tag:theconversation.com,2011:/institutions/phoenicia-university-2667/articlesPhoenicia University2020-04-08T17:26:42Ztag:theconversation.com,2011:article/1352752020-04-08T17:26:42Z2020-04-08T17:26:42ZOverloaded morgues, mass graves and infectious remains: How forensic pathologists handle the coronavirus dead<figure><img src="https://images.theconversation.com/files/326115/original/file-20200407-74220-elf1i1.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4977%2C3330&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The mortuary in Girona, Spain, one of the countries hardest hit by coronaviurs. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/worker-stands-next-to-a-coffin-at-the-mortuary-in-girona-news-photo/1209215783?adppopup=true">Marti Navarro/SOPA Images/LightRocket via Getty Images</a></span></figcaption></figure><p><em>The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can <a href="https://theconversation.com/us/topics/covid-19-front-lines-84846">find all of the stories here</a>.</em></p>
<p><em>Editor’s note: Most scientists and doctors in the coronavirus crisis are working to save the living. Those in the field of forensic pathology, however, <a href="https://theconversation.com/humanitarian-forensic-scientists-trace-the-missing-identify-the-dead-and-comfort-the-living-115623">focus on the dead</a>.</em> </p>
<p><em>Ahmad Samarji, a Lebanon-based scholar of forensic science, reports on the extraordinary challenges facing coroners and pathologists in outbreak zones, where governments have to take “very limited but essential choices” to avoid a dangerous pileup of dead bodies. This Q+A has been edited and condensed for publication.</em> </p>
<p><strong>What is the role of forensic pathologists in a pandemic?</strong></p>
<p><a href="https://www.crcpress.com/Forensic-Science-An-Introduction-to-Scientific-and-Investigative-Techniques/Bell/p/book/9781138048126">Forensic pathologists</a> are physicians who integrate <a href="https://www.sciencedirect.com/referencework/9780128000557/encyclopedia-of-forensic-and-legal-medicine">law and medicine</a> to determine the cause, mechanism, manner and time of a person’s death. Their everyday work has important <a href="https://trove.nla.gov.au/work/25224098?q&sort=holdings+desc&_=1586298130543&versionId=222122243+256989756">legal, social and economic consequences</a> for family members of the deceased and for the larger community. </p>
<p>During a pandemic, forensic pathologists are heavily involved in managing the crisis, either within their local communities or as part of a humanitarian mission working with vulnerable communities abroad. </p>
<p>Their role in these extremely challenging times is to ensure the proper management of dead bodies, minimizing the spread of the virus, and to guide authorities, hospitals and funeral directors about the “do’s and don'ts” of dealing with these bodies. </p>
<p>There is a general assumption in medicine that dealing with the deceased does not require the same urgency as working with an acutely ill patient, and normally that is true. However, in a pandemic like COVID-19, large numbers of the dead can quickly exceed local capacities if not managed in a timely manner. </p>
<p>With highly infectious diseases, it is urgent that the post-mortem procedures – from death, examination, certification, registration and release of the body to safe cremation or burial – flow as properly and smoothly as possible. </p>
<p><strong>Are the bodies of COVID-19 victims infectious?</strong></p>
<p>While a lot is known about the coronavirus family, much is yet to be understood about the transmission modes and effects on the body of SARS-CoV-2, the virus that causes COVID-19. We don’t know whether human remains are infectious, but the likelihood is high. So forensic pathologists <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-postmortem-specimens.html">around the world</a> are <a href="https://www.ecdc.europa.eu/en/publications-data/considerations-related-safe-handling-bodies-deceased-persons-suspected-or">urging governments</a> to <a href="https://www.mohfw.gov.in/1584423700568_COVID19GuidelinesonDeadbodymanagement.pdf">restrict viewing</a> and <a href="http://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Panduan/Pengurusan%20KEsihatan%20&%20kawalan%20pykit/2019-nCOV/Bil%204%20%202020/Annex%2020%20Guidelines%20Managing%20Dead%20Bodies_26022020.pdf">handling of the body after examination is completed</a>. </p>
<p>During the Ebola epidemic – which claimed around 11,300 lives in West Africa between 2014 and 2015 – handling of the dead was <a href="https://international-review.icrc.org/sites/default/files/irc98_15.pdf">one of the main modes of transmission of the disease</a>. So one of the lessons <a href="https://www.sciencedirect.com/science/article/pii/S0379073817303109?via%3Dihub">forensic humanitarians took from this experience</a> – which is now being applied to coronavirus – was that untrained first responders should not be involved in handling human remains during outbreaks of highly contagious diseases. </p>
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<a href="https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Bodies are moved to a refrigerated truck serving as a temporary morgue for Wyckoff Hospital, Brooklyn, April 4, 2020 in New York City, where someone dies from COVID-19 every few minutes.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/bodies-are-moved-to-a-refrigerator-truck-serving-as-a-news-photo/1209150285?adppopup=true">BRYAN R. SMITH/AFP via Getty Images</a></span>
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<p><strong>Are cities with coronavirus outbreaks able to manage the dead safely?</strong></p>
<p>With the death toll from coronavirus <a href="https://www.nbcnews.com/news/us-news/dr-deborah-birx-predicts-200-000-deaths-if-we-do-n1171876">projected to exceed many hundreds of thousands worldwide</a>, governments everywhere are scrambling. But health systems that have planned for pandemics – and allocated sufficient resources to manage them – seem to be in decent shape. </p>
<p>My colleague Dr. Ralph Bouhaidar – a consultant forensic pathologist at the University of Edinburgh – told me that in addition to spending long hours in the Edinburgh City Mortuary, he is closely collaborating with prosecutors, police, funeral directors and hospitals across Scotland to review, assess and update existing procedures for managing “excess deaths in a pandemic.” </p>
<p>Dr. Bouhaidar emphasized that an appropriate COVID-19 response does not “emerge from a vacuum.” Rather, he said, proper management of the dead is “the result of cumulative work and planning…to have an understanding of local capacities and study our resilience in dealing with such possibilities, whilst liaising nationally and internationally with colleagues to share knowledge and experiences.”</p>
<p>So far, with <a href="https://www.edinburghnews.scotsman.com/health/coronavirus/41-deaths-linked-covid-19-nhs-lothian-number-cases-rises-79-2533182">4,565 confirmed COVID-19 cases and 366 dead</a>, Scotland’s hospitals and morgue are not overwhelmed.</p>
<p><strong>But there are grim reports from hard-hit cities – like New York and <a href="https://www.reuters.com/article/us-health-coronavirus-ecuador/ecuador-struggles-to-collect-the-dead-as-coronavirus-spreads-idUSKBN21I03Q">Guayaquil, Ecuador</a>, for example – of coronavirus patients dying so fast that bodies are just piling up. Both cities are considering <a href="https://www.nytimes.com/2020/04/06/nyregion/mass-graves-nyc-parks-coronavirus.html">digging mass graves</a>.</strong></p>
<p>When national plans for managing dead bodies in pandemics are exhausted, it leads to the piling up of bodies, issues with storage and refrigeration, and decomposition. That, as a result, increases risk of infection across the community. </p>
<p>Under such conditions, local and federal governments have very limited – yet essential – choices to handle the volume of bodies. </p>
<p>They should allow for the certification of medical deaths due to COVID-19 by the treating clinician, without the need for a post-mortem examination, to enable a swifter flow of the deceased within the system. They must also set up temporary mortuaries big enough to accommodate thousands of bodies. British authorities, for example, are building a special COVID-19 mortuary at the Birmingham Airport to <a href="https://www.itv.com/news/2020-03-27/work-starts-on-birmingham-airport-covid-19-mortuary-for-up-to-12-000-bodies/">accommodate 12,000 bodies</a>. And, yes, they may need to excavate mass graves. </p>
<p>All this must be done while ensuring a dignified burial for the bodies and proper labeling of the graves as <a href="https://ihl-databases.icrc.org/customary-ihl/eng/docs/v2_rul_rule115">required by international humanitarian law</a>. </p>
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<a href="https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The eastern Ukrainian city of Dnipro has prepared more than 600 graves for coronavirus victims, April 7, 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/view-shows-dozens-of-freshly-dug-graves-at-a-cemetery-in-news-photo/1209325869?adppopup=true">STANISLAV VEDMID/AFP via Getty Images</a></span>
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<p><strong>What dangers does the COVID-19 pandemic present for forensic scientists?</strong></p>
<p>Despite all protective measures, forensic experts are at constant risk of exposure to this deadly virus. And when pathologists in hard-hit areas contract coronavirus, it intensifies a vicious cycle. </p>
<p>They must absent themselves from work for at least 14 days, and some will die. This worsens an already miserable situation with the handling of dead bodies and, as a result, threatens the health of the entire community. </p>
<p>Forensic scientists from the Red Cross are being <a href="https://www.icrc.org/en/document/icrc-operational-response-covid-19">sent into refugee camps, war zones</a> and overwhelmed cities on humanitarian COVID-19 missions to provide pandemic assistance. In these places, the risk of contagion is even greater. The morgues they work in there most likely face shortages of staff with expert skills and appropriately equipped mortuaries. </p>
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<a href="https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People wait next to coffins and cardboard boxes to bury their loved ones outside a cemetery in Guayaquyil, Ecuador, April 6, 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-wait-next-to-coffins-and-cardboard-boxes-to-bury-news-photo/1209305597?adppopup=true">JOSE SANCHEZ/AFP via Getty Images</a></span>
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<p>Generally speaking, the forensic examination of a dead person doesn’t require highly complex equipment and machinery compared to other health specialties. Pathologists just need appropriate storage, personal protective equipment, basic dissection tools and specimen collection material. </p>
<p>But our work falls within a larger chains of events. Hospitals must have the capacity to identify the person, determine their cause of death, physically dispose of the body and work through the various legal complexities that these cases attract – and to do so swiftly.</p>
<p><strong>You mentioned how forensic scientists learned about Ebola on the job. What are we learning about coronavirus that’s aiding the pandemic response?</strong></p>
<p>The lessons from Ebola were reflected into the revised “<a href="https://www.paho.org/disasters/index.php?option=com_docman&view=download&category_slug=books&alias=2468-management-dead-bodies-after-disasters-a-field-manual-for-first-responders-second-edition-8&Itemid=1179&lang=en">Management of Dead Bodies following Disasters</a>” manual, published in 2016 by the World Health Organization and International Committee of the Red Cross, that is now aiding governments and first responders worldwide in the COVID-19 pandemic. </p>
<p>Today, cross-disciplinary research is underway about COVID-19 that connects the knowledge of forensic pathologists with that of clinical medical practitioners, virologists and biochemists. </p>
<p>In Italy, for example, <a href="https://www.pathologica.it/article/view/101">a study published March 26</a>, led by 25 health professionals across fields, warned health care professionals and morgue staff about specific risks in handling COVID-19 patients and provided guidance for autopsies of suspected, probable and confirmed cases of COVID-19.</p>
<p>Such work, when replicated and carried out across various research teams and countries, will greatly assist in managing this global crisis, formulating an effective treatment plan – and potentially creating a vaccine. </p>
<p><em>The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can find <a href="https://theconversation.com/us/topics/covid-19-front-lines-84846">all of the stories here</a>.</em></p><img src="https://counter.theconversation.com/content/135275/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ahmad Samarji does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An expert on forensic science explains the critical role of coroners and pathologists in the COVID-19 crisis, as many cities struggle to manage the soaring number of dead bodies.Ahmad Samarji, Associate Professor of Forensic Science Education & STEM Education and the Assistant Dean of the College of Arts and Sciences, Phoenicia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1156232019-08-28T12:57:43Z2019-08-28T12:57:43ZHumanitarian forensic scientists trace the missing, identify the dead and comfort the living<figure><img src="https://images.theconversation.com/files/288560/original/file-20190819-123741-o58bes.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Red Cross forensic specialist Stephen Fonseca, right, searches for bodies in a field of ruined maize in Magaru, Mozambique, after Cyclone Idai, April 4, 2019. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Mozambique-Cyclone-Searching-for-the-Dead/df28c0f7584f4ef09f8d8a02c38975f4/4/0">AP Photo/Tsvangirayi Mukwazhi</a></span></figcaption></figure><p>The word “forensic” is typically associated with crimes and legal disputes. <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/forensic-medicine">Forensic medicine</a>, for example, applies medical knowledge to establish the causes of injury or death. </p>
<p>But forensic science can have a <a href="https://www.icrc.org/en/document/forensic-science-and-humanitarian-action#.VL_PRCinGm8">humanitarian role</a>, too. Working under international humanitarian law rather than local or federal criminal systems, these forensic experts help ensure the proper identification and respectful handling of people who die during war, natural disaster and <a href="https://migrationdataportal.org/themes/migrant-deaths-and-disappearances">migration</a>, preventing them from becoming missing persons. </p>
<p>We are forensic scientists who have <a href="https://theconversation.com/how-dental-records-will-help-identify-bodies-from-mh17-29535">studied</a> and <a href="https://forensic.meetinghand.com/en/">organized</a> international conferences about the forensic work required at conflict zones and natural disaster sites. And we’d like to introduce the world to this <a href="https://www.icrc.org/en/document/forensic-science-and-humanitarian-action#.VL_PRCinGm8">emerging profession</a>, which is expanding across the globe.</p>
<h2>Natural disasters</h2>
<p>Interpol, the international police agency, publishes global standards for <a href="https://www.interpol.int/en/How-we-work/Forensics/Disaster-Victim-Identification-DVI">appropriately identifying and handling the dead</a> after major disasters. But achieving those standards may be beyond local authorities’ abilities when the death toll is very high and simply finding and identifying casualties presents a challenge. </p>
<p>Starting in 2004, the International Committee of the Red Cross developed the concept of “<a href="https://www.icrc.org/en/document/worlds-first-international-centre-humanitarian-forensics-launched-india">humanitarian forensic action</a>” to ensure that those who die in war, disaster and other complex emergencies are <a href="https://www.who.int/hac/techguidance/management-of-dead-bodies/en/">treated respectfully and with dignity</a> and don’t become missing persons.</p>
<p>The Red Cross’ forensic humanitarians work closely with local authorities worldwide, as well as train, brief and supervise other aid workers, to ensure the proper and dignified management of the dead while the laborious process of identification is underway. </p>
<p>Its experts were on hand after Mozambique’s deadly 2019 typhoon in which over 1,000 people died. They were there after Haiti’s <a href="https://www.nytimes.com/2010/01/13/world/americas/13haiti.html">2010 earthquake</a>, which killed an estimated 230,000, and <a href="https://theconversation.com/same-problems-that-dogged-tsunami-response-bedevil-humanitarian-aid-today-35781">Super Typhoon Haiyan</a>, which devastated the Philippines in 2013. </p>
<h2>Conflict</h2>
<p>Humanitarian forensic experts also help factions in armed conflicts fulfill their international obligations towards the dead in battle. </p>
<p>The <a href="http://www.weaponslaw.org/instruments/1949-geneva-conventions">1949 Geneva Convention</a> and subsequent agreements require that the dead are searched for, collected, documented, identified and disposed of in a dignified manner, ideally by returning the remains to bereaved families. </p>
<p>Decades after Argentina and the United Kingdom went to war over the Falkland Islands, which are known as the Islas Malvinas in Argentina, the two countries <a href="https://www.icrc.org/en/document/falklandmalvinas-islands-icrc-presents-argentina-and-united-kingdom-results-humanitarian">agreed</a> in 2016 to invite the Red Cross to exhume 122 unnamed soldiers buried in the Darwin military cemetery on the islands in what became a model of humanitarian forensic action. </p>
<p>Using a variety of forensic disciplines – such as anthropology, archaeology, pathology, dental testing and DNA analysis – the humanitarian forensic experts successfully identified nearly all of the 122 unknown soldiers. </p>
<p>The exhumed Falklands War dead were later reburied in new coffins in marked graves, and the cemetery restored to its original shape. In March 2018, after 35 years of suffering and uncertainty, more than 200 family members <a href="https://www.nodal.am/2018/03/familiares-combatientes-malvinas-visitaron-tumbas-la-isla-luego-del-reconocimiento-cuerpos/">visited</a> the cemetery to pay their final respects. </p>
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<a href="https://images.theconversation.com/files/288559/original/file-20190819-123741-9o5t63.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/288559/original/file-20190819-123741-9o5t63.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288559/original/file-20190819-123741-9o5t63.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288559/original/file-20190819-123741-9o5t63.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288559/original/file-20190819-123741-9o5t63.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288559/original/file-20190819-123741-9o5t63.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288559/original/file-20190819-123741-9o5t63.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288559/original/file-20190819-123741-9o5t63.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The relative of an Argentine soldier killed in the Falklands War with Britain grieves at the Darwin Military Cemetery on Falkland Islands (Islas Malvinas), March 26, 2018.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Argentina-Britain-Falklands/29c378fa525e480283e622f1cd46568a/3/0">AP Photo/Caiti Beattie</a></span>
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<h2>Humanitarians in danger</h2>
<p>In conflict zones where militants are engaged in battle against their own governments, the official rules of war may not apply. </p>
<p>In such places, the job of the humanitarian forensic expert involves negotiating the humane treatment of dead bodies, the return of human remains to the families and the honorable disposal of bodies according to the rites of their religion or faith. </p>
<p>This can be dangerous. </p>
<p>In 2007, the Red Cross’ humanitarian forensic team was asked to help in the recovery of the bodies of 11 legislators who had been <a href="https://www.theguardian.com/world/2002/apr/12/colombia.martinhodgson">abducted by the FARC</a>, a Colombian guerrilla movement, five years before and had <a href="https://www.latimes.com/archives/la-xpm-2007-sep-10-fg-colombia10-story.html">recently died</a> under contested circumstances. </p>
<p>The guerrillas said the hostages died in a botched rescue operation by government forces, while the government <a href="https://www.nytimes.com/2007/06/29/world/americas/29colombia.html">accused the guerrillas of executing them</a>. </p>
<p>After a lengthy negotiation, both sides agreed on a brief ceasefire while the Red Cross team collected the bodies. Locating the burial site of the bodies took days, according to <a href="https://www.icrc.org/en/author/dr-morris-tidball-binz-0">Dr. Morris Tidball-Binz</a>, a leading forensic expert with the International Committee of the Red Cross. </p>
<p>He and his colleagues walked for dozens of miles through the Colombian jungle, some of it defended with <a href="https://www.reuters.com/article/us-colombia-landmines/colombia-aims-to-rid-country-of-landmines-by-2021-govt-idUSKBN15T2FM">landmines</a>. </p>
<p>“At night, there were a couple of occasions when we heard explosions around, which indicated the fragility of the ceasefire,” Dr. Tidball-Binz <a href="https://www.icrc.org/en/download/file/84078/irrc_99_905_12.pdf">recalls</a>. </p>
<p>Humanitarian workers undertaking similar conflict-related identification of the dead have become targets of direct or indirect threats in <a href="https://www.icrc.org/en/international-review/article/using-forensic-science-care-dead-and-search-missing-conversation-dr">Argentina and Libya</a>. </p>
<h2>Missing persons and migration</h2>
<p>International humanitarian law includes another difficult-to-meet <a href="https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule114">obligation</a>. Families are supposed to be informed about the fate and whereabouts of loved ones who go missing during <a href="https://www.hrw.org/world-report/2019/country-chapters/iraq">war</a> or <a href="http://www.laht.com/article.asp?ArticleId=2407515&CategoryId=12393">armed conflict</a>. </p>
<p>After gathering <a href="https://en.oxforddictionaries.com/definition/ante-mortem">all information possible</a> about the missing person based on the physical evidence available, they closely collaborate with family members to paint a more complete picture of the victims, using DNA, identifying marks and personal belongings to try to identify a missing person. </p>
<p>This is sensitive work. War survivors may be hesitant to speak about missing loved ones because they fear retaliation from the government or an armed faction. Yet family cooperation is essential to locating and identifying those missing in war.</p>
<p>Humanitarian forensic scientists have also played a fundamental role in Europe’s migrant crisis, which has claimed the lives of thousands who <a href="https://www.iom.int/news/mediterranean-migrant-arrivals-reach-4216-2019-deaths-reach-83">die or go missing in the Mediterranean Sea</a> attempting to flee Africa and the Middle East. </p>
<p>After a <a href="http://www.thenewhumanitarian.org/news/2016/10/10/egypt-boat-disaster-shines-light-new-migration-trend">boat packed with migrants</a> sank several miles off the coast of Rasheed, Egypt, in September 2016, for example, just 163 people were rescued. Thirty-three were found dead inside the boat and 168 people drowned. </p>
<p>Scientists from the Egyptian Forensic Medicine Authority were called to the scene to <a href="https://www.reuters.com/article/us-europe-migrants-egypt/boat-carrying-600-migrants-sinks-off-egypt-killing-at-least-43-idUSKCN11R1L0">identify the dead</a> and establish their cause of death.</p>
<p>Humanitarian forensic scientists don’t always succeed. Sometimes, their investigations reach a dead end. The fate of those missing remains a mystery.</p>
<p>In the best-case scenario, though, the difficult work of these humanitarian scientists brings closure to families so that they can start mourning their loss. </p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/115623/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dina Shokry is head of the Forensic Medicine Department at the Armed Forces College of Medicine, Egypt, and President of the Arab Union of Forensic Medicine and Toxicology. She was the President of the 10th International Conference on Forensic Medicine and Sciences, for which the International Committee of the Red Cross was one of the main conference sponsors.</span></em></p><p class="fine-print"><em><span>Ahmad Samarji does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Meet the unsung aid workers who put their lives on the line during war and natural disaster to make sure the dead are treated with respect – and that their grieving families get closure.Ahmad Samarji, Associate Professor of Forensic Science Education & STEM Education and the Assistant Dean of the College of Arts and Sciences, Phoenicia UniversityDina Shokry, Professor of Forensic Medicine, Cairo UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/621672016-08-02T20:09:24Z2016-08-02T20:09:24ZLet forensic science help prevent a crime or a disaster<figure><img src="https://images.theconversation.com/files/132444/original/image-20160729-24686-1p3xy3g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Forensic scientists should be encouraged to shed more light on a pattern of behaviour when investigating incidence.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/worldskillsteamuk/15175997703/">Flickr/WorldSkills UK</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>One of the basic principles of forensic science is Locard’s Exchange <a href="http://aboutforensics.co.uk/edmond-locard/">Principle</a> which says: “Every contact leaves a trace.” It was formulated in the early 20th century, by French criminologist Edmond Locard, and still informs forensic inquiries today.</p>
<p>But the term “trace” is no longer explicit to physical and biological traces. It also includes digital ones where cyber or virtual contacts (emailing, Skyping, surfing the net, and so on) leave digital imprints such as an IP address or the International Mobile Equipment Identity (<a href="http://whatis.techtarget.com/definition/IMEI-International-Mobile-Equipment-Identity">IMEI</a>) of a mobile phone.</p>
<p>The work of forensic scientists has so far been overwhelmed with identifying, collecting and analysing such traces to see if they map to a suspect in a specific investigation. </p>
<p>But hardly any time, resources or support are used to try to detect certain patterns across those traces. Forensic scientists worldwide are not encouraged or even allowed to be proactive; rather, they are simply reactive.</p>
<p>The main reason behind the lack of support and shortage in funding for forensic scientists is that the <a href="http://www.tandfonline.com/doi/abs/10.1080/19409044.2014.929760">relationship between law enforcement and forensics</a> is more of control and dominance rather than true partnership.</p>
<p>In other words, the vast majority of law enforcement agencies worldwide still control forensic science practice, set their priorities and set the budget for things such as research and training. </p>
<h2>Evidence from the past</h2>
<p>But forensic scientists have in the past done much to identify patterns that have led to changes in behaviour.</p>
<p>It was forensic medical practitioners who <a href="http://am-medicine.com/2013/10/simpsons-forensic-medicine-13th-edition-pdf.html">identified</a> that placing babies face down to sleep was one of the contributors to sudden infant death syndrome (SIDS).</p>
<p>Following awareness campaigns such as the worldwide Back to Sleep campaign in the early 1990s, <a href="http://am-medicine.com/2013/10/simpsons-forensic-medicine-13th-edition-pdf.html">SIDS</a> has declined from 2 to 0.5 per 1,000 live births in many developed countries in 2007. In England and Wales it has dropped to 0.28 per 1,000 live births.</p>
<p>Other examples on the preventive role of forensics can be extracted from transportation safety regulations, where the investigation carried out by forensic experts led to improvements such as seatbelts and avoiding texting while driving.</p>
<h2>Evidence from the present</h2>
<p>The notion of protective and preventive forensic science was reflected in the recent International Academy of Legal Medicine <a href="http://www.ialm2016venice.org/en/sistemacongressi/ialm-2016-venice/website/home/">conference</a> that I participated in, held in Venice in June.</p>
<p>The conference’s theme was P5: Medicine and Justice. The P5 symbolises the five Ps: personalised, preventive, predictive, participatory and protection. These five Ps support the proactive notion of forensic science and forensic medicine. </p>
<p>But much is still needed. For instance, the conference was told that forensic medical practitioners in a number of countries report instances of <a href="https://sistemacongressi.fervetopus.net/static/uploaded/IALM2016_Programme.pdf">domestic and sexual violence against foreign housekeepers</a>. They have detected certain patterns in the assessment of these cases and are keen to combat this issue, but to no avail. </p>
<p>Law enforcement and authorities are mainly interested in the forensic work and autopsy if required. </p>
<p>Another example is forensic medical practitioners who are called to investigate incidents relating to refugees and displaced people in camps. They <a href="https://sistemacongressi.fervetopus.net/static/uploaded/IALM2016_Programme.pdf">told the conference</a> that in some incidents, death was not a result of a criminal behaviour but due to negligence and lack of safety measures.</p>
<p>These practitioners are very keen to work on awareness campaigns to minimise and reduce these incidents. These practitioners are the ones on the frontline and they are the best situated to recommend to authorities the Dos and Don'ts. </p>
<p>But no one is really interested to listen beyond their forensic report and testimony in a court of law.</p>
<h2>Lessons for the future</h2>
<p>We now live in a world faced with more security challenges, terrorist attacks, repeated security breaches in what we once assumed were secure places such as airports.</p>
<p>There is increasing ambiguity surrounding incidents, for example aeroplane <a href="https://theconversation.com/the-search-for-mh370-sharing-the-costs-fairly-46079">crashes</a> and mobile phones <a href="http://www.dailymail.co.uk/news/peoplesdaily/article-3033655/Boy-12-chunk-flesh-blown-FACE-mobile-phone-explodes-charging.html">exploding</a> while charging, so a shift from the reactive to proactive mode is required.</p>
<p>Imagine if forensic scientists who examined the personal items collected from a terrorist could further investigate such items – and those of other terrorists – so they could detect certain patterns. This could help prevent the occurrence of further attacks. </p>
<p>Imagine if forensic scientists investigating a suspected death of a child wandering with a digital device were able to build a hypothesis relating to the device. They could then consult with engineers to further research the matter and come up with extra measures for product safety. </p>
<p>Imagine if similar patterns were identified for workplace-related injuries. Imagine how safer and securer it would be.</p>
<p>The current quasi-military and legal mindset needs to change and support forensic scientists to go beyond the standard work on traces. They need to be encouraged to investigate patterns or potential patterns across these traces. </p>
<p>Such inquiries will prompt collaborative work with criminologists, engineers, social psychologists, educators, police, intelligence departments and policymakers. The aim of all would be to find out how to prevent the occurrence or minimise the recurrence of an incident, crime or attack. </p>
<p>It is about time forensic scientists are listened to and that the science and scientific mindset lead the work. </p>
<p>It is about time that scientific curiosity for pattern identification leads proactive conversations across various fields and disciplines to ensure safety, security, protection, prevention and justice.</p>
<p>Conventionally, forensic science and forensic medicine have been perceived as sciences associated with crimes, deaths, disasters, disputes and offences. It is about time that forensics is seen as a science for life and for cherishing life.</p><img src="https://counter.theconversation.com/content/62167/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ahmad Samarji does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Forensic scientists should be encouraged to help detect patterns of behaviour in the incidents they investigate. This could lead to changes in the way some things are done and potentially save lives.Ahmad Samarji, Academic: Forensic Science Education, Maths Education, STEM Education, and ICTE, Phoenicia UniversityLicensed as Creative Commons – attribution, no derivatives.