Domestic abuse is a hidden epidemic, warns the BMA

All women attending accident and emergency departments with injuries should be asked if they are victims of domestic abuse, specialists said yesterday.

The British Medical Association warned there was a hidden epidemic of violence in the home which was putting thousands of women and children at risk.

Doctors need to ask their patients the right kind of questions about domestic abuse and respond appropriately, the BMA said in a new guide. It calls for training to be extended to all health professionals.

An estimated 350,000 people in England and Wales suffer domestic abuse costing £3.1bn a year in health, legal and other costs. Both men and women can be victims, but more than 80 per cent of reported cases involve women. Almost a third begin during pregnancy.

Vivienne Nathanson, the BMA's head of science and ethics, said: "The figures are shocking but perhaps more alarming is that they are likely to be grossly underestimated. Domestic abuse is an unspoken scar on our society and many individuals never report that they are victims."

Gene Feder, professor of primary care research at St Bartholomew's and the London Medical College, said: "If domestic violence were an infectious illness we would call it an epidemic."

The key to protecting women against abusers is to get social workers, police, schools, housing agencies and the courts working together, the report says. It highlights the role of advocates in co-ordinating support. According to charities working with abused women, the use of advocates is the most effective way of protecting victims. In Cardiff, repeat offences of domestic abuse have fallen from more than 30 per cent to 8 per cent in five years, after the Women's Support Unit pioneered the use of advocates to "throw a safety net" round threatened women. Homicides linked with domestic abuse in south Wales have fallen from 11 a year to one.

In Worthing, all women attending the A&E department with bruising or wounds are asked about domestic violence and victims are referred to an independent advocate whose job is to co-ordinate local agencies to provide protection.

The success of the schemes has attracted the attention of the Home Office, which has backed the charity Co-ordinated Action Against Domestic Abuse to train 275 advocates. Diana Baron, who heads the charity, said: "A school link worker went round to a house to inquire about a six-year-old who had been absent from school and found an axe embedded in the front door. When she asked the six-year-old why he was not at school, he said he was too afraid his dad would kill his mum.

"What the advocate can do is put in place a package of measures to protect the woman and child - from civil injunctions to window locks. They inform the school, the police and put a marker in the A&E medical records so checks can be made."

Jane, council worker, Cardiff: 'The police told me I should stop panicking'

Jane thought the loneliness she had felt since her divorce was at an end when the plumber she had hired asked her out. She had an eight-year-old daughter and was nervous about entering a new relationship, but he seemed kind.

That was two years ago. Last week, after a campaign of harassment and abuse, he was found guilty of assault and will be sentenced next month. "He was nice at the beginning but then we started having arguments and he would throw things if he couldn't get his way. We broke up but he kept sending flowers to me and pleading to get back together. Then he would phone the house and threaten to beat me up," said Jane, a council worker, from Cardiff.

Finally, Jane and her daughter had to be rescued by a passer-by. "The police were hopeless. They kept saying they would arrest him but they never did. They told me I wasn't injured and I should stop panicking. I finally got him to court only with the help of the Women's Safety Unit. They believed in me and helped me cope with the trial."

Names and some personal details have been changed

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