PHA-Exchange> Mass burial in natural disaster unnecessary, says WHO

[claudio at hcmc.netnam.vn]

Vern Weitzel <vern at coombs.anu.edu.au>:


 <mailto:PIO_Unit at wpro.who.int> PIO_Unit at wpro.who.int

 Mass burials in natural disasters unnecessary, says WHO

Manila, 7  December 2006-The World Health Organization (WHO) Regional Office 
for the Western Pacific has issued recommendations and guidelines to dispel 
myths in the aftermath of typhoon Reming (Durian) that has claimed many 
lives.  

Dr Art Pesigan, WHO Regional Adviser in Emergency and Humanitarian Action, 
emphasized that survivors, and not the dead, are more likely to be the source 
of disease outbreaks if public health care strategies for the survivors and 
their families are not made a priority.  WHO issued the clarification after 
local officials involved in rescue efforts ordered the mass burial of bodies 
to prevent an epidemic.    

 "Epidemics do not spontaneously occur after a disaster and dead bodies will 
not lead to catastrophic outbreaks of diseases," Dr Pesigan said.  The key to 
preventing disease, he explained, is to educate the public and improve 
sanitary conditions, including the provision of safe water and food.

 Rescue workers began Sunday to bury hundreds of victims of landslides on the 
slopes of Mount Mayon in Albay Province triggered by the typhoon.  With many 
more people unaccounted for, local officials fear the death toll could exceed 
1000. 

 WHO issued the following guidelines:

*        The body of a person killed as a result of a disaster does not pose a 
risk for infection. 

*        Mass graves should not normally 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 those affected. 

*        Every effort should be made to identify bodies.  As a last resort, 
unidentified corpses should be buried in identified burial ground, in 
individual bags with photos and proper tagging.  

 Dr Pesigan also explained that the identification of bodies is essential for 
prompt recovery among survivors from the severe stress and personal losses 
caused by sudden natural disasters.  The inability to mourn a relative can 
contribute to the many potential mental health problems associated with 
disasters and make the rehabilitation process that follows more difficult.

_Fact Sheet

Care of the Dead in Disasters

Background

Every year, more than 100 000 people are killed during natural disasters and 
millions are injured and disabled. Governments are frequently overwhelmed by 
such large numbers of dead and may order mass burials in the interests of 
protecting public health. Initial media focus is often on the dead and graphic 
images of dead bodies among the debris creates pressure on governments to "do 
something".

There is a widespread and erroneous belief, even among some health 
professionals, that dead bodies are a source of disease and therefore a threat 
to public health. This is untrue. There has never been a documented case of an 
epidemic occurring after a natural disaster that could be traced to exposure 
to dead bodies. In fact, epidemics of any kind are very unusual after natural 
disasters. In the past five years, there have been many major disasters with 
tens to hundreds of thousands of dead lying uncollected for days or even 
weeks. In none of these disasters did epidemics of any kind occur.

Those killed by natural disasters are generally healthy at the time of their 
death, and therefore very unlikely be a source of infection to others. The 
micro-organisms responsible for the decomposition of bodies are not capable of 
causing disease in living people. Most infectious agents of public health 
concern that may be present at the time of death will themselves die within 
hours of the person dying. Generally, for an epidemic to occur, certain 
necessary conditions related to infectious agents, susceptible hosts and a 
favourable environment have to be met. If any of these conditions are not 
present an epidemic cannot occur. Experience has shown that a disaster event 
of itself does not automatically create these conditions. 

However, epidemics certainly can occur in the period after a disaster. The 
peak danger period is between 10 days and one month after the event. Unsafe 
food and a lack of access to safe water, lack of facilities for personal 
hygiene and safe sanitation arrangements all create a real risk for outbreaks 
of infectious disease at any time, but after a disaster these conditions, 
added to large numbers of people in overcrowded temporary shelters, makes an 
epidemic certainly possible. It is how the survivors are managed, rather than 
how the dead are managed, that determines if and when an epidemic may occur. 
Despite this potential, there have been no recorded serious epidemics in 
recent times after a disaster, which is evidence of the great progress made in 
disaster planning, response and recovery.

Certain diseases, such as HIV and hepatitis, pose a potential risk for 
individuals who come into close contact with dead bodies, but not for the 
general public. Those assigned any roles associated with handling dead bodies 
and body parts should be properly trained and always use protective equipment.

Overall, care of the dead is not a primary health sector responsibility. There 
is no public health threat from dead bodies and this misapprehension causes 
unnecessary diversion of staff and resources at a critical time. Pressure from 
misinformed journalists and media organizations can cause governments to 
behave inappropriately, for example spraying the area around dead bodies with 
disinfectant or covering dead bodies with lime. These operations are costly, 
time consuming, require complicated logistics and coordination, take staff 
away from caring for survivors and are totally unnecessary.

Recommendations for the care of the dead

Care of the dead and missing is an important area of work after a disaster and 
is clearly a major social responsibility of government. It is very important 
for the psychological recovery of survivors to have their dead relatives 
returned to them for culturally appropriate rites and disposal.

A well organized system for the retrieval, storage, identification and 
disposal of the dead is an essential part of a national disaster management 
structure, but like other parts of that structure, it must be properly planned 
and resourced. 

WHO recommends the following:

1.                                 Governments must define in law and national 
policy the arrangements required for dealing with the dead after a disaster 
and mandate a specific agency to take responsibility for this task.

2.                                 The mandated agency must have the resources 
needed to fulfil its responsibility and its staff must have the required 
knowledge and skills to fulfil their role.

3.                                 Local government must have plans in place 
for dealing with large numbers of dead bodies, based on the protocols, 
procedures and guidelines issued by the mandated agency.

References
 
A list of references and downloadable material can be found at:

http://www.who.int/hac/techguidance/ems/myths/en/index.html

Contact Information

Dr Art Pesigan, WHO Technical Officer, Emergency and Humanitarian Action 
Office, at (63 2) 528 9810; e-mail: pesigana at wpro.who.int .




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