The coronavirus pandemic has put into sharp focus the need for more stringent burial and cultural rites if a Muslim person dies of COVID-9. Ulema bodies across the country have deliberated extensively on this issue over the past few weeks as South Africa deals with the harsh reality of the disease. Since its first detection in South Africa in early March, the number of COVID-19 cases has been steadily climbing – with five deaths and total infections standing at 1 353.

The challenge for Islamic scholars during this crisis has been to ensure that Muslim deceased are buried in accordance with the Quran and Prophetic tradition while maintaining the health guidelines by the National Institute for Communicable Diseases (NICD) and the National Health Department. Burying the dead in a way that is safe and dignified is of utmost importance in Islam.

However, the handling of a COVID-19 body poses serious health and safety risks to undertakers, burial registrars and those who ghusl the deceased. For this reason, those at the frontlines of the burial process must be properly equipped and trained.

Speaking to VOC, Ebrahim Solomon, the chairperson of the Western Cape Muslim Undertakers Forum said he has been flooded with calls from members of the community asking if Muslim undertakers are ready to deal with the burials of coronavirus patients. He said members of the forum had previously undergone training during the Ebola crisis, which has assisted them in preparing and understanding the health and safety risks of COVID-19.

However, broader education within the Muslim community is equally important.

“I went to Groote Schuur hospital two weeks ago and as you enter, there were hospital staff to sanitise your hands. The two Muslim women behind me said ‘No, Allah protects us”. This shows that people need to be educated on this virus,” said Solomon.

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At the time of death
After the person has taken his or her last breath, the body must be classified by a medical practitioner as a category risk. The medical practitioner must wear protective clothing: gloves, plastic aprons, an N95 mask, tight-fitting goggles or a face shield. All tubes, drains, catheters attached to the deceased body must be removed and disposed of as medical waste. Contact with members of the family should be kept to a minimum and the bereaved family should wear personal protective clothing (PPE).

Handling the deceased

The body must be placed into a robust and leak-proof transparent plastic bag which should be zipped closed. The deceased body should be placed in a secondary layer of covering, either wrapped with a mortuary plastic sheet or placed in an opaque body bag. The outside of the body bag should be wiped with a 0.5% sodium hypochlorite solution and should be left to air dry.

“Just lifting the body from a bed to a stretcher can cause air to come out of the body because the coronavirus is a respiratory virus. This poses a huge risk. We need to be cognizant of this, not for our own safety but for the safety of others,” said Solomon.

Mortuary
All deceased bodies must be identified and must be correctly labelled with identity labels and category tags. All trolleys and equipment used to transport the bodies must be disinfected using 0.5% sodium hypochlorite solution after use. Special precautions for autopsies must be observed.

Funeral workers

While the coronavirus has not been confirmed to spread through blood, funeral workers should, however, be cautious and avoid direct contact with blood and body fluids from the deceased body.

Move the body as it was prepared by the mortuary staff. Observe strict personal hygiene and wear appropriate PPE clothing. All guidance and precautions should be adhered to if the body needs to be stored for some reason or the other and may only be stored at designated facilities.

Once the body is transported, wipe down all stretchers, bier (Kaatil) and the inside section of the hearse with a 0.5% sodium hypochlorite solution and it should all be left to air dry.

After handling the deceased body, remove PPE gear and dispose as medical waste and immediately wash hands with soap and water for at least 20 seconds. Funeral workers should not smoke, drink or eat while busy with the deceased body. More importantly, do not touch your eyes, mouth or nose while busy with the deceased body.

The ghusl or washing of the body
The guidelines for Ghasiel/Ghasiellah (Toekamanie) is particularly important as many community members perform this role in times of urgency. The person washing the body of the deceased must avoid direct contact with blood and body fluids of the deceases body. They must wear appropriate PPE gear and observe strict personal hygiene as always but more important with infectious bodies.

“I recently got calls from some undertakers asking where they can purchase the gloves and masks and this upset me. Even before COVID-19, we were told that the Ghasiel/Ghasiellah must wear gloves, masks and PPE. This has been a standard all along from a health perspective,” said Solomon.

The ghasiel/ghasiellah must ensure all open wounds are covered with waterproof bandages or dressings. They should remove the body from the plastic body bag and dispose of it as health care risk waste. All clothes, cotton wool or swabs used to wash the body must be disposed of as health care risk waste. During this process, use lots of camphor in the water when performing the Ghusl.

The facility where the body is washed must be certified by all health standards and the body must not be washed at any other premises. These facilities and any organization involved in the burial process must have a contract with an approved health care risk waste removal company.
Lay the body out and wash as usual (Ghusl).

Given that the COVID-19 patients must be washed at a special facility, Solomon said this rule may soon apply to all deceased.

Shrouding or Kafan

During the shrouding, the ghasiel/ghasiellah must place the body in a strong and leak-proof plastic bag which should be zipped closed. Wipe the outside of the plastic body bag with a 0.5% sodium hypochlorite solution twice while wearing PPE and allow to air dry.
Shroud the deceased body as normal, over the body bag. After shrouding/ kaffaning the deceased body, place it into the Bier/Kaatil and close the lid.
Wipe the outside of the Bier/Kaatil with a 0.5% household bleach solution while wearing PPE.

Paying the last respects

The viewing of the body is naturally an emotional experience for the loved ones of the deceased, but due to the fear of the virus spreading, this must be in a controlled setting. If family members wish to view the body, arrangements can be made but family members must use gloves and masks and not make contact with the body. Family members cannot touch, kiss or hug the deceased. The PPE used by the family must be disposed of as medical waste after each use.

Viewing should preferably take place where the washing/Ghusl took place, the body should be laid in the Bier/ Kaatil, the shroud could be opened around the face as normal, and viewing is only permitted through the transparent bag.

Once the family have paid their respects, re-shroud the face and replace the lids of the Bier/Kaatil. The Bier/Kaatil must be wiped down with a 0.5% sodium hypochlorite solution before moving fo prayer/Janaazah Salaah.

Salahtul Janaza / prayer

Prayer or the Janaazah Salaah can take place as normal but it is advisable to have the prayer at the cemetery/Maqbarah so that the body can be laid to rest as soon as possible. Those attending the Janaazah should stand at least 1 m apart from each other and not shake hands or hug each other.
Those handling the Bier/Kaatil must wear appropriate PPE and must not come into contact with others while wearing PPE.

Burial
Since the first coronavirus infection was announced in South Africa, there has been a huge debate amongst the ulema, Muslim undertakers, government health officials and medical experts on how a Muslim deceased should be buried. There was a strong view from health officials that the deceased should be placed in a triple body bag, placed in a sealed coffin and should be cremated. The health department mulled on the issue and later decided the body can be washed as the virus is respiratory and the water cannot be contaminated. This is on condition that the Ghasiel or Ghasiela is dressed in full protective gear. Following consultation between the MJC, the forum and health officials, it was agreed that the bodies could be buried.

Solomon said it cannot be overstated enough that those handling the Bier/Kaatil must wear appropriate PPE gear and must be kept a minimal number. Burial workers who will get into the hole must wear appropriate PPE as well. The burial can take place as normal. Any equipment used in the burial must be disinfected after use by persons using PPE.

NEXT: Janazah proceedings during the national lockdown