kuta Bali bombing offers lessons for disaster relief

Abstract

Ice duty at the Sanglah hospital mortuary in Bali was a daily occurrence for more than a week after two bombs tore through the neighbouring Kuta entertainment district and killed far more victims than the morgue's refrigerators could cope with Each morning at about 9 am, a motley crew of tourist volunteers and employees of a local cleaning firm formed a human chain to shift several hundred 10 kg, metre-long blocks of ice from a lorry to a long row of black body bags laid out in the crematory garden. Under an Interpol treaty, identification has to be confirmed by dental records, fingerprints, or DNA analysis before a body can be handed over. Because visual identification was ruled worthless, some families had to go through the harrowing experience of seeing their loved ones return to the list of the missing. Keeping the Balinese casualties in Bali was a political decision, but international assistance was provided in the form of donations of medicine and the arrival of a team of plastic surgeons from Singapore who operated on many of the burn victims 4 days after the bombing.

Ice duty at the Sanglah hospital mortuary in Bali was a daily occurrence for more than a week after two bombs tore through the neighbouring Kuta entertainment district and killed far more victims than the morgue's refrigerators could cope with

Each morning at about 9 am, a motley crew of tourist volunteers and employees of a local cleaning firm formed a human chain to shift several hundred 10 kg, metre-long blocks of ice from a lorry to a long row of black body bags laid out in the crematory garden.

It was an essential task to keep the remains, already charred by the explosion and subsequent fires, from decomposing in the tropical sun while the long and difficult process of identification was underway.

Apart from the physical labour, ice-duty was one of the easiest jobs at the morgue for volunteers, many of whom had arrived in Bali only days before with the intention of surfing, scuba diving, or soaking up the sun.

In the chaotic days immediately following the blasts, some volunteers—including some as young as 16 years old—were called upon to search the bodies for identifying marks, to take photographs of mutilated remains, and to organise the storage of the dead.

At one point, a furniture designer from Australia took charge of moving all the remains to refrigerated trucks for the night. There was so little space that the bodies, which had earlier been separated into identifiable and unidentifiable, had to be mixed up again.

The volunteers' willingness to step into such a horrendous situation at a time when the morgue was completely overwhelmed was heroic, but the families of the bereaved are still suffering from the consequences.

Identification was always going to be a huge problem after such a powerful explosion, but the process has been made more difficult by the total breakdown of bureaucratic order at the morgue in the first few days after the blast.

With little or no guidance from the authorities, the volunteers filled some bags with a collection of partial remains rather than keeping each body part separate. This has made DNA sampling difficult because of cross-contamination inside the bags.

Adding to the grief of relatives, the criteria for identification have also changed. At first, the hospital allowed families to claim bodies simply by visual recognition of faces or tattoos, but this led to at least one of the dead being claimed by five different people.

After 4 days, when the Australian authorities started to take control of the situation, stricter international criteria were applied. Under an Interpol treaty, identification has to be confirmed by dental records, fingerprints, or DNA analysis before a body can be handed over. Because visual identification was ruled worthless, some families had to go through the harrowing experience of seeing their loved ones return to the list of the missing.

The confusion at the morgue deepened an already appalling tragedy, but what could have been done differently? With more than 180 dead and 325 injured, the Sanglah hospital was never going to be able to cope with the huge casualties of the Bali bombing.

“Well-intentioned volunteers had nowhere to turn for guidance in trying to organise the bodies”

Although it is seen as one of the best hospitals in Bali, care is inevitably rudimentary given that the Indonesian health budget amounts to little more than US$1 for each of the country's 220 million population.

Foreign governments quickly evacuated their injured so that they could receive higher-quality care in Australia and Singapore, but the Balinese were not so fortunate. Volunteers and Indonesian families who have kept a vigil at the hospital say foreigners were given beds in the immediate aftermath of the accident, while local victims were forced to lie on the floor. The hospital denies these claims. Even after getting beds, Indonesian burn victims were kept in humid wards without air-conditioning. Nurses fanned them by hand to try to cool their bodies.

Keeping the Balinese casualties in Bali was a political decision, but international assistance was provided in the form of donations of medicine and the arrival of a team of plastic surgeons from Singapore who operated on many of the burn victims 4 days after the bombing.

Given such conditions and the fact that Bali was completely unprepared for an attack, a degree of chaos at the morgue was inevitable. The hard work and self-sacrifice of so many of those involved is also undeniable, but there are lessons to be learned.

The Indonesian authorities completely failed to respond to the crisis. Soldiers were posted to guard the morgue, but instead of restricting access, they spent most of their time sitting on coffins smoking cigarettes while anyone and everyone was allowed to wander among the bodies.

Consular officials from the two countries with the most victims—Australian and British—did not establish a help desk at the morgue for 3 days, which meant that some families seeking their loved ones found it difficult to get government advice.

Well-intentioned volunteers had nowhere to turn for guidance in trying to organise the bodies and the hospital appeared to be unaware of the Interpol regulations for identification of the dead.

How to prevent such mistakes in the future is a question that needs to be answered with some urgency given the threats to other tourist resorts in southeast Asia and elsewhere. Britain's minister of consular affairs, Baroness Amos, said she would recommend the establishment of a rapidresponse team, including consular officials, communication experts, doctors, detectives, and bereavement counsellors.

Given the different cultural sensitivities towards the dead in different nations, it may be difficult to include mortuary experts who could give advice on organising morgues in the wake of large-scale attacks. But the experience of Bali suggests that international disaster relief operations must consider the needs of the dead as well the living.