Safe & Dignified Burials
As the response evolved, burial protocols embraced the concept of safe and dignified burials. Groups of locally-staffed, specially-trained teams handled the emotional duty of safely removing bodies from people’s homes. These teams worked to observe family and community customs, and, at the same time, ensured that the dead were buried in a safe manner. In the best scenario, when called to a home, the burial teams would first meet with the families of the deceased. They offered condolences and consulted with the families, making sure they approved of the burial process. Then, while some team members remained with the families, others prepared for the burial. They dug graves to a safe depth of 8 feet, often together with community members, and donned their protective gear. Then they carefully moved and buried the dead bodies. Families were able to observe the burials and say prayers from a safe distance.
A proper, dignified burial with meaningful acts of closure restored a tiny sense of normalcy to a mourning process heavily impacted by medical protocols. When family members participated in a respectful burial experience, they told their friends. People in the community then became more willing to turn over the bodies of their loved ones to burial teams.
Dr. Seung Hee Lee-Kwan discusses some burial practices and emotion that had to be addressed in Sierra Leone in ensuring safe and dignified burial.
What is a Safe Burial?
During any Ebola outbreak, all dead bodies are considered potentially infectious, and are tested post-mortem for the disease. The bodies of people who die from Ebola are highly infectious, so strict infection prevention and control is necessary. Burial teams tasked with picking up bodies from homes and villages are required to wear personal protective gear. In the case of an ETU death, the hospital hygiene team takes the body to the morgue until time for burial.
However, these strict procedures don't account for cultural and religious customs. In the West African epidemic, they were later adapted to allow family members and communities more opportunities to participate in burial rituals without risking exposure to Ebola.
The following visual aid provides instructions for what to do when someone dies at home to follow prevention protocol.
Carol Rao, CDC epidemiologist, describes her experience accompanying a burial team in Sierra Leone.
Burial Teams in Liberia and Sierra Leone
The Liberian National Cemetery
In Liberia in August and September 2014, the numbers of people dying as a result of the outbreak were too many for burial teams to keep up with. As a result, highly-infectious bodies were left in the streets. In August 2014, the President of Liberia made the decision to introduce cremation—an affront to traditional burial practices and a cultural taboo. The Hindu community offered the use of its crematorium, and all bodies were cremated—even when Ebola had not been confirmed as the cause of death.
Working with the U.S.-based NGO Global Communities, the Liberian National Cemetery at Disco Hill outside of Monrovia opened in December 2014. The site was purchased by the government of Liberia to provide safe and dignified burials and managed by Global Communities. When the cemetery management was transferred back to the Liberian government in January 2016, over 3,000 people had been buried there.
King Tom Cemetery is Freetown’s oldest cemetery. When the crisis hit, it was neglected, crumbling, and overrun with weeds. As the death toll rose, the Sierra Leone government said anyone who passed away must get a safe, medical burial. This meant the dead were taken from homes by trained burial teams wearing full protective gear, put in body bags, and taken to cemeteries, including King Tom.
In October 2014, Concern Worldwide and the International Federation of Red Cross and Red Crescent Societies (IFRC), two international NGOs, took over the burial system in Freetown. Things had become chaotic—burial workers weren’t properly paid or equipped. Families were distraught at the way burials were carried out. Cemeteries struggled to handle the number of bodies, and many graves were not marked or named.
King Tom Cemetery is now clean, and graves are all arranged in order so that family members can get easy access. The cemetery was handed back to city authorities in 2016. To ease the pressure of so many burials, a new cemetery, Waterloo, was also established, which now holds over 10,000 graves.