Two boys help to fill a large grave with body bags at the Basper public cemetery in the typhoon-hit city of Tacloban, Leyte province, Central Philippines on Thursday, Nov. 14, 2013.
Philippine workers are struggling with few resources and little time to bury bodies in hastily dug trenches, a delicate operation that may delay but not necessarily prevent desperate families from learning the fates of their missing loved ones, say two of America’s top mass-casualty experts.
Searchers and rescuers in decimated locales are working against the clock to funnel supplies to survivors and control disease outbreaks while simultaneously removing, storing and identifying thousands of decaying corpses – a grim job with a euphemistic name: “fatality management.”
“Communities don’t want the lingering memory, vision, or odors as they try to transition into recovery,” said Dr. Andrew Garrett, director of the National Disaster Medical System (NDMS), which dispatches mobile mortuary teams to domestic calamities to identify remains. (The U.S. teams are not working in the Philippines). Garrett helped oversee that task in Joplin, Mo. following a 2011 tornado that killed 158 people.
“Every mortuary mission I’ve been involved in, the pressure is really on to do it right – promptly, appropriately and respectfully – to get it done so communities can move on,” said Garrett, who was in Haiti in 2010 to identify American bodies following the earthquake that killed hundreds of thousands of people. “In Tacloban, they’re struggling to maintain public health and basic essential services. … That gets a community to the very difficult decision of doing mass burials.”
But huge, collective graves can be an acceptable – albeit visually disturbing – shortcut when the bodies are at least first tagged with a number and if those sites are mapped to later remove the remains for the painstaking process of identifying decomposed cadavers, said Dr. Edward Kilbane, director of fatality management for the NDMS.
Typhoon Haiyan: Hundreds of unidentified victims buried in mass graves
“The term ‘mass burial’ has a chilling connotation to it. But a lot of times it's just temporary – a way to store the bodies because you have no way of handling all those bodies now, no place to put them,” Kilbane said. The latest death toll following Typhoon Haiyan has surpassed 4,400.
A stench of death wafted Thursday throughout Tacloban as workers began collecting the victims – most yet to be identified – and placing many in large holes then draping them with soil.
“There are ways to do that in an orderly manner so that remains are documented,” Kilbane said. “You don’t know who they are … but you can later on you can go back, disinter those remains, then take them through the procedure.”
In America, following colossal tragedies like hurricanes and plane crashes, local police may ask the federal government to roll in one of their three mobile mortuary response units to help with the gruesome task of cataloging body parts and giving names to people whose faces, wallets, jewelry or clothing may be gone. The teams often set up in airplane hangers or auditoriums, using plastic sheets to partition makeshift exam stations where civilian experts are tasked with various scientific identification methods: dental analysis, X-rays, photographs, fingerprinting, DNA sampling and anthropologic detective work – deciphering, for example, if bones came from males or females and if they can offer clues to the approximate size, age and ethnicity of the deceased person.
The sterile, somber hubs take on an assembly-line feel as remains are ushered by hand from one station to the next, preserving the chain of evidence, and as the experts try to document identities using two or three separate scientific means.
The World Health Organization discourages the use of mass graves in most emergency situations, and notes that properly putting a name to those killed in a massive storm or other disaster can sometimes prove nearly impossible if proper action isn't taken right away.
“One of the major challenges of effective management of dead bodies is their early identification and tagging,” according to a WHO note. “Records of deaths and funerals need to be kept to monitor mortality rates and the incidence of disease and to be able to provide timely, understandable and accurate information to relatives of the dead.”
In resource-strapped nations like Haiti or the Philippines, however, there typically isnt the technology or time to set up such precisely run identification centers. Properly designating the dead may have to wait weeks, months or years as local doctors later match unearthed bodies to names via old broken bones or dental work.
American experts who staff those mobile mortuary stations at home are cloaked from their heads and faces to their hands and feet in protective garments, and the gear is meant to guard the workers from possible infections that may come from directly touching bodily fluids during post-mortem exams. That can mislead observers to believe that corpses strewn through a tragedy-ravaged community may themselves be a source of disease.
“In terms of a public health scourge, remains are not typically thought of as something that are a source themselves of infection – although that’s not necessarily how a community feels,” Garrett said, adding that a community’s collective mental health is marred by seeing scattered bodies.
According to the Centers for Disease Control and Prevention, bacteria and viruses from human remains in flood water are only “a minor part of the overall contamination” that can include sewage, soil-water organisms, and industrial chemicals.
Whether those bodies are buried or are still above ground, identification experts also fight time – along with weather conditions – when eventually trying to give those victims a name, Kilbane said.
“Human remains will deteriorate. How fast depends on the environment. … Features are destroyed. Clothing gets destroyed. Time takes its toll,” Kilbane said.
“But the same scientific methods we use all the time can be used with the decomposed body. We can use the bones, if they’re still intact. The teeth are very resilient. DNA can last a long time. Even fingerprints, scars, evidence of surgeries – objective evidence that can be used for identification is pretty durable,” Kilbane added. “But we are constantly under time constraint. No one is comfortable with any type of delay. Families want the remains and they want to know [the outcome] as soon as possible.”
First published November 15 2013, 10:18 AM