Fortun, Forensics and the Yolanda Aftermath: Recovery, Storage, System Restore, Repeat

Print pagePDF pageEmail page

A line of casualties drawn along Basper cemetery. Photo courtesy of Dr. Raquel Fortun.

A line of casualties drawn along Basper cemetery. Photo courtesy of Dr. Raquel Fortun.

The absence of a system—responsible for elaborately defining deaths to be investigated, identifying who will examine them and determining how the examiners conduct the investigation—results in misidentification and loss of bodies, stolen property, extortion by funeral parlor personnel, fake death claims and claimants, among numerous problems. This observation was discussed in “Managing the Dead in a Mass Casualty Incident,” excerpted by UP Padayon Reports (2011) from Dr. Raquel del Rosario-Fortun’s book Management of the Dead During Disasters: A Manual for the Philippines (2007),”

The absence of such a system was evident in the aftermath of typhoon Yolanda. Another obvious consequence was the national government’s downplaying of the number of casualties.

In her article, Dr. Fortun said an on-call Philippine Disaster Mortuary Response Team (DMORT) with pathologists, dentists, anthropologists and radiologists was organized to professionalize the handling of the dead. Among the factors the team had to consider were: the type of incident, estimated number of fatalities, probable condition of the remains, location of the incident, personnel, and funding.

Initial Processes: Recover and Store

Remains shall be retrieved as soon as possible to improve the accuracy of identification and “lessen the distress among the living,” said Fortun. Site layout prior to the incident shall be taken into consideration so that one can approximately determine where best to look for passengers, occupants or residents. The affected area shall be mapped so that a systematic and expeditious search plan can be enforced while ensuring that places already searched are marked to avoid useless repetitions.

Fortun mentioned a number of means to document relevant details. These include drawing a simple sketch of the scene and marking the spot where the bodies are recovered; taking photographs or videos; and mapping via GPS (Global Positioning device). Shots shall include over-all shots and close-ups, if possible, noting the date and time the image was taken. The documentation procedures depend on the availability of resources.

Separated body parts and items (such as evidence and property) shall be tagged as “PARTS” and “PROPERTY,” emphasized Fortun. Should the respective parts and/or the items obviously belong to a particular body, those shall be placed with that body. Otherwise, the location in reference to the nearest body/bodies must be noted. In collecting and transporting remains, property and evidence, Fortun said that a general principle in securing physical evidence is to ensure against loss, contamination, tampering, switching or damage; hence, remains shall not be exposed and must be kept covered at all times.

As regards “contracting infectious disease from dead bodies,” Fortun said that the risk is small and [these] basic measures alone [i.e. wearing heavy duty gloves and boots, hand washing and a change of clothes after handling remains] should be enough. She further said that advantages in wearing masks are largely psychological, and hence should not be encouraged especially because it will not block the inevitable unpleasant smell from decomposing remains which do not pose a health risk.

Ideally, there shall be “refrigerated container vans” with temperature at four degrees centigrade “to preserve the remains while awaiting examination and release,” Fortun said. However, in reality, remains quickly decompose due to the absence of refrigeration; thus it is practical to properly mark and accurately tag temporary burial or embalming, which postpones decomposition once chemical preservatives are injected into the body.

Fortun at Barangay Basper, their first work site. Photo courtesy of Dr. Raquel Fortun.

Fortun at Barangay Basper, their first work site. Photo courtesy of Dr. Raquel Fortun.

Post-Yolanda Identification: Differences

In an interview with the UP FORUM, Dr. Fortun, forensic pathologist and UP College of Medicine professor who headed the post-Sendong forensics team of UP Padayon in 2011, recounted how the Department of Health (DOH), under the command of the Office of the President, organized a team to manage the identification of bodies in the affected areas in the Visayas.

The team was led by Dr. Chito Avelino, for “Oplan Tamang Libing” intended to manage dead bodies post-Yolanda. Fortun said, “I was consulted by DOH on Nov. 14, together with foreign World Health Organization (WHO) consultants. The decision on how to organize the DOH response team including the people involved, the procedure on how to do the postmortem examination and antemortem information gathering, what logistical supplies were needed, etc. was a collaborative effort among the DOH, the WHO and me. The International Committee of the Red Cross (ICRC) and the Philippine Red Cross (PRC) were also represented in our Nov. 15 final meeting.”

With pressure brought about by urgency, magnitude, limitations, the team had to act fast, regardless of the seemingly inversely proportional total of resources and remains. “All the remains would therefore undergo basic examination, inventory, tagging and orderly burial. The idea was to record as much postmortem information as possible, then bury the bodies without compromising identification,” said Fortun. The places where  bodies were retrieved were  documented under the DOH-WHO system, followed by individual bagging, sequential tagging and descriptive and photo-documented physical examination.

“Initially the collection point for Tacloban bodies was a small cemetery in Barangay Basper. Upon our recommendation the LGU identified a site for the collection, examination and burial of the bodies in Barangay Suhi. We started to bury the remains already examined in an orderly manner, mapped out in trenches, to facilitate exhumation of particular bodies for later identification.” After recovery and storage, the next step was identification, which was carried out by “comparison of postmortem and antemortem.”

Commencing on Nov. 18, ten days after the incident, these examinations were “limited to determination of sex and general age category (infant, child, adult); documenting clothes, jewelry, other personal effects like wallets, phones; checking for tattoos.” The team recorded the information in “a much simplified, short form—maximum of 3 pages.” In contrast, the National Bureau of Investigation (NBI) preferred the “INTERPOL way. It entailed detailed postmortem exams per body—the forms are around 15 pages long, complete with dental charting—best done by a dentist, and DNA sampling—best is to saw off a section of the thigh bone or extract teeth.” All these procedures, despite the fact that they were mere fingerprinting “was not practical, if not impossible.”

Fortun said  the INTERPOL way is “very tedious and time-consuming—not to mention the packaging, labeling, and storage of the samples, though not necessarily more accurate than the DOH-WHO way” and that “NBI merely mentions DNA sampling, not actual testing.” She added, “The insistence of  the NBI—and the PNP which is tasked to take charge of ‘man-made’ disaster victim identification or DVI—on using the INTERPOL protocol is not practical. It is also not universally accepted. First-world countries with death investigation systems in place (e.g. US, UK, Japan) do not rely on the INTERPOL system. The emphasis on DNA in the identification of victims of mass disasters in 3rd world countries is also misplaced.”

Fortun expressed uncertainty whether the NBI’s decisions were geared “toward understating or delaying the official death toll.” She “believe[s] it is more of institutional arrogance, insisting that they are in charge even if they are undermanned, minimally trained and ill-equipped for the job.” She said that the NBI attended the aforesaid Nov. 15 DOH meeting. “The NBI officer-in-charge and their chief medico-legal doctor” were present when the group agreed that they “would be assigned to different places in the Visayas and were to work separately,” given that “there were so many dead.” She further said, “ the NBI had no disaster victim identification (DVI) system in place when the DOH team started work in Tacloban on Nov. 18. Then on Nov. 22, they practically grabbed what the DOH had set up and they just had to work also in Tacloban. There is no news of  the NBI examining the dead in other places.”

Volunteers amid the buried and unburied dead at Basper cemetery. Photo by Dr. Raquel Fortun.

Volunteers amid the buried and unburied dead at Basper cemetery. Photo by Dr. Raquel Fortun.

Pre-Yolanda Propositions: Reprise

“The unpleasant encounter with the NBI over forensic matters such as DVI is not new or unique to the DOH Tacloban experience,” said Fortun, since it had happened “when UP sent a forensic team to help Iligan with its dead, post-Sendong. The same thing happened although the confrontation was slightly more civil [then]. The 3-day trip to Iligan in 2011 was a waste of time and resources, forensics-wise.”

Despite existing documents with relevant information for capacity-building and post-disaster measures, it seems that the same mistakes are repeated because recommendations of field experts and concerned stakeholders were not applied and tested. This is perhaps due to limited resources, the aforesaid “institutional arrogance,” and  the inadequate political will of the national government to institutionalize new, better systems.

“Every time we encounter a disaster with multiple casualties—and they are occurring with alarming regularity—we panic and scramble when confronted with so many dead bodies. We do not learn from each incident but merely react, come up with some semblance of a management-of-the-dead response and once the bodies are buried—typically unidentified, they are soon forgotten,” said Fortun. She reiterated her suggestion in her 2007 article that calls for the institutionalization of a DMORT, “preferably within the more general context of finally setting a national death investigation system. The present ‘system’ merely assigns ‘natural’ disasters to NBI and the ‘man-made’ ones to PNP. Neither of them is up to the task. Ironically this is according to DOH Administrative Order 2007-18, from the institution itself which is supposed to be in charge of the dead.”

“Death is a health concern and therefore death investigation—identification, cause and manner determination—falls under the mandate of the DOH, not the police or an agency like the NBI. This is how it goes in developed countries,” said Fortun. “It was such a pleasant surprise therefore for DOH to actually organize a forensic team for Yolanda’s dead. I very willingly helped when asked to. But it was such a disappointment that they dissolved the team they organized after only a week. Later I was told it was upon orders of the OP. Too bad even the dead like the survivors were victims twice over, of the strongest storm ever recorded, and petty politics.”

Perhaps the post-disaster tragedy—of downplaying the effects of the actual disaster for the sake of the government’s popularity ratings—is beyond “petty politics.” With this mismanagement comes criminal injustice, which perpetuates, with the issue of overpriced bunkhouses, among many overlapping layers of corrupt practices that cost human lives. This post-disaster tragedy of the Aquino government’s indolence and insensitivity merits prosecution. If we go by Oxford dictionary’s definition that “forensics” pertains to “scientific tests or techniques used in connection with the detection of crime,” then this article is an attempt at gathering and presenting “forensic evidence” suggesting that a crime of neglect has been committed, and the culprits remain at large. The justice that the victims and plaintiffs demand is yet to be served, as the order of damages, with other accompanying penalties, is yet to be pronounced.
——————–
Email the author at [email protected]

FacebookTwitterGoogle+