News and Information for the International Community
A Disaster Myth That Just Won’t Die
Mass burials and the dignity of disaster victims
In Indonesia, relief workers helped disaster survivors in the process of identifying lost family members.
Doti Idrasanto, Ministry of Health Indonesia
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.
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.
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.
Doti Idrasanto, Ministry of Health, Indonesia
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.
What do readers think about PAHO’s publications?
At the end of 2004, PAHO conducted a study on the impact of its publications and training materials in four Spanish-speaking countries - Colombia, Ecuador, Honduras and Costa Rica - to gauge who our users are, their interests and expectations and especially, their level of satisfaction. The study yielded a sound idea of how the publications are used and the impact they have on the field of disaster reduction.
The study looked at four major categories: user profiles; awareness and consultation of the material; how the material is used and its impact; and the level of user satisfaction. Following is a sample of the most relevant conclusions.
Level of satisfaction
On average, users rate the sources of information and the publications as “good” or “very good.”
Readers under 30 years of age consider the content innovative. A majority of users (71%) between 31-60 years of age recognize clearly how this material has helped them achieve professional goals and therefore use the publications and other material more widely. Some adults over 61 found the publications difficult to comprehend and did not see any specific value added.
More than 62% of those surveyed are very satisfied with the quality and format of the publications. They consider the information contained in the publications credible and perceive the content as useful and up-to-date. In terms of format, the CD-ROM generated the greatest degree of user satisfaction, although many users pointed out that it is important of this medium being well designed and user -friendly.
Dissemination, distribution, and access to publications
The web page and the newsletter Disasters are the key sources of information and provide the greatest satisfaction. Users also expressed satisfaction with the Publications Catalog, the Virtual Disaster Library, the Regional Disaster Information Center (CRID), and other local documentation centers. However, 17% of survey respondents noted the newsletter does not reach them on a regular basis.
When it comes to how users get the information, the highest level of satisfaction is reserved for the Internet, where users can download full-text copies of all publications. This is followed by individual responses to their requests or queries, the CRID, PAHO’s local offices, and PAHO meetings or workshops. It is interesting to note that although 93% of the respondents said they had Internet access, this does not necessarily mean they use this tool to access or download publications. The study indicated that access to publications is still a matter of technology, training and resources that limit widespread Internet use.
In terms of channels of distribution, there is an “average” level of satisfaction, primarily because users think there are not enough options. The study pointed out that respondents have the most difficulty in obtaining hard copies of books.
Who uses PAHO’s disaster publications and materials? Professionals interested in emergency and disaster management, technicians in specialized institutions, health sector personnel, NGOs and municipalities, and staff at the decision making level, in that order.
Over the years, these publications have sparked the interest of new generations of disaster professionals and, for many who were trained or specialized using these materials, they have had a significant impact on their work. Twenty-five years ago, disaster management was still a relatively new field and there was little literature available. These publications have opened the door for many and helped to develop a common knowledge base, particularly in the Americas.
Some of the suggestions and comments from those surveyed include:
• An interest in participating in the “fieldtesting” of new materials.
• The need to improve distribution.
• Publish more material geared toward the managerial and political levels.
• Update obsolete publications.
• An expressed interest on the part of many in the four countries surveyed to develop further material on mental health, the transport of dangerous materials and chemical accidents.
Consult the complete study on the web at www.disaster.info.net/encuestainforme. For more information on the survey, contact email@example.com. Review all of PAHO’s publications at www.paho.org/disasters (click on Publications Catalog).