Abstract
Objectives
Homeless and unclaimed dead bodies are a social as well as legal stigma on a country's development index. In addition, homeless people are exposed to increased incidence of diseases, accidents and mortality. Lucknow city, a city situated in the heart of the great Gangetic plain in the northern region of India, is surrounded by rural towns and villages and has seen tremendous growth in the past few years; with this the problem of migrants and homelessness has also increased. This has resulted in a spectrum of problems relating to law and order, including frequent incidences of unclaimed dead bodies, both due to natural and unnatural causes. Few studies on this subject have been published in India.
Study design
Observational retrospective study.
Methods
Data was collected from the files of the Department of Forensic Medicine & Toxicology between 2008 and 2012.
Results
A total of 20877 autopsy cases were registered, out of which 3169 (15.17%) were unclaimed bodies. The majority of cases belonged to males (2218, 69.99%) as compared to females (951, 30.01%). Most unclaimed bodies were in the age group of 41–60 years (47.24%) and the least affected age group was 1–20 years (265, 8.36%). The most common manner of death was accident (1098, 34.64%), followed by suicide (1062, 33.51%), natural (927, 29.25%) and homicides (82, 2.59%). The most common cause of natural death in both males and females was chronic lung disease. Railway and road traffic accidents accounted for 516 (68.25%) accidental deaths in males, whereas in females they accounted for 301(88.01%). The most common mode of suicide among males was by poisoning (391, 48.81%), while poisoning (149, 57.08), hanging (78, 29.88%) and drowning (23, 8.81%) were the main modes of suicide in females reported in our study. Majority of the cases of deaths were reported during rainy season (2209, 69.70%).
Conclusions
This autopsy-based study tries to highlight the picture of homeless deaths in Lucknow and the problems faced by the law enforcing authorities. More research is needed to identify the health-related problems of such people and possible contributory factors to mortality.
Introduction
“Homeless and Unclaimed dead bodies” refers to people who have died without identification and whose remains have not been collected by relatives or others prepared to provide for burial or other final disposition. 1 Studies on death of homeless or unclaimed bodies are scarce in India. Lucknow, the political and administrative capital of Uttar Pradesh, is a bustling city situated in the heart of the great Gangetic plain in the northern region of India. As reported in the Census of India 2011, 2 Lucknow had a population of 4,588,455 of which males and females were 2,407,897 and 2,180,558, respectively. There was a change of 25.79 percent in the population compared to 2001. It is the largest city of Uttar Pradesh and second largest metro of north and central India after Delhi. As the city is growing at a fast rate with high-rise apartments coming up at every nook and corner, this invites problems in the form of migration of construction workers and homeless from surrounding less-developed districts making it their abode. DUDA, OXFAM and RSAC have conducted studies to estimate the total vulnerable population and location of slums in Lucknow city. DUDA (530), OXFAM (787) and RSAC (714) claim recognized urban slums in Lucknow city. 3 “Unclaimed body” refers to a person who dies in a hospital, prison or public place, which has not been claimed by any near relatives or personal friends within such time period as may be prescribed. 4 The body is preserved in the mortuary for 72 hours from the time the telegram message is sent. If no one claims the body after 72 hours the police are legally authorised to dispose of the body. However, if the police think that the body may be identified by relatives, it should be preserved until a relative comes to claim the body. The cost of disposing of the body in unidentified cases is born by the police department. This is applicable in medico-legal cases where the person died either inside or outside of the hospital. 5 These unclaimed bodies may pose a challenge to the autopsy surgeon and also to the law enforcing authorities, as in most of these cases the victim will be found dead which may arouse suspicion of foul play. In addition, DNA profiling of unclaimed or unidentified bodies is not a routine or recommended protocol in India due to lack of funds and infrastructure. In addition the problems associated with homeless and unclaimed dead bodies can be (1) identification, (2) cause and manner of death, (3) poor access to health care and health awareness, (4) substance abuse, (5) alcoholism, (6) physical abuse of the children, etc. In this scenario the autopsy surgeon and the law enforcing authorities have to rely upon age-old methods of identifying the dead bodies, but this may not be possible in a putrefied or dismembered body, resulting in negative identification. We retrospectively analyzed the autopsy records of the Department of Forensic Medicine & Toxicology during the 5-year period between Jan 2008 and Nov 2012 to contribute to the efforts targeted at lowering the death rate in Lucknow of the homeless and unidentified by documenting the current status of this group, particularly in terms of mode of death.
Method
The study was conducted in the Department of Forensic Medicine and Toxicology, King George's Medical University, UP, India. The autopsy records of all the unclaimed bodies were reviewed retrospectively over a period of 5 years from Jan 2008 to Nov 2012. Information regarding unclaimed bodies with regard to age, sex, cause of death and manner of death was sourced from the autopsy reports and the inquest papers of the Investigating officer. The age of the deceased was ascertained with the available data from the investigating officer and was corroborated with anatomical features on the dead body.
Results
Year-wise distribution of unclaimed bodies.
Age-wise distribution of unclaimed bodies.
The most common manner of death was accident (1098, 34.65%), followed by suicide (1062, 33.51%), natural (927, 29.25%) and homicide (82, 2.59%) (Table 3). The most common cause of natural death in males was chronic lung disease (360, 56.43%) followed by heart disease (98, 15.36%), septicemia (82, 12.85%), miscellaneous (57, 8.94%) and cerebrovascular accident (17, 2.66%). The cause of death in 24 (3.84%) cases was unascertained (Table 4). In females the commonest cause of natural death was chronic lung disease (749, 78.71%) followed by gastroenteritis (105, 11.07%) and heart disease (97, 10.22%) (Table 5). Railway and road traffic accidents accounted for 516 (68.25%) of accidental deaths in males whereas in females they accounted for 301 (88.01%). Electrocution was the second most common cause of accidental death in males (97, 12.83%) (Figure 1). The commonest mode of suicide among males was by poisoning (391, 48.81%) (Table 6), while poisoning (149, 57.08), hanging (78, 29.88%) and drowning (23, 8.81%) were the main modes of suicide in females (261, 100%) reported in our study (Figure 2).
Accident death classification. Suicidal deaths classification. Manner of death in males and females. Deaths due to natural causes in males. Deaths due to natural causes in females. Suicidal causes of death in males.
Number of cases according to weather.
Discussion
Homelessness increases the risk of death from a variety of causes. Increased mortality risks associated with homelessness can partly be explained by the high prevalence of morbidity but homelessness itself confers an additional risk.1,6,7 The risks associated with homelessness vary with diagnosis. There are important differences in the implications for health and social interventions. Mortality rate is higher in young homeless when compared to elderly.8–10 The results of our study indicate a male preponderance and this is in confirmation with previous studies conducted in South Delhi, Istanbul, Fulton County and Osaka city.4,11–13 The commonest age group involved was 41–60 years followed by 21–40 and >60 years, which is similar to South Delhi, India, study, 4 but this was in contrast to the observations made in a study done in Istanbul, Turkey. 12 The predominant manner of death was accident followed by suicide and natural causes which was in contrast to studies in South Delhi and Istanbul, where deaths due to natural causes were most common followed by accident, homicide and suicide. The probable reasons could be attributed to lack of road safety measures provided by the city administration and awareness of the general public. Suicide was the second commonest manner of death which could be attributed to poverty, disease and mental distress. Natural causes were third most common cause and may be under-reported due to poor access to health care facilities in a developing country like India. The gender-wise distribution of manner of death was in accordance with the entire population. The commonest natural cause of death in males and females was chronic lung disease, followed by heart disease and septicemia. This can be attributed to poor living conditions, alcohol abuse and poor access to health care.
Conclusion
The findings of our study indicate that homelessness is an important cause of morbidity and mortality in the city of Lucknow located in North India. Males are the most affected population; the common age group affected is 40–60 years and the predominant manner of death is accident. However, more studies are recommended to find the actual prevalence of homelessness and its health-related effects on morbidity and mortality, which will help in proper distribution of health care facilities to the needy. The question of identification of homeless or unclaimed dead bodies has to be answered with greater importance as DNA profiling of unclaimed bodies is not a routine procedure in this part of the world due to financial and manpower constraints. However, more detailed and anterospectively programmed studies on this subject, a growing social problem, should be carried out. As with every retrospective study, this study has its limitations, and the authors would propose prospective studies to bring out more facts in relation to deaths in homeless. Further work is needed to determine whether interventions to address homelessness in patients with drug misuse, circulatory and respiratory disorders would be effective in reducing the excess mortality we found.
Footnotes
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Ethical approval
Ethical approval declared from the King George's Medical university ethics committee wide letter no-865/R-Cell-12. Ref. code: 55 E.C.M.II A/P20.
Declaration of conflicting interests
The authors declare that there is no conflict of interest.
Acknowledgements
The authors are grateful to Professor & Head, Dept of Forensic Medicine & Toxicology, King George's Medical University, India, for encouraging research and its publication in international journals of repute.