JALALABAD, Afghanistan » It is doubly miraculous that the young woman named Gul Meena is alive. After she was struck with an ax 15 times, slashing her head and face so deeply that it exposed her brain, she held on long enough to reach medical care and then, despite the limitations of what the doctors could do, clung to life.

"We had no hope she would survive," said Dr. Zamiruddin, a neurosurgeon at the Nangarhar Regional Medical Center in the eastern city of Jalalabad who, like many Afghans, uses only one name. After she was brought in, he worked for more than six hours in the hospital’s rudimentary operating theater, gently reinserting her brain and stitching her many wounds.

For weeks afterward, she was often unconscious, always uncommunicative and, but for the hospital staff, utterly alone, with no family members to care for her. That is because, if the accounts from her home province are true, she is an adulterer: Though already married, she ran away with another man, moving south until her family caught up with them.

Locals say that the man who wielded the ax against her, and also killed the man with her, was most likely her brother.

That she reached a hospital and received care at all is the second part of the miracle: The villagers, doctors and nurses who helped her were bucking a deeply ingrained tradition that often demands death for women who dishonor their families.

Such "honor killings" of women exist in a number of cultures, but in Afghanistan they are firmly anchored by Pashtunwali, an ages-old tribal code prevalent in the ethnic Pashtun areas of the country that the government and rights advocates have fought for years to override with a national civil legal system. This year, six such killings have been reported in Afghanistan’s far east alone, more than in each of the past two years, and for every one that comes to light, human rights advocates believe a dozen or more remain hidden.

Gul Meena’s story, as best it can be pieced together from relatives, tribal elders and others, gives insight into that deeply entrenched tribal culture. But it is also a story about a society struggling to come to terms with a different way of thinking about women.

The Americans and Europeans have put a special emphasis on programs to help Afghan women and raise awareness of their rights. Now, as the Western money and presence are dwindling, women’s advocates fear that even the limited gains will erode and a more tribal and Taliban culture will prevail, especially in the south and east of the country, where Pashtun tribal attitudes toward women are strongly held.

It is a credit to many people — villagers, doctors, the police, rights advocates — that they chose to help Gul Meena, overcoming centuries of distaste for dealing with so-called moral crimes. The doctors at the Nangarhar Regional Medical Center who first treated her and cared for her for weeks were aware of her likely transgressions and chose to ignore them. However, the doctors, who say Gul Meena is about 18, were also bewildered about what to do with her.

"She has no one; no mother has come, no father, no one from her tribe has come," said Dr. Abdul Shakoor Azimi, the hospital’s medical director, as he stood at the foot of her bed looking at her. "What is the solution? Even the government, the police, even the Women’s Affairs Ministry, they are not coming here to follow up and visit the patient."

A patient in an Afghan hospital without a family member is a neglected soul. Most hospitals are so impoverished that they offer only the bed itself and limited medical care. Gul Meena lay in her own urine when a reporter first visited her because no relative was there to change her sheets. Hospital staff members were able to tend to her sporadically, but they are overstretched. Without a relative, the patient has no one to pay for drugs, drips, needles or food, no one to bring fresh clothes.

Azimi manages the hospital’s Zakat fund, a charitable collection that all the physicians contribute to, and for the first three weeks of Gul Meena’s care, the fund and individual doctors paid for everything.

Many women are not so fortunate and lie in unmarked graves in Afghanistan’s mountains and deserts, but as the culture urbanizes and women begin to consider marrying for love, families and tribal codes are being tested.

"As the numbers of these moral cases increase, the severity of punishment decreases," said Ahmad Gul Wasiq, a professor of theology at Jalalabad University, who also counsels families when there are marriage problems and who had heard about Gul Meena’s case.

Gul Meena first arrived in the area, in a village called Kandi Bagh in a rural stretch of Nangarhar, about two months ago, traveling with a man named Qari Zakir. The villagers asked few questions, although the two had traveled south from Kunar province with just a single bag. That is hardly the profile of a married couple hoping to set up housekeeping in a new place.

"Everybody avoids such cases, and doesn’t want to get involved in others’ troubles," said Hikmat Azimi, 27, who lives in Kandi Bagh and works as a teacher at a nearby agricultural institute.

The last time anyone saw Zakir was about a week after their arrival, on the night before he was killed. He was seen buying a large bag of fruit, it seemed in honor of Gul Meena’s brother. He had turned up a few days earlier, according to villagers’ accounts related by Col. Nasir Sulaimanzai, the head of the Nangarhar police investigative division. Her father had also come but then left, Azimi said. The next morning, a distant relative of Zakir’s who lived in the area knocked on the couple’s door. When no one answered, he climbed over the wall that surrounds most Afghan homes and was met by a scene of carnage: Zakir lay on a bed, blood clotted black around his neck, his head all but severed. Gul Meena lay on a separate bed bleeding profusely. Her brother had vanished.

"I shivered when I saw it," said Azimi, who was one of the villagers called in to help. He and others borrowed a car and drove her to the hospital in Jalalabad.

For days as Gul Meena lay in the hospital, government entities in Jalalabad held meetings and discussed what to do with her.

Her situation was not helped as people learned more specifics. According to villagers and tribal elders as well as her relatives in Kunar province and just over the border in Chitral State in Pakistan, Gul Meena was married, as was Qari Zakir. So the couple had broken fundamental moral codes as well as Afghan law.

According to Gul Meena’s relatives, her family moved to kill her in part because of pressure from her husband’s family.

"Her husband’s family came to them and said, ‘If you don’t do this thing, we will come after you,"’ said a close relative of Gul Meena who asked not to be named because the issue is so delicate. "Her mother agreed to let them kill her in order to protect her sons."

The provincial council, with its overwhelmingly male membership and many people from traditional backgrounds, seemed paralyzed. "We have some tribal customs and provisions that are tough for females," said Mufti Moin Muin Shah, the chairman of the Nangarhar provincial council, saying he favored following Shariah law, which would have required a trial. He said that maybe only 1 in 20 of his constituents would agree with him — and that the rest would embrace the swift, brutal Pashtun tribal law.

Sulaimanzai, the provincial police official, was recently assigned here from Kabul, and he sees the tribal code as the root of the problem in a case where Afghan civil law should prevail.

"What is destroying us is this useless, unofficial justice, these tribal jirgas. The tribal elders, the jirgas, always violate the provisions of the law," he said. "Many things in this case need investigation: why did she run away from her husband’s house? Maybe he was old, maybe he was impotent, maybe he didn’t feed her," he added. "They should bring her to the court. We have laws in this country."

One of the few female members of the provincial council that weighed in on Gul Meena’s fate, Angaza Shinwari, insisted that the woman had also been failed by the government and other agencies: "We have lots of NGOs operating in this country and spending a lot of money; how can they not have someone to take care of her?" she said, referring to nongovernmental organizations. "Our Women’s Affairs Ministry office has a lot of employees. Why can’t they send someone to stay with her in the hospital?"

For their part, officials with the Afghan Ministry of Women’s Affairs said they were unwilling to move Gul Meena to a shelter, in part because of her continuing medical needs but also because of security concerns. Her attacker is still at large, and the police say they believe he had slipped over the nearby border into Pakistan to avoid arrest.

"What if something bad had happened to her, who would have been held responsible for that?" said Anisa Umrani, the provincial head of the women’s ministry office, referring to the common situation in which vengeful relatives try to drag girls from shelters and kill them. "We do have problems dealing with moral crimes. We are scared of dealing with such issues. We are facing threats and danger while dealing with these cases."

Ultimately it was an Afghan-American human rights organization, Women for Afghan Women, that arranged to move Gul Meena from Jalalabad to a safer, better supplied hospital in Kabul, and the organization has paid for 24-hour care, underscoring the crucial importance of the West in supporting women here. She is now physically far better, able to speak, but not to remember what happened to her.

"Things are changing, but they are changing slowly," said Manizha Naderi, who runs the organization that is now caring for Gul Meena. "We’re trying to change the culture, and that takes a long time."

© 2012 The New York Times Company