Disasters

Interim Health Recommendations for Workers who Handle Human Remains

Human remains may contain blood-borne viruses such as hepatitis viruses and HIV, and bacteria that cause diarrheal diseases, such as shigella and salmonella. These viruses and bacteria do not pose a risk to someone walking nearby, nor do they cause significant environmental contamination.

Bacteria and viruses from human remains in flood water are a minor part of the overall contamination that can include uncontrolled sewerage, a variety of soil and water organisms, and household and industrial chemicals. There are no additional practices or precautions for flood water related to human remains, beyond what is normally required for safe food and drinking water, standard hygiene and first aid.

However, for people who must directly handle remains, such as recovery personnel, or persons identifying remains or preparing the remains for burial or cremation, there can be a risk of exposure to such viruses or bacteria.

Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA

“Our common concerns as cemeterians are storage and handling and burial procedures in the event of a tragedy — natural or manmade,” said Msgr. Joseph Rebman, director of cemeteries for the Diocese of Wilmington and a member of the conference’s subcouncil.

Other responsibilities include transportation of the remains, issuing death certificates, respect for religious customs, health of cemetery workers and mental health of the bereaved, he noted.

Management of the dead is one of the most difficult aspects of disaster response, and natural disasters, in particular, can cause a large number of deaths. Although the humanitarian community has been aware of these challenges for over 20 years, the massive loss of life following the South Asian tsunami in 2004 highlighted limitations in our current capacity to respond. Several large natural disasters in 2005, including Hurricane Katrina in the United States, Hurricane Stan in Central America, and the earthquake in Northern Pakistan and India, further reveal the need for practical guidance.

Natural disasters frequently overwhelm local systems that care for the deceased. Consequently, the responsibility for the immediate response falls on local organizations and communities. The absence of specialist advice or mass fatality planning amplifies the problems, often resulting in the mismanagement of human remains. This is significant because the way victims are treated has a profound and long-lasting effect on the mental health of survivors and communities. In addition, correct identification of the dead has legal significance for inheritance and insurance that can impact on families and relatives for many years after a disaster.

This manual marks an important step toward promoting better treatment of victims and their families. It recognizes the vital role of local organizations and communities and the exceptionally difficult task of managing human remains following disasters.

This manual will be useful during the immediate response to a disaster and where forensic response is unavailable. Furthermore, it will be useful for those preparing mass fatality disaster plans. The recommendations are relevant for local, regional and national authorities as well as for non-governmental organizations.

Annex 1. Dead Bodies Identification Form

Annex 2. Missing Persons Form

Annex 3. Sequential Numbers for Unique Referencing

Annex 4. Body Inventory Sheet

Oliver Morgan—Honorary Research Fellow,
London School of Hygiene and Tropical Medicine

Morris Tidball-Binz
Forensic Coordinator, Assistance Division, International Committee of the Red Cross

Dana Van Alphen—Regional Advisor,
Pan American Health Organization/World Health Organization

This 97 page book can be downloaded.

As a result of these special requirements, some religious groups maintain facilities such as small morgues, crematoria, and other facilities, which are generally operated by volunteers. Religious groups should be contacted to ensure these facilities and volunteers are prepared to deal with pandemic issues.

Religious leaders should be involved in planning for funeral management, bereavement counselling, and communications, particularly in ethnic communities with large numbers of people who do not speak the official languages.

• Mortuary staff should be informed that the deceased had pandemic influenza.
• If mortuary staff is responding to the death of a pandemic influenza patient who died at home, full barrier PPE should be used while in the home.
• In the mortuary, mortuary staff should use standard precautions when caring for the body. This includes appropriate PPE and performance of hand hygiene to avoid unprotected contact with blood, body fluids, secretions, or excretions, particularly during disinfection of mucous membranes.
• Minimize splashing and moving of body.
• Embalming may be conducted as per routine.
• Use infectious waste containers as required.
• Hygienic preparation of the deceased (e.g., cleaning of body, tidying of hair, trimming of nails, and shaving) should be conducted using standard precautions.
• The body in the body bag can be safely stored in the mortuary, sent to the crematorium, or placed in a coffin for burial. The body bag is primarily used for transport and storage of the body. The body may be removed from the body bag and handled using standard precautions, if necessary

Floating Corpses Least Of Public Health Worries

What people need to understand is that "for almost all infectious agents, when the body dies, so does the agent," said Michael T. Osterholm, Ph.D., 

This manual provides the technical information needed to support State authorities in the proper management of dead bodies, taking into account the following principles:

• The body of a person killed as a result of a disaster does not pose a risk for infection;

• Mass graves should never be used for burying disaster victims;

• Under no circumstances should mass cremation of bodies take place when this goes against the cultural and religious practices of the affected population;

• Finally, it is necessary to exhaust every effort to identify the bodies, and as a last resort bury unidentified corpses in individual niches or graves. This is a basic human right of surviving family members.

Pan American Health Organization (PAHO)
Washington, D.C:

Chapter 14 - Mortuary Service and Handling of the Dead

... where there are large numbers of deaths following a disaster, requiring organized services for handling the dead. Dead or decayed human bodies do not generally create a serious health hazard, unless they are polluting sources of drinking-water with faecal matter, or are infected with plague or typhus, in which case they may be infested with the fleas or lice that spread these diseases. In most smaller or less acute emergency situations therefore, families may carry out all the necessary activities following a death, where this is customary practice.

Disasters have a deeply disruptive effect on communities. Even if their more easily observable consequences are death, wounds, disease, loss of property, etc., the psychological consequences can be equally important and may be longer-lasting. Unfortunately, the techniques for dealing with people suffering from psychological trauma are not as clear-cut as those for dealing with material injuries and a great deal of improvisation will have to be accepted. The community’s solidarity networks, rituals and codes are very important in dealing with the psychological impact of disasters and death, and they should be encouraged.

In a disaster, ritualized behaviours normally available to deal with death may be swept aside. The large number of deaths occurring together, the lack of advance warning, the previous good health of so many of the victims, and the clustering of deaths within house-holds can overwhelm normal coping mechanisms, and leave survivors with profound and possibly lifelong trauma. For this reason, the ceremonies of burial or other forms of disposing of the dead should be as formal and as well planned as possible. Many such ceremonies will be religious and involve the entire community or all the family members.

Whatever their nature, these ceremonies are essential aspects of the grieving process. Unfortunately, popular beliefs about the health risks of human corpses have sometimes led to the hasty and undignified use of lime or burning to dispose of human remains. Authorities should resist this: ceremonial grieving for the dead is the beginning of recovery in the disaster-recovery cycle. Relief organizations should cooperate with the authorities in the disaster area to facilitate ceremonial burials. If desired, individual ceremonies can be carried out by families, but collective burial ceremonies may better help society as a whole to deal with the disaster.

Edited by B. Wisner and J. Adams

This technical guide (TG) is designed to educate mortuary affairs personnel about the safety measures for protection against bloodborne pathogens (BBP) and mycobacterium tuberculosis (MTB) associated with handling human remains.

The debate about the issue of mass disposal of bodies of victims who have died from trauma due to a disaster cannot be solely confined to the public health arena. In fact, in this case, public health is a non-argument. This remains a problem despite the fact that in most countries, domestic laws provide a series of requirements for the proper disposal of bodies.

The real challenging argument for the appropriate management of dead bodies is the recognition that identification and proper disposal of a dead body—if not clearly and unambiguously in legal terms a basic human right—is at least a basic human need.

When someone dies, there is not only a legal, societal need to identify the person, but also the human need for the moral comfort of his/her relatives.

The disposal of dead human bodies obeys a variety of sacred religious principles and traditions: immediate burial before sunset for Muslims; burial after one night of mourning in the Jewish religion; and burial after three days for the Catholic and Orthodox faiths.  This array of customs—across cultures and religions—confirms that respect for the dead is both universal and indivisible.

In that sense, it is appropriate that the identification and proper disposal of a dead body be linked to international human rights instruments, as human rights are by nature universal and indivisible across cultures, traditions, and customs. Whether there needs to be a legal international instrument that spells out this obligation is certainly an important part of this discussion.

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