Why identify the dead?

Rain opened the month of June this year. For those who were affected in previous years’ typhoons and who are still recovering from the aftermath, continuous strong rain brings back memories of loss of lives and properties in affected areas. Moreover, many survivors realize in a vivid way their total helplessness against an environment we have forgotten to protect. In 2011 for example, Typhoon Sendong caught the entire Philippines by surprise. The entire nation was shocked when it realized the extent of the damage and the large number of people that remain missing. Not used to typhoons and harsh weather, the cities of Iligan and Cagayan de Oro had to grapple with problems they had never encountered before. Both cities had to weigh their priorities and manage their resources to more effectively aid the communities that were most affected. In order to assist in the post-disaster effort, the University of the Philippines established “UP Padayon” () and sent a multidisciplinary team composed of medical doctors, dentists, geologists, public health personnel, forensic pathologists and forensic DNA scientists to Iligan City several days after the flood. The forensic group tasked with specifically helping in the identification of recovered remains discovered the need for a more efficient system for disaster victim identification (DVI) when handling a disaster of such a magnitude.

But why identify the dead? Many people including policy-makers have posited — should we not allocate resources for the living and bury the dead, even if unidentified? The identification of the dead is a complex and potentially expensive task especially when all the necessary information is not documented before body decomposition sets in. Why then should we identify the dead when they are dead? There were several reasons that were provided. These included 1) the need to investigate if the death was caused by a criminal act or a natural calamity; 2) the planned re-marriage of the living spouse; 3) financial reasons particularly in the payment of pensions, insurance and other death benefits to the deceased’s family; 4) proper burial following the traditional belief of the family; and 5) the need to provide proper closure for relatives of a missing person. Simply stated, the identification of the dead is not for the sake of the dead, but for the sake of the living.

In recent times, the changing climate appears to bring more damage to properties and a greater loss of lives. Addressing the cause of climate change is important to prevent such losses. However, we also need to manage the effect of severe typhoons and to give importance to helping communities to move forward as quickly as possible. Part of the rehabilitation process is an efficient DVI strategy. DVI is a complex task with three primary means for identification: fingerprint analysis, dental examination, and DNA typing. Information about the external appearance of the recovered remains and other secondary but distinguishing features are useful in the process (http://www.interpol.int/ INTERPOL-expertise/Forensics/DVI). DVI teams work in an interdisciplinary manner and engage the services of experts in various fields, as needed. One major step in DVI is the establishment of a missing person database that serves as the repository of information of all material about missing persons after a disaster.

Fingerprint analysis is useful when bodies are not severely decomposed. Moreover, fingerprint and dental records taken ante-mortem should be available for comparison with the same data obtained from recovered remains. In contrast, DNA profiling may be used even after the start of decomposition and in the absence of ante-mortem data. The selection of the appropriate method for human DNA profiling relies on the condition of the recovered sample for DNA typing and the availability of reference samples, e.g. from family members and relatives, needed for genetic comparison.

Availability of robust and sensitive DNA typing systems will affect the successful resolution of a case and one system may be more informative than another in certain cases. The recommended parameters for DNA profiling methods are sensitivity, repeatability, reproducibility and profile quality assessment. Blood or intact soft tissue samples are ideal for DNA-based human remains identification, but when body putrefaction precludes DNA preservation, and the possibility of soft tissue co-mingling is suspected, bone and tooth samples are preferred. DNA preservation in human remains may be influenced by a complex interaction of taphonomic processes, including exposure of remains to moisture, humidity, UV radiation, fire, microbes, flora, fauna, and soil.

Routine DNA typing procedures have preferentially used compact bones because of the relatively high success rate of DNA recovery reported from the femur shaft, as compared to other bone types. In general femur, ribs and tooth (for skeletal remains) and tissue samples (for intact, not severely decomposed bodies) are among the more common elements sampled in the identification of human remains. Rib specimens are used because of the accessibility of rib bones during autopsy. Other sources of genetic material such as body fluids may be collected and analyzed depending on the specific scenario of the disaster. Because the DNA degradation of soft tissues progresses rapidly with time, this method requires that the samples should be taken from fresh material. Hence, one of the major recommendations of the UP forensic team in Sendong is the training of all local government units in mass disaster management and empowering local health officials to assist in the collection of information as well as biological samples that are properly coded for the missing person database.

As a golden rule, the immediate collection of biological samples prior to any form of chemical treatment, e.g. formalin, lime, provides better sources of DNA for analysis. All samples must be coded with a coding system that is strictly followed by all team players in the recovery and identification effort. Once collected, all biological samples must be stored cold to prevent further decomposition. Much like a fire drill, it seems imperative that communities undergo a “disaster drill” now that more rains have been experienced in many parts of the Philippines. Cooperation, coordination and preparedness are elements necessary for an effective disaster response.

After Typhoon Sendong, >1,200 people were reported dead, and many remain unidentified. More than a year after the tragedy, news on the identification of the dead is scarce. Have the victims of the tragedy accepted the loss of their family members who remain to be missing rather than dead? How have they handled the implications of this situation? In addition, a master plan for disaster victim identification for local government units remains to be seen. The Philippine climate has changed, but have we learned from our past mistakes?

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GC Calacal is a senior scientist at the DNA Analysis Laboratory, Natural Sciences Research Institute, University of the Philippines Diliman (www.dnaforensic.org). She received the NAST Outstanding Young Scientist Award in 2010 for Molecular Biology and UP Gawad Chancellor for Natatanging REPS (Research Category) in 2011 and 2007. She is currently involved in a research project entitled “Human Remains Identification” which aims to validate DNA typing procedures for environmentally challenged samples. This project received funding from the Philippine Council for Health Research and Development of the Department of Science and Technology (DOST-PCHRD; http://www.pchrd.dost.gov.ph/) for 2013-2014. MCA de Ungria is the current head of the DNA Analysis Laboratory and the Director of the Program on Forensic and Ethnicity of the Philippine Genome Center (www.pgc.edu.ph). The UP-NSRI DNA Laboratory offers its parentage testing and DNA profiling expertise as part of its commitment to serve the community. The laboratory may be contacted at 632 925-2965 and [email protected]. GC Calacal and MCA de Ungria are members of the forensic team of UP Padayon (https://www.facebook.com/UPDisasterResponseTeam).