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ManagementDeadCover 3/30/06 10:01 AM Page 1 World Health Organization ManagementDeadCover 3/30/06 10:01 AM Page 2 Management of the dead is one of the most difficult aspects of disaster response. It has profound and long-lasting consequences for survivors and communities. Globally, disasters claim thousands of lives each year. However, care of the deceased is often overlooked in disaster planning and the absence of guidance for first responders has recently been highlighted following several large disasters. Immediately after a major disaster, identifying and disposing of human remains are often done by local communities. Forensic specialists may not be available or unable to rapidly access the affected area. There are simple steps that first responders can take to ensure the dead are treated in a dignified way and that can assist in their identification. This Field Manual for First Responders presents simple recommendations for non-specialists to manage the recovery, basic identification, storage and disposal of dead bodies following disasters. It also makes suggestions about providing support to family members and communicating with the public and the media. This manual will be useful during the immediate response to a disaster and where forensic response is unavailable. Furthermore, it will be useful for those preparing mass fatality disaster plans. The recommendations are relevant for local, regional and national authorities as well as for non-governmental organizations. The principles outlined in this document are being implemented and promoted by a variety of organizations, including the Pan American Health Organization, the World Health Organization, the International Committee of the Red Cross and the International Federation of Red Cross and Red Crescent Societies. This document can be viewed on Internet at: www.paho.org/disasters (click on Publications Catalog) 525 Twenty-third Street, N.W. Washington, D.C. 20037, USA disaster-publications@paho.org Management of Dead Bodies after Disasters: A Field Manual for First Responders Editors Oliver Morgan—Honorary Research Fellow, London School of Hygiene and Tropical Medicine Morris Tidball-Binz Forensic Coordinator, Assistance Division, International Committee of the Red Cross Dana van Alphen—Regional Advisor, Pan American Health Organization/World Health Organization PR O S A LU T E O O P S VI M U ND P A H O I N Area on Emergency Preparedness and Disaster Relief World Health Organization Washington D.C., 2006 PAHO HQ Library Cataloguing-in-Publication Morgan, Oliver -- ed Management of dead bodies after disasters: a field manual for first responders. Washington, D.C: PAHO, © 2006. ISBN 92 75 12630 5 I. Title II. Tidball-Binz, Morris -- ed III. Van Alphen, Dana -- ed 1. CADAVER 2. NATURAL DISASTERS 3. DISASTER EMERGENCIES 4. DISASTER PLANNING NLM WA 840 © Pan American Health Organization, 2006 A publication of the Area on Emergency Preparedness and Disaster Relief of the Pan American Health Organization, the World Health Organization, and the International Committee of the Red Cross. The views expressed, the recommendations made, and the terms employed in this publication do not necessarily reflect the current criteria or policies of PAHO/WHO or of its Member States. The Pan American Health Organization welcomes requests for permission to reproduce or translate, in part or in full, this publication. Applications and inquiries should be addressed to the Area on Emergency Preparedness and Disaster Relief, Pan American Health Organization, 525 Twenty-third Street, N.W., Washington, D.C. 20037, USA; fax: (202) 775-4578; e-mail: disaster-publications@paho.org. This publication has been made possible through the financial support of the Division of Humanitarian Assistance, Peace and Security of the Canadian International Development Agency (HAPS/CIDA), the Office of Foreign Disaster Assistance of the United States Agency for International Development (OFDA/USAID), the United Kingdom’s Department for International Development (DFID) and the European Commission Humanitarian Aid Office (ECHO). TABLE OF CONTENTS Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 2. Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 3. Infectious Disease Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 4. Body Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 5. Storage of Dead Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 6. Identification of Dead Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 7. Information Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 8. Long-Term Storage and Disposal of Dead Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . .21 9. Communications and the Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 10. Support to Families and Relatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 11. Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Annex 1: Dead Bodies Identification Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Annex 2: Missing Persons Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Annex 3: Sequential Numbers for Unique Referencing . . . . . . . . . . . . . . . . . . . . . . . . . .41 Annex 4: Body Inventory Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Annex 5: Supporting Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Annex 6: International Organizations Involved in the Development of this Document. . . .44 III FOREWORD Management of the dead is one of the most difficult aspects of disaster response, and natural disasters, in particular, can cause a large number of deaths. Although the humanitarian community has been aware of these challenges for over 20 years, the massive loss of life following the South Asian tsunami in 2004 highlighted limitations in our current capacity to respond. Several large natural disasters in 2005, including Hurricane Katrina in the United States, Hurricane Stan in Central America, and the earthquake in Northern Pakistan and India, further reveal the need for practical guidance. Natural disasters frequently overwhelm local systems that care for the deceased. Consequently, the responsibility for the immediate response falls on local organizations and communities. The absence of specialist advice or mass fatality planning amplifies the problems, often resulting in the mismanagement of human remains. This is significant because the way victims are treated has a profound and long-lasting effect on the mental health of survivors and communities. 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. This manual marks an important step toward promoting better treatment of victims and their families. It recognizes the vital role of local organizations and communities and the exceptionally difficult task of managing human remains following disasters. We are pleased that the principles outlined in this document are being implemented and promoted by a variety of organizations, including the Pan American Health Organization, the World Health Organization, the International Committee of the Red Cross and the International Federation of the Red Cross and Red Crescent Societies. Mirta Roses Periago Director Pan American Health Organization V CONTRIBUTORS Chapter 1 Introduction Chapter 2 Coordination Chapter 3 Infectious Disease Risks Chapter 5 Storage of Dead Bodies Chapter 4 Body Recovery Chapter 6 Identification of Dead Bodies Chapter 7 Information Management Chapter 9 Communications and the Media Chapter 8 Long-term Storage and Disposal of Dead Bodies Chapter 10 Support to Families and Relatives Chapter 11 Frequently Asked Questions Annexes Dead Bodies Identification Form Missing Persons Form Oliver Morgan Dana van Alphen Morris Tidball-Binz Dana van Alphen Boonchai Somboonsook Oliver Morgan Oliver Morgan Oliver Morgan Pongruk Sribanditmongkol Stephen Cordner Pongruk Sribanditmongkol Morris Tidball-Binz Oliver Morgan Yves Etienne Boyd Dent Morris Tidball-Binz Morris Tidball-Binz Claude de Ville de Goyet Ute Hofmeister Morris Tidball-Binz VII Management of Dead Bodies after Disasters: A Field Manual for First Responders Affiliations Oliver Morgan Morris Tidball-Binz Dana Van Alphen Boonchai Somboonsook Pongruk Sribanditmongkol Stephen Cordner Yves Etienne Boyd Dent Claude de Ville de Goyet Ricardo Perez Ute Hofmeister VIII Honorary Research Fellow, London School of Hygiene and Tropical Medicine, UK Forensic Coordinator, Assistance Division, International Committee of the Red Cross, Geneva, Switzerland Regional Advisor, Pan American Health Organization/World Health Organization Deputy Director, Department of Health Service Support, Ministry of Public Health, Thailand Associate Professor, Department of Forensic Medicine, Chiang Mai University, Thailand Director, Victoria Institute of Forensic Medicine, Australia Head of Assistance Division, International Committee of the Red Cross, Geneva, Switzerland Lecturer, University of Technology, Sydney, Australia Consultant in Emergency Response Regional Advisor (Publications), Pan American Health Organization/World Health Organization Forensic Advisor, Assistance Division, International Committee of the Red Cross, Geneva, Switzerland