IRBIL, Iraq — Three weeks after she was burned, the petite 18-year-old lay in a hospital bed, her head, arms and upper torso swathed in cotton. Her seared face was daubed with ointment.
She looked at the ceiling and thought about her new life. "I don't know about the future," she said, still looking up. "It will be whatever Allah brings." She refused to give her name.
A gas stove had exploded when she'd tried to light it, she said.
Her nurses don't buy it. They recognize the pattern of the burns and have seen hundreds of cases like hers, many with variations on the same story. A teenage girl with a young marriage, and "a cooking accident."
In many parts of the world, such accidents would be attributed to "honor killings," the murders of young women by family or spouses because they didn't work hard enough, complained too much or dated the wrong men. There are honor killings in Iraqi Kurdistan, as well.
But health-care professionals and women's experts stress that what they're seeing here is different: a suicide epidemic in which Kurdistan's girls and young women are setting themselves on fire.
Suicide by fire among girls and young women in the region has been increasing sharply since 2004, said hospital workers, regional health officials and women's advocates.
The reasons may be manifold. Some experts blame an economic boom that's lured traditional villagers into cities with more modern values, resulting in family strains. But because the victims include lifelong city residents as well, a patriarchal culture that gives little power to women may be a bigger factor.
Kurdistan, a largely self-governing region of three provinces in northern Iraq, doesn't have accurate historical health data, but there were at least 360 female-burning suicides last year, said the region's health minister, Zyran Osman Yones.
Some victims are as young as 12, but most range from age 15 to 25. Nearly all choose fire as their method. The typical method is dousing themselves with kerosene and striking a match, often in a locked shower room.
"It's the most painful way to die," Yones said. "I don't know why they do it. In other cultures, they may use pills or guns, but for Kurds, they burn themselves. We even hear of cases among Kurds who have immigrated to Europe."
Hundreds more have survived with horrible scars, only to have their husbands and friends desert them and parents hide them from the rest of the family and visitors out of shame, said Mahabat Amin Monsour, the director of the Women's Union of Kurdistan, the largest women's advocacy group in the region.
Almost none admits a suicide attempt, partly because suicide is forbidden for Muslims. But half a dozen nurses and physical therapists interviewed at Kurdistan's two major burn units, in the cities of Irbil and Sulaimaniyah, said that about 80 percent of the women brought in with burns had tried to kill themselves and the number increased each year.
The rising number of cases, Yones said, coincides with the economic boom triggered by the U.S.-led ouster of Saddam Hussein in 2003. Saddam had been the region's greatest enemy, periodically attacking the Kurds and killing tens of thousands.
Now, strong security that's prevented much of the terrorism that racks the rest of Iraq along with a wave of construction and foreign investment have made Kurdistan a Middle East success story.
In the cities, hundreds of new buildings are under construction, the skylines dominated by scaffolding and cranes. Porsche and Mercedes SUVs pick their way through battered taxis in the anarchic traffic, and residents choose between traditional market stalls and gleaming shopping centers and malls.
New jobs are luring families from villages steeped in traditional culture to the cities, where Western values — such as young women picking their own husbands — are coming to the fore.
Also, young people from poor families see material goods pouring into the cities and don't understand why they can't have cell phones or cars, Monsour said.
Many of the suicides are in families that have moved to the city in the past year or two, Yones said.
"We're passing a transition period between old cultural beliefs and opening to a new civilized world," he said. "The children adapt to the new developments in the cities while the older people, including their parents, don't, and that results in conflicts."
While doing research in 2004 and 2005, Monsour investigated about 200 cases in the Irbil area that probably were suicide attempts.
Sometimes, Monsour said, after she'd spent hours talking quietly with the women in the hospital, they'd confess what had happened.
The victims included not just newcomers to the city but also lifelong residents. Some were poor and uneducated, others had college degrees and office jobs.
"It could be anyone," she said.
The common factor, though, was usually the traditional, patriarchal culture, which often leaves women feeling powerless in dealings with husbands, fathers or even brothers.
That powerlessness is magnified when a girl marries young and comes under a husband's domination before she has a chance to learn much about life, Monsour said.
"Maybe she's a teenager, and she has to take care of the house, the husband and the kids and she just can't handle it," Monsour said.
Sometimes the girl's parents forced her to marry someone she didn't love or they rejected a suitor she did want.
Other times, with teenage hormones raging, the trigger may be as simple — and illogical — as a brother commandeering a cell phone, a single argument with a husband or even a bad grade on an exam.
Whatever the problems before they try to kill themselves, if they survive, their lives will be worse.
If the burn victim is married, frequently her husband will leave her as soon as she signs the police statement saying the cause was an accident, Monsour said. He'll wait because if she claims he had anything to do with her burns, he could be jailed.
"Then, if she goes to her parents, they will isolate her from the family, because she'll be unacceptable and they don't want any guests to see her," Monsour said.
"They will feel like it's a big shame because their daughter ran away from her responsibility," she said. "They give her a mattress and put her in a room and that's it."
Because it's so painful, fire is a puzzling choice of weapon, even to the experts who follow the problem.
Kurdish culture, though, is tied to fire. Kurds celebrate the new year by burning tires. Also, the trend feeds on itself, with some girls, nurses say, copying suicides they hear about in local news media.
Then there's the simple fact that many Kurdish women spend the day in the kitchen working with fire, while they may not have access to, say, pills, Yones said.
There's almost no mental health care available to help girls and women before or after they try to kill themselves. The regional government should build counseling centers to teach men and women the basics of relationships, Monsour said.
Also, to help those who tried to kill themselves, she said, hospitals need post-discharge centers with psychologists and counselors to train victims how to cope with their new lives, to make them feel acceptable again and, if their families have deserted them, to help them get jobs.
(Price writes for The News & Observer in Raleigh. McClatchy Newspapers special correspondent Yaseen Taha contributed to this story.)