Ethical and sociocultural challenges in managing dead bodies during epidemics and natural disasters

Abstract

BackgroundCatastrophic natural disasters and epidemics claim thousands of lives and have severe and lasting consequences, accompanied by human suffering. The Ebola epidemic of 2014–2016 and the current COVID-19 pandemic have revealed some of the practical and ethical complexities relating to the management of dead bodies. While frontline staff are tasked with saving lives, managing the bodies of those who die remains an under-resourced and overlooked issue, with numerous ethical and practical problems globally.MethodsThis scoping review of literature examines the management of dead bodies during epidemics and natural disasters. 82 articles were reviewed, of which only a small number were empirical studies focusing on ethical or sociocultural issues that emerge in the management of dead bodies.ResultsWe have identified a wide range of ethical and sociocultural challenges, such as ensuring dignity for the deceased while protecting the living, honouring the cultural and religious rituals surrounding death, alleviating the suffering that accompanies grieving for the survivors and mitigating inequalities of resource allocation. It was revealed that several ethical and sociocultural issues arise at all stages of body management: notification, retrieving, identification, storage and burial of dead bodies.ConclusionWhile practical issues with managing dead bodies have been discussed in the global health literature and the ethical and sociocultural facets of handling the dead have been recognised, they are nonetheless not given adequate attention. Further research is needed to ensure care for the dead in epidemics and that natural disasters are informed by ethical best practice.

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“…During the pandemic, images of bodies being stored in ice rinks or empty rooms [ 35 , 36 ] created in the public mind the view that persons who died from COVID-19 were being subjected to dehumanised treatment. This understanding would explain, at least in part, why health care professionals believe that respect for the body of the deceased is now more difficult to achieve than in 2018.…”

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“…The uncertainty surrounding the fate of their loved ones profoundly affects the families they leave behind, who face the anguish of ambiguous loss. The many unclaimed dead in South Africa represents a significant humanitarian crisis, yet it garners less attention than the Central Mediterranean Route (Suwalowska et al, 2023). In response to this dire situation, the Pretoria Regional Delegation of the ICRC has undertaken commendable efforts across various initiatives.…”

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“…While clearly there are risks to physical health during mass fatality incidents, literature and standards on how to handle the dead have been developed to mitigate risks to physical health (Suwalowska et al, 2021 ). The International Committee of the Red Cross, for example, developed guidance for managing the dead, which includes prioritizing health and safety, and specifically notes that protective equipment is needed for reducing infection (Finegan et al, 2020 ).…”

“…MFM has dire mental health consequences as well, much of which is largely absent from literature and guidance on handling mass fatality events (Suwalowska et al, 2021 ). Because of the overwhelmed death care management system, during the COVID‐19 pandemic, the dead were often cared for without dignity and without regard to cultural and religious death care practices (Entress, Tyler, & Sadiq, 2020 ).…”

“…Poor death care practices, including delays in burials or funerals, can cause psychological trauma, anxiety, and depression for those left behind (Entress, Tyler, & Sadiq, 2020 ). For example, limited resources and the high number of bodies led to some COVID‐19 victims being buried in mass graves, making it difficult for families to find closure and ultimately leading to psychological impacts for survivors (Suwalowska et al, 2021 ). This, coupled with limited social contact during funerals and/or memorials due to COVID‐19 infection control, can compound the mental health consequences of COVID‐19 victims' families (Entress, Tyler, & Sadiq, 2020 ).…”