Managing the dead in mass disasters; a collaborative effort
Dr Sameera A Gunawardena
The Easter Sunday attack evoked many unpleasant memories of the numerous suicide bombings and massacres that plagued our nation over the last three decades. It was the biggest death toll from a single event since the 2004 tsunami. An incident of this nature, which results in injury and death to an extent that overwhelms available support services, is referred to as a mass disaster. Since the end of the separatist war, mass disasters in Sri Lanka occurred mainly in the form of natural catastrophes such as the Koslanda and Aranayake landslides, the floods in 2016 and 2017 and the collapse of the Meethotamulla garbage dump in 2017.
Both the public and private sectors in Sri Lanka are generally quite swift to respond to the needs of affected communities after a mass disaster. However, in comparison to providing care for living persons, the emphasis on managing the dead has often assumed a lesser priority.
This subjacent consideration is perhaps a reflection of the general attitude that there is no more that could be done to help the dead. Though this may be true from a purely physiological perspective, past experiences have shown that families could face numerous long-term issues and hardships if proper attention is not given to this aspect. The best example being the 2004 tsunami, where families were separated and many unidentified dead bodies were recovered from various parts of the country. Instead of dealing with them through a systematic investigation, many were disposed of through mass burials with no proper record keeping or documentation. As a result, even today, some parents are unaware if their infants and toddlers were killed or are still surviving. Due to the lack of a legally valid confirmation of death, surviving kin- folk were deprived of access to properties, financial accounts or insurance claims.
When managing the dead, consideration must be given to the statutory requirement of conducting inquests into these deaths. A post-mortem examination of each body or body part becomes mandatory. A question often asked is; “What is the point of doing post-mortems after disasters such as bomb blasts when the cause of death is obvious?”
The answer is that a post- mortem examination or autopsy has many purposes, and in disaster scenarios, rather than finding the cause of death, the autopsy concentrates mostly on establishing the identity of the deceased. In other words, the emphasis is on ‘who’ has died rather than ‘how’. This process of establishing the identities of dead bodies from a disaster is termed disaster victim identification, or DVI.
Many jurisdictions now require a scientific confirmation of the identity before issuing a death certificate. It is a serious responsibility as even a single misidentification can have several repercussions. Imagine a family who conducts their funeral rites on a wrongly identified body while their actual loved one continues to lie unclaimed and unidentified in the morgue. Meanwhile the family seeking this misidentified body would not receive any confirmation of that person’s death; thus prolonging their agony and distress.
In normal day-to-day life, we identify people mostly through visual recognition of their facial and bodily characteristics. After death, however, these features can be significantly altered and the possibility of misidentification, even by close relatives, is high. In the Meethotamulla and the Easter bomb disasters, there were instances where all the members of the immediate family perished. Thus the bodies had to be claimed by distant relatives; some of whom were seeing the deceased persons for the first time after years! This is why, even though the relatives may claim that they are certain of the identity, the body cannot be immediately released to them until a scientific DVI is done.
The principle of a DVI is to compare the information known about a possible missing person (ante-mortem data) with information gathered through examination of the dead body ( post- mortem data). Antemortem data could be gathered by interviewing the relatives, or retrieved from the missing person’s home, workplace or national databases. There are many different types of ante-mortem data that forensic investigators could use to establish identity. Of these, the types that provide the highest discriminative value, referred to as primary identification markers, are fingerprints, odontology and DNA.
Fingerprints are perhaps the quickest and cheapest method for confirming or excluding the identity, but only if the person’s fingerprint is on record. Some of the overseas victims that died from the Easter bombs were from countries that had their fingerprints imprinted on national identification cards which facilitated their identification.
Matching odontological features in a dead body with ante-mortem dental records is now a popular method. Even in the absence of such records, teeth can be used to estimate the age of a dead body. Sometimes, all that is needed is a recent smiling photograph to match the pattern and arrangement of the teeth. During some of the recent disasters at Aranayake, Meethotamulla and the Easter attack, forensic odontology was used in identifying some of the severely decomposed and traumatised remains.
DNA matching, or DNA fingerprinting, is very much a household term, although sometimes over- sensationalised through media. It is an essential component in DVI, but has certain limitations. A key factor is the ability to extract good quality DNA from the body which may not always be possible, especially in severely dismembered or decomposed bodies. The continually expanding sophistication in DNA testing technology is sometimes referred to as a ‘double- edged sword’ where along with the increasing sensitivity, the potential for erroneous matching also rises. DNA laboratories are required to maintain high standards of quality assurance. It is a costly exercise and in a country like Sri Lanka, routinely testing DNA in all disaster victims would not be a feasible option.
In many of the recent disasters, forensic investigators did not have to depend solely on these three primary identification markers. The majority of victims could be identified through a combination of secondary identification markers ranging from clothing, jewellery, birth marks, scars, deformities, tattoos, cosmetic alterations or even medical and surgical devices. Some of them were so unique that they were sufficient to establish the identity on their own. Relatives can assist the DVI process by providing as much information as possible about the deceased. If the person had any medical records including X-rays, bringing these documents greatly improves the chances of identification.
Caring for the surviving relatives is an important aspect that is often neglected in post- disaster management of the dead. Although not physically affected by the disaster, they too would be traumatised emotionally and psychologically. Ensuring that the dead are treated in a dignified and humane manner goes a long way in minimising the trauma of the living. It is sad to notice how disaster sites always become public spectacles. Through increasing smartphone usage, people are inclined to photograph and video the events, and with the advent of social media, these images enter the virtual dimension, possibly for eternity. People fail to consider that the bodies are often in a mutilated and gruesome state. It is hard to imagine just how distressing such candid recordings would be to surviving family members. Disasterresponse teams should pay adequate attention to this aspect and ensure that the disaster site and the dead are protected from exposure to the public.
It is natural for lay persons and onlookers to get involved with the removal and transport of dead bodies from a disaster scene. Though this is done with good intentions, the DVI process could get complicated if they are not supervised by trained personnel. During the Meethotamulla disaster, body parts of different victims were sometimes placed in the same body bag which caused confusion. Some personal items and jewellery had been removed. Ideally, each body or body part should be bagged and labelled separately in a systematic manner. There will be an urgent need for plastic body bags, waterproof identification tags, cable ties and body transportation vehicles which should be included in disaster aid programmes.
It is imperative that bodies are placed in cold storage in an organised and secure manner. In a hot and humid country like Sri Lanka, putrefaction sets in by the second day. Therefore, forensic units must be provided with temporary storage facilities. The most suitable would be freezer container trucks which are capable of preserving bodies for a considerable period. Assistance in obtaining
such equipment and also the space to keep them are important areas where voluntary organisations can support.
Fo l l owing a disaster, throngs of people flock to the mortuary in search of their family and friends who are presumed dead. Thus there will be need for temporary shelters, seating arrangements, sanitary facilities, refreshments and sometimes even a liaison unit between the forensic staff and the public. Most DVI protocols now avoid displaying the bodies and instead have photographs on display for the relatives to screen through. This minimises the distress on the relatives to a great extent, but it is still an agonising process. The police often run a desk to gather ante- mortem information on the missing persons which can also be exhausting. Attending to the necessities of these grieving relatives is yet another area where government and charity organisations can assist.
Just as in life, every individual has the right to be treated with dignity and respect after death. Performing the necessary funeral rites on behalf of their loved ones is an outlet for families to release some of their grief and achieve ‘ closure’. The forensic community in Sri Lanka has taken great strides in developing the systems and processes for managing dead bodies after disasters according to internationally accepted scientific guidelines. But they need the support of the public, security forces and other administrative and judicial institutions. Managing the dead in disasters is a team effort, where all stakeholders must collaborate to ensure that the dead victims are treated appropriately and that their surviving family and friends have been given adequate opportunity to bid them a final farewell.
Only then, can they truly rest in peace!
(Dr. Sameera A Gunawardena is a Senior Lecturer in Forensic Medicine, Faculty of Medicine, University of Colombo)