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Disaster Relief and Health Issues

Interim Health Recommendations for Workers who Handle Human Remains Human remains may contain blood-borne viruses such as hepatitis viruses and HIV, and bacteria that cause diarrheal diseases, such as shigella and salmonella. These viruses and bacteria do not pose a risk to someone walking nearby, nor do they cause significant environmental contamination.


Bacteria and viruses from human remains in flood water are a minor part of the overall contamination that can include uncontrolled sewerage, a variety of soil and water organisms, and household and industrial chemicals. There are no additional practices or precautions for flood water related to human remains, beyond what is normally required for safe food and drinking water, standard hygiene and first aid.


However, for people who must directly handle remains, such as recovery personnel, or persons identifying remains or preparing the remains for burial or cremation, there can be a risk of exposure to such viruses or bacteria.

Disaster Recovery Fact Sheet

Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA

 Sep 2008
Leadership and Supervision for Body Recovery in Mass Death There is usually negligible risk for disease due to dead bodies. Risk of disease from handling dead bodies depends on the diseases that are present in the area, the adequacy of sanitation, and the health practices of the population. Center for the Study of Traumatic Stress
Catholic cemeteries officials plan for disaster response The report from the conference’s Mass Fatality Management Subcouncil outlined the responsibilities of cemetery employees in time of an emergency and updated the conference on its participation in planning sessions with other private sector responders.

“Our common concerns as cemeterians are storage and handling and burial procedures in the event of a tragedy — natural or manmade,” said Msgr. Joseph Rebman, director of cemeteries for the Diocese of Wilmington and a member of the conference’s subcouncil.

Other responsibilities include transportation of the remains, issuing death certificates, respect for religious customs, health of cemetery workers and mental health of the bereaved, he noted.

  Oct 2007
Management of Dead Bodies After Disasters: A Field Manual for First Responders

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.

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.

Annex 1. Dead Bodies Identification Form

Annex 2. Missing Persons Form

Annex 3. Sequential Numbers for Unique Referencing

Annex 4. Body Inventory Sheet

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


This 97 page book can be downloaded.

The Canadian Pandemic Influenza Plan for the Health Sector – Annex I – Guidelines for the Management of Mass Fatalities During an Influenza Pandemic 3.1 Special Populations – A number of religious and ethnic groups have specific directives about how bodies are managed after death, and such needs must be considered as a part of pandemic planning. First Nations, Inuit, Jews, Hindus, Muslims, all have specific directives for the treatment of bodies and for funerals. The wishes of the family will provide guidance, however, if no family is available local religious or ethnic communities can be contacted for information. For example, in the case of First Nations peoples, mechanisms currently exist to communicate with band councils for this purpose (established to deal with archeological issues) and medical examiners should contact the band council of the individual where this is possible.

As a result of these special requirements, some religious groups maintain facilities such as small morgues, crematoria, and other facilities, which are generally operated by volunteers. Religious groups should be contacted to ensure these facilities and volunteers are prepared to deal with pandemic issues.

Religious leaders should be involved in planning for funeral management, bereavement counselling, and communications, particularly in ethnic communities with large numbers of people who do not speak the official languages.

  December 2006
Pandemic Influenza Plan (Supplement)
Technical Section J: Care of the Deceased
Page 217 of 378
Version 2.5,
Care of the deceased in the mortuary

  • Mortuary staff should be informed that the deceased had pandemic influenza.
  • If mortuary staff is responding to the death of a pandemic influenza patient who died at home, full barrier PPE should be used while in the home.
  • In the mortuary, mortuary staff should use standard precautions when caring for the body. This includes appropriate PPE and performance of hand hygiene to avoid unprotected contact with blood, body fluids, secretions, or excretions, particularly during disinfection of mucous membranes.
  • Minimize splashing and moving of body.
  • Embalming may be conducted as per routine.
  • Use infectious waste containers as required.
  • Hygienic preparation of the deceased (e.g., cleaning of body, tidying of hair, trimming of nails, and shaving) should be conducted using standard precautions.
  • The body in the body bag can be safely stored in the mortuary, sent to the crematorium, or placed in a coffin for burial. The body bag is primarily used for transport and storage of the body. The body may be removed from the body bag and handled using standard precautions, if necessary
Minnesota Department of Health April 2006
Funeral Services and Final Disposition of Mass Fatalities Resulting From a Pandemic Influenza in the United States The collective insight of gathered experts through model simulation, brainstorming and peer critique/inquiry reveals a distinct misalignment between current government disaster planning and the realities of mass fatality due to pandemic conditions. It is clear that the National Response Plan (NRP) Emergency Support Function (ESF) #8 lacks the depth and breadth necessary when facing a potentially dire tragedy of such immense proportion. An ESF so geared to medical services and preventing loss of life only acts as a disservice when morgue operations, body disposition, identification and all multifaceted peripheral operations are inadequately addressed. Further, it is recommended that an optimum integration of the issues identified during this collaboration be formed into actionable plans, with the utmost consideration being given to an ESF dedicated to mass fatality response. Altieri, Jason C., President/CEO, Commonwealth Institute of Funeral Service.
Biggins, Robert J., President, National Funeral Directors Association.
Boetticher, Robert M., Sr., Director of Special Operations, Service Corporation International.
Fells, Robert, External Chief Operating Officer and General Counsel, International Cemetery and Funeral Association.
Horton, Buddy, United States Air Force Europe, Mortuary Affairs.
McWilliams, Edward L., President, Barrier Products LLC.
Rahill, Paul, President, Matthews Cremation Division.
Rutledge, Laurel K., Vice President of Planning and Strategy, Batesville Casket Company.
June 2006
Floating Corpses Least Of Public Health Worries

What people need to understand is that “for almost all infectious agents, when the body dies, so does the agent,” said Michael T. Osterholm, Ph.D.,

Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis September 5, 2005
Management of Dead Bodies in Disaster Situations

This manual provides the technical information needed to support State authorities in the proper management of dead bodies, taking into account the following principles:

  • The body of a person killed as a result of a disaster does not pose a risk for infection;

  • Mass graves should never be used for burying disaster victims;

  • Under no circumstances should mass cremation of bodies take place when this goes against the cultural and religious practices of the affected population;

  • Finally, it is necessary to exhaust every effort to identify the bodies, and as a last resort bury unidentified corpses in individual niches or graves. This is a basic human right of surviving family members.

Area on Emergency Preparedness and Disaster Relief

Pan American Health Organization (PAHO)
Washington, D.C:

Environmental Health in Emergencies and Disasters: A Practical Guide

Chapter 14 – Mortuary Service and Handling of the Dead

… where there are large numbers of deaths following a disaster, requiring organized services for handling the dead. Dead or decayed human bodies do not generally create a serious health hazard, unless they are polluting sources of drinking-water with faecal matter, or are infected with plague or typhus, in which case they may be infested with the fleas or lice that spread these diseases. In most smaller or less acute emergency situations therefore, families may carry out all the necessary activities following a death, where this is customary practice.

Disasters have a deeply disruptive effect on communities. Even if their more easily observable consequences are death, wounds, disease, loss of property, etc., the psychological consequences can be equally important and may be longer-lasting. Unfortunately, the techniques for dealing with people suffering from psychological trauma are not as clear-cut as those for dealing with material injuries and a great deal of improvisation will have to be accepted. The community’s solidarity networks, rituals and codes are very important in dealing with the psychological impact of disasters and death, and they should be encouraged.

In a disaster, ritualized behaviours normally available to deal with death may be swept aside. The large number of deaths occurring together, the lack of advance warning, the previous good health of so many of the victims, and the clustering of deaths within house-holds can overwhelm normal coping mechanisms, and leave survivors with profound and possibly lifelong trauma. For this reason, the ceremonies of burial or other forms of disposing of the dead should be as formal and as well planned as possible. Many such ceremonies will be religious and involve the entire community or all the family members.

Whatever their nature, these ceremonies are essential aspects of the grieving process. Unfortunately, popular beliefs about the health risks of human corpses have sometimes led to the hasty and undignified use of lime or burning to dispose of human remains. Authorities should resist this: ceremonial grieving for the dead is the beginning of recovery in the disaster-recovery cycle. Relief organizations should cooperate with the authorities in the disaster area to facilitate ceremonial burials. If desired, individual ceremonies can be carried out by families, but collective burial ceremonies may better help society as a whole to deal with the disaster.

World Health Organization

Edited by B. Wisner and J. Adams

Guidelines for Protecting Mortuary Affairs Personnel
from Potentially Infectious Materials
This technical guide (TG) is designed to educate mortuary affairs personnel about the safety measures for protection against bloodborne pathogens (BBP) and mycobacterium tuberculosis (MTB) associated with handling human remains. U.S. Army Center for Health Promotion and Preventive Medicine
October 2001
Stop Propagating Disaster Myths The international response to the tragic earthquake in Turkey highlights the need to reassess the myths and realities surrounding disasters, and to find ways to stop these destructive tales. The myth that dead bodies cause a major risk of disease, as reiterated in all large natural disasters from the earthquake in Managua, Nicaragua (1972) to Hurricane Mitch and now the Turkish earthquake, is just that, a myth. The bodies of victims from earthquakes or other natural disasters do not present a public health risk of cholera, typhoid fever or other plagues mentioned by misinformed medical doctors. In fact, the few occasional carriers of those communicable diseases who were unfortunate victims of the disaster are a far lesser threat to the public than they were while alive. Often overlooked is the unintended social consequence of the precipitous and unceremonious disposal of corpses. It is just one more severe blow to the affected population, depriving them of their human right to honor the dead with a proper identification and burial. Dr. Claude de Ville de Goyet, formerly at PAHO’s Emergency Preparedness and Disaster Relief Program

301-657-3898  5405 Center St, Chevy Chase, MD 20815

April 2000
WHO Warns Against Health Misconceptions in Wake of Turkish Earthquake … natural disasters do not import diseases which are not already present in the affected area and they do not provoke outbreaks of communicable diseases. The risk of an increasing incidence of sporadic cases (below epidemic levels) exists due, in the case of an earthquake, to the rupture of water sanitation infrastructure, the interruption of public health services such as immunization and sanitation measures in urban settings, and the loss of control of disease vectors like mosquitoes and rodents. Dr. Michel Thieren, Medical Officer in WHO’s Department of Emergency and Humanitarian Action August 1999
Identifying Cadavers Following Disasters: Why? One of the most common myths associated with natural disasters is the myth that cadavers are responsible for epidemics. In many cases, the management of cadavers is governed by the false belief that bodies represent a serious threat of epidemics if they are not immediately buried or burned. This threat is used as a justification for widespread public health malpractice that gives top priority to mass burial or cremation of victims. More than simply being scientifically unfounded, this practice leads to serious breaches in the principle of human dignity by depriving victims of an appropriate identification and disposal of their body.

The debate about the issue of mass disposal of bodies of victims who have died from trauma due to a disaster cannot be solely confined to the public health arena. In fact, in this case, public health is a non-argument. This remains a problem despite the fact that in most countries, domestic laws provide a series of requirements for the proper disposal of bodies.

The real challenging argument for the appropriate management of dead bodies is the recognition that identification and proper disposal of a dead body—if not clearly and unambiguously in legal terms a basic human right—is at least a basic human need.

When someone dies, there is not only a legal, societal need to identify the person, but also the human need for the moral comfort of his/her relatives.

The disposal of dead human bodies obeys a variety of sacred religious principles and traditions: immediate burial before sunset for Muslims; burial after one night of mourning in the Jewish religion; and burial after three days for the Catholic and Orthodox faiths.  This array of customs—across cultures and religions—confirms that respect for the dead is both universal and indivisible.

In that sense, it is appropriate that the identification and proper disposal of a dead body be linked to international human rights instruments, as human rights are by nature universal and indivisible across cultures, traditions, and customs. Whether there needs to be a legal international instrument that spells out this obligation is certainly an important part of this discussion.

Robert Guitteau, Executive Director of the Center for Human Rights and Humanitarian Law at Washington College of Law – American University with Michel Thieren in the April 2000 issue of ” Disasters: Preparedness and Mitigation in the Americas,” Pan American Health Organization.  April 2000

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