Amelia Joaquim (left), Rosita (centre left) and Fatima Mequissenne (right) pay their respects at the graves of their loved ones near the village of Matarara, Mozambique, in March 2019, shortly after a cyclone devastated the region. Their deceased family members were wrapped in body bags and properly buried at collective burial sites. Miora Rajaonary/ Everyday Africa/ ICRC
Geneva (ICRC) – The number of deaths caused by COVID-19 could overwhelm local capacity to handle dead bodies properly, the International Committee of the Red Cross warned today. Officials can overcome this risk through proper preparation and planning so that the dignity of the deceased and surviving family is respected.
The failure to plan and prepare for mass casualties risks people being buried in mass graves, with few records and little understanding of who died and where the body was taken. The suffering of people not knowing where their loved ones are buried could be devastating.
"Mass fatality planning doesn't mean there will be mass fatalities. But it's imperative that plans are made and, if needed, carried out to help lower the pain that families and broader society feel in the face of a high death toll," said Oran Finegan, the head of the forensics unit at the International Committee of the Red Cross. "Undignified management of the dead is avoidable."
Even in countries not affected by conflict, funeral homes and morgues have been quickly overwhelmed by COVID-19 deaths. In conflict zones, the situation could be even more dire due to limited capacity to properly handle high numbers of deaths. Emergency response plans should be established or activated now, before any crisis overwhelms responders and resources, to ensure the reliable identification and documentation of the dead. The process for obtaining death certificates, death registration and burial permits should be facilitated.
"People often don't see the importance of forensics until it's your loved one – your mother, brother, or child. Then, you care deeply about how a body is handled. If countries plan now, body management can still be dignified. If not, we could see mass graves and little understanding of who died and where their body is," said Stephen Fonseca, the ICRC's head of forensics in Africa.
Changes or restrictions to funerals and burial practices can be hugely distressing for families, exacerbating their grief. It's critical that families and communities have clear information about any necessary measures put in place to deal with high numbers of deaths. This helps to reduce the psychological impact on families and improve adherence to the measures.
When it come to the handling of the dead, the ICRC advises the relevant authorities that:
• The safety and wellbeing of staff managing COVID-19 deaths hold the utmost priority; health care workers and staff handling the dead must use appropriate personal protective gear.
• Respect for deceased individuals and their families is ensured through proper burials or cremations with identification and documentation.
• Authorities should ensure they have the physical structures needed for storage of bodies, enough burial space and perform burials or cremations according to cultural and religious needs.
• Preventive measures should be specially adopted in detention facilities, refugee camps, and large city slums, including dispelling myths and ensuring preparedness to deal with a higher than normal number of deaths than current capacity can handle.
Many Red Cross and Red Crescent National Societies have extensive experience supporting safe management of the dead during infectious disease outbreaks and are preparing to support safe burials in places where mortuary services are not readily available.
The ICRC is working on dignified management of the dead issues in regions around the world, including:
The preparation and planning for mass fatality events includes determining the amount of space needed for burials. This is a necessary consideration for COVID-19 in the case that more deaths occur than can be accommodated. Even if the death toll requires communal burials – or what are referred to as trench burials – plans can be made and adhered to so that bodies are buried in a manner that avoids commingling or ensures traceability.
"If African countries see a peak in cases like in Europe or the United States, our priority is to support authorities with their planning to manage the dead properly and respectfully, which includes avoiding hasty disposal of remains in unmarked graves. For a mourning family, this means having a specific burial place to visit. Planning and preparedness avoids further suffering," Fonseca said.
In some countries in Asia, the ICRC is concerned about the impact on bereaved families whose loved ones have been cremated against their religious beliefs due to fear of the spread of COVID-19. While authorities take necessary measures to prevent the further spread of the virus, the ICRC calls on them to adopt or incorporate international guidelines that allow both cremation and burial and permit the observing of religious rites and ceremonies as much as safely possible.
The ICRC forensic experts in collaboration with national forensic authorities are developing guidelines on the management of COVID-19 deaths in Afghanistan, Bangladesh, Indonesia, Myanmar, Pakistan, and the Philippines. The ICRC is concerned about situations where there is no COVID-19 continency planning or that lack considerations on how to handle the dead during a pandemic.
In Central and South America:
To assist with the situation in Ecuador, the ICRC gave the National Forensic Medicine and Forensic Sciences Service 1,500 N95 masks, 1,000 body bags and 800 biosafety suits to be used by the forensic service, the armed forces, the police and other public bodies for the removal, transfer and disposal of bodies in Guayaquil and the surrounding area. An external consultant hired by the ICRC is providing guidance to Ecuadorian authorities on dead body management.
In Venezuela and Colombia, the ICRC has donated personal protective equipment and sanitation materials to morgues and hospitals to assist with the management of dead bodies. ICRC forensic experts have been disseminating recommendations for the management of COVID-19 deaths with authorities in México, El Salvador, Nicaragua, Guatemala, Costa Rica, Panamá, Venezuela, Colombia, Ecuador, Perú, Brazil, Uruguay, Paraguay, Chile, Guatemala.
In Eur-Asia region:
In Ukraine, the ICRC has provided recommendations and personal protective equipment and body bags to authorities, including forensic personnel. The ICRC has also been providing technical support to offices in charge of forensic work in non-government-controlled areas in eastern Ukraine.
In Georgia, the ICRC is donating body bags and personal protection equipment for use by mortuary staff. The ICRC is also providing forensic recommendations and support in Georgia and to Ossetian and Abkhaz forensic services to ensure that the bodies are managed in a dignified way.
In the Middle East and North Africa:
People in some countries around the Middle East have expressed fears of not being able to carry out a proper Islamic burial if the person or a family member dies of COVID-19. The region has also witnessed communities preventing burial of coronavirus victims due to fears of infection. The ICRC is giving technical advice and recommendations on management of the dead and burials to government ministries, forensic authorities, first responders, and is also in contact with religious authorities to raise awareness with the public about appropriate measures in these cases.
The ICRC is promoting the development and/or implementation of emergency preparedness and response plans to manage a possible increase in the number of dead from COVID-19.
Note for public officials: Based on its experience from the management of the dead in emergencies, the ICRC has prepared a set of recommendations publicly available in English, Spanish, French, Arabic, Russian, Portuguese which the ICRC hopes will help in the efforts to respond to the crisis.
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