By Lin Taylor
AMMAN (Thomson Reuters Foundation) - Ahzan was shopping in a market in the Iraqi capital of Baghdad when an explosion ripped through the street, lifting her off her feet and shattering her lower body.
As the dust settled, Ahzan saw parts of her body strewn across the ground. The 33-year-old's left leg was so badly injured, the doctors had no choice but to amputate.
It was the start of more pain and misery, she said.
Ruptures in her abdomen and leg never healed, and offers of marriage quickly dried up.
"I had suicidal thoughts, I wanted to die. I just wanted to stay at home all day doing nothing," Ahzan said through a translator at a Medecins Sans Frontieres (MSF) hospital in Jordan's capital Amman.
As an amputee requiring ongoing medical assistance, which has brought her to the MSF hospital, Ahzan is seen as a burden on her community.
For women young and old, being disfigured or maimed by conflicts in Middle East is a stain that stigmatizes them for life, health workers say. Many are shunned by society, divorced by their husbands or deemed unfit for marriage and motherhood.
"People make me feel disabled, like I'm not a whole person who can be depended on," said Ahzan, who asked that her full name be withheld for privacy.
Ten years after the bombing, Ahzan, now 43, remains single and childless. A mark of shame for women in her culture, her status is also a source of depression, she said.
"THEY LOSE THEIR LIVES"
MSF staff at the only hospital in the Middle East to perform complex reconstructive surgery on victims who have been blown apart and disfigured by conflicts, say the stigma female patients endure when they return home is far worse than for men.
Some young women will drop out of school or university out of embarrassment, others are ostracized by family and friends. This isolation, compounded by their physical ailments, can seriously affect their mental health, MSF says.
Since it opened in 2006, the hospital has transported and treated almost 4,400 patients from Iraq, Yemen, Syria and Gaza, free of charge.
Around 60 people, mainly young men, undergo complex orthopedic, facial and burn reconstructive surgery at the hospital each month, according to MSF. They also receive psychological care and counseling during their stay.
Clinical psychologist Yafa Jaffal, who is treating Ahzan for depression as she recovers from surgery to treat the wound on her leg, said patients who have undergone amputations can at least hide their missing limbs with clothing.
They can learn to use prosthetic arms or legs to gain autonomy again.
But convincing women with severely disfigured faces to move on with their lives is near impossible, she said.
"Many of them have trouble dealing with their children after the injury ... because sometimes the children don't recognize them," Jaffal told the Thomson Reuters Foundation.
"This is so difficult for a mother - to say 'hello' to your child and they reply, 'No you're not my mother'."
It is also common for husbands to divorce their wives, taking their children with him, or to marry a second wife, said MSF mental health worker Muntaha Mashayekh.
"I can count on my fingers the females who stay with their husbands after she is injured, especially those who have been burnt. They lose their lives," said Mashayekh, who counsels females patients at the hospital.
As part of their recovery, women at the hospital are offered classes in applying make-up to help cover their facial scars and burns, as well as dance therapy to boost their self-esteem and confidence.
Mashayekh takes the women to local markets so they can start integrating into society again.
"You have to be confident in yourself, you are a human being and you should be respected," she said. "It will take time for society to accept them, but we are trying."
It will be a few more weeks until Ahzan is physically well enough to return to Baghdad from the hospital in Amman.
But as the primary carer of two older brothers with mental disabilities, she said she will not have time to rest and recover from the operation.
It is a strange blessing in disguise, she said, as their condition has helped her feel useful again and accepted by her family.
"I forced myself to walk again, to do things on my own and be independent to look after my brothers," she said.
"I feel like I've gone from being a disabled person to someone who functions wholly."
(Reporting by Lin Taylor @linnytayls, Editing by Katie Nguyen. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters that covers humanitarian issues, conflicts, global land and property rights, modern slavery and human trafficking, women's rights, and climate change. Visit http://news.trust.org to see more stories)