19/12/2025
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When the marks don’t show .
Mia (not her real name) didn’t see any bruises in the mirror the next morning. That was the part that confused her. Her throat ached. Her voice felt wrong. Her thoughts were slow, as though they were wading through mud. But her skin? Untouched.
Later, she would learn that what happened to her has a name: Non-Fatal Strangulation and Suffocation. A violent act that cuts off oxygen and blood flow to the brain, often without leaving a single visible mark.
Most people expect bruising. Most people miss the internal injuries when the external injuries aren’t there.
What happened to Mia is far more common than most realise. Last year, in Whanganui alone, 212 people came to our hospital because of intimate partner or interfamilial violence. In 64 of those cases, strangulation or suffocation was involved. Nationally, most family violence is never reported at all - around 67% goes unreported.
Only 33% of family violence is reported.
Mia didn’t report it to Police. Many don’t. But she did go to ED. That choice mattered.
A clinician checked her breathing, her voice, her neurological signs. She learned that a loss of consciousness, or even bladder or bowel control, can be a sign of how close to death someone has come. She learned that concussion, confusion, and even stroke can follow in the hours or days after. And she learned she wasn’t alone.
Before she left the hospital, staff told her something important: There’s a specialist Post Non-Fatal Strangulation and Suffocation assessment, offered around 10 days after the event - only Police can make the referral, and only with consent. No statement required. No pressure. Just another layer of care if she wanted it.
Mia also learned she didn’t have to explain anything to her workplace if she needed time. Every New Zealander has a legal right to up to 10 days of domestic violence leave. There are national helplines ready to guide people through this, gently and confidentially.
Maybe someone reading this has lived through something like Mia. Maybe there were no marks. Maybe there was fear. Maybe there was silence.
You are allowed to seek help. You deserve medical care. You deserve safety.
• If you’re in danger, call 111.
• If you arrive at ED and say you’re not safe, we will help you.
• 24/7 help is also available: Phone 0508 SHINE or 0800 733 843 (Women’s Refuge).
