Cultural Burial as a Human Rights Consideration Within the Ebola Response and Beyond

Mary Glenn Krause

Humans should have the right to practice cultural burial or similar body deposition (CBOSBD) using mortuary rituals (including last rights, mourning rites, preparation of the body, and final disposition) that are connected to one’s religion, belief system, and/or sociocultural community. However, there are circumstances where public health responsibilities to the living conflict with certain mortuary practices. When mourners are denied the ability to dispose of their dead in accordance with their mortuary rituals due to public health concerns such as the spread of infectious diseases, it can lead to unintentional psychological and physical health consequences.

The pressing need for a CBOSBD right is best exemplified in the Ebola virus (Zaire ebolavirus or EVD) epidemic within the Democratic Republic of the Congo (DRC). Transmission of EVD occurs through direct contact with infected bodily fluids or fomites. [1] Therefore, the physically intimate funerary or burial practices that more than two hundred cultural groups practice in the DRC put mourners at high risk for infection from the EVD victim’s body. Risky aspects of these traditions include cleaning and decorating the cadaver, transporting the body to the deceased’s home village for internment, and holding large public funerals with the body present. These customs put not only the next of kin but also the wider community at risk for infection. [2] Furthermore, the virus remains viable for up to seven days,and its RNA remains detectable in body fluids for ten weeks. [3] This longevity creates a notably extended period for potential infection.

In a national environment already plagued by systematic inequality and low institutional trust, critical standard containment protocols for EVD increase tensions between affected communities and response workers. [4] Only about 7% of the DRC’s population have internet access, making it difficult for many citizens to make informed decisions. [5,6] As a result, misinformation can be easily spread through rumors. In past EVD epidemics, these tensions built upon misinformation, and communal distrust of authorities peaked regarding patient burials. Because communities were unable to observe the body after death, claims were made that body parts and tissues were harvested from the dead and used in witchcraft or otherwise trafficked. [2,7] Even an in-person demonstration of response workers taking saliva samples for testing from a person who may have died from EVD led to protests that the workers were trying to extract organs from the mouth.[7]

The use of body bags in patient burials specifically created unease in the DRC’s EVD response. [2] Rumors occurred claiming that the cadavers were stolen and that the opaque body bags used to quarantine the body were filled with rubble to deceive the community. [8] Some people voiced religious concerns about the body bag’s inability to rot, which in turn would prevent the deceased’s spirit from ascending into the afterlife. [9] These types of rumors led to reports of stolen bodies and coffins from treatment centers and gravesites for secret burials. [10] In order to prevent further infection and mistrust, the International Coalition of the Red Cross (ICRC), the Red Cross Movement, and the British government switched from opaque body bags to transparent body bags in order to allow families and communities to confirm their loved ones’ identity and observe the condition of the body. [10]

Academics, public health officials, governments, and emergency health responders are beginning to recognize the widespread need for a safe compromise between standard containment protocol and CBOSBD within the EVD response. Dialogue with community leaders has increased. Families are now permitted to don personal protective equipment and participate in the preparation and burial of the body. [11] The ICRC and UNICEF-affiliated Social Science in Humanitarian Action program both seek continual feedback from these communities. [11] ICRC volunteers routinely go door-to-door to collect comments and concerns about safe and dignified patient burial protocol as well as other EVD-related response efforts, and they publish their findings in routine reports. [9,12]

However, the conversations and subsequent actions need to go beyond the EVD response within at-risk countries. Respectful, sensitive, and educational dialogue on death and mortuary ritual needs to be mandatory for all healthcare professionals in all countries. We need to set up protocols that allow for sensitive mortuary rituals that also prevent infectious disease transmission. These conversations need to involve the recognized next of-kin in order to curb the negative psychosocial impact that can occur when mortuary rituals are not conducted. By recognizing CBOSBD as a fundamental human right, conversations about death can be brought to greater attention within the international organizations responsible for protecting human rights and global health.

References

1. Suresh Rewar and Dashrath Mirdha. Transmission of Ebola Virus Disease: An Overview. Annals of Global Health 80, no. 6 (2014): 444–451, http://doi. org/10.1016/j.aogh.2015.02.005.

2. Juliet Bedford. Key considerations: burial, funeral and mourning practices in Équateur Province, DRC. Social Science in Humanitarian Action, June 5, 2018, https:// reliefweb.int/sites/reliefweb.int/files/resources/SSHAP_burial_funeral_and_ mourning_practices.pdf.

3. Joseph Prescott, Trenton Bushmaker, Robert Fischer, Kerri Miazgowicz, Seth Judson, Vincent J Munster. Postmortem Stability of Ebola Virus. Dispatch 21, no. 5 (May 2015), https://doi.org/10.3201/eid2105.150041.

4. Patrick Vinck, Phuong N Pham, Kenedy K Bindu, Juliet Bedford, Eric J Nilles. Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. The Lancet 19, no. 11 (2019): 529–536, https://doi.org/10.1016/S1473-3099(19)30063-5.

5. Sally Hayden. “How Misinformation Is Making It Almost Impossible to Contain the Ebola Outbreak in DRC,” Time, June 20, 2019, https://time.com/5609718/rumorsspread-ebola-drc/.

6. Laura Spinney. “Fighting Ebola is hard. In Congo, fake news makes it harder,” Science, January 14, 2019, https://www.sciencemag.org/news/2019/01/fightingebola-hard-congo-fake-news-makes-it-harder.

7. Laura A Bagnetto. “Stealing tongues: miscommunication in the time of Ebola in DR Congo,” Radio France Internationale, April 11, 2019, http://www.rfi.fr/en/ africa/20191031-stealing-tongues-miscommunication-time-ebola-dr-congo-drc-northkivu-kinande.

8. Alex Carle. “‘Ebola is fake’: how do you fight a disease people don’t believe in?” Thomson Reuters Foundation News, June 21, 2019, https://news.trust.org/ item/20190620142457-zkby8/.

9. Kevin Bardosh, Ingrid Gercama, Juliet Bedford. Social Science and Behavioural Data Compilation, DRC Ebola Outbreak, November 2018–February 2019. Social Science in Humanitarian Action, March 5, 2019, https://reliefweb.int/sites/reliefweb. int/files/resources/SSHAP_burial_funeral_and_mourning_practices.pdf.

10. James Landale. “Ebola in DR Congo: The body bag that saves lives,” BBC, July 9, 2019, https://www.bbc.com/news/av/world-africa-48915618/ebola-in-dr-congothe-body-bag-that-saves-lives.

11. “Ebola: 1 Year On, Virus Continues to Rage in DR Congo,” American Red Cross, July 13, 2019, https://www.redcross.org/about-us/news-and-events/news/2019/Ebola- 1-Year-On-Virus-Continues-to-Rage-in-DR-Congo.html.

12. Anna Teehan. “Inside the response to provide safe and dignified burials in the face of epidemics,” Canadian Red Cross, March 20, 2019, https://www.redcross.ca/ blog/2019/3/inside-the-response-to-provide-safe-and-dignified-burials-in-the-faceof-epidemics.

-Mary Glenn Krause is a senior from Raleigh, NC, pursuing majors in Anthropology and Archaeology and a minor in Public Policy.-