Mortal remains repat challenges

ITIJ 213, Assistance and Repatriations Review, October 2018
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International funeral directors tell David Kernek that the challenges they face have more to do with bureaucratic paperwork and adjusting family expectations than the demographics of death overseas

A big part of the vacation travel industry is based on the business of selling dreams. ‘Can you recommend a good funeral director?’ is not a question often found in foreign language phrase books for tourists. Death in Venice was one of Thomas Mann’s greatest stories, but it’s not a good look for an Italian holiday brochure. 

While the vast majority of holidaymakers and business travellers return home after an uneventful trip, death turns some dream vacations and work secondments into emotional and sometimes bureaucratic nightmares. International funeral directors and repatriation companies have a business line that will never be rubbed out by technology, but how have their operations been adapted to meet demographic changes as the age range of vacation travellers widens to include more baby boomers taking their pre-existing conditions with them?
 
Shifting demographics
“Travelling abroad has become increasingly easier, cheaper and more accessible year-on-year, and with this we’ve seen a distinct change in the demographic of those travelling,” says Samuel Tester, operations manager at UK-based international funeral repatriation company Homeland International. “The most obvious change from our perspective is due to the increase in cruise travellers.” The number of cruise passengers on Royal Caribbean lines alone has risen steadily over the last decade from 3,905,384 passengers in 2007 to 5,768,496 in 2017, says Tester, and due to this, his company has seen a rise in repatriating mortal remains (RMR) cases across cruise regions. “We often have to work out challenging routes when people pass away in small ports and villages on their journeys,” Tester told ITIJ. “Even in many European cruise destinations, RMR’s can prove a challenge. In the Norwegian fjords, for example, cruise liners dock at small ports. Getting access to these ports by road is often a problem. We overcome such challenges by relying on the local knowledge we’ve built through our dedicated teams on the ground in such areas. Solutions are identified quickly enabling us to safely reach these locations to assist all of the parties involved.”
Looking at current patterns of RMR cases, Homeland International reports a decline in cases from Turkey, possibly due to the decrease in visitor numbers there over the last few years. “But this seems to be slowly rising again,” said Tester, “as it is now being considered a safer place to holiday. Conversely, we have experienced a rise in cases from more unusual destinations such as Montenegro and Tunisia. The majority of our cases currently, however, are from the typical tourist hotspots in Europe: Spain, Portugal and Greece.”
Just as passengers need documentation to travel, so do the deceased
Fiona Greenwood, Operations Director at UK-based international funeral repatriation company Rowland Brothers International (RBI) plays down the perception that ageing baby boomers are having a significant impact on the sector. “Working with bereaved families worldwide, we have always felt that older travellers don’t necessarily represent the greatest proportion of our homebound repatriation arrangements, but it’s difficult to find international statistics to corroborate our impressions. Does retirement boost travel?  We read that between the ages of 60 and 72, people travel more intensively, but less over the age of 75, perhaps due to concerns about health issues. Old and young alike might relish the challenge of journeys to remote areas, so we must be ready to engage with relatives who have lost a family member at any time of life.”
The most recent statistics from the UK government’s Foreign & Commonwealth Office record that in 2016, consuls helped the families of 3,670 British citizens who died overseas, says Greenwood. “British travellers continue their love affair with Spain, France, Greece, Italy and Thailand, which are frequent points of origin for repatriation,” she said, “but we manage repatriation also from every corner of the globe.”
At Singapore-based Flying Home, CEO Deborah Andres tells ITIJ: “Funeral and repatriation companies are definitely working with a wider diversity, not only in countries but also with religion, culture and traditions that go outside what their traditional communities may have once looked like.” 
 
Rules and regulations
With a more diverse range of travellers heading to a wider range of destinations, funeral repatriation companies have to keep abreast of the intricacies and logistics of working in any given part of the world. Andres highlights small islands and the Middle East as challenging locations from which to organise repatriations. “With small islands, there can be a degree of difficulty in getting to them,” she explained. “In the Middle East, where there are restrictions and regulations that can hamper and delay repatriation, it really is all about working closely with government agencies and embassies. A close trusted network is extremely valuable and partnering with local people and agencies helps tremendously.”
Homeland International’s Tester agrees that the Middle East can pose problems. “There are many different requirements for repatriation worldwide; every country has its own legislation and guidelines for departure as well as the destination country having additional requirements for entry. Locations such as the Middle East have a lot of involvement with the employers. There are many paperwork processes that require the employer to assist with meeting some of the regulations. The biggest difficulty is usually when registering the death; in some countries it is legal for us to register the death, in others we cannot. In cases where the individual was a lone traveller this can create challenges as it can mean there is nobody else there who can assist with registering the death.”
Tester says that flying the deceased’s family members out to the location is not usually advisable. “It can add cost and time to the repatriation, as well as adding stress for the family. Typically, we would require a doctor from the hospital to register the death, as more often than not they are legally endorsed to do so. This can often result in delays, when we have to wait until the doctor is available to leave the hospital in order to assist.”
Good working relationships with embassies are vital, Tester told ITIJ: “They regularly update and change their regulations, and to make things even harder, their regulations are not the same in every country worldwide. They might require one set of documents in the USA while in Cambodia, for example, they want an entirely different set of papers, even though they represent the same government. We have forged many personal relationships with embassies worldwide, which means it is easy for us to work closely with them and to keep on top of all the regulation changes they make.”
Logistics are always an important part of repatriation protocols, says Greenwood at RBI. “The combination of location, circumstances, nationality and destination sets unique parameters for each arrangement, which we manage from start to finish.  Collecting the deceased to bring them home can involve many forms of transport, from a boat to a private plane or a prolonged overland journey.  We never underestimate the value of relationships built over many years with partners around the world who share our can-do approach.” She said there is no one-size-fits-all policy when it comes to national authorities and the paperwork they require. “The documents required to complete the repatriation process, and the regulations, can change at any time, due to a change in the political situation in the country or updates on in-country regulations. This does not generally cause a problem although in some instances it might affect the timeline for repatriation slightly. In countries considered a war zone, each case needs to be reviewed on its own merits to determine if repatriation is possible, as the situation can change daily. The worst case might involve a local burial with a view to exhuming and repatriating at a later date once the situation has changed.”
The biggest difficulty is usually when registering the death
Dominic Vernhes, CEO of Paris-based international funeral assistance group Anubis, told ITIJ funeral companies are having to deal with a wider range of countries, laws and customs than ever before. “Funeral companies need to do their research and find out if they are equipped to respond to rules and regulations in different countries as well as cultural requirements for the deceased. Funeral formalities include obtaining the documentation that is required for transporting a body from the country where the death occurred and that for its destination. In certain cases, it is also necessary to obtain documents required for travelling through different countries during the journey, particularly when the repatriation takes place by road. Conventions exist between certain countries that facilitate the process or limit the number of documents that are required. But it can be complicated if the relevant countries do not have a diplomatic relationship or consular representation.” Religious requirements are also important when organizing the repatriation of a body, he said, so it’s necessary to have a wide knowledge of different rites and rituals in order to avoid making an irreversible mistake that might result in a claim for moral damages with high financial consequences. 
 
Logistical challenges
Logistical problems, Vernhes told ITIJ, are generally faced in regions such as the Caribbean, Polynesia and the Philippines, or ‘anywhere where a tourist destination is made up of a number of small islands’. A plane will usually be chartered for repatriation of a body from somewhere that doesn’t have an international airport, but sometimes this isn’t possible when the planes that are available don’t have a cargo door that is big enough for a coffin, Tester said. The alternative in this situation is to find an aircraft that suits requirements or to organise a transfer by a public or private boat to another island or to the nearest mainland that has an international airport. This involves extra costs that can add up quickly due to the logistics required for departure and arrival.
There can also be complicated logistical challenges, he says, arising from geographical and political situations, ‘often in Africa and the Middle East’. “Certain countries don’t have any specific regulations in place, he told ITIJ. “They don’t have funeral companies or regulation coffins. These countries include East Timor, Bhutan and far-away places such as Adélie Land on Antarctica, where we assisted after a helicopter crash. Problems might also arise when a death occurs on a private boat or on a cruise or cargo ship. A logistical solution is needed to recuperate the body and this can be particularly complicated if the captain decides to continue the boat’s journey. We responded to a case recently where a man died while carrying out an inspection on a ship. His body was supposed to be dropped off in Mauritius, but we finally recuperated it in Singapore. The same happened in another case involving a cruise ship that was supposed to go back to Antigua in the Caribbean but continued its journey to the UK.”
Furthermore, it’s sometimes necessary to ship vital equipment from neighbouring countries, said Vernhes. “Many years ago, for a petrol conglomerate client, we equipped a village clinic in Asalouyeh in Iran with cold chambers brought from Tehran, 800 miles away,” he told ITIJ. “They didn’t have any equipment prior to our intervention; dead bodies were put in a piece of sealed pipeline while repatriation was being organised.”
We must be ready to engage with relatives who have lost a family member at any time of life
 
E-mail and mobile phones have enhanced processes and shortened timelines, says Flying Home, although Homeland International says that the RMR sector has been generally reluctant to take advantage of the latest kit. “Technology is certainly slowly making an impact on improving services,” said Tester, “but the sector is still far slower in this area than other medical and travel assistance operators. Most companies in the funeral sector are very traditional, and use dated software and equipment. Off-the-shelf software for our sector is also very dated and non-user friendly, which is why we took the decision to create our own bespoke case management system. We reap the benefits from this daily, allowing us to utilise technology to manage a number of areas including finance, cost containment, provider network and client base. It enables us to operate smoothly in all areas. The system is flexible and can be used on any operating system and device. It needs only an internet connection, which ensures we can work collaboratively wherever our teams are in the world.”
Technology, agrees Vernhes, is changing the way things work in the funeral sector, ‘but this is happening at a slow and steady pace because every country has its own regulations and every service provider has their own communications system’. “Unfortunately, there is no such thing as an electronic visa for repatriating a body, or a one-stop information site that can deal with the range of necessary formalities," he said. “Generally, these tasks will need to be dealt with at different offices at the relevant location. In the US, it is possible to declare a death online, but all other formalities must be dealt with in person. In Europe, countries that signed the Berlin Convention use the same template for death certificates and repatriation transport authorisation forms, but all the other necessary documents vary from country to country.” 
Technology has without doubt facilitated an easier way to exchange information and to keep a record of communication as well as keeping people up-to-date with a situation, said Tester, ‘but we cannot ignore the fact that a human presence is essential when dealing with death’. 
 
Assistance covered
Are international funeral repatriation companies seeing an increase in the number of families paying privately for their services, or does a greater proportion of their business come via travel and IPMI insurers and assistance providers?
“Our Asian platform,” says Vernhes, “is seeing an increasing number of cases in which a family pays privately for our services. I think that this is due to the fact that their insurance policies and cover are very different to the policies available in Europe or North America.” 
RBI also works with both types of clients, but most of its business comes from emergency travel assistance companies. “Occasionally, families decide to pay and claim if they can’t wait for a medical history, due to faith or other personal reasons,” said Greenwood. “For most families, the grieving men news of a death away from home is totally unexpected and, for some, funding repatriation privately is difficult. Some families expect that if a travel insurance product was purchased, cover is automatic for any emergency. If cover is declined, families might turn to crowdfunding or to extended family, friends, employer or charities to seek help with repatriation costs. They might ask about an alternative solution, such as cremation in resort, if this is available and compatible with their faith.”
Most of Homeland International’s missions, similarly, come from assistance companies, Tester explained: “It is positive that RMR is covered by most travel insurance policies, as it protects families financially and gets them access to companies that can operate effectively wherever they are in the world. But we hear of too many stories about families overseas who, when a loved one who was uninsured has passed away, are forced to pay the full bill themselves, relying on an unregulated, low-grade local company that might not offer the same quality and understanding as one of the worldwide repatriation companies. This makes the whole process a lot harder for the family at an already tragic time and gives the sector a poor reputation.”
Flying Home’s Andres said that the decision to pay privately for a RMR will normally depend on regional, cultural and religious traditions. “For example, here in Singapore, if the deceased is from Malaysia and Indonesia, the families will pay because they want their loved one home the same day. Westerners, on the other hand, understand processes and will normally wait for the insurance approval before proceeding.”
 
Improving communication
Are there ways in which communications between insurers, assistance companies and funeral repatriation operators could be improved to make the process less stressful for families? 
‘Undoubtedly’, says Tester at Homeland International. “One of the largest issues we face when working on behalf of assistance companies is the time between providing a quote and receiving the go-ahead. While policies are being checked and prices compared with providers who have taken longer to respond, issues can arise. The first setback is that we lose time and families are left in limbo overseas.” There is little protection for families, so local funeral companies will often go to the hospital and offer support, taking advantage of a grieving family, he told ITIJ. “Unaware they are being duped, a family will sign paperwork quickly and the local company will move the deceased person to their premises without proper consultation. By the time we have been assigned to start the case, the deceased person has been moved from the hospital. The funeral home will then charge us an extortionate price to remove the deceased, making the case far more expensive for the client. Insurance and assistance companies should advise families not to sign anything at all at the first call stage. Then, when we get involved, it will all be far easier. It will save costs from rising and make the process quicker.”
The majority of our cases currently are from the typical tourist hotspots in Europe: Spain, Portugal and Greece
Shaping the expectations of bereaved families is also important. “We feel privileged to work with assistance companies around the world,” said Greenwood at RBI. “No two arrangements are ever the same, but it is important to maintain the same standards across everything we do. Setting clear expectations, with empathy and honesty, is important to our team, our clients and the bereaved. If we can go ahead as soon as we are notified, families feel progress is being made while cover is explored. Provided this is clearly explained to the family, this works well.” 
In most cases, the relocation of a loved one is accomplished in a relatively short time, but if local protocol prolongs the arrangements, communication is crucial to reassure clients and families, explained Greenwood. “The essence of repatriation is not only managing the arrangement but also managing expectations across cultures and continents, providing a seamless service which respects family wishes and local, international and emergency assistance protocols.”
Assistance companies, thus, need to have knowledge of the processes and different regulations in different countries, explained Flying Home’s Andres, so that their client’s expectations can be managed. “Insurance company representatives sometimes have no prior knowledge of the repatriation process and what it entails and can sometimes hinder the process by promising families a timeline that cannot be met,” she told ITIJ. “They also need to know that time zones, locations and other factors can hinder a quick response. Other challenges have been with embassies and consulates. There are sometimes people stationed there who do not have any experience or knowledge of dealing with death and of their own government’s requirements.”
Dialogue and sharing experiences and knowledge at international events helps as this creates a bond of trust within the sector, said Andres. The consolidating of operating standards has also been discussed. “Having continued conversations with the World Health Organization about an international operating standard would certainly help,” commented Andres. “Medical examiners in different countries have different processes, especially for autopsies and the issuing of death certificates. That can be a problem because insurance companies need to know the cause of death before approving the claim and allowing repatriation companies to begin the process. Faster payment by insurance companies to smaller repatriation operators would also be helpful, as they do not have the means to go for long periods without payment.”
Lack of in-country knowledge and processes can be a problem, adds Andres. “In Singapore, the Chinese expect their loved ones to arrive fully dressed. If a repatriation company is experienced and knowledgeable, it would be able to manage the family’s expectations by letting them know that a repatriation from the Middle East normally arrives in only a shroud. If a receiving family isn’t told about this, they can find this quite shocking.” 
 
The Brexit question
Both Homeland and RBI appear to be relaxed about the consequences for RMR procedures to and from the UK and the EU 27 after Britain leaves the union in March next year. “We have yet to fully understand the outcome of Brexit in any walk of life,” says Samuel Tester at Homeland International, “and this remains the case with RMR cases. There is likely to be a slight increase in costs as well as the potential for longer customs procedures for cases in and out of the UK. But it is unlikely to present any real problems for us operationally. We are working closely with the European Federation of Funeral Services to make processes within Europe easier. We are working with the EU and different airline companies to identify ways in which we can implement a similar process to the Schengen agreement, whereby we could by-pass embassy and other regulations when repatriating deceased people within Europe. Ours is a global company, so if this were to be established, it would make a lot of our cases far easier.”
For most families, the news of a death away from home is totally unexpected
RBI’s Greenwood confirmed: “We don’t know yet if there will be any customs or security changes that could affect us after Brexit, but many protocols are already observed and could be adapted where necessary. Over many years of EU membership, there have been few changes to individual EU country requirements. A small number of countries still expect the coffin to be sealed by their embassy abroad before starting their final journey home. Just as passengers need documentation to travel, so do the deceased. Documents that accompany loved ones home authorise departure from one country and entry to another. Sometimes documents are certified where they originated, or by the foreign ministry where they will be used, or both. Attention to detail matters, as death certificates are not only important for a funeral to take place, but also for estate matters.”
Vernhes thinks Brexit could have an impact on repatriation costs. “The services required in order to repatriate a body will not change: a coffin will be required, certain formalities will need to be carried out, and it will be necessary to organise transport. But Value Added Tax (VAT) varies from country to country in the EU, and that could mean that a service provider invoicing a client in the UK will no longer be able to use an intra-EU VAT number to bill without VAT. This will depend on which EU zone the service provider is in and could have significant financial repercussions on repatriation costs – between 18 and 27 per cent. Service providers in the UK will be able to apply the same policy and add VAT to a repatriation invoice. However, the number of European deaths in the UK is significantly lower than the number of British bodies that are repatriated from Spain and France alone.”
While Brexit and the possible paperwork changes – affecting Britain and the EU 27 – that might flow from it will have no impact on Flying Home in Singapore, Andres spoke to ITIJ about the potential global standardisation of paperwork for the industry. The international organisation representing funeral service operators – FIAT/IFTA – issues a ‘passport for the dead’, said Andres, which its members use: “However, not every funeral company is a member. It would certainly be advantageous if this passport was used by all companies worldwide.” 
This ‘passport’– or what FIAT/IFTA calls its ‘indispensable’ Repatriation Document – is a free, downloadable uniform ID paper available in a range of major languages that provides the information national authorities require when human remains have to be taken across frontiers. If accepted and used universally, it could help to streamline the task of international funeral directors and RMR companies and alleviate some of the stress endured by often shocked bereaved families. ■
 
 

Case Studies

Libya to Bosnia/Herzegovina
 
Homeland International was requested by an assistance company to carry out a repatriation of mortal remains from an oil service location in the desert of southern Libya back to Sarajevo, Bosnia and Herzegovina. The case was urgent because there were no mortuary facilities in the vicinity. Homeland International recounts the details:
 
We have trusted local providers in every country worldwide, so we were able to mobilise our team on the ground within minutes. We responded to the case in the early evening, so made the decision to leave straight away as the eight-hour drive would be easier at night than in the daytime heat.
Our team was getting close to the location, about two hours away, when a sandstorm stalled progress and it was impossible to complete the journey in the vehicle the team had. We contacted another of our local agents who was in the area, and who had a more suitable vehicle for the terrain. The team changed vehicles and collected the deceased, arriving back safely in Tripoli the following morning. The Monday was a national holiday in Libya. We could not progress paperwork because government offices were closed, but as we operate 24/7 365 days a year we were able to prepare the coffin and the embalming. The government paperwork was completed the following day.
Now the process in Libya had been completed, we had to look for flights, which is tricky because of the political situation in Libya. Many airlines no longer operate from Tripoli, giving us very limited options for the outbound flight. As we needed to contain costs for our client, private aircraft was never an option. Eventually, we were able to find a route to Sarajevo via Tunis and Istanbul, which was available that evening. The family had told us about the Bosnian funeral home they wished to use. We liaised with the funeral home and supported it with the import procedures before they were able to collect and move the deceased to its premises in Sarajevo. Despite a few hurdles, the case was completed smoothly and successfully.
 
A knifing at sea
 
A Philippian cook was injured when he was working on a cargo ship registered under a French flag. He was stabbed in the chest during an altercation with another sailor. The ship was in the Atlantic Ocean and heading for Pointe-Noire in the Congo. The man was hospitalised when the ship arrived in Pointe-Noire. Unfortunately, as is often the case in Africa, there was a power cut during the night. The patient was on a life-support machine, and he died. The shipping company and the family of deceased requested that his body be repatriated from Pointe-Noire to Manila. Anubis shares details of the repatriation:
 
The patient died in Pointe-Noire, but his injury took place in international waters. The boat was subject to French maritime law. This meant that the body had to be repatriated to Paris in order for an autopsy to be carried out. Transportation consent from the consulate was required in order to carry out this legal obligation. Once the autopsy had been carried out, the body was released and repatriation to the Philippines was once again requested. However, we encountered problems while putting together the documentation that was required for a transportation authorisation. The death took place in the Congo; the body was in Paris and needed to be repatriated to the Philippines. A doctor in the Congo issued the medical certificate and Pointe-Noire City Hall issued the death certificate. It took one month for us to have all the paperwork, because an original copy of the birth certificate had to be sent from the Philippines to Pointe-Noire City Hall before the file could be sent to Paris.  
In order to get all of the paperwork necessary for transportation, we also needed authorisation from a French judge and a ‘free from epidemic infection’ certificate. All of the paperwork then had to be translated into English so that it could be sent to the Philippine Embassy in Paris in order to apply for authorisation to enter the Philippines. But the Philippine Embassy in Paris rejected the application because the death took place in the Congo and is outside their intervention zone. We contacted the Philippine Embassy in Nairobi, Kenya, and had to send the original documents to Kenya along with the additional paperwork from the Congo and France. Two months after his death, the sailor’s body was repatriated to his home country.