/ 14 April 2020

The Covid-19 burial problem for South Africa

A Family Prepares A Gravestone For An Unveiling.
A family prepares a gravestone for an unveiling.

Recent drone footage of caskets being lowered into Hart Island’s trench-like graves is a grim reminder of the potential toll of the coronavirus.

As New York’s potter’s field, Hart Island has been a burial site for the densely populated city’s unclaimed dead for more than a century. The coronavirus outbreak in the city, which by Tuesday had claimed the lives of 7 349 New Yorkers, has led to a surge of burials on the island.

But New York is not the only city that will have to plan for what to do with the dead.

For years South African municipalities have warned that they are running out of burial land. The Covid-19 outbreak in the country will put pressure on the authorities to respond to this need. 

On Monday, Professor Salim Abdool Karim — who is advising the government’s response to Covid-19 — revealed South Africa’s eight-stage strategy for dealing with the disease and its aftermath. At the time of Karim’s presentation, the coronavirus death toll in South Africa was 27.

Stage seven of the plan deals with “the challenges of bereavement”, he said, which includes expanding burial capacity, instituting regulations for funerals and tackling the psychological impact of the outbreak.

“It is hard to say this. I know you don’t want to hear this. But we have to be ready,” Karim said. “We have to prepare now so that we can deal with the mental health consequences [and] the social consequences that are going to see us go through a difficult period.”

Burial and cremation guidelines

On the day before the March 27 lockdown began, the South African Cemeteries Association (Saca) released guidelines for “the preparation of mass burials and cremation of Covid-19 victims”.

“In anticipation of the increase in the death rate, municipalities are recommended to put plans in place if this has not already been done,” the statement read.

The statement recommends that municipalities identify extra land that can be used for burials in the event that deaths rise. It also suggests that municipalities procure incinerators so that more cremations can be performed.

Speaking to the Mail & Guardian, Saca chairperson Pepe Dass said he believes that the country will be able to cope with the potential death toll. “But what we were trying to put out in terms of a message as the South African Cemeteries Association is that municipalities must make the effort to be prepared.”

Dass said these preparations must be considered alongside the government’s other efforts to flatten the curve of the coronavirus outbreak.

According to the National Institute for Communicable Diseases (NICD), people who die of Covid-19 should be cremated. But if cremation is not possible, burial must follow strict procedures: the body must be placed in a leak-proof triple body bag and then buried in a nontransparent coffin.

In its statement, the cemeteries association pointed out that the low number of crematoriums in South Africa makes cremation a difficult option. Dass said the country’s crematoriums are not equipped to deal with a potential surge in deaths. “It definitely needs to step up,” he said.

Last month, when deaths in Italy passed 8 000, the Bergamo mayor Giorgio Gori told AFP that the city’s crematorium could not cope with the number of dead passing through its doors. The city, in northern Italy, was the epicentre of the coronavirus in the country, which now has the second-highest number of deaths after the United States.

Shortage of crematoriums

The three municipalities with the highest number of Covid-19 cases — the City of Johannesburg in Gauteng, the City of Cape Town in the Western Cape and the City of eThekwini in KwaZulu-Natal — have five crematoriums between them. 

In the past, cremations have been the less popular option. Data in a 2016 report by the South African Local Government Association (Salga) shows that between 2009 and 2012 burial was consistently the preferred practice across all eight metropolitan municipalities. 

The Salga report identified land scarcity as one of the main problems municipalities face in managing cemeteries.

Dass said: “Because you have a challenge, especially in large centres, like Durban, Cape Town and Johannesburg, with land — and because they are also major sites of infection — they should especially take heed and prepare.”

Major metropolitan municipalities have in recent years called for alternatives to traditional burials amid shrinking capacity at cemeteries. 

Cemeteries out of space

In 2018, then City of Johannesburg MMC for community development, Nonhlanhla Sifumba, warned that of the 32 cemeteries across the city, only four had not yet reached full capacity. 

More recently, in November last year, the City of Cape Town released a statement encouraging residents to seek alternatives to burials. The statement said that of the city’s 40 cemeteries, only 17 of them are still operational. “Of the 17 cemeteries still being used, only six have a significant amount of burial space left.”

Last month, the City of eThekwini announced that, because of shrinking burial space, it would reuse all unclaimed graves. The city has 65 cemeteries, but only nine of them still have burial space.

Dass said tackling the country’s grave shortage now “means dealing with a problem that will persist after the infection”.

“After we’ve managed to control the spread of the infection then we will still have these challenges that we face on a daily basis,” he said. 

“We will still have populations that grow … And we will also have to figure out how we deal with death. Those problems will always be there.”