BBC: Indonesia earthquake and tsunami - Management of dead bodies

1 October, 2018

This BBC news item on the recent earthquake and tsunami in Indonesia suggests persistence of the myth about dead bodies spreading disease, leading to rapid mass burial depriving the opportunity for the bereaved to grieve and hold their own funerals. (Clearly, dead bodies are a major health risk in situations such as Ebola, as guidance from WHO, below, explains) https://www.bbc.co.uk/news/world-asia-45701060

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A picture of large-scale destruction is emerging in and around the Indonesian city of Palu after an earthquake and tsunami struck on Friday.

At least 832 people are confirmed to have died but that figure is expected to rise sharply as more remote areas are reached.

The authorities have said they will begin burying victims in mass graves, fearing disease could begin to spread...

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Management of dead bodies: Frequently asked questions

http://www.who.int/hac/techguidance/management-of-dead-bodies-qanda/en/

2 November 2016

1. Do dead bodies cause epidemics?

No, dead bodies from natural disasters generally do not cause epidemics. This is because victims of such disasters usually die from trauma, drowning or fire and do not normally harbour organisms which cause epidemics. The exception to this is when deaths have occurred from highly infectious diseases (such as Ebola, Lassa fever, cholera), or when the disaster occurred in an area that is endemic for such highly infectious diseases. In these circumstances, the possibility of disease spreading from dead bodies exists.

2. What are the health risks for the public?

Unless the deceased has died from a highly infectious disease, the risk to the public is negligible. However, there is a risk of diarrhoea from drinking water contaminated by faecal material from dead bodies. Routine disinfection of drinking water is sufficient to prevent waterborne illness. (See question 6 for the health risks to those handling dead bodies.)

3. Can dead bodies contaminate water?

Yes they can, as do live bodies. Dead bodies often leak faeces which may contaminate rivers or other water sources, causing a risk of diarrhoeal illness which adequate treatment of water can prevent.

4. Is spraying bodies with disinfectant or lime powder useful?

Lime powder does not hasten decomposition and, since dead bodies are generally not an infectious risk to the public, disinfectant is not needed.

5. Local officials and journalists say there is a risk to the public of disease from dead bodies. Are they correct?

The risk from dead bodies after disasters due to natural hazards is misunderstood by many professionals and the media. Even local or international health workers are often misinformed and contribute to the spread of unfounded rumors about outbreaks and epidemics. Dead bodies from natural disasters generally do not cause epidemics. The risk of disease from dead bodies is real only in cases where the deceased has died of a highly infectious disease, or has died in an area where such infectious disease is endemic. Even then, the risk of disease transmission to a trained body-handler is low (see question 6)

6. Is there a risk for those handling dead bodies?

For people handling dead bodies (rescue workers, mortuary workers, etc.), there is a risk if the deceased are infected with highly infectious disease (such as Ebola, Lassa fever, cholera). The infectious agents responsible for these diseases last for varying periods after death. The internal organs that harbour organisms such as tuberculosis, which can survive for very long periods after a person’s death, are usually handled only by trained personnel during actual autopsy. This is not part of any procedure described in this manual. Processes to support persons handling the dead should be in place to deal with any psychological impacts arising from their work.

7. Should workers wear a mask?

The smell from decaying bodies is unpleasant, but the smell itself is not a health risk in well-ventilated areas, and in such areas wearing a mask is not generally required for health reasons. However, special masks may be required for health and safety purposes in some circumstances, including in the presence of toxic gases, smoke, particles, etc.

8. How urgent is the collection of dead bodies?

Body collection is not the most urgent task after a disaster from natural hazards. The priority is to rescue and care for survivors. Nevertheless, bodies should be collected and photographed as soon as possible (and preferably before decomposition has commenced), basic information about the bodies should be collected and recorded, unique body codes allocated, and the bodies should be temporarily stored to protect them and to assist possible identification. The earlier this is done, the greater the number of bodies which will be identified. In the presence of an epidemic of highly infectious disease, collection and proper management of dead bodies by trained personnel is an urgent priority

9. Should mass graves be used to speed up disposal of dead bodies?

Rapid mass burial of victims on public health grounds is not justified. Rushing to dispose of bodies without having taken photographs and relevant information from them, and without keeping track of the location of each body, traumatizes families and communities. If these simple steps to identify the greatest possible number of bodies are taken, serious social and legal consequences for families can be avoided. In exceptional circumstances, the use of communal graves as a form of temporary traceable storage and protection of dead bodies is acceptable if properly managed.

10. What should the authorities do with dead bodies in the short term?

Dead bodies should be collected and stored, using refrigerated containers where possible, or temporary burial. The simple steps required to help identify all the dead bodies should be taken. Photographs should be taken and descriptive information recorded for each body. Remains should be stored or buried temporarily to allow for the possibility of an expert forensic investigation in the future. [...]

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Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 18,000 members in 177 countries, interacting on five global forums in three languages. He also currently chairs the Dgroups Foundation (www.dgroups.info), which supports 800 communities of practice on international development, health and social justice. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org