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12 steps to safely bury Ebola victims


One of the devastating aspects of the Ebola virus is the hands-off, highly sanitized burial of those who have died from the disease to ward off its spread. After months of dispatching burial teams to handle the emotional duty, the World Health Organization has issued a detailed 12-step guide to safer burials in West Africa.

Step 1: Assemble the burial team

The burial team is composed of four members wearing full protective gear, one sprayer person equipped with a chlorine-water solution for hand hygiene and disinfecting objects and surfaces, a technical supervisor not wearing protective gear, a communicator not wearing the protective suit who interacts with the family and a religious representative also not wearing the white protective gear.

The teams come from the Red Cross Society, Ministry of Health, World Health Organization or Doctors Without Borders.

A member of the hospital burial team digs the grave of small child who died of Ebola earlier on Oct. 18 in Ganta, Liberia. Photo by Tanya Bindra for The Washington Post via Getty Images

A member of the hospital burial team digs the grave of small child who died of Ebola earlier on Oct. 18 in Ganta, Liberia. Photo by Tanya Bindra for The Washington Post via Getty Images

Step 2: Compile the gear

The materials needed include a vinyl, impermeable body bag with at least four handles; alcohol-based hand sanitizer; chlorine and water solution; soap and water; one pair of disposable gloves and one pair of heavy duty gloves; disposable coverall suit; rubber boots; bag for the reusable materials and another for disposal.

Step 3: Meet the family and assess the risks

The burial team, before putting on protective gear, greets the family and offers condolences before unloading the equipment. The communicator discusses the burial with the community’s faith representative. The burial team leader gets approval from the family’s representative before proceeding. The team identifies family members who wish to speak at the funeral and carry the coffin. The team makes sure the grave is dug.

The family decides whether the deceased’s belongings will be burned, buried or disinfected. The relatives can take photos of the burial procedures and voice their religious preferences. For example, a deceased Muslim should not be cremated or placed in the body bag naked, according to the WHO guidelines.

The family members are asked if they want to bury any items, such as religious ones, with the body. Instead of touching the body, the relatives are offered some alternatives such as sprinkling the body with water. The family can hold a memorial service at the time of the burial or at a later date.

Step 4: Put on protective gear

The team evaluates the room with the body to prepare for its removal and suits up.

Watch a video on how health workers put on and take off their protective suits.

Step 5: Place the body in the bag

A member of the epidemiology team collects a post-mortem sample for Ebola confirmation. The team then places the body in the bag and disinfects the outside of the bag.

Step 6: Put the body in the coffin

The team carries the body to the coffin outside the home and places it inside with the items selected by the family. The coffin is decontaminated and placed in the bed of the pickup truck for transportation to the burial site.

Step 7: Sanitize the environment

The team collects materials that were used to treat the patient in a puncture-proof container, and cleans all rooms with the chlorine solution. Any soiled bed linens and mattresses are burned away from the home. The team must replace these items, according to the WHO guide.

Step 8: Remove protective gear

The team members disinfect their boots but keep them on until they return to their headquarters, where they will disinfect them again. They take off their suits layer-by-layer and dispose of the single-use items, which are later burned. Their reusable gear is collected in a bag and disinfected.

Step 9: Transport coffin to gravesite

If the coffin hasn’t been soiled, the team members can handle it with just household gloves. The family members also can carry the coffin wearing the gloves. They can sit in the back of the truck with the coffin, but not ride inside the truck.

A Liberian Red Cross pickup truck carries bodies outside Island Hospital where people suffering from the Ebola virus are treated in Monrovia on Sept. 26. Photo by Pascal Guyot/AFP/Getty Images

A Liberian Red Cross pickup truck carries bodies outside Island Hospital where people suffering from the Ebola virus are treated in Monrovia on Sept. 26. Photo by Pascal Guyot/AFP/Getty Images

Step 10: Place the body in the grave

The carriers lower the coffin by ropes into the grave, and depending on local customs, the ropes are removed and the earth shoveled in a specific way.

Step 11: Burial at the cemetery

The family members can pray and make speeches, and they are the ones who may close the grave. The burial team retrieves and disinfects the gloves. The family members and attendants wash their hands with a disinfectant.

Step 12: Return to headquarters

Back at headquarters, the team incinerates the single-use items and disinfects the reusable equipment, including their boots.

The World Health Organization reported Friday that there are 13,268 confirmed and suspected Ebola cases, mostly in Guinea, Liberia and Sierra Leone, and 4,960 deaths.

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