Five-year study of unidentified/unclaimed and unknown deaths brought for medicolegal autopsy at Premier Hospital in New Delhi,India

Abstract

Delhi is the second largest city of the world both in terms of population and area, as well as being the capital of India. Every year, thousands of people from different states throng to the capital in search of a job in order to earn a living. When these people die and their bodies are found without any identifying documentation, it is very difficult for the police to establish their identities. These bodies are labelled as unidentified/unclaimed or unknown, and are sent for usually sent for medicolegal autopsy. Invariably, skeletonised bodies are also recovered, which are also subjected to medicolegal autopsy. Female foeticide is another social problem, and whenever such foetuses are disposed of illegally, they are also grouped under this category and brought for medicolegal autopsy. We undertook a five-year retrospective analysis (for the period 2010–2014) of all such cases brought for medicolegal autopsy at our centre, which caters only for the south and south-east districts of Delhi. A total of 7964 cases were brought for medicolegal autopsy, of which unknown cases accounted for about 16%. About 25–30 foetuses and skeletonised bodies were brought each year that was studied. The manner of death was certified as natural in about 71% of cases, with predominant pathology in the lungs. There was a clear predominance of males over females, with the 31- to 50-year age group accounting for half of all cases. There was an increase in the number of deaths during months of extreme temperatures. The average time between the recovery of a body by the police and the post-mortem was about seven days. These findings raise many questions, including the failure of governmental policies, police investigating agencies and social menace. The creation of a national missing-persons database as well as a DNA databank is needed to aid in the identification of unidentified/unclaimed and unknown bodies.

Keywords

Unknown unidentified unclaimed skeletonised foeticide identification

Introduction

Delhi, the capital city of India, is the second largest city in the world both in terms of population and area. Every year, thousands of people from different states throng to the capital in search of a job in order to earn a living. Many of these people live alone in the city without any relatives or acquaintances. When these people die and their bodies are found with no identifying documentation, it is very difficult for the police to establish their identities. These bodies are labelled ‘unidentified/unknown dead bodies’ (UIDB), and usually they are sent for medicolegal autopsy. Invariably, skeletonised bodies due to decomposition are also recovered, which are also subjected to medicolegal autopsy. In the absence of proper identification and no complainant, the police are not interested in investigating these unnatural deaths further, even in cases of homicide. There is no central DNA database for such individuals. The biometric system AADHAR¹ is also not fully functional at the moment. This study intends to highlight the magnitude of the problem backed by scientific data. Simply ignoring such deaths leads to the denial of social and legal justice for these individuals.

The aims of this study are: (1) to examine the pattern of UIDB deaths and to recognise the scale of the problem of people dying unidentified; (2) to analyse social and economic causes for such a high number of these deaths; (3) to review police procedures for identification in such deaths; and (4) to suggest steps that should be taken to establish the identity of these people and to trace their relatives.

Materials and methods

The capital city of Delhi is divided into 11 districts for law and order. The study was conducted at the Department of Forensic Medicine and Toxicology, All India Institute of Medical sciences, New Delhi, where medicolegal cases from two districts in Delhi – the south and south-east – are brought for autopsy examination. This was a retrospective study for the five-year period from 1 January 2010 to 31 December 2014. All the medicolegal autopsy cases of UIDB deaths during the above-mentioned period were included in the study. Foetuses, highly decomposed bodies and skeletonised remains were also included in the study. Data were collected and recorded from the autopsy reports. The data were further analysed for cause of death, manner of death, samples preserved after autopsy for identification and the time between the recovery of body and the autopsy.

Results

A total of 7964 cases were received for medicolegal autopsy during the five-year study period 2010–2012, of which 1261 (15.8%) were UIDB (Table 1). Males were predominant in number, with a male-to-female ratio of about 8:1 (Table 2). The most commonly involved age group was 31–40 years followed by 41–50 years. The very young age group of 0–10 years was least commonly involved (Table 3). The highest number of cases was reported in the peak of the summer season, that is, June and July. Another surge was apparent at the beginning of the winter season, that is, October (Table 4). Lung disease was the leading cause of death, with traumatic death being the second highest cause (Table 5). The manner of death was predominantly natural (Table 6). The average time between the recovery of the body and post-mortem examination was about seven days (Table 7). Samples for DNA profiling were preserved in 37.6% of cases (Table 8). Distinguishing identification marks were present in 21.4% (Table 9). There were more female foetuses than there were male foetuses (Table 10).

Table 1.

Frequency of UIDB by year.

Years	Total cases	UIDB	%
2010	1354	239	17.6
2011	1508	259	17.1
2012	1703	302	17.7
2013	1713	215	12.5
2014	1686	246	14.5
	7964	1261	15.8

UIDB: unidentified/unknown dead bodies.

Table 2.

Distribution of UIDB by sex.

Year	Male	Female	Unidentifiable	Total
2010	206	33	0	239
2011	232	27	0	259
2012	267	32	3	302
2013	190	23	2	215
2014	219	25	2	246
Total	1114	140	7	1261

Table 3.

Distribution of UIDB by age (in years).

Year	Unidentifiable	Foetus	0–10	11–20	21–30	31–40	41–50	51–60	61–70	>71	Total
2010	1	17	1	6	44	55	59	36	16	4	239
2011	0	12	3	3	40	68	74	41	17	1	259
2012	1	31	3	3	43	89	72	36	21	4	302
2013	1	24	3	7	30	51	47	26	22	4	215
2014	0	25	2	2	35	68	63	30	18	3	246
Total	3	111	9	21	192	331	315	169	94	16	1261

Table 4.

Distribution of UIDB by month.

Year	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec	Total
2010	21	8	22	17	12	29	17	24	32	25	20	12	239
2011	22	17	13	18	33	16	29	17	20	31	24	19	259
2012	21	16	18	20	31	43	45	25	20	22	23	18	302
2013	16	19	11	19	19	20	24	14	17	18	22	16	215
2014	22	16	12	16	12	46	34	15	21	15	16	21	246
Total	102	76	76	90	107	154	149	95	110	111	105	86	1261

Table 5.

Cause of death.

Cause of death	Total number of cases	%
Lung disease (acute and chronic)	798	63.4
Hepatic disease	41	3.3
Coronary artery disease	23	1.8
Foetus (non-viable, stillborn, dead-born)	109	8.6
Traumatic death (blunt/sharp force, electrocution, burns, etc.)	143	11.3
Highly decomposed	64	5.1
Drowning	27	2.1
Asphyxial deaths due to ligature compression (hanging, strangulation)	24	1.9
Miscellaneous natural diseases	32	2.5
Total	1261	100

Table 6.

Manner of death.

Manner of death	Total number of cases	%
Natural	894	70.9
Homicidal	30	2.4
Accidental	84	6.7
Suicidal	12	1.0
Undetermined	132	10.4
Foetus (non-viable, stillborn, dead-born)	109	8.6
Total	1261	100

Table 7.

Average time between finding body and post-mortem.

Year	Average number of days
2010	5.7
2011	7.4
2012	7.1
2013	6.9
2014	7.1
Total	6.8

Table 8.

Number of cases in which samples were preserved for DNA.

Year	Total number of cases	Number of cases	%
2010	239	64	26.8
2011	259	68	26.2
2012	302	85	28.1
2013	215	86	39.5
2014	246	172	69.9
Total	1261	475	37.6

Table 9.

Frequency of presence of distinguishing identification marks such as a tattoo, mole, scar, amputation, or burns.

Year	Total	Number of cases	%
2010	239	53	22.1
2011	259	32	12.3
2012	302	55	18.2
2013	215	57	26.5
2014	246	69	28
Total	1261	266	21.4

Table 10.

Sex distribution for foetuses.

Year	Male	Female	Undeveloped	Total
2010	7	10	0	17
2011	2	7	3	12
2012	10	17	4	31
2013	14	8	2	24
2014	12	11	2	25
Total	45	53	11	109

Discussion

To give a fair idea about the present status of the identification of UIDB, the following procedure is adopted by the police for identification in unknown deaths. The police send a wireless message through to the control room to be passed at Deputy Commissioner of Police level to all districts of the different states. An advertisement with the photograph of the deceased is published in the city newspapers. Pamphlets are distributed in the nearby area, and displayed at the police station and local public places such as community centres. Initially, the body is preserved for 72 hours, and after completing all the necessary formalities mentioned above, a post-mortem is conducted and the body is cremated or buried. In 2004, the police in seven states of Northern India and one union territory introduced a Zonal Integrated Police Network project (ZIPNET) to share criminal information in real time. Information about UIDBs is one of its modules.²

In a study conducted in Paris, France, Cavard et al.³ reported that out of 9.1% of the total unidentified autopsy cases, only 0.8% of the total autopsies remained unidentified after investigations. Hanzlick⁴ reported this to be only 0.2% of total autopsy deaths. This is in sharp contrast with the study conducted in Calcutta, India, by Chattopadhyay et al.,⁵ where initially 24.5% of the total autopsy cases were unidentified. Of these, 4.4% cases were subsequently identified, and 20.2% of the total autopsies remained unidentified. Most of such deaths are seldom identified until post-mortem examination. This indicates the ineffectiveness of India’s current system and procedures in this regard.

Vagabonds, drug addicts, beggars and so on have already been abandoned by their families, and nobody is searching for them. Moreover, the advertisements in the newspapers contain black and white photograph and the details of the facial features are not clear (Figure 1).⁶ India is a vast country, having 29 states and seven union territories with huge geographical and language variations. The newspaper editions also vary in terms of region and language. Even national newspapers such as Times of India and Hindustan Times have different editions for separate states. The advertisements are displayed in the edition of a particular city. Furthermore, many of these individuals are of low socioeconomic status, who are not very avid readers of newspapers. This is why, despite the average time between recovery of the body and post-mortem being about seven days (Table 7), the bodies are not identified.

Figure 1.

Advertisement for a unidentified/unknown dead bodies in a national newspaper.

Any distinguishing identification marks in UIDB such as a tattoo, old scars, old amputations, deformity, moles and so on are generally noted by the autopsy surgeons. They are mentioned in the autopsy report in the column of identifying features. In relation to teeth, abnormalities, deformity or any peculiar dental work which can help in the identification of the person is also noted during the autopsy. In India, most of the population does not have previous dental records which can help in the identification of a person. In the current study, these identifying features which are unique to an individual were found in only 21% of cases (Table 9). One point regarding age should be taken into consideration: the approximation of age was done by the police using only their own perception of how old the body looked to them. No documentary proof or scientific criteria are adopted by the police when mentioning the age of such persons in their advertisement. The autopsy surgeon correlates the tentative age of the deceased as mentioned in the inquest papers from the external features of the body, and in doubtful cases, age estimation is done by radiological and dental examination.

There are two categories of UIDBs: (1) beggars, vagabonds and the destitute, who are unclaimed but well-known homeless persons, dying from natural causes, and (2) unidentified persons who die from traumatic causes such as road traffic accidents, railway accidents, homicides and so on. They may not necessarily be homeless but should be considered as ‘missing persons’. The complaint of a missing person is registered with the jurisdictional police station of residence, but due to ineffective mechanisms of identifying UIDBs, relatives do not come to know about the deaths of their loved ones. Due to the lack of a proper mechanism of identification, the jurisdictional police where the body is recovered is unable to proceed with the legal investigation, and the criminality of the case is kept hidden. This can lead to the mental agony and emotional harassment of the relatives of such missing persons who are left with the hope of finding their loved ones. One recent example that will support this observation is the much-highlighted Sheena Bora murder case in Mumbai, in which the burnt skeletonised remains of the deceased were found in a forest but due to no proper system of identification in place, the police arranged for the autopsy to be conducted, and the remains were buried. The murder was kept under wraps for a good three years.^7,8 There have been cases in which the person died in the neighbouring district, an autopsy was performed as unknown/unclaimed and the relatives came to know about the death after the body was cremated. The Indian courts have taken note of the problem and have observed that there should be a better and more streamlined system regarding the identification of such cases.⁹ There have been also incidents where family members deliberately or wrongly identified the body, and the person was later discovered alive.^10,11

There was no specific trend in frequency of cases by year (Table 1). There was an increase in the number of cases compared with a previous study.¹² Males were the predominant group (Table 2), and persons in middle age groups were most commonly involved (Table 3). These findings are consistent with previous studies.^2,4,12–17

In the five-year period that was examined, more deaths were reported during the months of June and July (Table 4). These two months are extremely hot and humid. A peak was also observed in the month of October, that is, the beginning of the winter season in Delhi. The fewest deaths were reported in the months of February and March when the city has a pleasant climate. By analysing these data, we can infer that the frequency of deaths is affected by environmental conditions, particularly by extremes of temperature.

Lung disease, both acute and chronic, including bilateral pneumonitis, pulmonary tuberculosis and so on, was the leading cause of death (Table 5). People predominantly died of natural causes (about 71% of cases; Table 6). These results are similar to the other studies conducted in Delhi, Calcutta, Tokyo and Istanbul, all being metropolitan cities with similar problems.^4,12–14,17 The number of vagabond or beggars is very high, particularly near places such as railway stations, religious establishments, bus stands and so on. These people do not have any home, live on the streets and are exposed to all adverse environmental conditions such as pollution, temperature, humidity, infections and so on. Some of these people are chronic drug abusers. All of these factors mean that they are predisposed to natural diseases, particularly pneumonia and pulmonary tuberculosis. Zlonick reported that homeless people have a higher rate of morbidity than general population does.¹⁸ The Japanese government took note of this problem in 2003 and took remedial measures, which led to a steady decrease in the number of deaths of homeless people.¹⁷ However, if we compare our findings with the study conducted in same area of Delhi for the period 2001–2005, the percentage of UIDB has increased from 10.5% to 15.8%.¹²

A total of 109 bodies were of foetuses that were non-viable, dead-born or stillborn. This indicates that these babies were illegally aborted at unauthorised centres and were disposed of illegally. The overall male-to-female ratio in the study was about 8:1, whereas for foetuses the ratio was 1:1.17 (Table 10). This clearly shows the menace of the social problem of illegal abortion and female feticide, which persists despite strict legislation such as the MTP and the PCPNDT Acts (Tables 3 and 6). None of the previous studies in India have studied or highlighted this important aspect.^4,12,14–16

In the first three years of the study (i.e. from 2010 to 2012), autopsy surgeons preserved samples for DNA identification in about 27% of cases (Table 8). In 2014, this percentage rose to 69%, which indicates the increased sensitivity of doctors towards the importance of identification of the deceased.

Recommendations

Government authorities should take a proactive approach in cities to make shelters for the homeless and vagabonds, particularly during the months of extreme temperatures.

Police should register all homeless persons such as vagabonds, beggars, the destitute and so on in their areas, taking proper means of identity such as photographs and biometric data, and issuing them with a social security number such as the AADHAR.

DNA sample of the UIDB should be mandatorily collected and processed by the police.

There should be a central DNA database system in which the DNA samples of all such unknown deaths should be stored so that it can be matched at a stage when a claimant of such bodies appears, and identification can be done, leading to a proper investigation of the case.

Missing-persons complaints should be expedited by the police, and the identity should be matched with the UIDBs recovered in the specific duration in the probable locations.

Dental charts should be completed by autopsy surgeons mandatorily in all unknown deaths to be correlated with previous records, if any.

There should be a central dental database where patients’ dental records can be stored by dental surgeons.

Footnotes

Declaration of conflicting interests

The authors declare that there is no conflict of interest.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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