title: Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka.
abstract: BACKGROUND
  Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters.
  
  
  RESULTS
  After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support.
  
  
  CONCLUSIONS
  Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.
authors.affiliation: Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom. omorgan@bigfoot.com
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Morgan
authors.forename: Pongruk
authors.initials: P
authors.lastname: Sribanditmongkol
authors.forename: Clifford
authors.initials: C
authors.lastname: Perera
authors.forename: Yeddi
authors.initials: Y
authors.lastname: Sulasmi
authors.forename: Dana
authors.initials: D
authors.lastname: Van Alphen
authors.forename: Egbert
authors.initials: E
authors.lastname: Sondorp
mesh_terms: D004189:Disaster Planning / Q000458:organization & administration*; D004190:Disasters; D044707:Forensic Sciences; D017408:Guidelines as Topic; D006801:Humans; D007214:Indonesia; D017744:Medical Waste Disposal; D009027:Mortuary Practice; D015397:Program Evaluation; D015980:Public Health Practice; D012034:Refrigeration; D012107:Research Design; D018570:Risk Assessment; D013188:Sri Lanka; D013785:Thailand; D013997:Time Factors
chemical_list: D017744:Medical Waste Disposal