Posted in Issue 98 January 2005 Editorial
It was South Asia’s worst natural disaster in memory—the earthquake and tidal wave that claimed more than 250,000 lives in a dozen countries last December. But as the death toll climbed in the days following the disaster, media reports warned that a second calamity was in the making: dangerous disease outbreaks caused by the legions of rotting bodies.
“International organizations urged that the thousands of bloated corpses littering beaches, streets and makeshift morgues be disposed of quickly to stem the threat of disease,” one news agency reported. Other media reports were equally alarming. One quoted a microbiologist saying that “There is a very high risk of epidemics breaking out in all these places. Decaying bodies are bacteria factories. The bodies must be quickly disposed of.” Another noted, “Worried that rotting corpses could take more lives by spreading disease, health officials ordered them collected in city trucks and dumped in mass graves.”
The notion that dead bodies pose an urgent health threat in the aftermath of a disaster is one of several enduring myths about disasters and relief efforts that live on. Survivors, however, are much more likely to be a source of disease outbreaks. Most victims of natural disasters die of trauma, drowning or burns rather than from infection, and victims are no more likely to carry infectious agents than survivors. Someone who died without cholera is not likely to produce it after they are dead.
Survivors have a strong psychological need to identify lost loved ones and to grieve for them in customary ways. Denying survivors the right to carry out those rituals can add significantly to mental health problems that occur after a disaster.
An environmental epidemiologist at the London School of Hygiene and Tropical Medicine reviewed the scientific evidence on the issue in a recent article in the Pan American Journal of Public Health. “The microorganisms involved in decomposition are not the kind that cause disease.” “And most viruses and bacteria that do cause disease cannot survive very long in a dead body.” An exception is the human immunodeficiency virus, HIV, which has been shown to live up to 16 days in a corpse, but only under refrigeration. He points out that blood-borne viruses, such as HIV and hepatitis B and C, as well as tuberculosis and gastrointestinal infections, do pose a slight risk for relief workers charged with handling bodies. But the risk of contagion can be minimized with basic precautions and proper hygiene.
One valid concern is that fecal matter from decomposing bodies may contaminate water. Getting clean water to people should be a high priority, regardless of the source of contamination.
Despite the scientific evidence, the belief that dead bodies spread disease remains a chronic problem in disaster relief efforts. Alarming reports in the media about the risk of massive disease outbreaks can prompt authorities to rush to bury bodies in mass graves. This adds to the survivors’ anguish and to the chaos. It becomes one more blow to the affected population.
There is a larger problem: mass burials and cremations can make identification of remains all but impossible and they prevent survivors from burying loved ones according to local customs and beliefs. Survivors have a strong psychological need to identify lost loved ones and to grieve for them in customary ways. Every survivor’s hope is, of course, that they will find someone alive. But when that hope fades, there is a nearly universal human need to learn the fate of a missing loved one and to somehow say good-bye. This need must be recognized along with all the other needs that people have in the aftermath of a disaster. This is why following the recent tsunami disaster, countries with specialized forensic identification teams and technology offered their services to the affected countries in support of the disaster recovery effort.
Failure to find and identify a victim can have material consequences as well, leaving survivors in a kind of legal limbo with respect to property ownership, inheritance, or family benefits. In many cases, these problems add to the economic hardship caused by the disaster itself. Although authorities may feel public pressure to dispose of bodies quickly, families, neighbors and immediate community members are likely to resist efforts to bury victims en masse. Following Hurricane Jeanne in Haiti last September, residents of Gonaives reportedly stoned a truck trying to dump corpses into a mass grave.
Much of the news coverage of the tsunami catastrophe propagated the myth of dead bodies and epidemics, particularly in the first days following the disaster. But the coverage also reflected the enormous importance survivors place on identifying lost loved ones. Media reports were filled with stories and images of survivors searching desperately in hospitals and morgues, perusing bulletin boards with victims’ photos, and posting pleas on the Internet for help in finding lost loved ones. They also showed many instances in which relief workers tried to facilitate this process.
In disaster and emergency situations that produce mass casualties, dealing with large numbers of corpses is a critical challenge for disaster relief. The approach to this task should recognize the rights of survivors and be based on scientific evidence, which is widely available, rather than on unfounded fears.
This article is based on an upcoming article from Perspectives in Health, a biannual magazine published by the Pan American Health Organization. The full version will be online at: www.paho.org. Read more about infectious disease risks from dead bodies following natural disasters in an article by Oliver Morgan published in the Pan American Journal of Public Health (http://publications.paho.org/english/dead_bodies.pdf). An editorial in the same issue of the Journal on topic is online at http://publications.paho.org/english/editorial_dead_bodies.pdf. Finally, the new PAHO/WHO publication Management of Dead Bodies in Disaster Situations is available in full text on the web www.paho.org/English/dd/ped/ManejoCadaveres.htm