Within Islam, there are certain religious practices that are deemed obligatory to carry out upon death. This article explores the impact of the coronavirus pandemic on the application of these rites, and how Muslim communities, particularly within the UK but also with comparative references from elsewhere, have adapted to implement social distancing and infection control measures.

The obligatory rites carried out for a deceased Muslim are:

  • Ghusl: the body of the deceased is cleaned with soap and water, followed by ritual washing, which must be done a minimum of three times. It is important to ensure that water reaches all parts of the skin, hence the body must be turned during this process. Some practices also involve applying gentle pressure on the abdomen to expel bowel contents.
  • Kafan: shrouding of the deceased in white cotton sheets.
  • Salat al-Janazah: congregational prayer for the deceased, usually attended by large numbers according to Islamic tradition. Congregants stand close together to pray for the deceased.
  • Burial: it is obligatory for Muslims to bury their dead as soon as possible after death, typically within 24 hours. It is recommended that the washed and shrouded body is buried without a coffin, with the face of the deceased facing Mecca.

Prior to the coronavirus pandemic, Ghusl and Kafan were frequently carried out by elders of the community. With those over the age of 70 implementing rigorous social distancing, Muslim communities have swiftly trained and organised teams of younger volunteers to conduct this vital role.1,2 Social media platforms such as Zoom have proved invaluable in providing this training.

Within the UK, Covid-19 has disproportionately impacted BAME groups.3 Currently, there is no data available on the numbers of Covid-19 deaths specifically amongst the UK Muslim population, but anecdotal evidence suggests a high proportion of additional deaths. A mosque in Stanmore, North-west London, has carried out the burial rites of 58 individuals during April 2020, of whom 43 had Covid-19 either as the proven or highly suspected cause of death.4

This mosque usually performs the burial rites for those that have died in and around North-west London; however due to reduced availability of suitable facilities elsewhere, its catchment area has increased considerably. As a comparison, during April 2019, the same mosque carried out the burial rites of just 10 individuals.

The viability of Covid-19 in the tissues and body fluids of a deceased’s body remains unknown. Potential sources of infection from the deceased may arise from the release of droplets from residual air within the respiratory tract, from contaminated clothing or bedding, or from fluid secretions including faecal matter.5,6 During Ghusl, these are the key areas of risk that must be ameliorated.

Muslim communities have adapted their religious obligations 

Guidance from Public Health England advises that ritual washing and shrouding of the deceased in line with religious practice may continue so long as appropriate PPE is worn, due precaution against transmission is in place, and social distancing is maintained.5,7

The World Health Organisation8 and European Centre for Disease Prevention and Control9 also endorse washing and shrouding subject to these precautions. The National Burial Council (NBC)10 and The British Islamic Medical Association (BIMA)2 have published guidance on the handling of the deceased for mosques and funeral directors in the UK. Furthermore, The World Federation of Khoja Shia Islamic Muslim Communities (WFKSIMC) has also provided guidance on how burial rites can be performed.11 The key recommendations stipulate:

  • Individuals taking part in the Ghusl process to be under the age of 60, not have underlying health conditions and be asymptomatic.
  • The crucial importance of appropriate training for donning and doffing PPE, without which individuals should not participate.
  • The PPE to be used: a full sleeve plastic gown, fluid resistant mask, visor, gloves, head coverings and shoe coverings.
  • The presence of a healthcare professional to supervise the process.
  • Appropriate clinical waste disposal systems to be in place.
  • Face mask to be applied to the nose and mouth of the deceased.
  • Movement of the deceased’s body is to be kept to a minimum.
  • Water not to be sprayed to avoid the production of aerosols.
  • The premises where the Ghusl takes place to have adequate ventilation.
  • Premises to be fully disinfected following the completion of the Ghusl and Kafan.
  • Salat al-Janazah to be performed at the burial ground by a minimum number of individuals maintaining a distance of 2 metres from each other.14
  • Coffins or burial caskets to be used if required by local authority regulations.

In situations where Ghusl cannot be performed, a dry wash (Tayammum) whereby soil/sand is applied onto certain sections of the deceased’s body or directly onto the body bag, can be administered. Furthermore, if the facilities and resources do not exist even for this then the deceased may be buried without Ghusl and Kafan.

Globally, there are considerable variations in regulations pertaining to burial rites, based on individual countries’ own risk assessments and previous experience of infectious diseases. In Kenya a National Muslim Covid-19 Task Force has been established, and is responsible for handling Muslim deaths.12 Ghusl is not performed, the body is wrapped in white sheets followed by a biodegradable bag, and the deceased buried.13

In Canada, burial rites vary according to provincial regulations.15 In Ontario, faith groups must follow the guidelines set down by the Bereavement Authority, which requires only licensed funeral homes to carry out the transfer and handling of the deceased.16 The Canadian Council of Imams have provided extensive guidance on how Muslim burial rites can be performed.17 Where mosques do not have licences, and funeral homes do not have facilities for these rites, the Canadian Council of Imams have advised that as a last resort the deceased may be buried without Ghusl. Other provinces such as Alberta have permitted the Ghusl and Kafan to be administered prior to burial.18 Indonesia, home to the world’s largest Muslim population, requires the deceased to be wrapped in a plastic bag, which cannot be opened, and placed in a coffin wrapped in plastic and buried within 4 hours in cases where Covid-19 is proven or suspected.19 Under these circumstances, Ghusl and Kafan are not performed.

These examples illustrate how Muslim communities have adapted their religious obligations in light of the current Coronavirus pandemic and infection control guidance. In essence, within the UK those carrying out the burial rites are younger, have been trained in the use of PPE, and have adapted Ghusl and Kafan to reduce the risk of splashing and duration of exposure to the deceased. Furthermore, burials are more likely to take place using coffins and the congregational prayer is performed by a smaller number of congregants. Globally, where significant concern exists about the risk to volunteers of contracting the virus, the ritual washing and shrouding are omitted.

              


Sukaina Hirji, General Practitioner & Associate Trainer, Chorleywood Health Centre, Chorleywood, Hertfordshire WD3 5EA.

Arifali Hirji, Head of Energy Trading Analytics, Centrica.

Edin Lakasing, General Practitioner & Trainer, Chorleywood Health Centre, Chorleywood, Hertfordshire WD3 5EA.

Email: edin.lakasing@nhs.net

 


Competing interests: SH and AH are members of the WFKSIMC Covid-19 Task Force.

 

References

  1. Swerling G, Self-isolation forcing Muslim elders to teach burial traditions to the young, The Telegraph, 18th April 2020.https://www.telegraph.co.uk/news/2020/04/18/self-isolation-forcing-muslim-elders-teach-burial-traditions/
  2. British Islamic Medical Assocaition (BIMA) guidance on the performance of ghusl for deceased persons with suspected or confirmed COVID-19, 30th March 2020 https://britishima.org/wp-content/uploads/2020/04/BIMA-Ghusl-guidelines-QA.pdf
  3. Razaq A, Harrison D, Karunanithi S et al, BAME COVID-19 Deaths-What do we know? Rapid Data & Evidence Review, The Centre for Evidence-Based Medicine, 5th May 2020 https://www.cebm.net/covid-19/bame-covid-19-deaths-what-do-we-know-rapid-data-evidence-review/
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