1. General Aspects Regarding Management of Dead Bodies; Tsunami Victim Identification in Thailand
Dr. Pongruk SRIBANDITMONGKOL
Department of Forensic Medicine,
Faculty of Medicine,
Chiang Mai University, Thailand

2. Prepared by
Dr. Pongruk Sribanditmongkol
Dr. Porn Pongpanitanont
Dr. Nop Porntrakulseree
Dr. Maythinee Petju
Dr. Supachai Kunaratanapruk
Pol.Lt.Col. Pattana Kitkailass, MD
Pol.Col. Pornpraseart Ganjanarintr
Gen Nopadol Somboonsub

3. Country information THAILAND USA Surface Area 514,000 sq km
Population
Doctor
Forensic Doctor
64,865,523
30,000 70
293,027,571
Distribution
0-14 yrs: 24.1%
15-64 yrs: 68.7%
> 65 yrs: 7.3%
0-14 yrs: 20.8%
15-64 yrs: 66.9%
> 65 yrs: 12.4%
GDP (US$)
$7,400
$37,800
Labour force
agriculture 49%
industry 14%
services 37%
agriculture 1%
industry 39%
services 60%

4. Scope of presentation Tsunami victim identification in Thailand
What have been done?
What did not work?
What do we learn?
What should be done?

5. December 26, 2004, a 9.0 Richter scale earthquake occurred north of Sumatra Island.

6. struck countries on the coast of the Indian Ocean, including Thailand
Caused a huge tsunami
struck countries on the coast of the Indian Ocean, including Thailand
from Manfred Leier, World Atlas of the Oceans, 2000, Firefly Books, Buffalo NY, USA.

7. Tsunami hit Thailand 10:05 hours Max. height 4-10.6 m (12-32 feet)

8. Causes destructions
to the beaches

9. Cause destructions
to the land

10. Mass fatalities

11. Summary of the human toll caused by the tsunami as of 23 March 2005
Countries
Dead
Missing
Displaced
Homeless
Indonesia*
220,153 -
400,062
n/a
Sri Lanka
31,147
4,115
519063
480000
India
16,389
647599
20000
Maldives 82 26
21663 Na
Thailand
5,395
2932
Myanmar 90 10
3200
Malaysia 68 12
4296
East Africa
312
158
2320
Total
273,636*
7,253
>1,590,707
>507,496
From MOPH, Thailand
* 265,000 – 3140,000

12. The number of deaths in Thailand
Province
No. of Deaths
Ranong
160
Phang Nga
4,224
Phuket
279
Krabi
721
Trang 5
Satun 6
Total
5,395
reported by the Thai authorities Official figures as at 24 March
Photo from

13. Forensic Aspect
Under the Thai law, a forensic investigation is required for these types of deaths.
In general, the purpose is
to identify the victim
to determine the time and place of death
to determine the cause and manner of death.
main purpose for
tsunami victims

14. Management of Dead Bodies in Thailand
Coordinated by
Responsible Institution
Supported by
Inter-institution Teams
Search and Recovery
Identification
Storage and preservation
Final Arrangement
Assistance for Family members

15. Responsible Institution
At the beginning- not clear, no command center related to management of dead bodies
During the early period; under
Department of Disaster Prevention and Mitigation, Ministry of Interior
The Royal Thai Police
The Ministry of Public Health
Jan 13, 2005; Set up The Tsunami Victim Identification Executive Committee, chaired by the Minister of Interior

16. Inter-institution Team
academic institutes
local government
military
police
Public Health
NGO
volunteers

17. Body search and recovery
Conducted by
Local Government / Ministry of Interior
Military
Charity Foundations Team (volunteer rescue teams)
Different from the WHO recommendation

18. Body search and recovery
Performed after rescued survivors
Transferred bodies to temporary morgues
No central coordinator, not in a good order
Did not map the location where the bodies found
Did not label the corpses

19. Examination of bodies Morgue sites
Established in the affected area by forensic teams and local government
Using temples or public areas

20. Setting in the temporary morgues
Holding area
On the floor
In the pavilion of temples

21. Examination Area On the site sunny and temperature up to 39 ˚C
performed examination on the ground, no facilities

22. Body identification
Phase 1. Conducted by local authorities then released at scene.
Phase 2. Conducted by Thai forensic teams from many institutes (1-2 weeks)
Phase 3. Conducted under the TTVI operations (Thai authorities Thai forensic team and international DVI teams)

23. Body identification
1. Conducted by local authorities then released at scene.
Families came and identified victims at scene.

24. Body identification
2. Examined by Thai forensic teams from various institutes.
Using institute’s protocol
Labeling number to the cases
Photographing
Recording external appearance, personal belongings and specific marks.
Collecting DNA specimens
No committee nor meeting together before start working.

25. Finger printing Conducted by crime scene investigation police
performed about 600 cases
Reasons not to collect all of the cases
Lack of cooperation between relevant authorities
Not enough staff
Bodies were decomposed

26. Dental examination Occurred on the fifth day after the disaster
Organized by the Thai Dentist Council
Conducted by the Thai dentists from
Various universities - Government hospitals
Private hospitals and clinics
About 550 dentists, mostly were not forensic dentists

27. Identification and released of the bodies
Summary of identifications, examinations and releases by Thai forensic teams
No. of deaths
Identified by local authorities
Examined by Thai Forensic team before TTVI
Released by Thai Forensic team before TTVI
5,395
213
3,698
1,390
Almost identified by external and physical appearance

28. Summary of victims identified by Dental record during the early phase
No. of deaths
Dental examination by Thai Dentist team
Identified and released based on dental records
5,395
2070
111

29. DNA analysis Specimen collection from post mortem
Buccal during the first few days
Hairs during the first few days
Muscle during the first few days
Rib
Tooth
Femur

30. DNA Laboratories Department of Forensic Medicine, Siriraj hospital
Forensic unit, Ramathibody hospital
Institute of Forensic Medicine, and Crime Scene Investigation Police Office, Royal Thai Police
Forensic Science Institute, Ministry of Justice

31. Result of DNA analysis from Thai laboratoriesAM PM
Possible match
1930 cases
664 cases
310*
*In the process of identification or collecting more specimens to compare

32. Storage and preservation of the bodies
During the first week
After the second week
During the end of first week
Same and difference
From WHO recommendation

33. Bury the deceased
After a week, without any proper preservation method and the bodies were more decomposed.
About 300 corpses from Phang-Nga then were buried after forensic examination, but later the bodies were exhumed and kept in the refrigerated containers for further identification.
We should emphasis this point in WHO recommendation (how?)

34. Assistance for Family members
To receive victim’s ante mortem data using
local hospital staff
police
volunteers
No really set up the AM center nor the Family assistance center to help the family members get over with this tragedy and accept for the losses of their loved ones.

35. Problems in victim identification
Management perspective
Technical perspective

36. Problems in victim identification
Management perspective
Lack of central coordinator and command center.
No proper storage method and preserve the bodies
Shortage of available resources response to the situation

37. Problems in victim identification
Technical perspective
No single numbering and labeling system
No standard protocol of body examination.
Redundant body examinations
Lack of experienced and number of staff, eg. forensic dentists, fingerprint experts
Cannot consolidate information to single system.

38. Problems in victim identification
Lack of ante mortem information from families especially dental records and fingerprints

39. Problems in victim identification
Lack of National Mass Fatality plan

40. Consolidation of victim identification
Thai Tsunami Victim Identification (TTVI)
International DVI and Thai forensic teams cooperation under the control of Thai authorities
All bodies were treated equally using the Interpol DVI examination protocal.
All the information are consolidated into a single system

41. Temporally morgue in Phang-Nga under TTVI

42. Temporally morgue in Phuket under TTVI

43. Approximately 41 % of total deaths in Thailand
Number of bodies examined, identified and released under TTVI operation
Body examination (including additional examination)
Identified and released (cases)
Bodies unidentified (cases)
3,684
1,468
2,230
Approximately 41 % of total deaths in Thailand
Source: TTVI on April 30, 2005

44. Reconciled bodies by primary evidence
83.86 %
14.37 %
0.48%
1.29%
Source: TTVI on April 30, 2005

45. At present
All the unidentified bodies had dental, fingerprints and DNA specimens collected.
All post mortem data are placed in the TTVI database (PLASS data)
2301 ante mortem records are in the system, only 444 from Thai

46. Reconciled Thai victims by primary evidence under TTVI (after Feb 3, 05)
49 %
46 %
2 %
3 %
Source: TTVI on April 30, 2005

47. What do we learn?
Identification and return bodies back to their families is an important health issue related to mass disaster.
This tsunami devastation is over the expectation and the available resources.

48. What do we learn?
The command center of victim identification is necessary and should be set up as soon as possible and responsible for the whole processes of identification.
The labeling and numbering should be one system to avoid confounding bodies and data.

49. What do we learn?
Preparation of morgue sites as well as storage system is important at the beginning in order to have a proper work place and avoid any hazard to personnel as well as the environment.
Data should be consolidated to one system so that it is easy to access by victim’s families.
The local and international ?
The language and term used in different countries?

50. Do we need to confirmed by other evidence
What do we learn?
Do we need to confirmed by other evidence
Identification of the victims should based on the external evidences, dental records, fingerprints, and DNA.
Should not rely only on DNA-

51. What should be done? National Mass Fatality Plan
System of National Mass Victims Identification
Recruitment of personnel.
Post mortem storage and examination.
Ante mortem information from families.
Long term storage of unidentified corpses.
Data management
Family assistance

52. What should be done?
Since the severity of any disaster may not be predicted exactly, preparation of the relevant resources may not enough.
International cooperation and assistance are necessary and play an important role in an international disaster.

53. Legal Health Interpol-DVI D.M.O.R.T SEARO VEPRO PAHO Member countries
ADOP
Legal
Health
Interpol-DVI
D.M.O.R.T
WHO
Red Cross
U.S.A.
SEARO
VEPRO
PAHO
Member countries
National mass
fatality plan
Regional plan
National mass
fatality plan
Regional plan
National mass
fatality plan
Regional plan

54. The best way to pay respect to the Tsunami victims is to use the lessons learned to create a safer future.

55. Thanks for your attention