The forgotten tragedy of unidentified dead in the Mediterranean

Why identification matters: an explorative study on six cases of family reunification

The escalating phenomenon of migration, accompanied by a disturbing surge in associated tragedies, has persistently violated internationally protected human rights. Absence of physical evidence, namely the presence of adequately identified corpses, may impede the full enjoyment of human rights and-in some cases-the course of justice as it obstructs the initiation of legal proceedings against individuals implicated in causing such catastrophes. It also presents administrative obstacles, as death certificates are indispensable in legitimizing statuses like orphanhood and widowhood. Family reunification, particularly for orphans, plays a significant role for those attempting to reconnect with their relatives all over the world. Likewise, for mothers, the acknowledgment of their marital status or widowhood can be a pathway to regain their marginalized right to social life. To elucidate this issue, we analyzed six representative cases from the tragic October 3, 2013, shipwreck near the Italian island of Lampedusa, where 366 individuals were retrieved dead from the sea. These cases underscore the practical challenges involved, highlighting the compelling need for continued efforts to ensure that this burdensome problem transcends from being a mere ethical, moral, and legal discourse. Although considerable progresses, these cases also reveal that substantial work still lies ahead. There is a pressing need for improved mechanisms to certify kinship ties, which are often the limiting factor in many reunifications, and can hinder the granting of custody to children. The severity and far-reaching implications of this problem necessitate thoughtful attention and action, especially considering the ongoing escalation in migration and related fatalities.

Drilling down into ethics: A thematic review of ethical considerations for the creation and use of 3D printed human remains in crime reconstruction

The existing literature contains some exploration of the ethics concerning human remains in forensic and virtual anthropology. However, previous work has stopped short of interrogating the underlying ethical concepts. The question of how people understand and apply these concepts in practice, and what it means to act ethically, remain underexplored. This thematic review explores the ethical considerations that contribute to the creation and use of 3D printed human remains for forensic purposes. The three main branches of ethical theory are outlined to explore how they may apply to forensic practice. Key themes relating to 3D printing human remains in forensic contexts were explored to better understand the ethics landscape, ethical challenges, and the current guidelines in place. Through this thematic review, nine ethics principles were identified as key principles for guiding best practice: anonymity, autonomy, beneficence, consent, context, justice, non-maleficence, proportionality, and transparency. It is suggested that these principles could be incorporated into adaptable guidelines going forward to support ethical practice. The findings also suggest that holistic ethics cognition training may have value in supporting forensic scientists in ethical decision-making, together with procedural and structural design that may promote best practice and reduce cognitive load.

Understanding the burden of unidentified bodies: a systematic review

While human identification is a crucial aspect of medico-legal investigations, many individuals remain unidentified each year across the world. The burden of unidentified bodies is often referred to when motivating for improved methods of identification, and anatomical teaching, yet the actual burden is somewhat unclear. A systematic literature review was undertaken to identify articles that empirically investigate the number of unidentified bodies experienced. Despite the large number of articles returned, an alarmingly low number (24 articles) provided specific and empirical details on the number of unidentified bodies, demographics and trends thereof. It is possible that this lack of data is due to the variable definition of 'unidentified' bodies and the use of alternative terminology such as 'homelessness' or 'unclaimed' bodies. Nevertheless, the 24 articles provided data for 15 forensic facilities across ten countries of both developed and developing statuses. On average, developing countries experienced more than double (9.56%) the number of unidentified bodies when compared to developed nations (4.40%). While facilities were mandated under different legislations and infrastructures available varied greatly, the most common issue faced is the lack of standardised procedures for forensic human identification. Further to this, the need for investigative databases was highlighted. Through addressing the standardisation of identification procedures and terminology, alongside the appropriate utilisation of existing infrastructure and database creation, the number of unidentified bodies could be significantly reduced globally.

The rights of migrants to the identification of their dead: an attempt at an identification strategy from Italy

Europe is turning a blind eye on a humanitarian disaster unfolding at its doorsteps, with thousands of migrants dying unidentified in Mediterranean waters. Since 2014, Italy has been struggling in an almost indifferent international scenario to identify its dead migrants. Despite the lack of sufficient resources, of the difficulties in collecting post mortem data from the disseminated bodies, and of the problems of contacting and collecting ante mortem information from relatives, it has been proven, with a series of pilot studies, that not only can these bodies be identified but that relatives are also looking for their loved ones and need death certificates. This article focuses on the administrative limbo and lack of regulations obliging single states to engage in appropriate procedures to maximise identification.

Utility of micro-CT for dating post-cranial fractures of known post-traumatic ages through 3D measurements of the trabecular inner morphology

Fracture dating is an issue at the forefront of forensic sciences. While dating fracture is crucial to understanding and verifying the chronology of events in cases of abuse and violent death, its application is the subject of considerable discussion in the scientific community, filled with limitations and difficulties. Current methods for fracture dating are mainly based on a qualitative assessment through macroscopy, microscopy, and imaging and subject to variations depending on the experience of the observer. In this paper, we investigated the potential of quantifiable micro-CT analysis for fracture dating. Five histomorphometric parameters commonly used for the study of the 3D bone trabecular microarchitecture with micro-CT were calculated based on nine fractures of known post-traumatic ages, including the degree of anisotropy, connectivity density, bone volume fraction, trabecular thickness, and trabecular separation. As a result, trends in the evolution of the microarchitecture of the bone relative to age of the callus could be identified, in particular concerning anisotropy, trabecular separation and connectivity density, consistent with the healing bone process. The findings obtained in this pilot study encourage further research in quantifiable parameters of the bone microarchitecture as they could represent useful features for the construction of objective models for fracture dating.

Rediscovering the value of images in supporting personal identification of missing migrants

The crisis concerning the identification of dead migrants is forcing forensic scientists to deal with the unavailability of classical antemortem (AM) data such as radiological information and DNA. However many times there is abundant AM photographic data of which the availability and quality is underestimated. Independently of when facial image comparison can be used as a valid identification method, description of the unexpected quality and quantity of images in the scenario of unidentified migrant decedents is given in this observational study. It focuses on the overall characteristics of the AM images available for a group of 74 missing migrants related to the disaster of October 3rd, 2013. 394 images were collected: an average of 6 for each missing person. 18% are original pictures, 47.5% scans of original images, 9.9% scans of printed images while 9.4% downloaded from social networks such as Facebook. 42.7% of images resulted in focus. Among all the images, about the 10% has been used in the personal identification process to ascertain the identity of 22 persons, because of the visibility of identifying details (facial, dental and body features). The importance of such a finding should not be diminished by its simplicity. Today, those involved in collecting AM information from relatives of dead migrants are underestimating the possible presence of images, even in sub-Saharan populations, where, contrary to belief and data, technology, though simple, is available and images may turn out to be abundant and useful (and at times the only resort) for identification.

A first for forensic genetics in Africa: successful identification of skeletal remains from the marine environment using massively parallel sequencing

In unrelated circumstances, two young adult males allegedly went missing off the coast of Cape Town, South Africa, within two months of each other. Weeks after the second disappearance, a decomposed human lower limb was recovered from a beach in Cape Town, followed by a washed-up decomposed hand three days later. An item of female clothing was found with the remains, and preliminary analysis of the skeleton indicated a female, leading to confusion regarding the possible identity of the decedent. Consequently, DNA analyses were requested to determine the biological sex of the remains, and whether the two sets of remains originated from the same individual. Various samples were collected, including bone, nails and swabs of soft tissue. DNA quantity and quality varied between sample types, with better results obtained from metacarpal bone and swab lysates. DNA profiling revealed a male sex, which suggests cognitive bias may have played a role in initial sex estimations. In addition, massively parallel sequencing confidently matched the two sets of remains (random match probability: 1 in 2.70 x 10³¹). These results were a first for Africa where massively parallel sequencing was successfully used and assisted in the identification of human remains, thus, affording closure to the next-of-kin. Moreover, this constitutes the first global report where soft tissue lysates from a marine decomposition case yielded full DNA profiles with a massively parallel sequencing approach.

Analysis of Prehospital Care of Migrants Who Arrive Intermittently at the Coasts of Southern Spain

Background: The aim of this study is to identify the sociodemographic characteristics and the most frequent diseases and nursing interventions carried out on migrants arriving by sea at southern Spain. Method: Cross-sectional, descriptive, and retrospective study based on the database of the Spanish Red Cross Intervention Activation System. All migrants who arrived on the coasts of a southern province during 2016 and were assisted by the Red Cross were included. Results: A total of 2027 people were registered, mostly males, aged between 18 and 40 years. Of these, 4.9% required healthcare, and 2.9% were referred to hospital. Highlighted diagnoses were headaches (15.6%), pregnancy (12.8%), and lower-limb wounds (6.4%), and outstanding nursing interventions were “care of wounds” (24.7%), “pain management” (21.9%), and “prenatal care” (15.2%). Statistically significant relationships were found between the diagnosed diseases and gender, geographic area of origin, and seasonal time of the year, as well as between nursing interventions performed and those three variables. Conclusions: Although in general, a good health condition was observed in most of the migrants treated, the most frequent health situations attended were related to dermatological, gynecological, and headache problems. The most performed nursing interventions were related to skin/wound care and promotion of physical comfort, requiring a low need for hospital transfers. Female gender, origin from sub-Saharan Africa and arrival in the summer period carry a greater risk of suffering health problems when migrants reach Spanish coasts.

Greek land borders and migration fatalities - Humanitarian disaster described from the standpoint of Evros

The area of the regional unit of Evros in northern Greece is considered the main gateway to the East and marks the end of the European territory and the beginning of the Asian continent. The natural boundary of the Evros River has been the last major obstacle to overcome before entering the Schengen area for hundreds of thousands of migrants on the eastern Mediterranean route. The river stands, however, for the main place of death for thousands of people who try to enter the country, and therefore the European Union, illegally. The international social, political and economic conditions that prevail at times often determine the flows of migration on the eastern Mediterranean route and eastern land border of Greece into the European Union. On the Greek side of the Greek-Turkish border, for the last nineteen years, 398 cadavers of deceased migrants have been recovered. The majority of the illegal immigrants, or asylum seekers, who pass away in the Evros region are found after several days, weeks or even months. The diagnoses of the causes of death and the determination of the time of death are questions the coroner seeks to answer. Consequently, as the majority of the deceased are in an advanced state of putrefaction, the identification and attribution of the corpses to their relatives become matters of crucial importance and a high degree of difficulty. Until today, drowning in the Evros River remains the leading cause of death among border-related death incidents. The present article aims to depict the humanitarian disaster as it unfolds in the regional unit of Evros in northern Greece and the easternmost land border of the European Union along the Mediterranean route as well as the contribution of forensic science to the possible extent.

A retrospective statistical review of deaths owing to migration through the southeasternmost land borders of the European Union, Greece 2000-14

The land borders of Evros, Greece, have been a common entry point for undocumented migrants on their way to Europe through Turkey. Adverse conditions, however, have resulted in many human casualties over the years. On the Greek side, 334 cadavers were retrieved between 2000 and 2014. This study provides a detailed forensic account of the humanitarian disaster in Evros to create an official scientific record of the situation. It showcases the gravity of the global issue of migration relating to health and mortality, and encourages communication and continual improvement of the approach and patterns of practices surrounding the subject. A retrospective statistical research review was conducted of border-related fatalities between 2000 and 2014, assessing the age and gender of victims, the cause of death, the location of bodies, identification rates, and country of origin. Age ranged generally from 24 to 29 years, but infants and children were among the deceased.

The Utility of Skeletal and Surgical Features for the Personal Identification Process: A Pilot Study

This pilot study provides a conceptual framework for the application of the anthropological analysis of skeletal features and surgical interventions for the purpose of identification in cases of unknown deceased individuals with unavailable fingerprint, genetic or odontological antemortem data. The study sample includes 276 individuals with known demographic and clinical information from the Italian CAL Milano Cemetery Skeletal Collection. In the sample, 124 (45%) individuals showed one or more skeletal features that may be potentially individualizing. Of these, 79% showed two and more features, which occurred in a multitude of different combinations. Skeletal findings may provide useful postmortem information that can be compared with antemortem witness statements and clinical imaging. However, more research into the utility of dry bone findings and the availability of comparative material, including imaging, and epidemiological data needs to be undertaken before skeletal features can be implemented into identification protocols and databases.

Virtopsy and Living Individuals Evaluation Using Computed Tomography in Forensic Diagnostic Imaging

The applications of forensic radiology involve both Virtopsy both studies on living people - to demonstrate bone age, search for foreign bodies, such as voluntary injection of drug ovules or surgical sponges accidentally forgotten, to assess gunshot wounds, to evaluate injuries by road accidents, and cases of violence or abuse (both in adults and in children). Computed tomography is the most used imaging tool used in forensic pathology and its indications are mainly focused on cases of unnatural deaths or when a crime is suspected. It is preferred over the standard autopsy in selected cases, such as in putrefied, carbonized or badly damaged bodies; or as a preliminary evaluation in mass disasters.

Challenges in the identification of dead migrants in the Mediterranean: The case study of the Lampedusa shipwreck of October 3rd 2013

Every year thousands of migrants die during the endeavour to reach the Italian coasts, making the Mediterranean the theatre of one of the greatest tragedies of mankind. Over 60% of these victims is buried unidentified: one of the reasons behind this is related to the specific difficulties and lack of strategies concerning AM and PM data collection. The present article describes how Italy is trying to face the problem of migrant identification, thanks to the collaboration between government, the Italian national police and universities. In particular, this is the first pilot study carried out to identify the victims of the second greatest tragedy of its kind off the Italian coast, near Lampedusa, on October 3rd 2013, which caused 366 victims. The present article shows the strategies conceived to collect postmortem and especially antemortem data and to compare them to identify matches, using medicolegal, anthropological, odontological and genetic approaches. Thirty-one victims out of 53 missing sought by relatives were identified (58.5%). The type and the quality of antemortem data available, generally photos and videos, pinpoints the importance of the face and the body for identification when the bodies are well preserved and how DNA analyses may at times present difficulties. In fact, critical points emerged concerning especially the lack of genetic information of the populations to which the victims belonged, the number of genetic markers needed to reach a statistical support for the identification and the need to adopt lineage markers such as mitochondrial DNA and Y-chromosome polymorphisms to identify parental relationships. This pilot study however has proven that families continue to seek their relatives and that it is possible, as well as mandatory, to identify migrant victims in spite of the difficulties in the collection of antemortem and postmortem data. In addition, considering the peculiar scenario, novel strategies for positive identification have to be defined in each field (anthropological, odontological and genetic) as well as in combination.

The fate of human remains in a maritime context and feasibility for forensic humanitarian action to assist in their recovery and identification

The number of annual maritime fatalities reported in the Mediterranean has more than doubled in the last two years, a phenomenon closely linked to the increase of migrants attempting to reach Europe via the Mediterranean. The majority of victims reportedly never gets recovered, which in part relates to the fact that the mechanisms and interaction of factors affecting marine taphonomy are still largely not understood. These factors include intrinsic factors such as whether the individual was alive or dead at the time of submergence, the individual's stature and clothing, as well as extrinsic factors such including ambient temperature, currents, water depth, salinity and oxygen levels. This paper provides a compilation of the current literature on factors influencing marine taphonomy, recovery and identification procedures for submerged remains, and discusses the implications for the retrieval and identification of maritime mass fatalities as part of the humanitarian response, specifically humanitarian forensic action, to the consequences of the current migration phenomenon.