Module 14 Management of the Missing & Dead

8/8/2019 Module 14 Management of the Missing & Dead

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WHO European Region Training Course

PUBLIC HEALTH AND EMERGENCY MANAGEMENT

WHO PHEM Euro 1

ModuleModule 1414

MANAGEMENT OF THE DEADMANAGEMENT OF THE DEAD

AND THE MISSINGAND THE MISSING

IN MAJOR EMERGENCIESIN MAJOR EMERGENCIES


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WHO PHEM Euro 1

Learning ObjectivesLearning Objectives

By the end of this module, the participant should beable to:

y Discuss the usual problems of the management ofthe dead and the missing, including mass fatalitysituations

y Discuss public health issues in connection withdead bodies in mass fatality disasters

y

Identify the roles of the Health Sector in themanagement of the dead and the missing

y Discuss emergency preparedness for MDM


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WHO PHEM Euro 1

Public HealthPublic Health

y Why take a public health approach to management ofthe dead following natural disasters?

y Not just about identification

y

Physical health of survivors & relief workersy Impact on other health interventions

y Mental health Social life Community

y Legal issues

y Assessing the impact of the disastery What do you want to add ?


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WHO PHEM Euro 1

Common issuesCommon issues

y Ever eff rt t i entif victi s

y eed t reserveevidence

y Treat dies relatives it di nit res ect

y litical ress re

y Public ealt c ncerns


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WHO PHEM Euro 1

Coordination of the agenciesCoordination of the agencies

y

Information management (many data, complexity)y Resources

y Public information

y Plan of action

y Body recovery

y Storage of dead bodiesy Identification process

y Information: logistics and communication

y Disposal of the dead

y Support for families

y Security

y Liaise with international partners (DVI teams) andembassies

y PH issues


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WHO PHEM Euro 1


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WHO PHEM Euro 1

Quick brainstormingQuick brainstorming

yWhat is the situation in your country ?

yWho is in charge of managing the dead and

the missing ?

yWhat are the coordination mechanisms ?

y Is this issue included in the emergency

response plans? ?


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PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1

Health Risks and Public HealthHealth Risks and Public Health


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Assessing Disease RiskAssessing Disease Risk

Presence of

infectious

agent

Exposure to

the agentSusceptible

host

- Victims of natural

disasters die from

trauma/drowning/fire

- Unlikely to have acute

(epidemic) infections

- Possible chronic

infections

Natural disasters

- Public usually not

exposed

-Body handlers most

likely to be exposed

- Susceptible to

common chronic

infections

TB

HBV & HCV

HIV/AIDS

Enteric pathogens

Gloves

Basic hygiene

Vaccination

TB, HBV


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Risk to the PublicRisk to the Public

y Assessment suggests low risk

y WHO statement about disease risks caused concern &confusion

y WHO intense epidemiological surveillance

y No epidemics recorded

y Experience in many places such as Aceh, Indonesiasupports low risk assessment for public

y Thousands of unburied bodies for several weeks

y No epidemics


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WorkersWorkers

y Potentially a high risk group

y No occupational infections

y Musculo-skeletal injury

y Hazardous working environmenty Injury

y Tetanus

y some infectious diseases


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22. Body Recovery. Body Recovery


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Body search and recoveryBody search and recovery

y Conducted byy Local Government / Ministry of Interior

y Community members; relatives

y Military

y Red Cross; NGOs;

y Charity Foundations Team (volunteer rescueteams)


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Body RecoveryBody Recovery

y First thing to happen almost immediatelyy Stage of confusion

y Many different people involved

y No coordination

y Usually a short phasey Difficult to control

y Difficult to set up systems for bodyrecovery after a major disaster

y Should be considered as part ofpreparedness at local level (what wouldyou include in this?)


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33. Identification. Identification


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ChallengesChallenges

y Public/Media want rapid disposal of bodies

y Demand proper identification of victims

y Short time before decomposition

y Identifying suitable storage places and systems

y Limited resources

y Preserve as much evidence as possible


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Quick brain stormingQuick brain storming

y What are the main constraints we can identify ?

y How to get prepare for solving them ?

y What could be the role of the medical sector ?

y What is your own experience ?


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Methods for IdentificationMethods for Identification

y Viewing & visual identification

y Prepare the bodies

y Classify according to basic criteria

y

Collection of photographsyAdvance forensic techniques

yAnthropological studies

y Dental record

y

Finger printy Forensic genetic

y Molecular biology (DNA, etc.)

y Others


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Other elementsOther elements

y Personal effects

y Identity cards

y Rings, necklaces

y Telephone SIM cards

y Location of body (esp. earthquakes)

y Posters & flyers of missing

y Internet sites

y

ICRC lists of living in Aceh for instance


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ProcessProcess

Unique reference label

Photograph

Record

Secure


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PhotographsPhotographs

y Photographs face & body, special signs

y Soon after death

y Possibly the best post-mortem information available in

mass fatality incident

y Not as simple to do as it sounds

y Quality of photographs

yAvailability of photographic equipment

y

Cost


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Reconciled bodies by primary evidenceReconciled bodies by primary evidence

0

200

400

600

800

1000

1200

1400

en al in erprin P ysical

83.86 %

14.37 %

0.48% 1.29%

Source: TTVI on April 30, 2005


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Suggestions for identificationSuggestions for identification

Photographs &

documentation

Personal effects dataViewing & visual

identification if possible+

Storage +Forensic investigation

where possible


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Data managementData management

yWhat do we do with the data?

y Lots of photos, much information

y Difficult to use for identification

y Who owns the data?

y Who verifies the identification process?

Quic brainst r ing..Howdo ouwant tosolve t ese roblems ?


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44. Storage & Disposal. Storage & Disposal


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StorageStorage

y Not possible to keep bodies for long without storage

y Limited options if many bodies

y

Refrigerationy Ice

y Dry ice

y Temporary burial


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Buri lBuri l

y Preserve evidence

y Location of suitable grave sites difficult

y Local communities

y Environmental health concerns

y Operational difficultiesy Lack of suitable documentation

y Single graves or trench graves?

y Clearly marked, not a hole in the ground

y

Minimum burial depth, distance from water sources etc


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Suggestions for burialSuggestions for burial

y Trench graves

y One layer of bodies

y Location of each body clearly marked, correspondingwith identification data

y Grave constructiony Water table at least 2.5 m deep

y Bodies buried at least 1.5 m deep

y 30 m from springs & watercourses

y 250 m from wells & drinking water sources


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55. Coordination. Coordination


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Coordination & SupportCoordination & Support

Body Recovery Communities, volunteers, NGOs, police, military

IdentificationDoctors, medical staff, forensic specialists,

foreign embassies, INTERPOL, NGOs

Death certification Coroners, police

Disposal Military, police, local authorities


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Technical SupportTechnical Support

y No international mechanism currently exists toprovide technical support

y Potential sources of support

y

INTERPOLy Other countries (DVI Teams)

y WHO/PAHO

y Red Cross

y Field manual


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66. The missing. The missing


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Identified : 2,628

Local : 860

Foreigners : 1,768Unidentified : 1,149

Total Dead BodiesTotal Dead Bodies 44,,945945

AfterAfter 99 Months missing:Months missing: 13561356

Dead bodies ( in the process of DVI)Dead bodies ( in the process of DVI) 33,,777777

Updated on OctoberUpdated on October 2424,,20052005


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QUICK BRAIN STORMINGQUICK BRAIN STORMING

y WHAT ARE THE MAIN PROBLEMS WITH THE

MISSING ?

y HOW CAN THE HEALTH SECTOR CONTRIBUTE ?


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77.Preparedness.Preparedness


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DisasterPreparednessDisasterPreparedness

y Existing plans dont include mass fatality management

y Local capacity building

y

Policey Military

y Red Cross

y Hospitals

y EMS Systemy others

y Practical manual


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Group workGroup work

What do you suggest for promoting theWhat do you suggest for promoting thereadiness in your country ?readiness in your country ?


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RecommendationsRecommendations

1. Time for action is short

y Decomposition 24-72 hrs

y Body recovery begins immediately

2. Specialist equipment or teams may arrive too late

3. Simple methods of identification & data managementneed to be developed

4. Temporary burial may be best storage option where

refrigeration is unavailable

5. Management of dead needs to be included in disaster

preparedness


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RecommendationsRecommendations

6. Coordination by single person/agency with clear

mandate & legal authority

7. Technical support is needed for governments/local

organisations

8. Active engagement with the media

9. Ongoing programme of systematic learning from future

natural disasters


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Documents

Module 14 Management of the Missing & Dead