Repatriation when the cause of death is infectious

When the medical certificate names an infectious disease as the cause of death, families are often told, by a friend or by the internet, that a repatriation is impossible. For nearly all infections it is not. It needs a document that every repatriation now needs anyway, and sometimes a precaution in the preparation, and it goes ahead. For a very short list of diseases it does not go ahead, and this guide says which is which and why.

The free from infection declaration

A statement from the doctor who certified the death, or from the hospital, that the person did not die of a disease that poses a risk in transport, or naming the disease so that the destination and the carrier can decide. Most destination countries and most airlines ask for it, and since the pandemic almost all of them do, for every death. For an ordinary death it is a formality issued on the basis of the medical certificate. For an infectious death it is the document on which everything turns, and the doctor will either issue it with the disease named, which is the normal case, or decline, which is the exceptional one.

Deaths that can be repatriated

Almost all of them. Pneumonia, sepsis, influenza, tuberculosis, hepatitis, HIV, COVID-19 and the other infections that appear on medical certificates every week are all repatriated routinely. What changes is in the preparation: the funeral director follows the Health and Safety Executive’s guidance on infection risks in funeral premises, embalming may be done with additional precautions or, for a few diseases, replaced by a hermetically sealed coffin where the destination accepts one, and the coffin is sealed as it would be anyway. The destination’s health authority is told the cause of death through the declaration and in most cases raises nothing. The rules for moving a coffin across borders explains why the sealed coffin is what makes this straightforward.

Deaths that cannot

A short list, and it is the destination’s and the carrier’s list rather than the UK’s. The diseases the World Health Organization treats as international emergencies, the viral haemorrhagic fevers such as Ebola and Lassa, plague and a small number of others, are ones for which most countries refuse entry and every airline refuses carriage, and for which UK guidance itself advises against embalming and against transport. A death from one of these in the UK means a funeral in the UK, and we will say so on the first call rather than on the fifth day. A death from one of these abroad usually means a funeral there, and the consulate will say the same.

What the pandemic changed, and what stayed

During 2020 and 2021 every death was treated as potentially infectious, borders closed to everything including coffins for weeks at a time, airlines suspended cargo on whole routes, and consulates shut. Families waited far longer than usual. None of that is the case now, and the guidance the government issued for handling in that period is what settled into the normal practice this page describes. Two things stayed. The free from infection declaration is now on nearly every destination’s list, whatever the cause. And the preparation for a repatriation now follows written infection-control guidance as standard rather than as an exception, which is a good thing for everyone who handles a coffin.

What to tell us on the first call

The cause of death as the doctor gave it, or as the hospital told you, even if you are not sure of the word. From that we tell you the same day whether the destination and the carrier accept it, with what precaution if any, and whether embalming will be done as usual. Where the answer is that the repatriation is not possible, we say so on that call, because the family needs to plan a funeral here rather than wait for a no from a consulate. Repatriation, step by step is the process this fits into, and what documents does a repatriation need shows where the declaration sits among the rest.