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interference [49]. Villagers became hostile to these outsiders, who were never seen to understand (or were not allowed to understand) the deeper mysteries of life and the parallel worlds of life and the afterlife via rituals that were essential for securing protection, health, fertility, and social solidarity [50]. Ebola was a tragic disease that disrupted the social accommodations of the communities by requiring the isolation of the patients and biomedicalized burials. The issue attracted unwelcome international responses. Guineans began stigmatizing Ebola as an ethnic disease that affected only the Kissi or forestiers [48]. Those who would not accept that they had the disease were cast as immoral and were resented because of their connection to Ebola [32]. The resentment led to noncompliance and even violent resistance of health interventions. A week after Médecins Sans Frontiéres (MSF) constructed the first ETC in Macenta, urban youth attacked and threatened more than 50 new expatriates, arguing with them and saying that outsiders had brought Ebola into Guinea on purpose [32]. In fact, 26 Kissi villages in the Guéckédou Prefecture isolated themselves in June 2014 by cutting bridges, felling trees, and stoning ERT vehicles [51]. Within villages, conciliatory villagers were accused of being traitors, and those who assisted NGOs were also beaten [51]. Many delegations were assaulted, wounded, taken hostage, and even murdered. In September 2014, eight members of a delegation of doctors, politicians, and journalists were murdered and disposed of in a latrine in the Nzérékoré Prefecture. Survivors of the delegation were pursued [32]. Continued violence ranged from verbal to physical assaults inflicted on volunteers from the International Federation of Red Cross and Red Crescent Societies (IFRC), averaging 10 attacks per month beginning in July 2014 [52]. Because of villagers’ resistance to the ERT, efforts to control the epidemic in the early stages were severely hampered. Dignified, safe burials interventions from intergovernmental organizations To interrupt transmission and control Ebola in the midst of active community transmission, immediate, safe, and dignified burials by trained teams with appropriate protective equipment were essential [35]. At the same time, the dead also had to be respectfully treated. The WHO provided an updated version of its interim guidance in October 2017 for medical personnel or anyone involved in the management of burial to share a protocol for conducting safe and dignified burial of patients who had died from an infectious disease such as Ebola or Marburg [53]. Before taking the corpse, the burial team should fully inform the bereaved family about the dignified burial process and respect their religious and personal rights as much as possible. The initiation of the burial process was set out clearly in the WHO guidelines, stating that “no burial should begin until a family agreement has been obtained” [53]. The 12 steps of the burial process are as follows: In 2006, the Pan American Health Organiza- Journal of Health and Social Sciences 2020; 5,1:073-090 The Italian Journal for Interdisciplinary Health and Social Development 81 • Step 2. Assembling all necessary equipment. • Step 3. Arriving at home of the deceased: preparing burial with family and evaluating risks. • Step 4. Putting on all Personal Protective Equipment (PPE). • Step 5. Placing the body in the body bag. • Step 6. Placing the body bag in a coffin where culturally appropriate. • Step 7. Sanitizing family's environment. • Step 8. Removing PPE, managing waste and performing hand hygiene. • Step 9. Transporting the coffin or the body bag to the cemetery and provide respectful time. • Step 10. Burial at the cemetery: placing coffin or body bag into the grave. • Step 11. Burial at the cemetery: engaging community for prayers to dissipates tensions. • Step 12. Returning to the hospital or team headquarters. Table 1. 12 steps of the burial process by the WHO guidelines [53]. tion provided a field manual for the management of human remains after disasters [54]. Because the immediate management of the dead is done by nonspecialists, such as local organizations and communities, this manual focuses on practical recommendations, especially to promote proper and dignified management and to maximize the identification of the dead [54]. Although this manual was available at the time of several large natural disasters, such as the South Asian tsunami in 2004 and Hurricane Katrina in 2005, it could not be implemented or promoted during the 2014–2016 Ebola outbreak because of the lack of information about the management of the dead during an infectious disease epidemic. Ten years after the first version, the second edition was published in 2016 with the addition of a large section on infectious diseases [16]. Annex 6 in the document clearly indicates that untrained first responders should not be involved in the management of deceased victims of an infectious disease [16]. However, first responders and nonexperts can also be educated and trained by those who are experienced in handling a highly infectious disease for the correct management of human remains [16]. The principles that the body handler must maintain are as follows [16]: • An understanding of the organism, the disease, and its modes of transmission • Knowledge of the correct procedures for
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