The family of a late Melbourne woman are demanding an investigation into a cosmetic surgery clinic in Iran at which their now-dead mother was treated shortly before she died.
Layla Alwan, 51 required a knee replacement following two accidents but was told she should lose weight before an operation in Australia.
However, the pain from her knee made exercise difficult, so in August 2023 Alwan booked a tummy tuck and liposuction procedure to her stomach and breasts through Novin Irana Clinic in Mashhad, Iran.
Know the news with the 7NEWS app: Download today
Iran has a thriving medical tourism sector with many cosmetic and plastic surgery procedures available at far less cost than similar operations in Australia, the US or Europe.
Alwan, who is being remembered as an “invaluable advocate” for domestic violence survivors, died 10 days after the operation on August 26 while visiting family in neighbouring Iraq.
Alwan’s autopsy through Iraq’s Al Taj Private Hospital provided to 7NEWS.com.au stated her cause of death was shock from severe blood loss as a result of ulcers on her intestines.
It also found her heart was congested, her lungs haemorrhaged, swelling to her brain and fluid build-up around her abdominal wall.
The autopsy notes Alwan had recently undergone cosmetic surgery but does not make any findings on whether it was linked to her death.
Alwan’s daughter, Meriyam Hadi said her mother was in severe pain post-operation, struggling to move, eat and breathe and questioned why she was not given medical scans when she requested it before she died.
“I couldn’t believe that was how much pain she went through,” Hadi said.
“Anybody with a brain, you don’t have to be a health care professional, will know something is up when you see someone in that much pain.”
Hadi is calling on the Australian government to advocate for her mother, so Iranian authorities investigate her mother’s treatment at the clinic.
“Layla was advocating for Australia for 10 years … she advocated for children, women, men, everyone and she didn’t get paid a cent,” Hadi said.
What happened to Layla Alwan
Dr Jalal Motamedifar performed Alwan’s liposuction at Madar Hospital and Maternity Unit, according to her operation report.
In a recorded phone conversation between Alwan’s family and a Novin Irana staff member, heard by 7NEWS.com.au, the staff member says Alwan saw an unnamed doctor twice but was told her pain was normal despite her describing it as “knives cutting her up”.
The staff member questioned whether further investigation should have been done, telling Alwan’s family, “this shouldn’t have happened”.
However, Motamedifar said in a statement to 7NEWS.com.au that Alwan’s death was not a result of the procedure, and pointed out the autopsy found no signs of internal bleeding in her deeper skin layers and muscles.
“She was discharged in good general health after 24 hours of complete care … apart from rest and post-surgery medications, she didn’t require special care,” he said.
He said Alwan’s painkillers may have increased the bleeding from existing stomach ulcers.
“According to her guides and people at the clinic, Alwan had been using painkillers and narcotics such as tramadol, and like many people, she may have had gastrointestinal issues such as acid reflux even before the surgery,” Motamedifar said.
“Ten days after the surgery, severe stomach bleeding occurred which led to her death attributed to stomach bleeding not the cosmetic surgery.
“If someone is in serious condition and is not medically stable, they will not board the plane under any circumstances and they will not be allowed to fly,” he said.
But Alwan’s family said she had no diagnosed history of gastrointestinal issues.
The autopsy also found no traces of narcotics such as morphine in Alwan’s blood tests.
Motamedifar said “all necessary pre-surgery tests and consultations” were conducted to ensure she could undergo the operation.
He did not answer questions about why Alwan was allegedly not given the medical scans when she was reportedly in extreme pain or whether the clinic had investigated whether she had ulcers before the procedure.
“The clinic and the doctor are open to further transparency and in-person discussions with Ms Alwan’s companions,” Motamedifar said.
Her last hours
The night before Alwan died, she flew to Iraq to see family she hadn’t seen in a decade.
The following morning, she continued to complain of sharp, stabbing pain in her stomach and swelling.
She then vomited blood clots, fainted and was rushed to hospital.
Alwan was bleeding from her mouth and anus when she arrived in the emergency department, the hospital report said.
Despite the efforts of doctors, she could not be saved.
The Islamic Republic of Iran Medical Council, which is responsible for licensing Iranian health professionals, and Iran’s health minister did not respond to questions.
Macquarie University’s Professor Anand Deva said liposuction, generally, posed a unique risk of internal injuries to organs from the surgical cannula used to suction fat.
He said this damage might not be immediately obvious to the patient post-surgery but can manifest within three to five days.
“For abdominal liposuction (it can be) damage to the liver, and the spine or the bowels,” Deva said.
“The specific instructions patients or their carers should be given is in particular increasing swelling and increasing pain.”
“Those are things, the treating team should be made aware of immediately,” he said.
Deva said there was also a risk of internal bleeding and shock as a result of too much fluid being removed.
Some signs of these complications were weakness, lethargy and dizziness, he added.
“I would be worried if any patient of mine was in extreme pain after liposuction, I would want know about that,” he said.
Assistant Foreign Minister Tim Watts urged Australians to make sure they were fully informed before going overseas for medical treatment.
“I send my condolences to Ms Alwan’s family and loved ones at this tragic time,” he said.
“The quality of hospitals overseas can vary, so we urge Australians to do research on their destination, doctor, hospital and procedure before travelling overseas for medical treatment.”
A ‘remarkable’ woman and mother
Alwan’s death hugely impacted her children and grandchildren, but her loss was also felt by survivors of domestic violence across Melbourne following her decade working as a volunteer in the sector.
She was a founding member and volunteer of Victorian domestic violence service, inTouch’s NOOR Survivor Advocate Group.
In a statement, inTouch said Alwan “played a crucial role in strengthening Victoria’s response to family violence” and supporting women from migrant and refugee backgrounds.
“Layla’s commitment to helping others and spirit of generosity was remarkable … she was not just a colleague but also a trusted friend and support to many,” chief executive Rasha Abbas said.
“(Her) unique blend of passion, empathy, cultural understanding, and lived experience made her an invaluable advocate for women from migrant and refugee backgrounds.
“Her unwavering dedication helped drive meaningful systemic change and set her apart as a crucial voice in her community and the wider fight against family violence.”
Hadi said her family was never the same when their mother died.
Alwans’ children didn’t get to see her before she was buried, as a lack of space in the morgue meant she had to be buried within 24 hours of her death.
“She was amazing … she was a mother that grew up in war and she raised five kids in the Syrian war.
“The other day, my nephew told me he has pain in his heart … I asked him, ‘how many times do you think of bibi (grandma in Iraqi)?’ and he said, ‘I think of her every day, of every second’,” Hadi said.
Hadi said her mother never bragged about her achievements, so when she met her colleagues at inTouch, she was amazed to find out how much of an impact Alwan had.
“I found a notebook she had where she wrote in Arabic and translated it in English trying to study the laws and all that,” she said.
Hadi, a nursing student, created a jewellery line in her mother’s memory and to help raise funds for a lawyer to take on her case.
“I miss everything about her … the only thing I want right now is my mum … I miss going out with her,” she said.