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The country’s response to last Wednesday’s floods and explosion at the GOIL filling station at the Kwame Nkrumah Circle can be described as disastrous, to say the least.

It has exposed the country’s ill-preparedness to respond to emergency situations and raised questions about what the country has been doing since it gained independence 58 years.

The country does not have an Incident Command Centre to co-ordinate activities. As a result, it comes as no surprise when various institutions bundle different casualty figures around.

Figures ranging from 150 to 210 have been put out there by various institutions as the number of casualties.

It was disgusting to see corpses packed into the load compartment of pick-up and KIA trucks from the accident scene to the mortuary. 

The way and manner the corpses were bundled into the pick-ups and KIA trucks alone shows how insensitive we treat people who lose their lives in disasters.

The Finder’s investigations revealed that the National Ambulance Service does not have a single hearse to convey corpses, and that was why the corpses were conveyed in pick-up and KIA trucks.

Ambulances only carry living beings in critical conditions.

The way and manner last Wednesday’s disaster was handled was reminiscent of how the stadium disaster in the year 2001 was handled, a clear indication that the country did not learn any lesson from the stadium disaster.

In the 21st century, where disaster agencies typically have reserves of body bags for anticipated natural disasters to store and transport corpses, Ghana cannot boast of a single body bag.

Our checks revealed that a body bag costs as little as $3.

The World Health Organisation (WHO) states that where there are many fatalities, the collection and disposal of bodies become an urgent need. 

This is not usually due to any health-related risks, which are likely to be negligible, but is important because of the possible social and political impact and trauma. 

The KIA trucks used to convey the corpses belonged to private individuals and were driven by civilians.

It is surprising how emergency agencies assisted to bundle bodies into these private KIA trucks and just ordered the drivers to take them to particular hospitals.

Interestingly, the drivers send the bodies to the hospitals, discharge the bodies and return to the accident scene without hospital authorities taking details of the name of the driver, the individuals who came with him to discharge the bodies or even the registration number of the vehicle, let alone ask who directed that the bodies be brought to that particular hospital.

These trucks ply the roads with the bodies not covered.

The image of a victim of the disaster severely burnt in the upper part of the body who was made to walk, instead of being put on a stretcher, is one that exposes the weakness in the system.

NADMO’s relief items

It took the National Disaster Management Organisation (NADMO) more than 24 hours to offer those who survived the floods but lost all their belongings basic needs like water and food. The explanation is that they were taking stock of affected persons first. 

According to the WHO, emergency relief teams should primarily be concerned with the mental health of the community and its need to carry out the cultural obligations and traditions to take care of the dead, rather than potential disease transmission.

Way Forward

Clearly, the country has to establish an Incident Command, and the head of the command leads all emergency responses and every unit reports to that individual.

The situation where Police Service, Fire Service, NADMO, and Military spokespersons, among others, granted interviews to the media and gave conflicting figures could be avoided with the establishment of a unit that will be in charge of communication.

During flooding, vehicular movement becomes difficult, making evacuation with air ambulance critical. It is sad to know that 58 years after independence, Ghana cannot boast of one single air ambulance.

WHO Disposal of dead bodies in emergency conditions

Physical health risks

The widespread belief that corpses pose a risk of communicable disease is wrong. 

Especially if death resulted from trauma, bodies are quite unlikely to cause outbreaks of diseases such as typhoid fever, cholera, or plague, though they may transmit gastroenteritis or food poisoning syndrome to survivors if they contaminate streams, wells, or other water sources.

Mental health risks

The psychological trauma of losing loved ones and witnessing death on a large scale is the greatest cause for concern. 

It is, therefore, important to collect corpses as quickly as possible to minimise this distress. 

It is, however, not necessary to rush their burial or cremation. This does not allow for the correct identification and record taking of the details of the dead. 

Nor does it give the time for the bereaved to carry out the ceremonial and cultural practices which would normally occur after a death.

Cultural and religious practice

Relief workers should respect the wishes of the families and communities of the dead to observe whatever cultural and religious events are usually practiced after a death. 

This is important in helping people deal with the psychological impact of such disasters. 

Encouraging stricken communities to carry out traditional ceremonies and grieving processes set in motion the process of disaster recovery.

Recovery of bodies

To minimise the distress caused by the sight of dead bodies and the odours produced by their decomposition, it is important to collect and remove corpses to a collection point as quickly as possible. 

Anyone in charge of a body recovery team should be aware of the stress and trauma that team members might go through, and provide support for this where possible.

Mortuary services

It is important to provide secure morgue facilities where there are casualties following an emergency, where there is an epidemic, or if burial or cremation are likely to be delayed. 

A temporary mortuary site should consist of a reception, a viewing room, a storage chamber for bodies not suitable for viewing and a room to store personal possessions and records.

The recommended capacity for a field morgue is 10 bodies per 10,000 population. Bodies should be stored at 4ºC, although this is rarely possible. Mortuary staff should wear gloves and protective clothing and should wash with disinfectant soap. 

A complete list of mortuary requirements is given below. Where this is not possible, the minimum facilities are stretchers, leather gloves, rubber gloves, overalls, boots, caps, soap, disinfectants and cotton cloth. 

Following an emergency, when the decision is made to close a temporary mortuary, appropriate cleansing of the site should take place.

Identification of bodies

One of the major challenges of effective management of dead bodies is their early identification and tagging. Records of deaths and funerals need to be kept to monitor mortality rates and the incidence of disease and to be able to provide timely, understandable and accurate information to relatives of the dead.

Displaying bodies for identification needs space: 1,000 bodies require over 2000m2. 

Identification can be a lengthy process, especially where no personal documentation is carried. 

When relatives and friends of the dead are involved, it must be remembered that visual identification is not scientific.

In emergency situations, this process is even more difficult, as it may be necessary for relatives to view numerous bodies in the hope that they will make an identification. 

This would normally be avoided. Where possible, it is important to differentiate viewing a body for identification from viewing a body for grieving purposes, and separate locations should be provided.

Once identified, a death certificate should be issued, an official record of death prepared and the body tagged. 

With violent deaths, it is also important to record the cause of death for possible future investigation.

Body disposal

Burials in common graves and mass cremations are rarely warranted and should be avoided.

Burial

Burial is the preferred method of body disposal in emergency situations, unless there are cultural and religious observances which prohibit it. 

The location of graveyards should be agreed with the community and attention should be given to ground conditions, proximity to groundwater drinking sources (which should be a least 50m) and to the nearest habitat (500m). An area of at least 1500m2 per 10000 population is required.

The burial site can be divided to accommodate different religious groups if necessary. 

Burial depth should be at least 1.5m above the groundwater table, with at least a 1m covering of soil. Burial in individual graves is preferred and can be dug manually. 

If coffins are not available, corpses should be wrapped in plastic sheeting to keep the remains separate from the soil. Burial procedures should be consistent with the usual practices of the community concerned.

Cremation

There are no health advantages of cremation over burial, but some communities may prefer it for religious or cultural reasons. 

Factors against it are the amount of fuel required by a single cremation (approx 300kg. wood) and the smoke pollution caused. 

For this reason, cremation sites should be located at least 500m downwind of dwellings. The resultant ashes should be disposed of according to the cultural and religious practice of the community.