Disposal of Dead Bodies

1. Disposal of Dead Bodies

2. Introduction and Objective Setting

3. Overall Objective • To put the issue of dead bodies into a public health perspective (including psycho-social aspects) and understand the basics of managing dead bodies in the first phase following a disaster.

4. Specific Objectives • Describe the relative importance of dead bodies in an emergency (health risks to the public and those handling the dead) • Develop an action plan to manage dead bodies in a practical sense following a disaster • List 3 extra precautions needed in dealing with those who have died from a highly infectious disease such as cholera or Ebola.

5. Public Health Importance of Dead Bodies?

6. General Discussion • Question to group • Is the disposal of the dead a major public health priority in the aftermath of a disaster?

7. General Discussion • “Dead bodies do not cause epidemics…” • Source: PAHO et al, Management of Dead Bodies after Disasters: A field manual for first responders, 2006

8. General Discussion • Question to group • Having established that in general dead bodies do not pose a major physical public health risk what are the implications of action or inaction with regard to mental health?

9. General Discussion • “Burials in common graves and mass cremations are rarely warranted and should be avoided” • Source: Dispoal of Dead Bodies in emergency conditions WHO, Technical Note No.8, Draft revised 7.1.05

10. General Discussion • Question to group • If you have responsibility for the collection of corpses following an earthquake what are the infectious disease risks for those staff (body handlers) employed to undertake this task?

11. Infectious Disease Risks Risk to body handlers • Hepatitis B and C • HIV • Tuberculosis • Diarrhoeal disease

12. Group Work • Group to be divided into groups of four people to address the following scenario. • 20 mins to review the scenario and develop an action plan • 10 mins thereafter to present back.

13. Group Work • An earthquake has struck a large city in a part of South East Asia at the height of the hot season. The majority of the population are Christian. Approximately 20,000 people have died as a direct result of the earthquake. • Your agency has been delegated to address the issue of dead bodies. • Describe what you would do in this situation?

14. Group Work • Issues that you should have addressed include:- • Body Recovery • Storage of Dead Bodies • Identification of Dead Bodies • Information Management • Disposal • Communications and the Media • Support to Families and Relatives

15. Protecting Staff Key aspects to protecting staff • Provide personal protective equipment; heavy duty gloves and boots • Hand washing facilities with soap and water for after handling dead bodies, • First aid available for team members and tetanus vaccination for workers without vaccination cover.

16. Disposal • Question to group • What is the preferred method of disposal for dead bodies?

17. Burial Sites • Question to group • What are the criteria to consider in the selection of an appropriate burial site?

18. “Infectious Dead” • Question to group • What special precautions would you consider necessary in dealing with those who have died from a highly infectious disease such as cholera? • Example - Goma, Zaire now DRC, July 1994: Over 45,000 people died over a 3 week period from cholera and over 90% of those died outside a health facility.

19. Infectious Dead • Extra precautions might include:- • Extra personal protective equipment • The use of body bags at all times • The disinfection of the body with a 2% chlorine solution • Immediate burial

20. Management of Dead Bodies Key recommendations • Give priority to the living (e.g. provide sanitation facilities for the survivors first) • Promote the identification and tagging of corpses • Provide accurate information concerning the risks associated with corpses • Do not promote mass burial of unidentified bodies in large graves • Conserve fuel and resources • Respect the wishes and social customs of the families Source: Emergency Sanitation, WEDC, 2002

21. Have Objectives been met? • To understand the relative importance of dead bodies in an emergency (health risks to the public and those handling the dead) • To understand how to manage dead bodies in a practical sense following a disaster • To understand the extra precautions needed in dealing with those who have died from a highly infectious disease such as cholera or ebola.

22. Have Objectives been met? • To put the issue of dead bodies into a public health perspective (including psycho-social aspects) and understand the basics of managing dead bodies in the first phase following a disaster.

23. Key References • Davis, Jan., and Lambert, Robert., Engineering in Emergencies, A practical guide for relief workers. 2nd Edition, RedR/IT, 2002 (Pg 182-183) • Disposal of Dead Bodies in emergency conditions, WHO, Technical Note No. 8 Draft Revised 7.1.05 • PAHO et al, Management of Dead Bodies after Disasters: A field manual for first responders, 2006 • MSF, Infection Control in Health Care Settings, First Edition, 2006. • Harvey, Peter., Baghri, Sohrab., and Reed, Bob., Emergency Sanitation, Assessment and Programme Design, WEDC, Loughborough University 2002 • UNHCR, Handbook for Emergencies, Third Edition, February 2007. (Pg 277) • Davis, Jan., and Lambert, Robert., Engineering in Emergencies, A practical guide for relief workers. 2nd Edition, RedR/IT, 2002 (Pg 182-183) • Disposal of Dead Bodies in emergency conditions, WHO, Technical Note No. 8 Draft Revised 7.1.05