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The shock of Hart Island, New York
Sally Raudon

When drone footage emerged of New York City’s COVID-19 casualties being buried by inmates in trenches on Hart Island, the images became a key symbol for the pandemic: the suddenly soaring death toll, authorities’ struggle to deal with overwhelming mortality and widespread fear of anonymous, isolated death. The images shocked New Yorkers, most of whom were unaware of Hart Island, though its cemetery operations are largely unchanged since it opened over 150 years ago, and about one million New Yorkers are buried there. How does Hart Island slip in and out of public knowledge for New Yorkers in a cycle of remembering and forgetting – and why is its rediscovery shocking? Perhaps the pandemic, understood as a spectacular event, reveals what has been there, though unrecognised, all along.

Human Remains and Violence: An Interdisciplinary Journal
‘Evil deaths’ and the difficulty of mourning in Brazil in the time of COVID-19
Carmen Rial

Based on the anthropological classification of death into ‘good deaths’, ‘beautiful deaths’ and ‘evil deaths’, and using the methodology of screen ethnography, this article focuses on mourning in Brazil during the COVID-19 pandemic, especially the extreme cases of deaths in Manaus and among the Yanomami people. The article ‘follows the virus’, from its first role in a death in the country, that of a domestic worker, to hurriedly dug mass graveyards. I consider how the treatment of bodies in the epidemiological context sheds light on the meanings of separation by death when mourning rituals are not performed according to prevailing cultural imperatives. Parallels are drawn with other moments of sudden deaths and the absence of bodies, as during the South American dictatorships, when many victims were declared ‘missing’. To conclude, the article focuses on new funerary rituals, such as Zoom funerals and online support groups, created to overcome the impossibility of mourning as had been practised in the pre-pandemic world.

Human Remains and Violence: An Interdisciplinary Journal
Governing COVID dead in southern Arizona
Robin C. Reineke

Research into the governance of dead bodies, primarily focused on post-conflict contexts, has often focused on the aspects of the management of dead bodies that involve routinisation, bureaucratisation and order. Less attention has been paid to the governance of the dead in times of relative peace and, in particular, to the aspects of such work that are less bureaucratised and controlled. This article explores the governance of dead bodies in pandemic times – times which although extraordinary, put stress on ordinary systems in ways that are revealing of power and politics. Observations for this article come from over fifteen years of ethnographic research at a medical examiner’s office in Arizona, along with ten focused interviews in 2020 with medico-legal authorities and funeral directors specifically about the COVID-19 pandemic. The author argues that the pandemic revealed the ways in which the deathcare industry in the United States is an unregulated, decentralised and ambiguous space.

Human Remains and Violence: An Interdisciplinary Journal
Political lives of the surplus dead
Nicole Iturriaga and Derek S. Denman

This article sets forth a theoretical framework that first argues that necropolitical power and sovereignty should be understood as existing on a spectrum that ultimately produces the phenomenon of surplus death – such as pandemic deaths or those disappeared by the state. We then expound this framework by juxtaposing the necropolitical negligence of the COVID-19 pandemic with the violence of forced disappearances to argue that the surplus dead have the unique capacity to create political change and reckonings, due to their embodied power and agency. Victims of political killings and disappearance may not seem to have much in common with victims of disease, yet focusing on the mistreatment of the dead in both instances reveals uncanny patterns and similarities. We demonstrate that this overlap, which aligns in key ways that are particularly open to use by social actors, provides an entry to comprehend the agency of the dead to incite political reckonings with the violence of state action and inaction.

Human Remains and Violence: An Interdisciplinary Journal
Burial and the politics of dead bodies in times of COVID-19 (part 2)
Graham Denyer Willis, Finn Stepputat, and Gaëlle Clavandier
Human Remains and Violence: An Interdisciplinary Journal
Lessons Learned from an Intervention by Médecins Sans Frontières
Maria Ximena Di Lollo, Elena Estrada Cocina, Francisco De Bartolome Gisbert, Raquel González Juarez, and Ana Garcia Mingo

When the COVID-19 pandemic struck in early 2020, it rapidly became apparent that older individuals were at greater risk of serious illness and death. The risk was even greater for residents in care homes, who live in close proximity and may be suffering other comorbidities. Such facilities also saw a high turnover of staff and visitors, meaning an increased risk of transmission. Data has suggested that care home residents may account for up to a half of all COVID-related deaths in Spain.

As morbidity and mortality for COVID-19 was increasing in March 2020, MSF offered support to Spanish care homes during the first wave of infections. Our intervention included different axes: advocacy, knowledge sharing, training and implementation of measures for a reduction in transmission and for infection prevention and control (IPC).

The situation for care home residents was dire, with many people dying alone, away from loved ones and without access to palliative care. Staff were overwhelmed and ill-equipped to deal with the scale and complexity of this tragedy.

Although technical interventions to reduce transmission were crucial, it became clear that other people-centred activities that supported residents, their families and staff, were of equal importance, including facilitating contact between families, providing emotional support and offering adequate pain management and palliative care.

Residents in care homes have the same rights as everyone else. In the event of future crises, the most vulnerable should not be neglected.

Journal of Humanitarian Affairs
A Realistic Ambition?
Pierre Mendiharat, Elba Rahmouni, and Léon Salumu

Despite a concerted international effort in recent decades that has yielded significant progress in the fight against HIV/AIDS, the disease continues to kill large numbers of people. Although there is still no definitive cure or vaccine, UNAIDS has set an ambitious goal of ending the epidemic by 2030, specifically via its 90-90-90 (‘treatment cascade’) strategy – namely that 90 per cent of those with HIV will know their status, 90 per cent of those who know their status will be on antiretroviral therapy and 90 per cent of those on antiretroviral therapy will have an undetectable viral load. These bold assumptions were put to the test in a five-year pilot project launched in June 2014 by MSF and Kenya’s Ministry of Health in Ndhiwa district, where an initial NHIPS 1 study by Epicentre (MSF’s epidemiology centre) in 2012 revealed some of the world’s highest HIV incidence and prevalence, and a poor treatment cascade. Six years later, a new Epicentre study, NHIPS 2, showed that the 90-90-90 target had been more than met. What explains this ‘success’? And given the still-high incidence, is it truly a success? MSF Deputy Director of Operations Pierre Mendiharat and physician Léon Salumu, Head of MSF France Kenya programmes, discuss the political, scientific and operational challenges of the Ndhiwa project in an interview conducted by Elba Rahmouni.

Journal of Humanitarian Affairs
Open Access (free)
The Politics of Infectious Disease
Duncan McLean and Michaël Neuman
Journal of Humanitarian Affairs
Open Access (free)
Lachlan McIver, Maria Guevara, and Gabriel Alcoba

The COVID-19 pandemic has exposed multiple fault lines in the performances of health services at every level – from community to national to global – in ensuring universal, equitable access to preventive and curative care. Tragically, this has been to the detriment of those who have suffered and died not only from COVID-19, but also from the myriad other ailments affecting people around the world. Of those, we wish to highlight here some key categories of diseases that have caused a greater burden of illness and deaths as a consequence of the policies and political decisions made in relation to the COVID-19 pandemic. In our view, these should be considered epidemics or, more accurately, syndemics – the clustering and interactions of two or more diseases or health conditions and socio-environmental factors – of neglect.

Journal of Humanitarian Affairs
Positioning, Politics and Pertinence
Natalie Roberts

This article explores the actions of Médecins Sans Frontières during the 2018–20 Ebola outbreak in Nord Kivu, in the Democratic Republic of Congo. Based on the experiences of practitioners involved in the response, including the author, and on the public positioning of MSF during the first year of the epidemic, it argues that although the actions of response actors were usually well intentioned, they could rarely be described as lifesaving, may have exacerbated disease transmission as much as limited it and had the perverse effect of fuelling corruption and violence. The article documents and analyses contradictions in MSF’s moral and technical positioning, and the complicated relationship between the organisation and the international and Congolese institutions leading the response. It argues that the medical and social failure of the response was the result of an initial belief in a strategy designed at a time when the only realistically attainable outcome was to relieve suffering, and of the later inability of the organisation to convince the authorities in charge of the response to adjust their approach. It suggests that for future success new protocols must be elaborated and agreed based on a better social and political comprehension and a better understanding of the tools now available.

Journal of Humanitarian Affairs