Dead body management is a key element of disaster response: How corpses are dealt with can have a profound impact and long-lasting effect on the mental health of survivors and communities, say experts.
“Their proper management is a core component of disaster response, together with the rescue and care of survivors and the provision of essential services,” Morris Tidball-Binz, a forensic adviser at the International Committee of the Red Cross (ICRC) in Geneva, told IRIN.
Large-scale natural disasters may result in many tens of thousands of fatalities which can overwhelm local systems, and the absence of mass fatality planning can result in the mismanagement of dead bodies.
In the aftermath of the 2010 earthquake in Haiti, which killed more than 200,000 people, lack of coordination resulted in corpses being piled up outside morgues and hospitals, while thousands were buried unidentified in mass graves.
But there are also misconceptions about the management of dead bodies. Despite popular belief, cadavers resulting from a disaster do not spread disease.
According to the latest guidelines by the Pan American Health Organization and World Health Organization (PAHO/WHO), there is no evidence that corpses result in epidemics, as victims of natural disasters generally die from trauma, drowning or fire - not infectious diseases such as cholera, typhoid, malaria or plague.
Certain infectious diseases like tuberculosis, hepatitis B and C, and diarrhoeal diseases last for up to two days in a dead body. HIV may survive for up to six days. All these infections pose only a slight risk of contamination, say the guidelines.
“There is no existing evidence that dead bodies pose a significant public health risk for diseases outbreaks,” said Kouadio Koffi Isidore, a researcher on infectious diseases and public health risk management in disasters at the UN University International Institute for Global Health (UNU-IIGH) in Kuala Lumpur. “Any source of disease transmission will merely be among the affected disaster survivors,” he added.
While there is a potential risk of diarrhoea from drinking water contaminated by faecal material from dead bodies, routine disinfection of drinking water is sufficient to prevent waterborne diseases, experts say.
Nevertheless, death as a result of infectious diseases like cholera, typhus or plague may represent a health risk requiring appropriate disposal of corpses, said Isidore. “Certain precautions should be taken when disposing [of] corpses immediately after death, especially in a context of infectious diseases outbreak.”
PAHO/WHO guidelines recommend disinfection with chlorine solution, rather than lime powder which is commonly used but which has a limited effect on pathogens.
Awareness and training
There is also a need to raise awareness among communities on the risk of infection from practices such as the washing and shrouding of a dead body (an obligatory duty for Muslims), as well as large gatherings during funerals.
According to the PAHO/WHO guidelines, the empowerment and training of local communities is a major part of the management of cadavers, as local residents are typically the first to arrive to help rescue people.
The psychological aspect is also extremely important. Proper and dignified management of the dead can help ease the trauma of losing loved ones. Rapid retrieval of corpses should be a priority: It aids identification and reduces the stress on survivors. Another challenge is that the sight and smell of dead bodies can often distress survivors.
An important element is adequate training of body recovery teams to mitigate stress among team members.
According to the Asian Disaster Preparedeness Centre (ADPC), in the aftermath of a disaster, this is key in addressing the psychological trauma of losing a loved one and witnessing death on a large scale.
“Priority should be placed on helping people recreate social networks to avoid isolation, and to give people an appropriate opportunity to mourn,” International Medical Corps child psychiatrist Lynne Jones told IRIN in an earlier interview.
Religion and customs
Religious and community leaders can play a major role in helping relatives to better understand and accept the recovery and management of dead bodies, ADPC guidelines say.
Local communities should be encouraged to carry out traditional ceremonies and grieving processes and observe whatever cultural and religious events they normally practice.
“If deaths are not dignified - that is, lacking proper burials or mourning ceremonies - this denies people the means to accept and come to terms with their loss,” Jones told IRIN after the Haiti earthquake.
Under international best practice Sphere standards, corpses should be disposed of in a manner that is dignified, culturally appropriate, and based on good public health practices.
Rapid cremations, the use of bulldozers to gather dead bodies, or the lack of a place in which to bury a corpse, can cause a lot of stress.
Sphere standards require graveyards to be at least 30 metres from groundwater sources used for drinking water, with the bottom of any grave at least 1.5m above the groundwater table; surface water from graveyards must not enter inhabited areas.
ICRC advises that the cremation of unidentified bodies should be avoided since there are no health advantages: Burials are preferred in emergencies unless there are religious or cultural reasons for another course of action.
Moreover, cremation can destroy evidence needed for future identification, requires large amounts of fuel that can result in smoke pollution, and can cause logistical problems for recovery teams having to deal with a large number of corpses.