London School of Hygiene & Tropical Medicine

The Pan American Health Organisation (PAHO), in conjunction with the World Health Organisation (WHO), the International Committee of the Red Cross, and the International Federation of Red Cross and Red Crescent Societies, has published a new field manual that provides step-by-step guidance on how to recover and identify victims killed in disasters while respecting the needs and rights of survivors.

Management of Dead Bodies after Disasters: A Field Manual for First Responders is aimed at facilitating proper identification of victims and preventing mass burials and cremations. The book dispels the widely held misconception that dead bodies pose a serious health threat in the aftermath of disasters.

"After most natural disasters, there is a fear that dead bodies will cause epidemics," says Oliver Morgan, an honorary research fellow at the London School of Hygiene and Tropical Medicine and one of the book's three co-editors. "This belief is wrong-most infectious organisms do not survive beyond 48 hours in a dead body, and it is the surviving population that is more likely to spread disease. But authorities often feel political pressure to resort to unnecessary measures such as hasty mass burials."

Such practices can add to the mental suffering of victims' families and can lead to legal and other long-term difficulties by preventing proper identification of bodies.

"The way victims are treated has a profound and long-lasting effect on the mental health of survivors and communities," says PAHO Director Mirta Roses in the book's foreword. "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."

The job of managing dead bodies after a disaster, particularly in developing countries, usually falls to local organizations and communities rather than specialized teams of national and international experts. To reach this audience, the new field manual was written in plain language, with practical recommendations on how to accomplish key tasks. The book is available for download from the PAHO website at http://www.paho.org/english/dd/ped/DeadBodiesFieldManual.htm.

Among central points emphasized in the manual are:

The overwhelming desire of people from all religions and cultures is to identify their loved ones. Careful and ethical management of dead bodies is a critical component of disaster recovery.

Dead bodies pose a negligible threat to public health, since most victims die from injury, drowning or fire. Responders who handle dead bodies should wear gloves and practice good basic hygiene. Wearing face-masks is not necessary for infection control purposes but may help workers feel psychologically better. Bodies present virtually no risk of epidemic diseases.

Sooner is better for victim identification. The early work of non-specialists will determine much of the success of forensic specialists when they arrive. First responders should collect basic information about the deceased and take photographs before storing bodies for later forensic identification. Visual identification or photographs of fresh bodies are the simplest forms of identification.

Bodies should be stored at cold temperatures, either in refrigerated containers or buried temporarily in organized graves. Within 12 to 48 hours in hot climates, decomposition will be too advanced to allow facial recognition.

Accurate, timely, and updated information can reduce stress on survivors, defuse rumours, and dispel misconceptions. The news media are vital channels of communication with the public, and authorities should proactively engage them.

Chapters in the book cover provide practical information and guidance on topics including the true health risks posed by dead bodies, how to recover bodies, how to store them, methods for identification, long-term storage and disposal, communications and the media, and support to families and relatives. The book also provides practical annexes, including a Dead Body Identification Form, a Missing Persons Form, and a chart of sequential numbers for unique referencing of bodies.

"In many contexts around the world, when disaster strikes, those who are first on the scene often require simple and practical guidance to recover and manage the dead in a way that respects the right of families to know the fate of their missing relatives and to mourn their dead," says Dr. Morris Tidball-Binz, forensic coordinator at the ICRC and co-editor of the book. "Also, if these guidelines are followed, the work of forensic specialists, when they do arrive, will be made easier to help identify the dead."