It is one of the most memorable images of the December 2004 tsunami, as vivid as the swirling waters and the devastated landscapes: makeshift morgues crammed with unidentified bodies, awaiting urgently needed burial or cremation.
But one thing is wrong with this image. Technically, there was no urgent need to bury or cremate the bodies – though all too often mass burials and cremations were carried out anyway.
The same thing happens after most catastrophes with many fatalities – earthquakes, hurricanes, even wars and famines. Inexperienced local officials, local citizens, and local journalists are sure that rapid disposal of the victims, in mass graves if necessary, is essential to prevent disease outbreaks. Experienced disaster response and public health experts try to talk them out of it, explaining that dead bodies rarely harbor infectious diseases and almost never start epidemics, that corpses are not usually a danger to the living. Sometimes they succeed. Often they don’t.
Talking about dead bodies is a classic risk communication problem. It fits the “Risk = Hazard + Outrage” formula (though “outrage” doesn’t adequately capture the feelings of fear and revulsion). The hazard posed by dead bodies is usually small. But the outrage is huge, because of such classic outrage components as dread, morality, memorability, and unfamiliarity. So the impulse to get the bodies buried is emotionally compelling and nearly universal. Educating the public – explaining the facts about the low hazard without acknowledging and addressing the high outrage – is unlikely to do the job.
This column will offer some advice to public health authorities about how to talk about dead bodies after a natural disaster or other catastrophe. The advice is predicated on the World Health Organization’s bottom line about body disposal in emergencies: “Burials in common graves and mass cremations are rarely warranted and should be avoided.” We accept the word of public health officials that dead bodies are not usually dangerous to health.
We don’t want to overstate this claim. (Public health authorities shouldn’t overstate it either.) There are important exceptions, depending mostly on what killed the victims. Ebola and typhus victims, for example, are a lot more hazardous to survivors than otherwise healthy drowning and trauma victims. Even the bodies of drowning and trauma victims can contaminate drinking water after floods (as can sewage from the living, of course). And bodies in plain sight, littering the beach or the street, are a real threat to mental health, quite apart from worries about disease outbreaks. Collecting and segregating the bodies is important; keeping them away from drinking water is important; handling them with appropriate technical precautions is important; knowing if they are likely to have had certain infectious diseases is important. And accepting that the physical health risk is usually small is important too.
Most people find it hard to believe that dead bodies are pretty safe. If you want to see the evidence, or if you’d like to know more about the technical issues and the exceptions, see Oliver Morgan’s review of the literature, “Infectious Disease Risks from Dead Bodies Following Natural Disasters.” We’re going to turn to the risk communication issues.
Notice that public health authorities are in a bind when they talk about dead bodies. One of their key tasks after every natural disaster is to warn of the imminent threat of a second disaster: disease. Long after the immediate crisis has passed, the possibility of disease outbreaks continues; for one thing, diseases that are already endemic spread more easily when weakened survivors are housed in temporary camps. Money and cooperation are needed to protect the water supply, to inoculate people against likely pathogens, and so forth. So the message that dead bodies don’t cause disease comes in the context of a deeply conflicting message that post-catastrophe disease risks are real and serious.
All the more reason to spend scarce post-catastrophe resources on the biggest disease threats, not on small ones like bodies. A premature effort to bury the dead isn’t just unnecessary. It can be profoundly harmful. Sometimes there are still ongoing search and rescue missions that should take precedence; always there are the urgent needs of survivors, many of whom may be sick, injured, or homeless. Where cremation rather than burial is the custom, scarce fuel that could be boiling water or cooking food or heating emergency shelters is diverted. Mass burials and mass cremations exact an especially agonizing price from survivors whose loved ones cannot later be found and identified: perpetual uncertainty; inability to perform religious and cultural rites of farewell; even legal nightmares regarding inheritance, property, and pensions.
A Very Tough Sell
The long-known (but not well-known) truth that dead bodies don’t usually cause disease is a very tough sell. We haven’t spoken with Acehnese villagers or Chennai city residents about this. But here is how the retired city editor of a Pennsylvania newspaper reacted when we talked with her about how to help experts and the media convey the message: “Anybody who argues that dead bodies lying around do not pose a public health problem has his head up his ---, if you would like my scientific opinion.”
Why do people resist learning that corpses aren’t all that dangerous?
- Nausea. Start with the most obvious, most visceral reason: Corpses do make you sick. Literally. The odor of rotting flesh, the sight of bloated bodies being eaten by feral animals – nausea is nearly universal and vomiting is extremely common. Dead bodies do make you sick; it seems almost inconceivable that they don’t also give you sicknesses.
- Survivor guilt. Dead bodies remind us that we made it and they didn’t. They’re a reproach. Burying the bodies helps alleviate our guilt at failing to save them.
- Religious obedience. We are instructed to look after our dead when, where, and in the manner specified in our religious tradition. Some religions require followers to dispose of the bodies quickly. The obligation to bury the dead is also a theme in classic dramas such as Sophocles’ Antigone, in which the “law of the gods” requires that Antigone’s brother be buried.
- Respect. This is largely about our respect for the dead; it is also about our self-respect, which requires us to treat the dead well, even if significant sacrifice is required. Respect is evidenced in poor people’s expenditures on funerals, and in soldiers’ efforts not to leave their dead compatriots behind, even under fire.
- Recovery symbolism. Unburied bodies indicate that the society is still in chaos. Getting them buried is a sign of recovery. After an individual death, family members rouse themselves from their shock or depression to see to the funeral; that starts the normalization process. After a catastrophe, communities do the same thing.
- Ghosts and stigma. Every society, no matter how sophisticated, takes ghosts seriously. Some societies believe that victims of sudden death hover nearby until their bodies are laid to rest. Other societies assert aggressively that they believe no such thing, but their fiction, their slang, and their real estate market suggest otherwise. Burying the bodies addresses fears far less tangible than the fear of disease.
This is a formidable list, even without the sometimes legitimate health reasons (and the always legitimate mental health reasons) for wanting the bodies buried fast. It is understandably hard to convince people to wait.
It’s not for want of trying. The Pan American Health Organization (PAHO), for example, has a long history of arguing against mass burials after Latin American hurricanes and earthquakes. After the December 2004 tsunami in Asia, PAHO updated its customary advice and produced a news release that begins this way:
Washington, D.C., December 29, 2004 (PAHO)— The staggering human toll of the tsunami disaster has led to widespread reports that rotting corpses pose a serious health threat in affected areas from India to Indonesia. Contrary to popular belief, dead bodies do not lead to catastrophic outbreaks of diseases.
Disaster and relief experts from the Pan American Health Organization – which serves as the regional office for the Americas of the World Health Organization – have said that one of the most common myths associated with natural disasters is that cadavers are responsible for epidemics.
The mistaken belief often leads authorities to take misguided action, such as mass burials or cremations, which can add to the burden of suffering already experienced by survivors, according to Dr. Dana Van Alphen, an advisor in PAHO’s Office of Emergency Preparedness and Disaster Relief.
“In too many cases,” says Van Alphen, “authorities rush to bury victims without identifying them, under the false belief that bodies pose a serious threat of epidemics. It is just not true.” She adds that such practice is not only scientifically unfounded, it violates the human rights of victims and survivors. Public health experts have repeatedly emphasized that the key to preventing diseases is improving sanitary conditions and informing people.
“Unfortunately, we continue to see the use of mass graves and mass cremations to dispose of bodies quickly, based on the myth that they pose a high threat of disease outbreaks,” Dr. Mirta Roses, Director of the Pan American Health Organization, writes in the introduction to a PAHO book Management of Dead Bodies in Disaster Situations. It is a medical fact that infectious agents do not survive long in dead bodies.
What is missing from this well-intentioned release is balance – clear, empathic, repeated acknowledgment that PAHO’s experts understand people’s reasons for feeling an urgent need to bury the bodies. In their fervor to correct the myth that bodies cause disease, the experts have neglected to address the values and feelings that sustain this myth. Good risk communication does require awareness of the public’s factual misperceptions, so that they can be corrected. But good risk communication also requires something harder: awareness of people’s deeply held values and strongly felt emotions. These don’t get “corrected.” They need to be acknowledged and legitimized instead. Only then does a factual correction stand at least a small chance of prevailing.
The media have cooperated in getting out the message that quick burial is not essential to prevent epidemics. A PAHO public information official told us its tsunami news release was used by more newspapers than any PAHO release she could remember. But the contrary message – that dead bodies are dangerous – keeps showing up in the media as well. Here are two paragraphs from two different stories in the December 29, 2004 Washington Post:
On India’s hard-hit east coast, loudspeakers warned against drinking contaminated water. With many bloated corpses still lying where the floodwaters deposited them and basic sanitation infrastructure badly damaged, health officials said they feared an epidemic spread by contaminated water.
Health and relief workers in the area said unclaimed corpses must be swiftly disposed of to stave off the threat of diseases such as cholera or diarrheal infection, which spread easily in hot climates with contaminated water. But disease experts at the World Health Organization said corpses threaten mainly the psychological well-being of survivors and do not in themselves contribute in a major way to the spread of infection.
Parts of both paragraphs conflate the genuine problem of water contamination with the technically misguided but humanly inevitable fear of dead bodies.
Local officials and even emergency responders often make the same mistake, especially early in a disaster. A December 27 New York Times article reported that “Aid agencies were rushing staff and equipment to the region, warning that rotting bodies were threatening health and water supplies.”
All of which understandably frustrates the experts who know better. Note the tone as well as the facts in the following excerpt from a 2004 editorial on mass burials by PAHO’s Claude de Ville de Goyet:
Common epidemiological sense and evidence had no place in the emergency decisions made in the Americas or more recently in the earthquakes in Gujarat, India, and Bam, Iran….
As shown with emergencies, unsubstantiated and uncontrolled fears may override basic values, including respect for the dead.…
The problem is not anymore and perhaps has never been one of a lack of knowledge by epidemiologists and scientists. The issue is how those informed health professionals can and should stand up to the pressure of public opinion and protect the rights of the survivors when fears of the unknown are running rampant and officials seek an easy way to alleviate them.
Chiding people about their fears isn’t likely to alleviate those fears.
It is understandable that expert exasperation leaks into the experts’ public statements. And it is understandable that non-experts have trouble getting the message. The experts have responded to many disasters; they see the same public reaction over and over. But for the locals, it is usually their first disaster. Under horrific conditions, local officials and survivors are trying to absorb new information that goes against every natural impulse in the world.
Not Just Burials
Burying the bodies is not the only issue that arises out of people’s fear of the dead. Reoccupying places where the deaths occurred is also problematic – and not just in third world cultures or among the poorly educated.
After the September 11, 2001 terrorist attacks, a financial services company not far from the World Trade Center site was considering returning to its building. Engineers had pronounced the structure sound; industrial hygienists had pronounced the air clean and safe. Why then were managers and employees reluctant to go back? Fear of another attack and post-traumatic avoidance were factors. So was genuine skepticism about air quality near the site. But one very important factor was rarely mentioned: corpse dust. People who had fled through black smoke filled with tons of vaporizing debris had trouble getting past the sense that they were breathing in the remains of those who had perished. There was no way to reassure people that this wasn’t so. It was so, not just emotionally but even technically, statistically. The task wasn’t to disabuse them of a misimpression about corpse dust; it was to help them bear the profoundly disquieting truth.
This truth still hovers over the World Trade Center site, and over the endlessly controversial issue of the health effects of the Twin Towers’ fire and collapse. For many in lower Manhattan, the World Trade Center victims are still in the air. Before they can think clearly about whether or not the health hazards are serious, they need help acknowledging that the corpse dust is omnipresent and hard to bear.
Soon after the tsunami, another dead body avoidance reaction temporarily thwarted the desperate attempts of South Asian fishermen to restart their businesses. People feared that fish might have eaten the bodies of those who had drowned. And so surviving fisherman, traumatized already by what the ocean had done to them, were unable to sell what they caught. Fish markets and seafood restaurants trying to resume business had no customers. Hungry survivors were reluctant to eat an available source of food.
Officials immediately announced that the fish were safe – that fish that might have eaten corpses don’t cause disease. Some added that the fish were unlikely to have eaten corpses since there was so much other more desirable food in the ocean; or that any corpses eaten by fish would be thoroughly digested by the fish (as if that were reassuring); or that “germs” from the corpses couldn’t survive in the fish anyhow. These claims may all be true, but the official statements that carried them came too quickly and sounded too glib, very much like the U.S. government’s early over-reassurances that the air around the World Trade Center was safe.
Officials also called for compassion for the fisherman – a completely appropriate call. But there was very little compassion expressed for people who were reluctant to eat the fish. In fact, officials seemed to have a very narrow understanding of why people were reluctant to eat the fish.
The lack of compassion was mirrored in the media. A January 9 article in Singapore’s Straits Times begins:
As if they have not suffered enough. Fishermen, having outlived the tsunami, now face another threat to their survival: ignorance. It has bred a fear that has swept across Asia: from Singapore to Sri Lanka, Malaysia to Hong Kong, and Thailand to Tamil Nadu in India.
The fear: fish, crabs and prawns in the Indian Ocean are now feeding off untold number of bodies washed out to sea and they will pass diseases and bacteria from the decaying bodies to those who eat the seafood.
Governments, religious leaders and marine experts have been swift in dismissing the wild rumour but, like any urban legend, it has a stranglehold on people.
Later in the article, Malaysia’s Domestic Trade and Consumer Affairs Minister Datuk Shafie Apdal says: “Please do not listen to such rumours. It will only jeopardise the only source of income for our fishermen.” Experts from Singapore’s National University and Agri-Food and Veterinary Authority sound even more dismissive:
“So the fish and crabs have plenty of their usual food supply and don’t have to resort to eating dead human flesh,” said Prof Ng. If they, in the unlikely eventuality, feed off corpses, there is no health and safety issue, said AVA.
The reason boils down to a fact of science: Any human tissues nibbled off by scavengers, such as crabs and prawns, would be digested and absorbed to form part of the animals’ own tissue.
The Straits Times article refers to the efforts of government officials to “rubbish” the fear – a good description of how these assertions feel. Clearly reporters picked up the officials’ frustration.
Officials were so motivated to reassure people, in fact, that they rarely mentioned their own prior warnings about actual seafood risks, such as getting hepatitis from shellfish raised in sewage-contaminated waters. Professor Ng, a crustacean expert, must have known that coral reefs disrupted by large storm waves are a risk factor for ciguatera poisoning from large reef fish. Thus the reassurances were misguided on two grounds. First, they weren’t empathic enough about people’s natural fears of the dead, misinterpreting the fish problem as a purely technical issue of food safety. And second, they were too one-sided about the purely technical issue, failing to mention potentially real health hazards from post-tsunami seafood.
The empathy error is the main one. One of our deepest civilized instincts is revulsion at the thought of eating human flesh. “I don’t want to eat fish and crabs that might have been feeding off dead flesh,” housewife Lee Kim Eng told the Straits Times. This taboo needs to be validated before it can be countered with facts.
Many official comments were explicitly, casually dismissive of people’s feelings about the fish. On January 11, CNN reported:
The Chief of the World Health Organization said last week that he had been eating fish in tsunami-affected countries without problems.
“Fish is a good source of protein and I am eating fish every day. No problem,” WHO Director-General Lee Jong-wook said, according to an Associated Press report.
Lee said the widely held perception that fish were contaminated by the human corpses washed out to sea was wrong. “WHO advises people to eat fish,” he said.
It’s that perky “No problem” that sounds so out of touch with people’s normal feelings. How much better if Dr. Lee had said something like this: “I must admit I hesitated before I ate the fish. I couldn’t help wondering what the fish had eaten. But the experts tell me it is safe, and I want to do everything I can to help the local fishing industry recover. So I am eating the fish.”
One final example, again from the tsunami. The Thai resort Phuket was only lightly damaged by the tsunami, and within weeks tourism authorities were actively advertising that Phuket was “up and running.” But as of this writing, many tourists continue to avoid the place. Fear of ghosts? Yes, in a sense. It’s hard to lose yourself in a vacation and relax on the beach when there is that inevitable feeling that a dead body could wash up at any point, and that there are microscopic remains in every wave. Even though you know the survivors desperately want your business, it’s hard to avoid feeling that you are swimming in other people’s misery.
Acknowledge, Acknowledge, Acknowledge
For the dead body problem, as for so many problems in risk communication, acknowledgment is the biggest piece of the solution.
Of course acknowledgment has a precondition: understanding. Communicators must start by learning more about what people believe, and about the feelings and values that underlie their beliefs. Only then can you acknowledge what you have learned.
The first thing that needs acknowledging is the widespread belief that dead bodies cause disease. Calling this belief a myth or an urban legend doesn’t acknowledge the belief; it rubbishes it. Acknowledging the belief means explaining not just that it is widespread, but also that it is common sense, that it has some kernels of truth to it. Only then is it useful to add that, surprisingly, the experts say dead bodies are actually less hazardous than we all tend to think. This should be standard procedure for correcting misinformation and wooing people from one belief to another: You start where they are.
But the urge to bury the bodies is grounded in more than just misinformation. It is grounded also in values, traditions, and emotions that run deep. Acknowledgment means telling people that too. (They know it, but they don’t know you know it.) It means telling people, in some detail, why it makes sense to bury the bodies, hazardous or not. And it means telling them empathically. You should not imply that people are experiencing primitive reactions they ought to be able to shrug off. Your point is exactly the opposite – that they are experiencing universal reactions no one can easily shrug off. Paradoxically, this helps make these reactions easier to … well, not shrug off exactly, but get past, overrule.
Acknowledging people’s values and feelings empathically usually means acknowledging that you share some of them – that you too wish you could bury the bodies quickly (even though you know the facts). It is difficult to be empathic about reactions you don’t share, so it’s useful to emphasize the ones you do. And unless you’re a very unusual person, you do share some of these reactions. So you don’t have to fake it; you just have to let it show. (But as we shall see in a few paragraphs, “just” letting it show isn’t easy!)
American psychiatrist Elvin Semrad famously summarized the therapeutic process in three steps. The therapist, Semrad said, first helps the patient acknowledge what has happened and how it has made the patient feel. Then the therapist helps the patient bear it. Finally, the therapist helps the patient put it into perspective. Semrad insisted that we cannot put things into perspective until we have first acknowledged them and learned to bear them.
Local officials’ communications after the tsunami often seemed aimed at tamping down survivors’ emotions. But survivor outcome studies usually show that the absence of a strong emotional reaction “may be more pathological than its presence,” as David Spiegel wrote in “Psychotherapy for Extreme Situations.” Discussing disaster psychiatrist Erich Lindemann’s groundbreaking work with survivors of the 1942 Cocoanut Grove fire, Spiegel cited Semrad to summarize Lindemann’s crucial approach to helping people recover: “This is the painful process of acknowledging, bearing, and putting into perspective (using the words of Elvin Semrad) the loss.”
All too often, officials ask people to put a fear into perspective without first respectfully acknowledging it and helping them bear it.
The public deserves empathic acknowledgment from emergency response officials – and emergency response officials deserve empathic acknowledgment from commentators like us. It is hard to acknowledge empathically a public reaction you know is technically unsound, especially when the reaction impedes urgent work. Briskly telling people they don’t need to worry about getting the bodies buried feels appropriate to officials. Dwelling on why people might (mistakenly) feel they need to get the bodies buried feels off-target. Why reinforce the very impulses you’re trying to counter? Why not just tell people what’s true, instead of focusing so much on the feelings that underlie the error? Why not just educate the public with the facts? If it is the natural thing for ordinary people to want to bury the bodies quickly after a disaster, it is also the natural thing for emergency responders to want to tell them they’re wrong.
What’s hardest and most unnatural for emergency responders is to show that they share the public’s aversion to dead bodies. At the very least, it feels unprofessional to acknowledge such a reaction. But the problem goes deeper than that. Disaster response personnel have no choice in real time but to overcome their aversion to dead bodies and get on with the job at hand. Whatever emotional price this exacts is a price they pay later. They don’t usually become callous; most disaster response professionals are anything but callous. But they do learn how to steel themselves to sights and smells that the rest of us can hardly bear. If they sometimes sound a little brusque when addressing our squeamishness, that’s partly because they can’t afford to open the door to their own squeamishness.
Asking them to acknowledge publicly feelings that they may be working privately to suppress is asking an awful lot. This is, however, part of what it takes to enable the rest of us to bear our aversion to dead bodies and put it into perspective.
Malaysia’s New Straits Times got it exactly right in a magnificent January 17 editorial on the post-tsunami fear of eating locally caught fish:
Primal fear has dealt a double-whammy to the fishing industry. Finally putting out to sea again after repairing their boats and reassembling lives so rudely shattered and washed away by the December tsunamis, they now find no one wants to eat the fish they catch because … well, who knows where they’ve been, what they’ve seen – and eaten? The finger-in-a-fish-belly rumour that cut Penang’s fish sales in half in recent days was too obviously waiting to happen, and too predictable to be true. As with all urban myths and legends, someone was bound to find a way to express, in the simplest and most graphic way imaginable, Everyman’s deepest dread.
Let us not, therefore, dismiss these notions too disdainfully. The revulsion people feel at the very thought of eating an animal that has recently eaten a human being is not superstitious but primal. It is not irrational but sub-rational; it stems from the deepest and darkest recesses of the conscience, where resides, perhaps ironically, what it means to be human….
So this is a scare that must run its course….
[T]he present shunning of fish has little to do with whether they have become infected with pathogens like mad cows or tainted with toxins like clams in a red tide. These are perfectly edible and healthy fish people are shying away from these days. It ought to be seen, therefore, that they are doing so as a form of mourning, albeit expressed in fear and loathing. The Agriculture and Agro-based Industries Ministry has done the right thing in establishing a mechanism for the purchase of fishermen’s unsold catch. This will help keep that benighted community afloat until the mourning period has passed, and people accept that life has done what it does, and recycled, and moved on. In the meantime, the unwanted fish purchased by Majuikan can be turned into fertiliser or animal feed. In this case, perhaps not the latter.
How directly or indirectly to acknowledge people’s aversion to corpses is a matter of judgment. Not mentioning it at all leaves people alone with it, which undermines the effectiveness of the sound advice to eat the fish or leave the bodies unburied for a while. But framing it too directly can sound intrusive or accusatory: “Dead bodies make you anxious. You feel an urgent need to get them buried.” These are feelings and reactions that your audience might not want to own up to so explicitly. So try the “I–They–It–Some People” approach. “Even though I know the bodies are safe, I still feel a strong emotional urge to bury them quickly.” Or: “A neighbor I was talking with last night said she feels….” Or: “It is hard not to feel….” Or: “A lot of people understandably feel….” I–They–It–Some People finds a middle between ignoring uncomfortable feelings and accusing people of feeling them. Those who have these feelings and are able to acknowledge them will feel more understood. Those who aren’t feeling them, or are desperately denying them, won’t become so defensive.
There are therapy case studies showing that acknowledgment can lead to behavior change. Harvard professor Leston Havens writes: “The first order of business with a new patient is to acknowledge that his behavior may serve sensible ends. However misguided or even dangerous the patient’s behavior appears, it may express, at least partially, intentions with which anyone is able to identify…. I have seen many symptoms melt away with acknowledgment.”
Some Additional Suggestions
Empathic acknowledgment is fundamental, but here are some additional suggestions for talking about dead bodies.
Don’t overstate the claim that dead bodies are safe.
There is a natural tendency for authorities who are intent on rebutting people’s excessive fear of dead bodies to end up overstating the safety of dead bodies. People who absorb and rely on the experts’ overstatement may end up with a new misperception – and at some future time some other official may have trouble cautioning them against genuine risks. One example among many: Ebola readily spreads to family members who wash the victim’s body in preparation for burial.
The more common problem with overstatement is loss of credibility. People can learn that dead bodies are usually not as dangerous as they imagined, but they cannot accept that dead bodies are simply “safe.” The latter claim provokes “Yes Buts” rather than acceptance. Acknowledging the “Yes Buts” (the exceptions) and moderating the claim is more effective as well as more accurate.
In fact, a good way to launch a reconsideration of the risks posed by corpses is to say something about the conditions under which corpses are dangerous. In other words, don’t start with the hard-to-believe generalization and then mention the exceptions. Start with the exceptions. “Dead bodies can be dangerous to health if there is reason to think the victim might have died of Ebola, typhus, or….” This goes right in without resistance, since it is about the general topic of the riskiness of bodies, not the safety of bodies. Then it’s easier for people to absorb the follow-up: “The bodies of people who died of drowning or trauma, on the other hand, are surprisingly unlikely to cause disease.” And then some more exceptions: “Even so, it is important to be careful that….”
Show respect for people’s non-health reasons for hurrying to bury the dead – and think about why some officials may find that difficult.
The six non-health reasons for wanting to bury the dead quickly that we listed at the start of this column are valid reasons – even though there are compelling reasons not to act on them. People need to hear that you understand and respect their reasons (even the ones they are not fully aware of) before they can hear your counterintuitive facts about dead bodies and disease.
And if respecting people’s reasons is hard, try to give some thought to why it’s hard. It is a truism that people tend to be most intolerant in others of the tendencies they are not comfortable with in themselves. Disaster response professionals often have to struggle to harden themselves temporarily to the conditions under which they must work. The occupational obligation to suppress one’s own horror can easily lead to impatience with the unsuppressed horror of the survivors. (Psychiatrists call this projection.) Efforts to suppress the impatience may yield a pedantic, expressionless, just-the-facts tone that characterizes some of the disquisitions we have read on this issue. All of this may be easier to bear and to manage if it is itself acknowledged, at least among colleagues: “I feel that way too, but I have to set those feelings aside to do my job. Sometimes that makes me a little impatient when other people act out or say the things I am trying not to feel.”
Regret the need to focus on priorities other than burying the dead.
To the extent that conditions permit, burying the dead is a good thing to do. But in the wake of a catastrophe, other priorities are more urgent, which is why you’re trying to convince people to leave the dead unburied for a while – until the survivors have been found and stabilized, until the likelier sources of disease have been addressed, until the relatives have had more chances to identify their loved ones.
You’re right about this. But it is regrettable, and your regret should show. The word “regrettable,” by the way, won’t do the job; it’s too lawyerly a word. Try expressing wishes: “If only we could drop everything for a day or two and care for our dead.” Or look forward: “We hope that soon we’ll have enough help to turn some of our focus to funerals and burials.”
Consider giving people permission to decide their own priorities.
This goes beyond regret; it goes further than you may choose to go. Instead of telling people (even regretfully) that caring for the living must take precedence over attending to the dead, what would happen if you posed the question as a genuine dilemma: the strongly felt, legitimate wish to bury the dead versus the urgent health needs of the living? People are likelier to make sound choices when their autonomy is respected and guided than when authorities try to preempt it in ways that may feel disrespectful, one-sided, callous, and even ignorant. Perhaps sometimes disaster experts on the local scene could ask rather than tell: “We need to keep searching for survivors, and we need to keep working on protecting the water supply, and of course we want to bury the bodies. How shall we allocate our limited resources? Here’s our view. What do you think?”
People are often more willing to tolerate obvious but emotionally difficult choices if the choice is theirs to make. If the authorities insist less on not burying the bodies yet, people may insist less on burying the bodies now.
But what if we’re wrong, what if people care so much about getting the bodies buried that they want to put that task ahead of caring for the living – even after they learn that the bodies pose little health risk? That takes us to a still more controversial suggestion.
Consider getting the bodies buried.
In response to an early version of this column, a communications specialist at the infectious disease branch of a western country’s national health agency wrote to us as follows:
The dead-body-doesn’t-cause-disease argument is a nonstarter. Beyond the public perception, however erroneous, that bodies DO cause disease, lie the indisputable points that decaying flesh stinks, the bodies become unsightly, and the entire presentation, for many, overwhelmingly upsetting. The health consequence, therefore, may be more mental than physical, but possibly more long lasting and damaging. I would suggest that attending to the dead, in that context, addresses very important needs of the living. Obviously, first-aid to survivors is always a priority, but it is likely there are enough relief workers – especially countrymen (persons) of those most affected – to attend to both needs at once. We needn’t “educate” people about the limited disease-spreading capacity of the dead. It’s quite beside the point, I think, and while people on the street may be unable or unwilling to articulate, they have good reason for wanting the dead to be quickly dispatched for the environmental reasons already stated, and to afford a measure of dignity to victims.
At least in some circumstances, quick burials and even mass burials are inevitable. Rather than expending so much energy and credibility fighting the inevitable, disaster response professionals might want to implement a two-pronged strategy: Try to talk people out of it, but since that may well fail, also work to mitigate its most harmful effects. Suppose that relief agencies prepared more for the high probability of mass burials or mass cremations. In addition to marshalling the best counterarguments, they might also carry more state-of-the-art identification kits – digital cameras for making thorough photographic records of each victim; equipment for collecting and storing clothing, jewelry, fingerprints, and other clues to identity; a portable, efficient way to save DNA samples from each victim. A lot of this work goes on already. Perhaps ramping it up even further can relieve some of the agony caused by mass burials.
What does this suggestion have to do with risk communication? It is a way of being responsive to “inbound communications” – what the public is communicating to the experts, in disaster after disaster, about the need to bury the bodies. Using this social feedback during disaster management planning, technical experts might develop policies that are both more acceptable to survivors in future disasters and more capable of ameliorating the terrible pain of those searching for the nameless dead.
The disaster experts who are most exasperated about mass burials have been trying to stop them for decades; yet as they themselves point out, mass burials continue to be commonplace. Maybe it’s time to go to a fallback position.
What emerges from these recommendations is a five-step process for talking about dead bodies in natural disasters:
Tell people the ways that dead bodies can sometimes be hazardous, and that dealing with them is sometimes a health priority.
Note that dealing with dead bodies is usually less of a health priority than people naturally suppose.
Sympathetically discuss the non-health reasons why nearly all people want to bury the dead quickly.
Regretfully point out the more urgent health priorities that compete with burying the bodies for time and other resources.
Ask people to join you in making the painful prioritization decisions.
One final recommendation – though chronologically it comes first: Try to involve your communication specialists at all stages of disaster planning and management. Communicators aren’t just useful in explaining the emergency and emergency response policies to the public; they are also indispensable in explaining the public to those charged with preparing for the emergency and developing the policies. That way, when it comes time to communicate a policy, you are likelier to have a policy that’s communicable.
Technical experts are understandably focused on technical facts, in this case on the reasons why burying the bodies is not usually an urgent priority. Communication experts are likelier to notice the reasons why burying the bodies feels to people like an urgent priority. This is crucial input not just in deciding what to say, but even in deciding what to do.
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Copyright © 2005 by Peter M. Sandman and Jody Lanard