SPECIAL REPORT
Contemplating the forensic medical implications of the attack
The worst terrorist attack in history has created the largest
single forensic mass disaster investigation in history. At the
World Trade Centre site, both the number and the
identities of the dead must be clarified. Numbers will be
difficult to establish due to disruption of bodies and the
effects of fire. At this stage, we have to conclude that there
will be no traces left of some bodies. Subsidiary (but
nonetheless important) issues will be whether the
investigations will be able to determine if, and how many,
people died from inhaling fire and other fumes, or if they
drowned from fractured pipes or rescue attempts, or if they
died after different periods of survival. Most, however, will
have died immediately from massive injuries.
Disaster victim identification protocols have swung into
action: relatives and friends of those missing will be
providing information about sex, age, height, weight,
specific peculiarities (eg, scars, tattoos, circumcision, eye
colour, hair features), clothing, or jewellery being worn.
Disaster victim protocols require obtaining fingerprint
records, if available, and dental records. Teeth are generally
quite resistant to trauma and are particularly resistant to
fire. Through Interpol, these data will be passed on from
International gatherings of health leaders added to the casualties
Speaking with rare unity, the international community
joined together to condemn the Sept 11 terrorist attacks
on the USA, and to mourn the victims. And as the initial
shock subsided, there was a growing realisation that things
will never be the same again. The work of the United
Nations and its specialised agencies like WHO—although
more necessary than ever before—will become more
difficult.
In short, the days of huge gatherings of world leaders—
already under a cloud because of anti-globalisation
protestors—would seem to be numbered. The UN is
considering whether to postpone its General Assembly,
scheduled to open on Sept 24, or downgrade it from
presidential and prime minister level. The World Bank
and International Monetary Fund have put off their
annual meetings in Washington at the end of the month.
The most immediate casualty was the General
Assembly’s children’s summit, which had been scheduled
for Sept 19–21, with 75 world leaders, thousands of
delegates, and hundreds of children. Carol Bellamy,
director of UNICEF and a former New York City
councilwoman accepted the postponement, saying New
York “needs to focus its energies on more urgent matters
right now”. The conference had hoped to assess the
successes and failures since the first children’s summit in
1990, and adopt a new plan to tackle tragedies such as
AIDS orphans, child soldiers, and trafficking in children.
A progress review commissioned by the UN Secretary-
General, Kofi Annan, found that 60 countries had
reached the goal of reducing child mortality by one third.
But there was no real progress toward a target of halving
maternal mortality. Some 500 000 women die each year
in pregnancy or childbirth. Malnutrition now afflicts 150
million children aged younger than 5 years, a figure about
15% lower than previously, but still far from the goal of
50% set in 1990.
Annan’s report and health studies commissioned by
UNICEF and other children’s agencies are now all
gathering dust. Diplomats say it is hoped the conference
will be rescheduled for 2002, but that is far from certain.
Another UN summit—on global food supplies—is still
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For personal use. Only reproduce with permission from The Lancet Publishing Group.
overseas. On Sept 14, Interpol launched an “11 September
Task Force”, to coordinate international intelligence.
Disaster observations are made in a standard
internationally approved format. Limbs and fragments of
remains that cannot definitely be related to other sets of
incomplete remains must be kept separate. It is in these
circumstances that later DNA analysis may facilitate the
collection together of an individual’s remains and, if
necessary, link them to DNA (or RNA) samples from the
deceased, or from samples provided by blood relatives (eg,
hair from combs).
The exercise of identifying individuals has important
social and legal implications that particularly allow the next-
of-kin to know for certain the fate of their loved ones. The
formal mourning of their passing is obviously an important
part of dealing with those catastrophic events. But the
Americans have a good record in handling disaster victim
identification. Next-of-kin should be reassured that it is
difficult to think of any organisations who would be able to
handle this situation better.
Stephen M Cordner
meant to go ahead in Italy in November, despite the
Italian government’s attempts to have it moved elsewhere
because of fears of recurrences of the violence that scarred
July’s G-8 meeting in Genoa. A UN-wide ban on all non-
essential travel was imposed in the wake of the attacks,
forcing WHO officials to scrap plans to attend a meeting
hosted by the Iranian government dealing with liability
and compensation in the planned framework convention
on tobacco control.
But it is not just the high-profile summits that will
be paying the price of terrorism. The work of all
international agencies is expected to suffer because of
concerns about security and related travel problems. The
World Medical Association (WMA) has decided to
postpone its annual assembly,which was due to take place
on Oct 3–7 in Delhi, indefinitely, because North
American, Japanese, and Korean delegations were advised
by ministries that it would be too dangerous to travel in
large numbers. “It’s become increasingly evident that
there might be a war in that region”, WMA Secretary-
General Delon Human told The Lancet. He added that
some members had wanted to go ahead as a display of
defiance against the terrorists. “Most people see terrorist
acts in a political light. We see it almost exclusively in
terms of the damage to health and human rights of
individual patients”, Human said.
Officials say it is too early to predict the impact on
funding levels for UN programmes. WHO is thankful that
funding—from the US Centers for Disease Control and
Prevention, Rockefeller Foundation, Belgium, and
Finland—for one of its next major initiatives is secure: a
report on violence and health scheduled for release in the
middle of next year. The report is due to examine issues
including child abuse and neglect, youth violence, sexual
violence, suicide, and collective violence. It reflects the
concern of the medical profession about the impact on
global health. Project coordinator Etienne Krug said there
were no plans at present to add a new chapter on
terrorism.
Clare Kapp
THE LANCET • Vol 358 • September 22, 2001