Page last updated at 09:58 GMT, Tuesday, 19 January 2010

Do dead bodies in Haiti pose a health risk?

The Magazine answers...

In earthquake-hit Haiti, the dead are being hastily buried in mass graves, amid fears their bodies spread disease. But is that true?

Man with lime over nose, top, and another covering his nose with a cloth
Trying to disguise the smell of decay

On the streets of Haiti, the living face a desperate struggle, for food, water, medicine and shelter. But the dead present a problem of their own.

Estimates of the number killed in last Tuesday's earthquake vary from 50,000 to at least 200,000.

Dead bodies are being left by roadsides, trapped under rubble, or cleared into pits. The underlying fear is that the bodies could spread disease and infection.

But is that assumption correct?

"There is this myth that bodies have to be disposed of incredibly quickly, which often leads to bodies being shoved into pits without any form of identification," Sir Nicholas Young, British Red Cross chief executive and a trustee of the main fundraising group, the Disasters Emergency Committee, told the BBC.

"[This makes it] impossible for the relatives to grieve. Impossible to know how many people died and impossible for people to identify their relatives. This is a terrible shame.

No, bodies of people who died healthy do not spread disease
People handling bodies run a slight risk, which can be reduced with basic hygiene

"The risk is absolutely minimal, unless there is disease in the population. This is a mistake and a waste of resources."

The charity has its own guidelines on cadaver management for disaster zones and signs up to 2009 advice from the Pan American branch of the World Health Organisations - Management of Dead Bodies After Disasters: A Field Manual for First Responders.

The guide was compiled after numerous disasters - the 2004 Asian Tsunami, Haiti's 2004 floods, Hurricanes Katrina and Stan and the Northern Pakistan and Indian earthquakes - highlighted an absence of advice on what to do and why.

It came after research by Oliver Morgan, at the London School of Hygiene and Tropical Medicine, that found dead bodies in natural disasters do not pose a public health threat.

Caustic chemicals

The guide sets out how ordinary people helping on the ground can manage the recovery, identification, storage and disposal of the dead. And how to help families come to terms with it.

If necessary, temporary burial is recommended, but the caustic chemicals used to try to "disinfect" bodies are not - they have no effect and make identification harder.

A man at a makeshift morgue in Port-au-Prince
Bodies pile up in the streets

Indeed, the guide says it is the "surviving population" that is "much more likely" to be a source of infection than the dead.

But care does need to be taken in handling dead bodies, says Dr Egbert Sondorp, senior lecturer in public health and humanitarian aid at the London School of Hygiene and Tropical Medicine.

"At the time of their death, people are likely to be healthy. You need to take care in handling them, precautions, as you don't know. But they are not in themselves a risk."

Those clearing dead bodies have to take basic safeguards like wearing gloves and hand-washing. These help protect against a range of diseases which can linger in the dead for two days - tuberculosis, Hepatitis B and C, diarrhoeal diseases. And HIV, which can last for six.

There are also risks in drinking water contaminated with faeces from the living and the dead.


So why are people buried so quickly, if the official guidance suggests they should not be?

One reason is the smell, says Dr Sondorp.

"A body which is decaying smells. In most communities you try to get that away, as psychologically it's awful to have them around. You want to stop dogs [and vermin] eating them, as that too is psychologically awful."

Also, there has been no-one on the ground in Haiti to say otherwise. Governmental and non-governmental organisation has been absent.

Tradition also plays a part - religions including Islam and Judaism like to see their dead buried within 24 hours.

Past epidemics

The deep-seated fear of disease emanating from dead bodies could also stem from epidemics of the past, where people died in their droves from cholera.

Mass grave outside graveyard in Haiti
And mass burial plots are dug outside graveyards

But earthquakes, floods and fires involve deaths from drowning, injury and burns, not disease.

Despite the human instinct to get rid of the bodies quickly, a more considered approach can have long-term benefits for the mental health of the bereaved, says Ute Hofmeister, forensic adviser at the International Committee of the Red Cross.

"In all disasters, that's the human instinct, because the bodies start to smell really bad, look bad and it's not very dignified having them hanging around in the street.

"But experience shows for people, even in natural disasters, it's important to know what's happened to their dead. It helps them very much to know where they're buried."

There are also practical implications. Correct identification of the dead has legal significance for inheritance and insurance that can affect families for many years.

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