01.19.10

Haiti's Grisly Problem

Authorities in Haiti are dumping thousands of bodies into mass graves. Famed pathologist Cyril Wecht on how to handle the dead, and the morbid challenge the country faces.

The scene is apocalyptic: bodies, by the thousands, being unceremoniously shoveled into mass graves. In the days since Haiti was rocked by a 7.0 earthquake, the country’s shell-shocked leadership has been struggling with the grisly problem of what to do with its dead. This Saturday, Prime Minister Jean-Max Bellerive announced that the government—or what’s left it—had already consigned some 20,000 corpses to giant holes in the ground, making little or no discernible effort to identify the deceased, let alone notify the next of kin.

You have to be mindful of what can be conveyed from the dead to the living; flies and other insects can carry various pathogens.

It isn’t supposed to work this way. Dr. Cyril Wecht, a leading American forensic pathologist, is a founding member of The American Board of Disaster Medicine, which certifies medical personnel on assisting survivors on-scene during catastrophes like the one in Haiti—and properly disposing of those who don’t make it. Wecht spoke with The Daily Beast about the horror in Haiti and its grisly aftermath.

The Daily Beast: What’s the closest thing you’ve experienced to the devastation in Haiti?

Dr. Cyril Wecht: After Katrina, I went down to St. Gabriel’s Parish in Louisiana at the invitation Dr. Frank Minyard, the coroner for New Orleans. I did 30 autopsies. But that was quite a different scenario. You had a structured society, the full force of city, state and federal governments. Those things weren’t handled perfectly within the U.S., with a system in place to handle bodies.

Who’s Giving the Most to Haiti?

Bob Shacochis: Clinton’s Shameful Haiti Legacy

The Daily Beast’s full Haiti coverage
There, bodies were found, most outside in the streets in the flood zone. They were recovered, and driven up to Carville, Louisiana, which had been a leprosarium in this country in the 1920s and 30s. They were brought up in refrigerated trucks to school property, where they’d erected giant tents. Bodies were photographed, x-rayed, looked at by a dentist, and handed down the line. Identifying materials—bone samples, say, for DNA--were collected by anthropologists. Then the bodies came to forensic pathologists for the autopsy….

Once they were identified, they’d be taken back to the funeral home, or to their families, if they could be located. The process in some instances took months. Some people could not be readily identified. Some people lived alone. Many bodies remained unclaimed for a length of time; others could be processed more quickly. Even there, in this kind of structured situation, with experts from disaster medicine—odontologists, pathologists, etc.—in place to move things along in an orderly fashion, it was a terrible challenge.

Contrast that with the situation on the ground in Port-au-Prince.

When you talk about Haiti, it’s a thousand times worse. There are tens of thousands of bodies. You don’t have the kinds of records we would have. Who lived where? Because it was a quake, with all of the physical collapse of buildings that is entailed, people were buried. In New Orleans, you did not have that. The people who survive and who are injured with broken limbs sitting in emergency rooms in hospitals where there are hospitals…how could you walk to the bathroom? Are there bathrooms? You have a festering wound in 90 degrees that, if it goes untreated, can lead to sepsis, and death.

The x-rays, the dental charting, the identification procedures, the autopsies—all the normal procedures… I don’t think that’s going to happen here.

How do you approach the corpses that are strewn everywhere?

You have to get the bodies out of the public square. You have to get them moved in an orderly fashion, not piled on top of one another. Everyone will be handled individually. The public health threat is enormous—the possibility for the spread of disease. Typhus. Typhoid fever. If you have dead bodies, pestilence, lice, with a 90 temperature--mosquitoes, flies--then you have serious problems. These people are living outdoors with no protection, they are exposed to the same vectors. You have to be mindful of what can be conveyed from the dead to the living; flies and other insects can carry various pathogens.

Pathogenic bacteria from the remains can get into water supplies. You have the people handling the bodies aren’t trained, don’t have all the equipment to protect themselves, no mask and gloves, they are at risk of being contaminated. You have everything from staphylococcus, E-coli…

In 90-degree temperatures, a body exposed to an outdoor environment and not refrigerated will begin to discolor in 24 hours, bloat in 48 hours. That’s all it takes. If you can take them into a shaded area, inside to a building with a cooling system, you can prolong by a few days. If the body is not refrigerated, within matter of three or four days, you will still have significant decomposition.

Given those horrible conditions, how should authorities proceed?

The military will have to build a warehouse of some sort. You’ll have to impose some sort of martial law, and determine who is responsible for dealing with the dead. With all of these different nations, who will coordinate all the countries’ efforts? It was bad enough in America, with all the agencies involved, which led to some antagonistic moments among them in Katrina. Imagine here, with nations from all over the world: who’s in charge? And you know what Haiti was like in the best of times.

Forensic pathologists should be trying to determine the cause of death. But I don’t know if there are any there. It’s staggering. The number of deaths correlated with the paucity of personnel, the absence of medical facilities…put that all together, and that spells disaster.

The bodies will be thrown into graves determined to be acceptable dumping grounds. I saw images of people pushing bodies into an empty crypt of another family, without any idea who it was. They’ll do what they can. What the hell can you do?

Tell us the first thing graduates of your Disaster Medicine program are trained to do upon arrival at a quake scene.

The first order of business is you have to set up a command post. You could have the greatest array of talent and equipment in the world, but if they’re not communicating, you’ll lose the battle. Communications. The Americans brought in their own communications system so they can talk to one another. It’s an incredibly complicated job just getting all of the representatives of the various nations down there to do even the most basic coordination.

You land at the airport? Who do you talk to? Where do you deploy? We have charts, diagrams, to show the flow of communication, authority, responsibility. You set up triage.

Given the chaos on the ground, it might be helpful to explain how forensic pathologists is supposed to work, if they have the time and the tools on the ground that are notably absent in Haiti.

It doesn’t matter whether we’re talking about a natural phenomenon like the Johnstown flood, the South Pacific tsunami, or the earthquake in Haiti--or a man-made event like the World Trade Center attack. The primary role and responsibility of the coroner/Medical Examiner’s office are essentially the same.

The three primary objectives are: examination of tissue and bones to determine if they are human remains. Positive ID of these human remains; and determination of the cause and manner of death. The C/ME also has several other important functions: identifying existing and anticipating future serious side-effects of the disaster—the spread of infectious diseases associated with contaminated food and water supplies, the further collapse of damaged buildings…collecting, identifying and properly preserving data and evidence collected from the disaster scene, and gathering data on victims for local national and international agencies investigating the scene. Preparing epidemiological summaries of the disaster victims. And developing information that can help to prevent or diminish future fatalities.

Obviously immediately primary attention and utilization of all aviable equipment and personnel must be directed to do whatever is necessary and physically possible to extricate these people and save lives. Attention then must be focused on locating dead victims. Once human remains have been identified and separated from other materials, their original locations should be marked and documented by photographs. Next the human remains need to be positively ID’d; the methods employed will be dictated to a great extent by the physical state of the remains and by the availability of appropriate forensic scientific experts—i.e. pathologists, anthropologists, radiologists and the like.

The methods at the disposal of the C/ME aside from direct visualization by close next of kin—tattoos, scars, anatomic abnormalities, med implants, dental comparisons, fingerprints and DNA analysis if necessary.

Autopsies should be performed by trained experienced forensic pathologists to determine the cause of death. In these cases the manner of death will almost always be ruled accidental. A non-traumatic death due to a heart attack, a suicide by a trapped, isolated victim, even a homicide will rarely be noted and identified as such in light of the rampant confusion, limited time for detailed investigations, inadequate number of appropriate technical and law-enforcement personnel, among other factors.

The dead need to be embalmed, as quickly and effectively as possible. They need to be placed in available caskets, and appropriately stored—in refrigerated units at hospitals or other buildings; large transport vehicles and any other cold areas should be identified and utilized for temporary storage of the deceased.

Dr. Cyril Wecht, a nationally-known forensic pathologist, is a past president of the American Academy of Forensic Science and the American College of Legal Medicine, and a founder of the American Board of Disaster Medicine.