Management of Dead Bodies after Disasters

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Management of Dead Bodiesafter Disasters

• A first responder manualMass fatality events
• PAHO/WHO, ICRC, IFRC

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• Two broad aims
• To promote the proper and dignified management of
  dead bodies
• To maximize their identification

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2. COORDINATION

• Effective local coordination command and control
• Local coordinator ( One person)
• Team functions
• Body recovery, Storage,
  Identification, Information and
• Communication, Disposal,
  Support for families, logistics
  
• Effective national coordination
• National mass fatality coordinator
• Mass fatality section of MCM plan
• Coordination group to advise on
• - Communication and
  information
• - Legal issues
• - Technical support
• - Logistical support
• - Liaison with diplomatic mission, inter-gov.
• and international organizations.

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Inter-institutional team

• Academic institutes
• Local government
• Military
• Police
• Public Health
• NGO
• Volunteers

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3. INFECTIOUS DISEASE RISKS

• Infections and dead bodies
• Cause of death trauma
• Viruses and bacteria
• not more than 48 hours
• ( except HIV )
• Risk to the public
• Drinking water- fecal contamination)
• Risk to body handlers
• Blood and feces contact
• ( Hepatitis B and C, HIV,
• tuberculosis)
• Injury and tetanus

• Safety precautions for body handlers
• Gloves and boots.
• Wash hands.
• Avoid wiping face or mouth with hands.
• Transportation of bodies
• (Wash and disinfect cloths
  and equipment).
• Face masks are
• unnecessary.
• Unventilated spaces
• (Hazardous toxic gases)

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4. BODY RECOVERY

• Methods and procedures
• Body bags
• Ambulances should not be used
• Treat body parts like full body
• 2 teams needed
• -one for collection point
• -one for identification storage area
• Note the place and date
• Personal belongings
• Health and safety
• Protective equipment
• Risk of injury debris or collapsed buildings.
• Tetanus.

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5. STORAGE OF DEAD BODIES

• .

• Each body or body part should be kept in a body
  bag or wrapped in a sheet before storage.
• Waterproof labels with a unique identification
  number should be used.

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STORAGE OF DEAD BODIES cont.

• .

• Options
• Refrigeration 2-4 C ( containers
  agreements)
• Temporary Burial good option for immediate
  storage and for long term. Where no other method
  is available.
• Dry ice may be suitable for short-term storage.
• Ice should be avoided
• Melts quickly and large quantities are needed.
• Melting ice produce large quantities of dirty
  waste water that may cause contamination.
• The water may damage bodies and personal
  belongings.

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Storage and preservation of the bodiesThailand
During the end of first week
After the second week
Dr Pungruk, Thailand
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6. IDENTIFICATION OF DEAD BODIES

• Key steps to identification
• a) Unique reference number b) Label,
• c) Photograph, d) Record e) Security
• Identification
• Viewing dozens of dead bodies may reduce the
  validity of visual recognition.
• Viewing photographs of the highest possible
  quality may be a better approach.
• Visual recognition should be confirmed by other
  information (clothing/personal effects)

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Identification cont.

• Release of body to relatives
• When identification is certain
• Responsible authority to provide documentation of
  the release (Letter or death certificate).
• Record who claimed the body.
• Bodies not recognized by visual identification,
  should be properly stored.
• Care should be taken before releasing bodies that
  are not whole.

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Number of bodies examined, identified and
released
Approximately 41 of total deaths in Thailand
Source TTVI on April 30, 2005
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Summary of victims identified by Dental record
in Thailand( post tsunami)
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Reconciled bodies by primary evidence
83.86
14.37
0.48
1.29
Source TTVI on April 30, 2005
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DNA analysis

• Specimen collection from post mortem
• Buccal during the first few days
• Hairs during the first few days
• Muscle during the first few days
• Rib
• Tooth
• Femur

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7. INFORMATION MANAGEMENT

• Use one single system to consolidate data
• Information centers at national and local level.
• Data should flow in both directions national
  local.
• Inform the public about
• Searching for the missing.
• Recovery and identification of dead bodies.
• Collection and release of information.
• Support for concerned families.
• (internet, notice boards, newspapers, Tv,
  radio, etc.)

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• Information about dead bodies
• Basic information must be collected about all
  dead bodies.
• Early data collection may use paper forms, and
  this information may be entered into an
  electronic database at a later stage .
• Valuable personal items and photographs.
• Chain of custody required to avoid misplacement
  of information.
• Centralization, consolidation.

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8. LONG-TERM STORAGE AND DISPOSAL OF DEAD
BODIES

• Burial preserves evidence for future forensic
  investigation.
• Cremation should be avoided as
• It will destroy evidence
• Large amounts of fuel are needed
• Achieving complete incineration is difficult
• It is logistically difficult to arrange for the
  cremation of a large number of dead bodies.

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• Location of burial sites
• Acceptable to the communities living near the
  burial site close enough to visit.
• Should be marked and surrounded by a buffer zone
  that is at least 10m wide.
• Distance from water sources
• At least 200m away from water sources such
  streams, lakes, springs, waterfalls, beaches, and
  the shoreline.
• Grave construction
• Clearly marked, individual graves.
• Religious practices may indicate preference for
  the orientation of the bodies (i.e. heads facing
  east, or toward Mecca, etc.)
• Communal graves should consist of a trench
  holding a single row of bodies each placed
  parallel to the other, 0.4m apart.
• Each body must be buried with its unique
  reference number on a waterproof label. This
  number must be clearly marked at ground level and
  mapped for future reference.

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Recommendations for grave depth

• Graves should be between 1.5m and 3m deep
• Graves with fewer than 5 people should allow for
  at least 1.2m (1.5m if the burials are in sand)
  between the bottom of the grave and the water
  table.
• For communal graves there should be at least 2m
  between the bottom of the grave and water table
• Distances may have to be increased depending on
  soil conditions.

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9. COMMUNICATIONS AND THE MEDIA

• Working with the media be proactive
• A Media-Liaison Officer should be assigned both
  locally and nationally.
• Working with the public
• Set up an information center for relatives
• List of confirmed dead and survivors
• Provide info about the processes of recovery,
  identification, storage, and disposal of dead
  bodies.
• Explain arrangements for death certification

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• Working with volunteers and NGOs
• Relief agencies have direct contact with affected
  communities and may act as a source of local
  information.
• Aid workers are not always well informed and may
  give conflicting information, especially about
  the infectious risks of dead bodies.
• Information management
• Respect the privacy of victims.
• Journalists should not have direct access.
• Authorities may decide to release information in
• a managed way to help with the
  identification process.
• Soon after a disaster, decision must be taken
  whether
• or not to provide information.

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10. Support to families relatives

• Establish family liaison focal point
• Inform family about findings, procedures. Be
  realistic.
• Idetification should be conducted as speedy as
  possible.
• Children should not help with visual recognition.
• Need for viewing

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• Cultural and religious aspects
• Support from religious and community leaders.
• Careful and ethical management of dead bodies.
• Providing support
• Local coping mechanisms.
• Local organizations, NGOs, and faith groups can
  provide emergency psycho-social care.
• Special legal provisions for those affected
  should be considered and publicize .

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International Legal Framework

• International Instruments on Human Rights
• They do not expressly mention
• a) the right of corpses to be
  identified
• b) and buried respecting the religious
  rites and cultural beliefs.

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• The right to identity is recognized by
• The Human Rights Declaration (Art. 6)
• The International Covenant on Civil and Political
  Rights (Art.16)
• The Convention on the Rights of the Child (Art. 7
  and 8)
• The American Convention on Human Rights. (Art. 5)
• The right to religious freedom is recognized by
• The International Covenant on Economic, Social,
  and Cultural Rites (Art. 13)
• The International Covenant on Civil and Political
  Rights (Art.18).
• The American Convention on Human Rights (Art.12 )

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• The right to identity is also recognized by
• a) Interpol Resolution AGN/65/Res/13 (1996)
• For legal, religious, cultural and other reasons,
  human beings have the right not to lose their
  identity after death
• The identification of victims is of importance
  for police investigations.
• There is a protocol that exists between all
  181-member countries to agree a standard of
  Disaster Victim Identification (DVI) in the event
  that they suffer fatalities within their country.
• b) Geneva Conventions (1949) and other protocols
  (1977)
• They expressly recognize the identification of
  the dead as a fundamental right.

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