Module 14

MANAGEMENT OF THE
DEAD AND THE MISSING
IN MAJOR EMERGENCIES

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 Learning Objectives
By the end of this module, the participant should be
able to:
Discuss the usual problems of the management of
the dead and the missing, including mass fatality
situations
Discuss public health issues in connection with
dead bodies in mass fatality disasters
Identify the roles of the Health Sector in the
management of the dead and the missing
Discuss emergency preparedness for MDM 

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 Public Health
Why take a public health approach to management of
the dead following natural disasters?
Not just about identification
Physical health of survivors & relief workers
Impact on other health interventions
Mental health – Social life – Community
Legal issues
Assessing the impact of the disaster
What do you want to add ?

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 Common issues

Every effort to identify victims

Need to preserve evidence
Treat bodies & relatives with dignity & respect
Political pressure
Public health concerns

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 Coordination of the agencies
Information management (many data, complexity)
Resources
Public information
Plan of action
 Body recovery
 Storage of dead bodies
 Identification process
 Information: logistics and communication
 Disposal of the dead
 Support for families
 Security
 Liaise with international partners (DVI teams) and
embassies
 PH issues
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 Quick brainstorming

What is the situation in your country ?

Who is in charge of managing the dead and
the missing ?
What are the coordination mechanisms ?
Is this issue included in the emergency
response plans? ?

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 Health Risks and Public Health

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 Assessing Disease Risk
Presence of
Exposure to Susceptible
infectious
the agent host
agent

Gloves Vaccination
Basic hygiene TB, HBV

Natural disasters

Victims of natural - Public usually not - Susceptible to -

disasters die from exposed common chronic
trauma/drowning/fire infections
Body handlers most -
likely to be exposed TB
Unlikely to have acute -
(epidemic) infections HBV & HCV
HIV/AIDS
Possible chronic - Enteric pathogens
infections
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 Risk to the Public
Assessment suggests low risk
WHO statement about disease risks caused concern &
confusion
WHO – intense epidemiological surveillance
No epidemics recorded
Experience in many places such as Aceh, Indonesia
supports low risk assessment for public
Thousands of unburied bodies for several weeks
No epidemics

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 Workers
Potentially a ‘high risk group’
No ‘occupational’ infections
Musculo-skeletal injury
Hazardous working environment
Injury
Tetanus
 some infectious diseases

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 2. Body Recovery

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 Body search and recovery
Conducted by
Local Government / Ministry of Interior
Community members; relatives
Military
Red Cross; NGOs;
Charity Foundations Team (volunteer rescue
teams)

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 Body Recovery
First thing to happen – almost immediately
Stage of confusion
Many different people involved
No coordination
Usually a short phase
Difficult to control
Difficult to set up systems for body
recovery after a major disaster
Should be considered as part of
preparedness at local level (what would
you include in this?)
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 3. Identification

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 Challenges

Public/Media want rapid disposal of bodies

Demand proper identification of victims
Short time before decomposition
Identifying suitable storage places and systems
Limited resources
Preserve as much evidence as possible

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 Quick brain storming

What are the main constraints we can identify ?

 How to get prepare for solving them ?

What could be the role of the medical sector ?

What is your own experience ?

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 Methods for Identification
Viewing & visual identification
Prepare the bodies
Classify according to basic criteria
Collection of photographs
Advance forensic techniques
Anthropological studies
Dental record
Finger print
Forensic genetic
Molecular biology (DNA, etc.)
Others
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 Other elements
Personal effects
Identity cards
Rings, necklaces
Telephone SIM cards
Location of body (esp. earthquakes)
Posters & flyers of missing
Internet sites
ICRC – lists of living in Aceh for instance

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 Process

Unique reference – label

Photograph
Record
Secure

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 Viewing

Arranged quickly
Arranged locally
Decomposition may be too advanced after 24-48 hrs
Logistically very difficult to arrange
Distressing for relatives
Error potentially quite high

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 Photographs
Photographs – face & body, special signs
Soon after death
Possibly the best post-mortem information available in
mass fatality incident
Not as simple to do as it sounds
Quality of photographs
Availability of photographic equipment
Cost

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 Reconciled bodies by primary evidence
% 83.86
1400

1200

1000

800

600

400 % 14.37

200 0.48% 1.29%

0
Dental Fingerprint DNA Physical

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Source: TTVI on April 30, 2005
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 Suggestions for identification
Photographs & •

+
documentation Viewing & visual
Personal effects data • identification if possible

+
Forensic investigation
Storage where possible

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 Data management
What do we do with the data?
Lots of photos, much information
Difficult to use for identification
Who owns the data?
Who verifies the identification process?

Quick brainstorming…..How do you want to

solve these problems ?

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 4. Storage & Disposal

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 Storage
Not possible to keep bodies for long without storage
Limited options if many bodies
Refrigeration
Ice
Dry ice
Temporary burial

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 Burial
Preserve evidence
Location of suitable grave sites difficult
Local communities
Environmental health concerns
Operational difficulties
Lack of suitable documentation
Single graves or trench graves?
Clearly marked, not a ‘hole in the ground’
Minimum burial depth, distance from water sources etc

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 Suggestions for burial
Trench graves
One layer of bodies
Location of each body clearly marked, corresponding
with identification data
Grave construction
Water table at least 2.5 m deep
Bodies buried at least 1.5 m deep
30 m from springs & watercourses
250 m from wells & drinking water sources

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 5. Coordination

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 Coordination & Support

Body Recovery Communities, volunteers, NGOs, police, military

,Doctors, medical staff, forensic specialists

Identification
foreign embassies, INTERPOL, NGOs

Death certification Coroners, police

Disposal Military, police, local authorities

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 Technical Support
No international mechanism currently exists to
provide technical support
Potential sources of support
INTERPOL
Other countries (DVI Teams)
WHO/PAHO
Red Cross
Field manual

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 6. The missing

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 Total Dead Bodies 4,945
Dead bodies ( in the process of DVI) 3,777
Identified : 2,628
Local : 860
Foreigners : 1,768
Unidentified : 1,149

After 9 Months ……missing: 1356

Updated on October 24,2005

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 QUICK BRAIN STORMING

WHAT ARE THE MAIN PROBLEMS WITH THE

MISSING ?

HOW CAN THE HEALTH SECTOR CONTRIBUTE ?

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 7. Preparedness

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 Disaster Preparedness

Existing plans don’t include mass fatality management

Local capacity building
Police
Military
Red Cross
Hospitals
EMS System
others
Practical manual
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 Group work

What do you suggest for promoting the

readiness in your country ?

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 Recommendations

1. Time for action is short

 Decomposition 24-72 hrs
 Body recovery begins immediately
2. Specialist equipment or teams may arrive too late
3. Simple methods of identification & data management
need to be developed
4. Temporary burial may be best storage option where
refrigeration is unavailable
5. Management of dead needs to be included in disaster
preparedness

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 Recommendations

6. Coordination by single person/agency with clear

mandate & legal authority
7. Technical support is needed for governments/local
organisations
8. Active engagement with the media
9. Ongoing programme of systematic learning from future
natural disasters

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