Why are funerals superspreading events for COVID-19 in Kurdistan?

 

In the Kurdistan Region of Iraq (KRI), funerals appear to be one of the most significant superspreading events for COVID-19. Officials from the Ministry of Health (MoH) referred to funerals as the source of clusters of cases in several locations. One funeral, for example, accounted for the largest spike in COVID-19 cases on a single day. The role of funerals in spreading the virus prompted the authorities to ban them along with other religious ceremonies and arrest those who organised them.

Exploring the anthropological role of funerals in public health has been examined concerning other emergencies such as Ebola. However, little is known about the particularities of the public health impact of this cultural practice in the Middle Eastern context of Iraqi Kurdistan. Without such knowledge, health policy measures, such as bans, are likely to be ineffective, counterproductive and could result in avoidable social distress. Deep understanding of the practice will help design culturally embedded and context-specific health policy measures in controlling the COVID-19 pandemic.

Notwithstanding minor variations, rituals pertaining to a deceased person involve several main rites, all of which impose potential risks for viral transmission. Although the body has to be buried as soon as possible, strict rituals have to be followed. An adult family member or professional ‘washers’ bath and shroud the body. Family members sit around the shrouded body to say goodbye. Large numbers then gather to say the funeral prayers typically in a mosque. After the prayer, the crowd follows the coffin which is carried first by a vehicle and then on shoulders to its burial site. Family members, relatives and friends alternate helping with burial often by using the same shovel. All of those who are involved in these proceedings at risk of contracting the virus from an infected body as well as from each other.

However, it appears that the most considerable risk of infection occurs mourning stage of funerals. After the burial, family and loved ones observe three days of mourning. At least three characteristics appear to contribute to the superspreading nature of this stage of the funeral. First, not unlike other super spreaders situations of SARS-CoV-2 places of mourning are also crowded and enclosed. In normal circumstances, funerals are often conducted in spacious mosque halls or under tents in open spaces. However, the banning of funerals has driven the practice underground. Many funerals, therefore, are currently undertaken secretly in smaller spaces aggravating their role in spreading the virus.

Second, mourners often actively touch each other creating opportunities for the virus to spread. For example, family members, relatives and friends, offer condolences by hugging, kissing and patting. In these circumstances, younger family members often kiss the hands of elders to greet and show respect which creates an ideal mechanism for viral transmission. The intimately touching mourners usually arrive from various destinations and gather in one location potentially bringing SARS-CoV-2 with them.

Finally, not unlike church choirs and music classes, mourning involves loud noise. During mourning, family members, relatives and friends usually wail, cry and loudly perform poetic laments to share their grief. Participants also remember memories about the deceased in melodised and heightened tone of voice. A mullah or sometimes a professional mourner (who goes from one funeral to another) loudly recites phrases from the Quran. Occasionally, howling ululations are performed mainly for the young or martyrs. The heavy and deep breathing associated these rituals and practices potentially involve shedding more virus particles. Furthermore, crying involves increased secretion of saliva and deeper respiratory droplets. Arguably, the combination of crying and wailing represent significant aerosol-generating behaviours.

Superspreading situations share important commonalities and policymakers can learn from practices related to funerals in other settings. However, significant particularities also exist that reflect diverging cultural, religious and social rituals. Exploring those characteristics can assist in tailoring public health measures to cultural practices such as funerals. Indeed, banning social practices would potentially make matters worse. Culturally embedded public health policy measures targeted to the more challenging aspects of social behaviours are arguably more productive to control the spread of the virus.

About the author

Goran Abdulla Sabir Zangana is a physician and an Associate Research Fellow with the The Middle East Research Institute

 Competing Interests:

I have read and understood the BMJ Group policy on declaration of interests and declare no competing interests.

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