8/8/2019 Module 14 Management of the Missing & Dead
1/41
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
8/8/2019 Module 14 Management of the Missing & Dead
2/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENT
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
8/8/2019 Module 14 Management of the Missing & Dead
3/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENT
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 ?
8/8/2019 Module 14 Management of the Missing & Dead
4/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENT
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
8/8/2019 Module 14 Management of the Missing & Dead
5/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENT
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
8/8/2019 Module 14 Management of the Missing & Dead
6/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENT
WHO PHEM Euro 1
8/8/2019 Module 14 Management of the Missing & Dead
7/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENT
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? ?
8/8/2019 Module 14 Management of the Missing & Dead
8/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
Health Risks and Public HealthHealth Risks and Public Health
8/8/2019 Module 14 Management of the Missing & Dead
9/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
10/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
11/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
12/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
22. Body Recovery. Body Recovery
8/8/2019 Module 14 Management of the Missing & Dead
13/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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)
8/8/2019 Module 14 Management of the Missing & Dead
14/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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?)
8/8/2019 Module 14 Management of the Missing & Dead
15/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
33. Identification. Identification
8/8/2019 Module 14 Management of the Missing & Dead
16/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
17/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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 ?
8/8/2019 Module 14 Management of the Missing & Dead
18/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
19/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
20/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
ProcessProcess
Unique reference label
Photograph
Record
Secure
8/8/2019 Module 14 Management of the Missing & Dead
21/41
8/8/2019 Module 14 Management of the Missing & Dead
22/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
23/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
24/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
Suggestions for identificationSuggestions for identification
Photographs &
documentation
Personal effects dataViewing & visual
identification if possible+
Storage +Forensic investigation
where possible
8/8/2019 Module 14 Management of the Missing & Dead
25/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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 ?
8/8/2019 Module 14 Management of the Missing & Dead
26/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
44. Storage & Disposal. Storage & Disposal
8/8/2019 Module 14 Management of the Missing & Dead
27/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
28/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
29/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
30/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
55. Coordination. Coordination
8/8/2019 Module 14 Management of the Missing & Dead
31/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
32/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
33/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
66. The missing. The missing
8/8/2019 Module 14 Management of the Missing & Dead
34/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
35/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
QUICK BRAIN STORMINGQUICK BRAIN STORMING
y WHAT ARE THE MAIN PROBLEMS WITH THE
MISSING ?
y HOW CAN THE HEALTH SECTOR CONTRIBUTE ?
8/8/2019 Module 14 Management of the Missing & Dead
36/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
77.Preparedness.Preparedness
8/8/2019 Module 14 Management of the Missing & Dead
37/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
38/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
Group workGroup work
What do you suggest for promoting theWhat do you suggest for promoting thereadiness in your country ?readiness in your country ?
8/8/2019 Module 14 Management of the Missing & Dead
39/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
40/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1
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
8/8/2019 Module 14 Management of the Missing & Dead
41/41
WHO European Region Training Course
PUBLIC HEALTH AND EMERGENCY MANAGEMENTWHO PHEM Euro 1