Abstract
BackgroundFollowing natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters.Methods and FindingsAfter the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents.Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24–48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support.ConclusionsEmergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.
Highlights
There are at least six natural disasters every year that kill more than 500 people [1]
Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies
Existing methods developed for transport accidents and acts of terrorism are not directly transferable as they are designed for a smaller number of victims within a criminal or international medico-legal framework [2,3,4]
Summary
There are at least six natural disasters every year that kill more than 500 people [1]. Experience from the last 25 y suggests that a common reaction following mass fatality natural disasters is fear that dead bodies will cause epidemics [5,6]. This fear has frequently been used to justify rapid burial of human remains in mass graves with no identification [7]. Natural disasters that kill many people occur frequently, most guidelines for the management of large numbers of dead bodies have come out of the experience gained from transport accidents and from terrorist incidents, and these guidelines are not directly relevant; for example, natural disasters often cause many more deaths than transport accidents or terrorist attacks. Such a belief can lead to the inappropriately rapid burial of bodies before identification has been done
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