INTRODUCTION
Corona Virus disease 19 (COVID-19) which is caused by SARS CORONAVIRUS 2 (SARS CoV 2) was declared a global pandemic by the WHO on the 11th March 2020 and has impacted all aspects of our lives including burial of deceased persons.
The purpose of this guideline is to highlight the MEDICAL considerations that should help inform decision making for persons responsible for administering religious burials for deceased Muslims.
For more detailed protocols and standard operating procedures please refer to your local (municipal, provincial and burial society) guidelines.
Current ISLAMIC burial practices must be shaped by the available medical and scientific evidence which are incomplete in relation to COVID-19. While it is understood that for Muslims ghusl is the normative obligation for the deceased according to most theologians a number of views have emerged advocating for and against ghusl during the current epidemic.
Hence guidance provided by Islamic and health authorities may differ with regard to Ghusl, Kafan, Salatal Janaaza and Dafan.
According
to the WHO (World Health Organization) there is no evidence to date of
persons becoming infected from exposure to the bodies of persons who died from
COVID-19.
However, a low risk does exist from splashing of fluids from the body and by
contact transmission.
ISLAMIC LEGAL MAXIMS PERTINENT TO THE COVID EPIDEMIC
- Harm must be removed
- Hardship begets ease
- Necessity lifts prohibitions
- Necessity is measured according to its proportion
- Matters shall be judged by their objectives
THE LIVES OF BODY HANDLERS AND THE COMMUNITY MUST NOT BE ENDANGERED
ROUTES OF TRANSMISSION
Key to implementing appropriate protocols in the performance or otherwise of ghusl is understanding how the virus is transmitted. This understanding will assist in informing appropriate protocols to mitigate the risk of contracting COVID-19 from a deceased body.
Most often spread from a LIVING person happens with close contact i.e. within 1,5 to 2 meters via respiratory droplets produced when an infected person coughs or sneezes. This route of transmission is not a concern when handling human remains. It is also possible to pick up the infection by touching a surface that has the virus on it and then touching one’s mouth, nose or eyes (mucous membranes).
CLEANING AND DISINFECTION
Human
Corona Viruses can remain infectious on surfaces for several days; therefore,
cleaning the environment is a critical component of controlling the spread of
infection. Environmental surfaces where the body was prepared should first be
cleaned with soap and water or a commercially prepared detergent solution. Thereafter
a disinfectant with a MINIMUM concentration of 0,1% (1000 ppm) sodium
hypochlorite (bleach) or 70% ethanol should be used to disinfect the HEARSE. Once
the body has been transported the inside of the vehicle and the stretcher
should be wiped down with diluted bleach and allowed to air dry.
PLACE OF GHUSL
The number of persons performing ghusl must be limited to FOUR. Persons with high risk medical conditions (respiratory illness, heart disease, diabetes, hypertension or immunocompromised conditions), persons over the age of 60 years and children should NOT be performing ghusl.
The ghusl area should have proper ventilation and effective water drainage. Avoid spraying water to minimize splashes. Preferable to use a bucket and jug to pour water gently over the body.
TRAINING
Without proper training the performers of ghusl put themselves at risk of infection. Training should cover all aspects of the burial process including hand washing, cleaning, disinfection and appropriate use and safe disposal of PPE (refer to illustrations below.) Ideally, a PERSONAL PROTECTIVE EQUIPMENT (PPE) trainer should train volunteers in each locality.
PERSONAL
PROTECTIVE EQUIPMENT (PPE)
PPE consists of full sleeve plastic disposable gowns, gloves,
fluid resistant surgical mask, water resistant
shoe covering or boots and eye protection (visor or
goggles). After removal of PPE perform hand disinfection by washing hands with
soap and water for at least 20 seconds or using an alcohol based, sanitizer
that contains at least 70% alcohol. Soap and water MUST be used if hands
are visibly soiled. Ghusl performers should remove the PPE, discard in a
medical waste container/bag, and disinfect. All surfaces that may be contaminated
should be wiped with appropriately diluted bleach (refer to table below)
which should be left for 15 to 30 minutes and then rinsed with water.
JANAZA SALAT
Minimum social / physical distancing must be maintained at all times (refer to diagram below).
The salat should preferably be performed in open air at the cemetery. Local guidelines as to number of people allowed to attend the burial must be adhered to at all times.
GENERAL
Not all COVID-19 deaths are certified as such; it is therefore advisable to use appropriate PPE and infection control measures with any suspected case. If despite all medical efforts the risk of infection cannot be mitigated, then alternative methods should be sought in consultation with local scholars.
For context specific advice communities are advised to contact local medical specialists and scholars
REFERENCES:
- MJC GUIDE: COVID-19 JANAA-IZ (FUNERALS) posted 18 April 2020
- British Islamic Medical Association (BIMA) Q&A on the performance of ghusl for deceased persons with suspected or confirmed COVID-19 updated 18 April 2020
- COVID-19 and Islamic burial laws: safeguarding dignity of the dead April 30, 2020, Analysis / COVID-19 and conflict / Islamic Law
Ahmed Al-Dawoody & Oran Finegan - Saaberie Chishty Society.
- IMWS Coronavirus Pandemic Management of the Deceased – www.imws.org.uk
- National department of Health South Africa
- National Institute for Communicable Diseases www.nicd.ac.za
AUTHORS:
- Dr A.K. Peer
- Dr Yakub Moosa Essack
- Dr Aboo Sayed
- Dr Khatija Ahmed
- Dr Suliman Ebrahim
- Dr Moosa Paruk