NEW DELHI: India faces a high burn burden with an estimated 2.1 million people suffering from injuries, 25,000 deaths, and 1.4 million disability-adjusted life years (DALYs) annually.
What is worrying is that the burn survivors not only face increased societal stigma in the form of bullying, staring, teasing, mocking, degradation, and labelling, but also witness daily discrimination at Indian healthcare institutions and from healthcare providers (HCPs), a latest study has said.
This lack of empathy - and sometimes physical abuse - from healthcare professionals leave them in emotional, physical, and psychological damage, particularly for patients with visible disfigurements or disability and those from underprivileged backgrounds, said the study, which is the first of its kind globally which aims explicitly to assess stigma faced by burn patients in hospitals and healthcare settings.
Published in the Science Direct Burns journal, the study suggests that institutional neglect, under-resourced facilities, overburdened staff, and systemic failures in India’s healthcare facilities are some of the reasons for burn patients receiving discriminatory and low-quality care.
The study was conducted by The George Institute for Global Health, India. Medical advancements have led to increased survival rates, but there is a need to focus on improving the long-term physical, psychological, and social impacts of burn injuries.
The researchers, which included Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh; Department of Plastic Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, and School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia, said patients also reported being blamed and criticized by healthcare providers, especially in the case of acid attack survivors.
“Such attitudes led to feelings of shame among the patients, complicating their psychological well-being,” the study conducted in Uttar Pradesh burn facilities said.
In fact, the study said even healthcare providers confessed to experiencing discomfort when treating burns, particularly if the patient had severe disfiguring burns or was new to the burn ward.
“Patients mentioned distressing experiences of physical abuse while getting treatment in the hospital, where they felt mistreated or subjected to rough handling by HCPs. This physical abuse not only exacerbated their physical pain but also deepened their feelings of vulnerability,” the study said.
Survivors also mentioned experiencing medical gaslighting, where their symptoms or concerns were dismissed or trivialised by HCPs, leading to feelings of distrust in the healthcare system.
According to Pratishtha Singh, The George Institute for Global Health, said, “Burn survivors, particularly women and poor people, receive blame and isolation and face neglect in hospitals. At the same time, overworked and under-supported healthcare staff struggle with burnout, which can lead to unintentional but harmful behaviour towards patients. Addressing patient experiences and system challenges is key to building compassionate and fair burn care.”
The study said “dehumanising experience made burn survivors fearful of returning to the hospital, where they may encounter judgment or stigma, deterring them from seeking essential follow-up care.”
“This negatively impacted recovery outcomes. Reluctance in follow-up visits and poor compliance with physiotherapy result in the development of contractures - a major complication among burn survivors. This further contributes to disfigurement and stigma,” it added.
Patients also shared that their socioeconomic status often overshadows their medical needs, resulting in dismissive and patronising attitudes from healthcare providers.
“Experiences of hospital staff in India suggest that burn survivors are often considered as ‘untouchables’- both from HCPs (healthcare providers) and other hospitalised non-burn patients, resulting in the provision of differential care. Such negative experiences in facilities may cause further social isolation, reduce quality of life, and increase mental health burden,” it added.
The study suggested an urgent need for reform within the health systems by developing policies and guidelines around discrimination-free healthcare, strengthening public-sector burn care, enhancing rehabilitation services, raising awareness of burns, and improving the social reintegration of survivors.
The study said the HCPs also mentioned healthcare facilities' financial challenges, which often operate within constrained budgets.
“Limited funding for essential services, including burn care, was identified as another key issue, leading to a compromise in patient care quality. Participants emphasised that deficiencies in public health infrastructure, like poor sanitation and hygiene, pose significant barriers to effective burn care,” it added.
“Due to this, HCPs often implemented rigorous infection control practices, such as maintaining distance from patients, isolating them, and wearing protective gear. However, HCPs also noted that while necessary for infection control, these measures may sometimes be perceived as stigmatising behaviour by patients,” it added.
Globally, there are about 180,000 deaths each year, with the most significant burden in low- and middle-income countries.