  “I want to hear more, Maha.” She sipped a cup of sweetened mint tea, relaxing her abbayah a little. We were in a private home, chatting on a breezy veranda. She wore a stylish silk blouse with a high throat tied in a bow over some fashionable boot-cut jeans. Maha was incredibly hip. The contrast of denim and abbayah was marvelous.

  “You must have seen the news. It was on the BBC, about our newsreader here in Riyadh, Rania al-Baz. She is the presenter of The Kingdom This Morning, a show on state TV.” I nodded in acknowledgment. Even though I didn't know the show, I had heard of the newsreader's story. Maha recounted the painful details.

  It had been an awful incident. Everyone had heard the story. She was beaten by her Saudi husband until she was so disfigured she had needed plastic surgical intervention. Reports were he had banged her head on the marble floor of their home, and when he went to dispose of her body thinking she was dead, in fact she stirred a little. Panicking, he had brought her to Bughshan hospital. He lied of course, saying she had been in a car accident and ran off to “rescue others.”

  Maha's lips curved in disgust as she continued.

  “They didn't know if she would survive. Can you imagine, he had inflicted over a dozen fractures, I think thirteen perhaps, and she had horrific injuries and bruises on her head. She was admitted like a rag doll, nearly dead. I don't know how she survived without brain damage, but Alhumdullilah she was saved in the end. While she was in ICU and recovering, it was her Saudi father who recorded her injuries in the photographs to be able to show her later what had happened. When she got better and had thought about it, she decided to release the pictures to the media. It was her choice; no one else's.”

  I had read some accounts myself. Her husband, it was clear, had been especially inflamed by his wife's growing success because she had become a symbol for women all over the Kingdom. A newsreader, she appeared on air with her head covered, but instead of sticking to regulation limp black scarves, she wore colorful silk scarves, often Hermes squares. On camera she was always perfectly made up. The headscarves framed her powerful beauty. She wasn't extinguished by veiling. Rather, somehow her beauty was enhanced because of veiling. The veil was merely a tool that she used in order to interface in the public arena. She was, judging by photographs, like the many Saudi women I knew: gorgeous. But as an icon, however, her significance transcended even her beauty. She represented the future, a future of possibilities for many women in the Kingdom where women on television were still a novelty. I couldn't help thinking how symbolic her husband's violence was, revealing a deep desire to destroy her, quite literally by crushing her beautiful face.

  “Anyway, she came on television with her fresh bruises and her swollen face as well as allowing the world to see her when she was critically injured. It was really painful to watch, but it did a lot for the awareness of women's abuse and that of children in our country.” Maha continued explaining, “I think that was our turning point, Qanta. I mean, it was terrible for her to have to go through that, but you know, she turned it into an opportunity to help millions in a way we hadn't imagined before.

  “You know she, Alhumdullilah, sought divorce and won custody of the children. The courts for once supported a wronged woman. One of our princesses paid her medical bills. Her husband was sentenced to three hundred lashes, but this was halved because she pardoned him publicly in order to secure custody of the kids. Of course, she was given the children, even though it is very unusual in the Kingdom. There was no way they couldn't. The public mood was outraged.

  “Her story is a sad one, Qanta. She is not from the lower classes; she was the daughter of a wealthy man, an hotelier. Remember, you know from your medical background that abuse affects all demographic profiles. No segment of society is immune.

  “Through her father's connections she was offered a spot in the media where, until then, the females (if any) had been mostly fully veiled and older. She broke the mold at the time and that voice, her voice, was really attractive to listeners.

  “As a young woman in media, she fell in love with the singer Fallata who just swept her off her feet. They married quickly. It was a love match, very unusual in our society at the time. But soon she had become a victim of regular violence at his hands, even after bearing him three children. I read in the paper, she had even complained to her grandmother about it, saying that she felt like his maid. And you know what?” Maha sputtered, choking on fury. I found myself holding my breath in tension.

  “The grandmother said, ‘Correct, you are his maid!’ I mean, this is a big part of the problem in our community. Generations of women are ignorant, ignorant of the Quran and its teachings. If we don't inform ourselves as women, we don't know about the rights we can exercise, which are empowering to women actually, because Islam is such an egalitarian religion, Qanta! Islam gave women inheritance rights and property rights and the rights to divorce and to choose a marriage partner. Servitude never enters the equation. Beatings are Haram.”

  Maha was burning with an inner energy. She continued, “Since Rania came back to her work, even though her colleagues supported her to go public with the story, she found herself unwelcome at the station. She was encouraged to quit by colleagues. She found that by speaking out she had lost her livelihood. I think she is writing her memoirs now, to be published in France, in Arabic. I cannot wait to read them.”

  Nor could I. I hoped for an English translation.

  “It's very typical that when women speak out, they become ostracized in our society. Can you believe because of her, the first research study on abused wives was published by the King Saud specialist Medical Center and it found ninety percent of the women in the study had seen their mothers go through the same abuse? Ninety percent
! So they are brainwashed. They think it's normal. They cannot betray their husbands because they might lose their children; in fact, their homes, their reputations, everything.”

  I also knew of the terrible culture of secrecy in the Kingdom. I believed it must be linked to shame. In the Kingdom, like many Muslim and Arab societies, matters were weighed between shame and honor. Either something brings honor or it brings shame. And families in the Kingdom appeared to bind all their honor in their womenfolk. Shame was so powerful that everything, even atrocities, must be buried.

  We sat in silence for a while. Maha paused for a breath, sipping her mint tea in an agitated state. She stirred the crystalline sugar stick maniacally for a few moments, banging it harshly against the Limoges porcelain. I was reminded of another female colleague, Dr. Sameera al-Tuwaijri, an obstetrician who had specialized in public health policy and long since left the Kingdom to work at the UN.

  “Qanta, the mandated veiling and the prevention of women driving in the Kingdom are not the disease itself; they are merely symptoms of the very serious illness at the center of our country. They are merely clinical signs of a much more significant syndrome.” I was beginning to see what she meant. She had added a further, much more ominous comment.

  “Qanta, I am from among the elite. I don't mean money. Alhumdullilah we have always had that. But from among the intellectual elite. I eventually realized I was as suffocated and oppressed as the illiterate women I was treating in my clinics. My country lacks any civil or human rights. I had to abandon living in the Kingdom. I hope the life I offer my daughter will be a healthier beginning, and that she will avoid the suffering I had to go through.”