Faced with the Covid-19 epidemic in Africa, preparing for the care of the sick also means anticipating decisions concerning how funeral rites will be performed. Anthropology has shown that these begin when the first signs of death appear. They continue after the burial until centralization.
They include a set of rituals, ceremonies, cares which are all cultural or religious imperatives perceived as essential to respect. Compliance with the biosecurity rules necessary to prevent the transmission of the disease in an epidemic context has a direct impact on the various funeral practices. It is as important for end-of-life support as for the treatment of the body of the deceased or collective ceremonies.
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What have we learned from the Ebola epidemic?
Epidemiological studies have shown that certain funeral rites contributed to the spread of the Ebola epidemic. Hence the establishment of “secure burial” procedures entrusted to specialized health workers. These agents were to carry out Ebola screening for all the deceased, with – during the epidemic period – an obligation to declare the cause of death. They also had to respect, among other things, the prohibition on the movement and manipulation of bodies by families.
In all the countries where they have been applied, these methods of mortuary care and burial have struck head-on against usual funeral practices. The inhabitants there often saw a lack of respect for the deceased, the family, and more generally the populations. Taking into account the values and social practices of the populations led the WHO and other institutions to develop burial procedures and to recommend “dignified and secure burials” (DHS) or “burials without risk and indignity “. Dignity here refers to respect for cultural and religious practices in agreement with the families of the victims. Securing means respecting biosecurity rules.
Despite these increasing humanization efforts, initiated since 2003 on the initiative of anthropologists during previous epidemics, these measures have not always been accepted. They have even sometimes led to violent revolts – including assassinations – against health workers or public officials.
What we know about Covid-19
In the current state of knowledge on SARS-CoV-2 (Covid-19), the infectious risk linked to the handling of corpses would be comparable to that of HIV (AIDS), HCV (hepatitis C), SARS-CoV (severe acute respiratory syndrome, SARS), H5N1 (avian influenza) or MERS-CoV (Middle East respiratory syndrome).
In a first provisional guidance document, the WHO specifies that there is no evidence that there is a risk of infection following exposure to the bodies of people who have died of Covid-19. However, until further information, a precautionary principle is applied.
We would like to emphasize that these WHO recommendations do not take into account the important phase of end-of-life support. However, additional reflection must imperatively be produced on this essential moment of funeral rites for families and respect for the dignity of the person.
What to do today?
WHO recommended practices are generally less restrictive than those in effect during the Ebola epidemic. However, their application will require adjustments to usual practices. On the one hand, it is a question of implementing biosecurity rules by professional and customary thanatopractors who must be provided with adequate personal protective equipment (PPE), soaps and antiseptics. On the other hand, all close relatives must be prohibited from all physical contact with the body once it has been prepared, apply a distance of one meter to the body. The distancing of the elderly, over 60 or medically vulnerable due to illness, is also indicated.
Adapt the ban on reunions to the social imperative of accompanying “his death”
The recommendations formulated for funeral rites also complement the measures to ban reunions. In urban as in rural areas, depending on the social prestige of the deceased, it is usual for several tens or even hundreds of people to be present at the ceremony. The spontaneity and the feeling of social obligation to participate in the event suggest that it may be difficult to ban these gatherings.
In Senegal, the testimonies reported of the burials of two national celebrities ( Mr. Papa Mababa Diouf dit Pape Diouf in Dakar, then Mr. Alioune Badara Diagne dit Golbert in Saint-Louis), at the end of March 2020, in the context of the state of ‘Covid-19 health emergency, show that the population abstained from participating in burials, thus scrupulously respecting the prohibitions.
It is through social networks that a significant part of the condolence messages has been expressed. Widespread use of mobile telephony and Internet communication could thus compensate, pending better finding, funeral groups. These media are already widely used for sharing mortuary photos or videos of ceremonies that are sent to family members living abroad or vice versa, such as in Italy, to affix condolences to coffins (for example children’s drawings), or send accompanying words to the dead just before burial; they have been used frequently in countries facing the Ebola epidemic.
Also, take into account syncretic funeral rites
Anthropological research has shown a wide variety of funeral practices, beyond just established or imported religions, with frequent processes of local, lineage or family variations of the possible recommendations made by religious dignitaries.
Ritual practices valued by culture or syncretic practices can be implemented by relatives (families, lineages, cultural groups, groups of initiates …) independently of religious leaders. They relate to the treatment of the body as well as its duration of conservation before burial and the ceremonies which surround the period of death. The redevelopment of such rites, in the context of the Covid-19 epidemic, must be approached locally taking into account these different practices.
Anticipate to avoid reactions of social disapproval, controversy or violence
In order to prevent the emergence of controversies or even conflicts related to the arrangements for funeral rites, it is necessary to promote debates on the subject, at the earliest and even before an increase in the number of deaths. It is important to involve religious leaders of different faiths, “traditional leaders” and other local leaders (members of women’s, youth, hunters, unions, etc. associations) in order to inform them of the health risks associated funeral practices and rites; to invite them to reflect on and develop adaptations of practices to show respect for the deceased while guaranteeing the application of sanitary measures; and, finally, to ask them to clearly inform the populations of which they are spiritual, moral or political referents.
Co-construct adaptation methods and resilience practices
Efforts will never be sufficient to prepare for the diversity of situations that are sure to emerge. Also, it is important that the epidemic control committees take the initiative to develop procedures for supporting the dying and for planning funeral rites, articulating bio-sanitary measures and socio-cultural imperatives, on the basis of ” interdisciplinary work with religious and traditional authorities and experienced anthropological researchers on this subject.
The experiences of various institutions and research in anthropology indeed show the importance of strengthening the capacity of intervention teams to develop, with families, adaptations and resilience practices on a case-by-case basis, without ever compromising on respect for biosecurity requirements, the dignity of the deceased and cultural or religious requirements.