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Dying, Death and Mourning amid COVID-19 Pandemic in Kashmir: A Qualitative Study

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Using a qualitative approach, this study aimed to examine the changing nature of death, dying and mourning among Muslims of Kashmir due to the COVID-19 pandemic. Telephonic Interviews were conducted with 17 participants, whose loved ones died after the outbreak of the COVID-19 in Kashmir. The findings of the study revealed that the deceased mostly died in isolation with no one around. Mourning the loss was also highly challenging with participants receiving less in-person support thus leading to mourning in isolation. The inability to perform last rites added yet another layer of grief which resulted in prolonged grief among the bereaved and impacted their overall wellbeing.
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Article
Dying, Death and
Mourning amid
COVID-19 Pandemic
in Kashmir: A
Qualitative Study
Wasia Hamid
1
and
Mohmad Saleem Jahangir
1
Abstract
Using a qualitative approach, this study aimed to examine the changing nature of
death, dying and mourning among Muslims of Kashmir due to the COVID-19 pan-
demic. Telephonic Interviews were conducted with 17 participants, whose loved
ones died after the outbreak of the COVID-19 in Kashmir. The findings of the
study revealed that the deceased mostly died in isolation with no one around.
Mourning the loss was also highly challenging with participants receiving less in-
person support thus leading to mourning in isolation. The inability to perform last
rites added yet another layer of grief which resulted in prolonged grief among the
bereaved and impacted their overall wellbeing.
Keywords
COVID-19, death, Kashmiri Muslims, mourning, qualitative approach
Introduction
The COVID-19 outbreak influences each and every segment of the population,
including poor as well as rich, young and elderly, people with (out) disabilities
1
Department of Sociology, University of Kashmir
Corresponding Author:
Wasia Hamid, Department of Sociology, University of Kashmir, Jammu & Kashmir 190006, India.
Email: Wasia.scholar@kashmiruniversity.net
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DOI: 10.1177/0030222820953708
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and native people in one way or the other (United Nations, 2020). COVID-19 is
defined as an ‘illness caused by a novel coronavirus now called severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2),’ which was first identified
amid an outbreak of respiratory illness cases in Wuhan city, Hubei Province,
China (Centers for Disease Control and Prevention, 2019 as cited in Cennimo
et al., 2020). COVID-19 is infecting both animals and humans, causing a series
of respiratory illnesses from the common cold to lung lesions, pneumonia and
finally leading to death (Bhat et al., 2020). The reach of COVID-19 has by now
taken on pandemic proportions (Remuzzi & Remuzzi, 2020) influencing more
than 200 countries in the world and two international conveyances, the Diamond
Princess cruise ship and MS Zaandam cruise ship in a matter of weeks and
months (Bhat et al., 2020). Pandemic is defined as ‘an epidemic occurring world-
wide, or over a vast area, crossing international boundaries and usually affecting
a large number of people’ (Heath, 2011; Last, 2001). There have been a number
of significant pandemics recorded in human history, including smallpox, chol-
era, plague, dengue, Acquired immunodeficiency syndrome (AIDS), influenza,
severe acute respiratory syndrome (SARS), west Nile disease and tuberculosis.
In the 20th century, ‘Spanish flu’ in 1918–1919, ‘Asian flu’ in 1957-1958, and
‘Hong Kong flu’ in 1968–1969 were the three influenza pandemics that have
impaired both human life and economic development (Qiu et al., 2016–2017).
Recent years have seen at least six large-scale outbreaks-hantavirus pulmonary
syndrome, severe acute respiratory syndrome, Avian influenza (H5N1), Swine
flu (H1N1 influenza), Middle East respiratory syndrome, and Ebola virus dis-
ease epidemic (Gostin et al., 2016 as cited in Qiu et al., 2016–2017). The
COVID-19 pandemic is the recent one in the list. As the novel virus transcends
the global barriers, it results in severe illness, death, and disturbs the life which is
familiar (United Nations, 2020).
COVID-19 pandemic is likely to keep on spreading extensively all through
the year 2020. In order to lessen the effects of COVID-19, safety measures such
as, social distancing and restrictions on visitations in the healthcare institutions
have been commonly put into practice (Wallace et al., 2020). In various health
care institutions such as hospitals, nursing homes, and hospice centers, both the
infected and non-infected patients are being kept in isolation with a major aim
of reducing the spread of virus, but without considering the repercussions of
such isolation on the mental health of patients and their families. Such situations
mostly lead to such patients dying in isolation without care and support from
their loved ones. In cases where dying individuals are taken care of at home,
visits from extended family members and relatives are few because of the phys-
ical distancing procedures in place (Ingravallo, 2020). In both the situations, the
dying person and the bereaved are parted away without being able to meet and
provide comfort to each other. Throughout the world, new guidelines and pol-
icies for the management of the dead bodies, funerals and burials are being
implemented to contain the spread of infection (Wallace et al., 2020). In
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Ireland, United Kingdom (UK), Canada, and India, guidelines regarding car-
rying out funerals, burials and cremation amid the COVID-19 pandemic were
issued by the concerned administrations and were strictly followed by the
people. According to these guidelines, only immediate family members are
allowed to participate in these ceremonies provided social distancing rules are
respected (maintaining a distance of at least 2 meters/3 steps from others) and
most importantly the number of people participating in these ceremonies should
not exceed 10 to 30. It was also mentioned in these guidelines that any mourner
who has COVID-19 symptoms or is in quarantine should not attend the funeral.
The ceremonies and rituals which involve singing, chanting, or raising voice
should be specifically avoided. Contact with the deceased like touching, kissing,
hugging or taking part in rituals like cleansing, packing the corpse should be
avoided. In rare cases only, few of the bereaved can take part in these rituals,
provided they are wearing Proper Protective Equipments (PPEs) (Government
of Canada, 2020; Government of India, Ministry of Health and Family Welfare,
2020; O’Mohony, 2020; Public Health England, 2020). Although, such policies
and regulations immensely help in controlling the spread of COVID-19, how-
ever, it complicates the process of grief (Wallace et al., 2020).
Every group, community or society has its own customs and rituals for death
and mourning (Mohanty, 2003). Although, there is much difference in such
rituals and customs from one culture to another, however, they share a key
ingredient-social connection (Weir, 2020). Rituals and practices surrounding
death and dying help the bereaved to overcome grief (Jahangir & Hamid,
2020). These rituals and ceremonies apart from playing other roles like honour-
ing the deceased, preparing him/her for acceptance in the world of ancestors,
preserving the cultural heritage, and aiding the bereaved to express their feelings
(Ademiluka, 2009; Mandelbaum, 1959), help in uniting people both with each
other and with circumstances and collectives beyond themselves (Myerhoff,
1984 as cited in Reimers, 1999), offer a significant, culturally normative map
for the expressions of emotions and help in adjusting in the milieu without the
deceased person (Pietkiewicz, 2012). However, the novel Coronavirus is altering
these revered customs and rituals around death and dying throughout the world.
These rituals and ceremonies which are performed to honour the deceased
person and console the bereaved have been shortened or discarded and restrict-
ed to the close ones only. Death rituals and customs that have sustained us in
diverse cultures for thousands of years have receded within no time (Adams,
2020). The funeral services at most of the churches, temples, mosques and
synagogues have been suspended until further orders (Sakal Times, 2020).
COVID-19 has swiftly forced utilitarian precedence to govern decision
making. As fundamental freedom are constrained, people are being requested
to do sacrifices for the collective good, including intense modifications in how
we care for the dying person and those they leave behind. Accounts of families
deprived of the access to meet the patients dying from COVID-19; limited
Hamid and Jahangir 3
visitations to those suffering from other ailments, denial to handover dead
bodies, restrictions on funerals and other rituals, restrictions on number and
relationship of mourners, and no close contact with the dead body are common
(Yardley & Rolph, 2020). Such restrictions are in direct conflict with the shared
and symbolic reactions to an individual’s death which are typically endorsed to
exhibit the survival of society and its values (Bloch & Parry, 1982; Durkheim,
1954; Hertz, 1960).
COVID-19 has also posed great challenges in the process of grieving or
mourning for the deceased person and caring and supporting the bereaved fam-
ilies. Grieving in isolation is an exceptionally complex and perverted character-
istic of bereavement due to COVID-19 pandemic. Grief is unavoidable and
multidimensional for persons with losses (Zhai & Du, 2020). However, the
COVID-19 is making the mourning process more intricate whether or not the
departed died due to COVID-19 infection. While dying in isolation may be a
cause of mental agony, mourning alone could be harder-the loss persists, the
connections transform, and the space for reunion shrivels (Sen, 2020). The
unanticipated grief process in a state of strict lockdown, confinement, lack of
opportunities to standby those who are near to death/dying, to console those
who are bereaved, to carry out funeral rituals as per one’s faith, beliefs and
traditions turns the process of mourning more challenging to handle (Remuzzi
& Remuzzi, 2020). There is recognition, both among those bereaved due to
COVID-19 in particular and in the society in general, that there is no choice
other than to follow the rules and that the public good always comes before
personal grief; however, those bereaved have indeed articulated their heart-
break, how stunned, irritated and hurt they have been by the loss of contact
with the deceased individual and the soothing rituals (O’Mohony, 2020).
COVID-19 fatalities also embody the attributes of a ’bad death’, making
them particularly devastating for bereaved kin, whose grief may be compounded
by their own social isolation, lack of practical and emotional support, and high-
stress living situations (Carr et al., 2020). The lack of rituals and grieving,
frequently results in disentrancement of grief and loss of social and cultural
recognition that weakens support resources in assisting a positive grieving pro-
cess. As a result of this bizarre, prolonged and grieving alone phenomenon,
more people are at higher risk of prolonged grief disorder (PGD) in this pan-
demic (Zhai & Du, 2020). This indeed reinforces mental stress and a feeling of
guilt for grieving silently among mourners.
In the Union Territory of Jammu and Kashmir (J&K) the first COVID-19
positive case was detected on 9th March 2020. As of 28 July, 2020, J&K have
reported 18879 COVID-19 positive cases and 333 people have lost their lives so
far. In comparison to the Jammu division, Kashmir is the worst hit division with
14812 positive cases and 309 cases of deaths as compared to Jammu division
where only 4067 positive cases are reported with only 24 cases of death resulting
from COVID-19 (Peer, 2020). To control the spread of COVID-19 infection,
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restrictions were imposed in many parts of Kashmir valley on March 19, 2020.
However, a complete lockdown was then announced across J&K on March 22
(Restrictions in Kashmir Valley Tightened Due to Coronavirus, 2020).
Guidelines issued by the Government of India, Ministry of Health and
Family Welfare (2020) regarding the handling of bodies, carrying funerals,
and burials were implemented in Kashmir in letter and spirit. These guidelines
emphasized that the body should be packed in a bag or a box by the medical
staff by taking standard precautions; only a moderate number of persons should
participate in funerals and disposal of dead bodies. Bathing, kissing and hugging
of the dead body should not be allowed, and social distancing measures should
be followed. Large gatherings should be avoided because of the possibility that
close family members may be symptomatic and/or shedding the virus. On one
hand, such restrictions proved helpful in curbing the spread of COVID-19,
however on the other hand it changed the whole scenario of death, dying and
mourning practices in Kashmir. Therefore, this study is an attempt to under-
stand and highlight how COVID-19 is restructuring the nature of death and
dying in Kashmir and how those who are left behind mourn the death of their
loved ones without any kind of social support. In doing so, the results of this
study can provide insights about the normal death practices vis-a-vis COVID-19
related death practices in Kashmir and can offer both theoretical and practical
implications.
Methodology
The current study used a qualitative research approach to investigate the impact
of COVID-19 pandemic on dying, death and mourning in Kashmir. The qual-
itative approach was deemed to be most appropriate in the quest for a deeper
understanding of the phenomenon under investigation. Purposive sampling
technique was employed to recruit participants. Only those individuals whose
loved ones died either due to COVID-19 infection or other causes were invited
to participate in the study. The study was restricted to the Sunni Muslims of
Kashmir only. A total of 22 potential individuals were contacted of whom 17
agreed to participate and seven rejected the invitation. The contact numbers of
the participants were taken from obituaries and personal contacts. Amid the risk
of contracting the infection, lockdown and restrictions on movement, it was
difficult to conduct face-to-face interviews with the participants. Hence, tele-
phonic interviews were conducted with all the 17 participants. There were six
female and 11 male participants with an age range of 29–69 (M ¼41.78). The
demographic details of both participants as well as the deceased persons are
provided in Table 1. A semi-structured interview guide was prepared to collect
data from the participants. The questions were mainly open-ended in order to
avoid forcing data into any presumptions of the researchers. Some of the ques-
tions asked were; how was the dead person related to you? What was the reason
Hamid and Jahangir 5
for death? What was the place of death? Who was there with the deceased
person when she/he was near to death? Were you with the deceased person
when she/he died? How being present or not present influenced you? Were
post-death rituals conducted for your deceased loved one? Did you participate
in these rituals? Did people come to offer condolences? What about the mourn-
ing period? Did the government rules and regulations influenced the mourning
process? During the first phone call, the participants were informed about the
purpose of the study and permission was sought from them. After getting con-
sent to participate, time and date for interview was decided mutually.
Interviewers assured the participants that data would not be used other than
for the academic purposes and their information will be kept confidential. Each
interview lasted for approximately one hour and 15 minutes. Interviews were
recorded through a call recorder with the prior permission of the participants.
All interviews were conducted in the local language of Kashmiri. At the end of
the interview each participant was thanked for her/his valuable time and coop-
eration. Apart from the interviews, local newspapers were also used as a primary
source of data in this study.
To facilitate data analysis, qualitative software Nvivo12 was used. The inter-
views were uploaded and coded in an Nvivo12 project. Data was then analyzed
Table 1. Demographic Information of Participants and their Deceased Relatives (N ¼17).
No. Gender Relative lost Place of death Cause of death
Age of deceased
at the time
of death
1 Female Grandmother Hospital Covid-19 70
2 Male Brother Hospital Accident 32
3 Male Mother Home Normal death 78
4 Male Distant relative Hospital Covid-19 80
5 Female Uncle (paternal) Hospital Illness 53
6 Male Cousin sister Outside country Covid-19 41
7 Male Daughter Home Cardiac arrest 19
8 Male Friend Home Suicide 29
9 Female Father Outside state Illness 61
10 Male Mother Hospital Covid-19 72
11 Male Brother Hospital Covid-19 39
12 Female Brother Home Normal death 82
13 Male Wife Hospital Covid-19 55
14 Male Father Hospital Illness 59
15 Female Nephew Place of accident Accident 28
16 Male Father Home Illness 85
17 Female Sister-in-law Hospital Covid-19 47
Source: Field work.
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using the techniques of Braun and Clarke (2006) which included getting famil-
iarized with data, generating initial codes, searching for themes, reviewing
themes, defining and naming themes and finally producing the report.
The analysis of data resulted in generation of five themes that described the
participants’ experiences of how COVID-19 affected the death, dying and
mourning in Kashmir.
To ensure trustworthiness, transcripts were independently coded by both the
researchers. Although the codes generated were quite consistent, however, in
case differences emerged, they were resolved by consensus. Memos were noted
down to make certain that the impressions, ideas, and reflections were not
missed in the analysis process. To ensure validity of the study, available partic-
ipants were asked to go through the description (send through the mail) to make
sure that it characterized their shared responses, viewpoints, and experiences.
Formal consent was received from all the participants before starting of
interview. In order to maintain privacy, every participant was assigned a
number and names were not disclosed. However, the names (if any) used in
the paper are the fictional names and not the real names.
Results and Discussion
How People Die Amid COVID-19
Globally, COVID-19 has taken more than 653 862 lives as of 28th July, 2020
(COVID-19 Situation Update Worldwide, 2020). The COVID-19 outbreak
affected all aspects of people’s lives in Kashmir. Apart from other consequences,
it showed a deep ramification on the process of death and dying. However there
are many who die not directly due to COVID-19 infection, but due to the
circumstances created by it such as closing of Out-Patient Departments
(OPDs) and In-patient Departments (IPDs) in Government hospitals, turning
hospitals into COVID-19 sanatoriums, and closing of the private hospitals and
clinics, followed by state-wide lockdowns. COVID-19 has left patients with
other ailments at the risk of deteriorating health conditions and treatment
(Rajagopal & Thacker, 2020). With an increase in COVID-19 cases, lockdown
was imposed in whole Kashmir which halted the movement of people. Also,
three hospitals, Jehlem Valley College (JVC) Bemina, Chest Disease (CD)
Hospital, and Jawahar Lal Nehru Memorial (JLNM) Hospital in Kashmir
were fully dedicated for COVID-19 patients only, due to which normal patient
care is affected greatly and which in turn placed the burden on remaining
hospitals for providing healthcare facilities to the general public. In such con-
ditions, those who were in need of immediate treatment faced difficulties in
managing it and in some cases people were not able to reach hospitals on
time. The non-availability of doctors and proper care was another way that
led to the death of many non-COVID-19 patients. This was also revealed by
Hamid and Jahangir 7
Doctors Association Kashmir (DAK) president, who claimed that the emergen-
cy patient care in Kashmir is badly hit, since the focus currently is mostly on
COVID related cases. It is due to such reason that people are dying of other
health conditions in Kashmir (Kashmir News Trust, 2020). “On 2nd April, my
brother was seriously injured after being hit by a speedy truck. We left the home to
take him to the hospital. As JVC hospital Bemina (closest to our home) was
converted into COVID-19 sanatorium, we were forced to take him to Sher-I-
Kashmir Institute of Medical Sciences (SKIMS) hospital Soura. It took us
more than one hour to reach SKIMS hospital. While we were on the way, my
brothers condition worsened. When we reached the hospital, doctors declared him
brought dead. Doctors also told us that we were half an hour late,” (P2). The
participant lamented that his brother would have survived if JVC hospital
Bemina would not have been converted into COVID-19 sanatorium.
The restrictions imposed on the movement of people due to the COVID-19
outbreak in Kashmir also influenced the way people died. Due to these restric-
tions many people died because they did not receive treatment on time. The case
of Abdul Lateef, who died at hospital due to illness is unique in this sense. He
was admitted in the hospital for a kidney transplant. “Two days after admission
in the hospital, a junior resident came out of ICU and informed me that my father’s
condition is getting worse with every passing hour and they need a consultants help
for his treatment. As it was Sunday, there was no consultant on duty in the hos-
pital. I asked for consultants’ number from the doctor, but his phone was switched
off. After getting the address from other doctors, I rushed in my car so that to pick
the consultant from his home. It took me almost 2 hours to reach his home. I was
stopped at many checkpoints by police because of the curfew imposed in the
Srinagar after it was declared red zone,” (P14). When he reached hospital
along with the doctor, Abdul Lateef had already passed away. This is how
their experiences show additional barriers created as a by-product of COVID-
19 pandemic.
Carelessness at the hands of the doctors and hospital staff amid COVID-19
led to the death of a young lady and her stillborn twins in South Kashmir. As
per the reports in newspapers, the family members of the lady have alleged that
the hospital staff did not take care of her properly when they knew she came
from a red zone area (after first COVID-19 positive case was reported from her
village). The lady was declared positive for COVID-19 posthumously. Family
members of the lady reported that on April 25, 2020, the expectant mother
complained of severe pain, to which they immediately approached the doctor
who she was consulting throughout her pregnancy. To their shock the doctor
refused to treat her saying no private hospital will admit her knowing she is from
a COVID-19 red zone area. The lady was then taken to the Maternity and Child
Care Hospital (MCCH) Anantnag, where the staff at first refused to treat her
because they were from a red zone area and had not registered the pregnant
lady’s name at the MCCH before. Without the prescription and documents
8OMEGA—Journal of Death and Dying 0(0)
required for the treatment of any pregnant woman at the said hospital, the lady
was denied the treatment for the sake of protocols. After many requests and
continuous pleading from the family, she was finally shifted to the labor room.
In a period of four hours she delivered two children, both dead. Her relatives
alleged that she was not given proper post-delivery care which resulted in her
death. Within 10 hours, the husband of the lady lost his wife and two children.
He was busy in burying her dead twins, when he was informed that his wife has
died as well (Rashid, 2020).
Shifting critically-ill patients who are on life-support from various hospitals
to COVID-19 designated hospitals is also contributing to increased mortality in
Kashmir. In COVID-19 hospitals such patients lack quality treatment for want
of specialists and equipments (KNT NEWSDESK, 2020). In such a case, while
following the protocols, a young law student died in CD Hospital, Srinagar. The
Student was seriously injured in a road accident on June 27, 2020. He was
admitted to Shri Maharaja Hari Singh (SMHS) hospital and was getting satis-
factory treatment there. On June, 22 he was declared COVID-19 positive, which
suddenly changed the nature of his treatment and then protocols took prece-
dence over patient-care. As SMHS didn’t treat COVID-19 patients, Doctors at
SMHS shifted him to CD hospital that treats cough and cold and lacked the in-
house neurosurgery department essential for the treatment of the said patient.
Attendants of the patient alleged that after reaching CD hospital, no on-call
surgeon visited him from the time he arrived at till he died on June, 23. While
authorities officially counted him among the day’s COVID-19 fatalities, his
family claimed that he died of huge medical negligence under the garb of
COVID-19 (Dharma, 2020).
In the din of war against the COVID-19 pandemic, Kashmir is witnessing the
poignant takes of false positives (The Hindu, 2020). Amid the rise in COVID-19
cases in Kashmir, people believe that whosoever visits the hospital and dies there
(even due to non COVID-19 reasons) is labelled as COVID-19 positive and then
handled as per given protocols and guidelines. This fear among people is the
reason that many people with urgent medical conditions are avoiding going to
the hospitals. “From last few days we heard about many cases wherein patients
who died naturally in hospitals were labelled as COVID-19 positive. In such cases
the dead bodies were not returned to the families for burial. Instead they were
thrown into a pit shaped grave with the help of a bulldozer. It was due to this reason
that my father didn’t get ready for going to the hospital for treatment. He was
suffering from heart problem and was living with a pacemaker. Three day before he
died, he complained of severe pain and was feeling uneasiness. I called my son and
told him to start the car so that we can take him to the hospital. But my father
refused and said that there is a chance that he will be declared COVID-19 positive
if he visits hospital. He insisted that he wants to die at home so that at least he can
get a normal burial after death,” (P16). According to a report by DAK, fear of
getting stigmatised also leads to delay in seeking medical help which is the main
Hamid and Jahangir 9
reason for increase in the number of COVID-19 deaths in Kashmir valley.
Stigma makes people to hide their illness and keep them away from seeking
health care. Patients in such situation arrive at hospitals only when their symp-
toms worsen which decreases their chances of survival (KNT NEWSDESK,
2020).
Dying in Isolation
The moments before death are considered to be very significant for both the
dying persons as well as their families. Muslims usually wish to die with family
members and other close acquaintances surrounding them and providing them
comfort (Gardner, 1998; Suhail et al., 2011). When a person is near death, she/
he is laid in the direction of Mecca and people surroundings make supplications
and prayers. Few drops of plain water, Zamzam (water from the holy city of
Mecca) or honey are put into the mouth of the dying person. Surah Yasin
(Chapter 36 of the holy Quran) is recited and the dying person is encouraged
to pronounce the Shahadah (Declaration of faith) (B
_
IC¸ ER, 2009; El-Aswad,
1987; Hamid et al., 2019; Jahangir & Hamid, 2020). Such practices help the
dying person to leave this world in peace and serenity and also make the
bereaved feel that they were able to perform their duties towards the dying
person. However amid COVID-19 pandemic these end of life practices are
being altered in one way or the other.
Like in other parts of the world, the hospitals in Kashmir do not allow family
members or others to visit the COVID-19 patients in general and those at the
end of their life in particular to contain the spread of the infection. This
increases the possibility of patients especially those suffering from the
COVID-19 infection to die alone with no one around. This is what happened
to Haniefa, who died at the hospital after being tested positive for COVID-19.
Her family members were not allowed to meet her when she was dying because
of the increasing rate of infectivity in the hospital and the high risk of spreading
of the virus. “We were not even allowed to enter the premises of the hospital. We
requested them that we will see our mother from a distance, but they did not give us
the permission. They were right at their place, but we were not able to control
ourselves,” (P10). In such situations, where families were not allowed to take
care of the terminally ill patients, the dying people were also not able to meet
their loved ones for the last time. Thoughts of what dying in isolation was like
yet added an additional level of complexity to the grief of their loved ones. “My
grandmother always used to tell us that she wishes to see her children’s and grand-
children’s face when leaving from this world. She died with this desire in her heart.
She would have definitely wished us to be there, sitting around her and giving her
all love and support. She would have died with a smile on her face but only God
knows how she managed it,” (P1). Family members and friends missed the
chance to provide comfort for their loved ones at the bedside during the last
10 OMEGA—Journal of Death and Dying 0(0)
moments. Another participant also shared same kind of experience. “My wife
died in isolation in the hospital ward. There was no one with her who would have
given her comfort and made her leave this world in peace. The thought of ‘what she
would have been passing through every single moment’ is making me feel pathetic.
There are many things a person tells to her/his family members when she/he is
close to death. May be my wife would have also desired to talk with anyone of us
about anything. I would always be in a dilemma about what would have been her
last wish,” (P13).
Although dying alone was revealed to be highly challenging for the deceased
person, however it was more traumatic for the survivors who felt guilty for not
letting the deceased person die with dignity. “Hours before his death, my brother
called me. I was delighted when I heard his voice, however, he told me that his
condition has worsened and that he could die anytime. He told me that he wanted
to see us before he dies. He also told me that he wanted to die at home. I was out of
the words and didn’t know what to tell him. I was feeling guilty and sad at the same
time,” (P11). Majority of the participants in our study highlighted that although
they feel miserable because their loved ones died alone, without anyone around,
however, it was revealed that they were not only feeling bad for the dying person
who died in isolation, but they felt bad for themselves also because they were not
able to take care of their loved ones when they needed them the most. The
thought of not performing the religious-cultural rituals at the time of death
also haunted the participants to a greater extent. “What was most painful for
us that no family member was with our father when he passed away. If we would
have been there, we would have recited Surah Yasin for him, made supplications
and prayed for his better life in hereafter. We would have turned his face towards
Mecca and prompted him to say Shahadah. This is what he always wished for. We
feel very guilty because we were not able to perform such rituals for him, so that he
could have died in peace,” (P14). Another participant with same experience
stated that, “Few days after my cousin sister died in Oman, I called my
brother-in-law to ask him how she died. She was a kind of person who always
feared death and she used to tell us ‘never let me die alone’. My brother-in-law told
me that when she was close to death she had asked doctors in the hospital (where
she died) to recite Surah Yasin for her so that she will get some peace. He also told
me that he was feeling angry and asked himself why he was not besides his wife
when she was dying,” (P6).
For many hospitalized patients regardless of COVID-19 diagnosis, the visi-
tors are either prohibited or only limited number is allowed to visit the patient.
In order to be at safer side, every hospital in Kashmir which remained open for
patients other than those suffering from COVID-19 allowed only one or two
attendants to accompany patients in hospital. Nazima was the only one present
in the hospital with her uncle the day he died. When doctors told Nazima that
her uncles’ condition is serious, she requested doctors to let her see him for few
minutes. “As I went close to him, I saw tears in his eyes. He uttered only one
Hamid and Jahangir 11
sentence ‘I want to see your aunt before leaving this world.’ I knew it was difficult
because of the lockdown. Still I came out of the room and called my cousin to reach
hospital with his mother as soon as possible. When I again came inside the room I
saw him taking last breathes and with this he died before seeing his wife,” (P5).
Whenever Nazima looks at her aunt, she feels sad because her uncle died with-
out meeting his wife at the end of his life. She says that if restrictions on number
of attendants due to COVID-19 would not have been there, her aunt would have
been in the hospital with her husband when he was dying.
Missing the Last Moments
Visiting the dying person by the close ones at the time of death is an important
practice followed by Muslims everywhere (Ahaddour et al., 2017; Yasien-
Esmael & Rubin, 2005). In Kashmir too, close family members, relatives, friends
and neighbours come to the house of dying person and meet her/him and pray
for them. If the dying person has relatives who live in some other places, they are
called so that they can see the dying person for the last time. It helps them to
accept the loss and makes them feel good as they are able to see the deceased
person for the last time (Jahangir & Hamid, 2020). However, in cases where
people are not able to meet or see the dying person, it proves to be devastating.
COVID-19 resulted in not giving chances to people to meet their loved ones who
are dying and thus affecting their mental wellbeing. Although, few of the par-
ticipants were able to be with their loved ones and see them through virtual
spaces which proved to be beneficial also, however, it has its own limitations.
“Hours before his death, my brother made a video call and we were delighted to see
him after so many days. Although, it provided us the opportunity to be together
virtually, however that was basically not same as holding hands, taking care of him
face-to-face and experiencing deep connections,” (P11). Not meeting their loved
ones at the end of the life also resulted in denial of accepting the loss. Many
participants narrated the stories wherein family members were not ready to
accept that their loved ones or dead and not alive. “My mother is most depressed
from my grandmother’s death because she was not able to see her mother when she
was dying. As she was a COVID-19 positive, her dead body was not brought home
but was directly taken to the graveyard for burial. This way she was not even able
to see her mother even after death,” (P1). The participant further revealed that
her mother is not ready to believe that her mother is dead and behaves like a
mad person. She tells her family that her mother is admitted in the hospital for
treatment and will come back when she gets better and repeats the same thing
every single day.
Being in quarantine was yet another reason for a participant for not being
able to be with his mother when she died at home. “After coming back from
Chandigarh, I was placed in a quarantine centre. On the second day, my uncle
called me and informed me about the death of my mother. I was in shock. I asked
12 OMEGA—Journal of Death and Dying 0(0)
the in-charge of the quarantine centre to let me go for a while so that I can have a
glimpse of my mother’s face for the last time and take part in her funeral, but he
did not allowed me. I wanted to see her and kiss her forehead before her burial, but
the situation did not let me do that. When I came home, I reminisced my mother at
the entrance welcoming me and giving me a tight hug,” (P3). Some people were
not able to see the deceased person before burial, because the bereaved them-
selves had requested people not to come for offering condolences in person
because of the risk of spread of infection. Also the restrictions being in force
on the movement of people also resulted in people missing the chance of meeting
the dying/dead loved one for the last time. “My sister was not able to come home
when our brother was dying as there was strict curfew under place in Srinagar city
that day. We waited for her for almost one hour, so that she would see her brother
before burial, but she couldn’t reach on time. She is in shock and very much
disturbed as she was not able to see her brother for the last time,” (P12).
Another participant also narrated same story. “When I heard that my friend
had committed suicide I rushed on my scooty to reach his home. As strict restric-
tions were in place due to COVID-19, I was stopped by police at many of places.
Every time I was stopped, I had to narrate them the whole story. Almost an hour
was wasted in it. When I reached his home he was already buried,” (P8).
Changing Rituals and Practices Surrounding Death and Dying
The death of a loved one is considered to be the most traumatic life-cycle event
with family members usually experiencing intense grief (Pietkiewicz, 2012). That
is why rites and rituals, always and everywhere, have circumscribed death
(Ari
es, 1974; Van Gennep, 1960). These rituals and customs evolved in response
to the disruption in the social fabric prompted by death that was perceived as a
threat. Apart from serving other purposes; they are largely focused on providing
support and comfort to the bereaved (Thomas, 2003 as cited in Bahar et al.,
2012). In Kashmir too, death related rituals and practices and mourning com-
monly follow the demise of an individual. The body is washed, shrouded,
offered funeral prayer and buried as per religious-cultural framework. People
continuously visit the bereaved to offer condolence and share the grief of the
bereaved family. These practices and rituals help the bereaved to express the
loss, accept the reality and reorganize their lives without the deceased (Hamid et
al., 2019; Jahangir & Hamid, 2020). However, amid the COVID-19 pandemic,
with increasing mortalities and continuous lockdown, a paradigm shift is being
witnessed around death related rituals and practices. This is not only the case for
those who die from COVID-19, but those dying natural deaths are also getting a
quite farewell. Participants whose loved ones died from COVID-19 highlighted
that no post-death rituals were conducted for their loved ones. Rather, their
bodies were sealed in a wooden box at the hospital and taken to the burial
ground, without giving ritual bath, and without shrouding and the funeral
Hamid and Jahangir 13
and burial was done with limited number of people attending it. “It is a moral
obligation to give the ritual bath to the deceased person, wrap the body in a shroud,
and offer the funeral prayers. But unfortunately we were not able to do such things
for our grandmother. The restrictions in place did not allow us to do so,” (P1).
Although in such cases (who died of COVID-19) other rituals were not per-
formed however limited number (two or three) of close family members were
given the chance to attend the funeral prayer and burial. These strict instruc-
tions for a restricted number of mourners to be present at funeral prayers goes
against the customary funeral congregations, usually attended by hundreds of
people who pray for a good life for the deceased person in hereafter. “When we
got a call that our mother is dead, we were told that only two or three persons can
attend her funeral and burial. It was decide that I will go along with my uncle. I
was sad and depressed because I was not able to carry my mother’s coffin to the
graveyard. The closed box also prevented me from seeing her face for the last
time,” (P10). Another participant who had also faced the same situation nar-
rated that, “The death rituals help the bereaved to acknowledge the reality and
learn to handle the grief. Seeing the body while it is given the ritual bath, placing it
on the bier, having a final look at the face of the deceased person, carrying the
coffin to the graveyard, offering funeral prayer and burying the body makes it easy
to accept the loss and gives an assurance that we sent the deceased person with
dignity. But we were robbed of all such things. Her body was brought to the
graveyard in the hospital ambulance and only few were present for funeral prayers.
We were not even able to lower her body into the grave,” (P13). Not being able to
perform the rituals for the deceased lady or to take part in her burial makes it
difficult for her family members to believe that she is no more and at the same
time they feel depressed, discriminated, and excluded.
In Kashmir, after a person is diagnosed with COVID-19 her/his whole family
is sent to quarantine centres. If the person dies immediately, then her/his family
members are not able to participate in the funeral because of being in quaran-
tine. In such cases, those dying from COVID-19 are often buried in the absence
of the close family members, as they are required to be quarantined after being
coming in contact with the deceased person. It has resulted in the deprivation of
rights to conduct rituals of death and dying. On 27th April an elderly woman
from the Rainawari area of the Srinagar city was diagnosed with COVID-19
infection. On the same day her whole family was sent to a quarantine centre.
Only the other day she lost her battle against the disease and died in the hospital.
Being in quarantine, her family members could not participate in her funeral or
burial. Instead she was buried by few neighbours and men from the police
department. “When Fatima was tested positive for COVID-19, her whole
family was sent to quarantine centre the same day. Next day she died in the
hospital, but the most disturbing part for us was that no one from her family or
relatives was present when she was being buried. We think we are the most unlucky
people, because in other COVID-19 related deaths at least few of the family
14 OMEGA—Journal of Death and Dying 0(0)
members have the opportunity to be present at funeral and burial, but in our case it
was not so,” (P4). The inability of the deceased person’s family members and
relatives to give their loved ones a normal farewell greatly impacted them and
resulted in complicated grief. It influences not only their grief process, but
people in Kashmir attach many belittling things to such families and they are
even stigmatized.
When people do not have a dead body to lay to rest, it is likely for them to
expect that the individual is still alive somewhere. In Kashmir, the presentation
of the dead persons’ face to the bereaved for the last time is considered to be
highly significant. Coming across the face of the deceased individual is thought
to be useful in recognizing the reality of loss since it clarifies any doubt about the
death (Hamid et al., 2019). However amid the COVID-19 pandemic, this is
missing for many people throughout the world. In our study we found that
those participants whose loved ones died outside Kashmir had to deal with
different kind of the grief without dead body. Due to the COVID-19, flights
were suspended, and the dead bodies couldn’t reach their home for burial. “Last
year my cousin sister had gone to Oman to be with her husband. Few days back,
she was tested positive for COVID-19 and died at hospital there. Due to suspension
of flights, we could not bring her mortal remains back to her homeland and instead
she was buried there,” (P6). Her death and burial in foreign land that too with-
out her family being there except for her husband shattered her near and dear
ones back in Kashmir. The biggest challenge for them was that they were not
even able to bury her dead body in their native graveyard.
For those whose loved ones died naturally, they were also forced by the
circumstances to not go for large funerals. The family of Abdul Samad, who
belonged to a well-off family, would have hosted a large gathering on his
demise. But in these extraordinary times, only few close relatives and neighbours
were present when he was given the ritual bath. His funeral also had only a few
dozen attending it, all standing away from each other, in order to abide by social
distancing norms. Those who attended his funeral, left right from the graveyard
without visiting his home. “We had requested people not to visit our residence
because of the fear of the spread of COVID-19. We also published an obituary in
the local newspapers and placed personal ads on Facebook where we requested our
near and dear ones to stay back and pray for the deceased soul from their respec-
tive homes,” (P16). Although it was disturbing for the family of Abdul Samad
because they had to mourn in isolation, however, keeping in mind the positive
impact of their action, they were feeling satisfied. They were also satisfied with
that Abdul Samad died at home which made it possible for them to perform pre-
death and post-death rituals for him and in this way they were able to fulfil their
duties towards the deceased person.
Some participants also revealed that due to precarious situations generated
from COVID-19, they faced difficulties in arranging grave diggers and washer
persons so that to dig the grave for their loved ones and give them the ritual
Hamid and Jahangir 15
bath. The family of Mohd Iqbal faced the same issue when their young daughter
died suddenly. On 29 March, the daughter of Mohd Iqbal, who was suffering
from a heart disease died at her home. In Srinagar people hire professionals to
give ritual bath to the dead person and to dig the grave. Mohd Iqbal also did the
same thing. “I dialled the number of the washerwoman who lived nearby and she
agreed to come. Then I called the grave digger and asked him to come to the
graveyard, but due to the fear-psychosis generated from the COVID-19, he
refused. He told me that he couldn’t risk his life and to call some other grave
digger. I quickly called two more professional grave diggers but they also refused
by saying they will not be able to come on time because of the lockdown,” (P7).
Being worried and disheartened, Mohd Iqbal asked God for help so that he
would be able to bury her daughter on time. Luckily one of his relatives (from
his wife’s side) who had come to participate in his daughter’s funeral ceremony
knew the work of grave digging and agreed to do it for them. Mohd Iqbal
lamented that, “If the person from my relatives would have not been there God
knows what would have happened.”
Mourning in Isolation
Mourning the death is an important tradition in every culture of the
world. Mourning allows people to come together and support the bereaved.
Mourning facilitates the bereaved to share their grief with people, express
their emotions, and begin to work through grief together in a loving and sym-
pathetic atmosphere. It is considered to be essential for a normal and positive
grief process (Gesi et al., 2020; Getty et al., 2010; Mandelbaum, 1959; Yasien-
Esmael & Rubin, 2005). Like in other Muslim societies, a three day long mourn-
ing period is observed apart from 4th day in Kashmir. People in large numbers
including neighbours, friends, relatives and other acquaintances visit the
bereaved, express their condolences and provide them support. Close relatives
live with the bereaved family for few days which help the bereaved to overcome
the grief (Hamid et al., 2019; Jahangir & Hamid, 2020). However, the COVID-
19 pandemic and the social distancing measures have changed the whole struc-
ture of mourning everywhere and Kashmir is no exception to it. The public
gatherings of mourning no longer take place which results in bereaved left to
mourn alone thus adding to the already existing trauma of losing a loved one.
“When my young nephew died in accident, the restrictions in Srinagar on the
movement of people were in its full swing. Even our close relatives were not able
to come to share our grief. We were only five and we mourned alone. We were not
even able to discuss anything because everybody in the family was mourning in
their own way. I was feeling suffocation because I was not able to share my grief
with anyone,” (P15). Yet another participant revealed that, “Losing someone is
itself very complicated, but to mourn alone is the most unfortunate and scariest
thing I have ever experienced in my life,” (P1). Few of the participants also
16 OMEGA—Journal of Death and Dying 0(0)
revealed that they were not able to visit the bereaved to offer condolence or
attend the funeral due to the restrictions on public mourning in Kashmir. In
such circumstances they offered their condolence by calling the bereaved family.
“When my family heard about the death of my uncle, they came to my uncle’s
residence to support his family. Few days before my uncle’s death, one of their
neighbors had died due to coronavirus, so there was tight security in that area. As
my family reached there, there was police on the entrance and they did not allow
them to go inside. Police did not even allow them to participate in his funeral
prayer. Although my family had tried to resist, however, they were forced to go
back. Although my family members later on talked to them on phone, but I think
mere calling is not enough. COVID-19 and the associated social distancing have
snatched the right to express our condolences which we consider a moral
obligation,” (P5). It was not only due to restrictions on gatherings that people
did not visit the bereaved. In many cases, people themselves choose not to visit
the bereaved family because of risk of contracting the COVID-19 infection.
“Only few of the neighbours and relatives came to our house the day my brother
died. People were afraid that they might catch the infection if they come in contact
with a large number of people. The people who came to offer condolences left after
sitting for a short time, so short that we were not even able to express our grief
properly,” (P12). Fighting grief amid covid-19 pandemic has become a painful
battle, which people know they will never win. Another participant who has
experienced same situation stated that, “Usually during mourning, people offer
care and support to the bereaved. The bereaved express their grief and share
memories of the deceased person with people. It helps the bereaved to acknowledge
and accept the reality of death, and they slowly start thinking about how to live life
forward without the deceased person. But for our family the situation was totally
opposed. We experienced a total isolation. No one from outside was allowed to
enter our premises by police. We were saddened and frustrated because we not able
to vent out our emotions. Dying alone is a complicated thing, but it is more com-
plicated when you are left to grieve alone. We knew it was for the general good, but
still we were hurt,” (P11). Another participant whose sister-in-law (husbands
sister) died in hospital due to COVID-19 revealed that she, her child and
mother-in-law were totally left alone to mourn in their home. “When my
sister-in-law was tested positive for COVID-19, my husband accompanied her to
the hospital. After 20 days she died of pneumonia. My husband was placed in
quarantine the same day. I and my mother-in-law were not even able to visit her
house and were forced to remain indoors and mourn alone. My other sister-in-laws
were also not able to visit our house and be with their mother due to restrictions.
My mother-in-law was in shock for many days and was very much depressed
because her children were not with her when she needed them the most,” (P17).
She further stated that they had to remain without food on the first day. For
next few days their neighbours prepared food for them which they used to place
on their Verandah in disposal boxes.
Hamid and Jahangir 17
To weep for the deceased person is one of the crucial features of mourning in
Kashmir. In Kashmir weeping and wailing is mostly done by women, who do it
right from the inception of death until the commemorative ceremonies. Weeping
and wailing over the dead person gives women solace, because it is considered to
be the best way to express grief (Jahangir & Hamid, 2020). However, those
bereaved by COVID-19 were left without the dead body and thus the right to
weep over the corpse of their loved ones was snatched from them. “My heart is
in deep pain because I was not able to weep and lament over the dead body of my
grandmother. Weeping over her dead body would have helped me in relieving the
pain I was feeling due to her death,” (P1).
In Kashmir, as like in other Muslim communities, food is made for and
served to the bereaved families and guests during the first three days of mourn-
ing. This is done to relieve the bereaved from the burden of preparing the food
and provide them the opportunity to mourn properly ( El-Aswad, 1987;
Jahangir & Hamid 2020; Yasien-Esmael & Rubin, 2005). However this
custom was no longer available for the majority of the participants in our
study. They revealed that they were forced by the circumstance to prepare the
food themselves. “We didn’t even get the time to grieve the death of our grand-
mother properly. Due to COVID-19 our neighbours were not able to arrange food
or tea for us. In such circumstances, we were forced to make tea and food for
ourselves and guests also. For those few days, I was so busy in preparing food that I
did not get the time to mourn or share my feelings with anyone,” (P1).
One of the participants whose father died in Mumbai had a different expe-
rience. The grieving family was not able to mourn the death in proper sense,
leaving them without closure. “My father had gone to Mumbai for treatment and
my mother and eldest brother were accompanying him. He died there in hospital
due to illness. We were not able to bring his body home because of the suspension of
flights and consequently he was buried in a cemetery there. My mother and brother
were left alone to grieve away from home with no one present there to console
them. Here in Kashmir we mourned without my father’s dead body. No condolence
meeting was held due to social distancing and lockdown. Unlike other people we
even don’t have a grave to visit and feel some comfort,” (P9). Another participant
revealed, “People who get the opportunity to held mourning ceremony are lucky
enough, because people come to comfort them and provide them social support. But
we were unlucky in this matter. We had no one besides us who would have sup-
ported us and shared our grief,” (P15).
Conclusion
The COVID-19 pandemic has severely changed people’s daily lives, restructured
social order, and social practices, including how people die and mourn the loss
of their loved ones. Death and mourning in COVID-19 pandemic emerged as
well-known themes in the lives of countless individuals, families, groups, and
18 OMEGA—Journal of Death and Dying 0(0)
communities in diverse contexts. It emerged as a new challenge that is changing
the traditional ways of carrying out death related rituals and practices all over
the world and Kashmiri society is no exception to it. The results of our study
suggest that COVID-19 pandemic is proving to be a disastrous by not only
affecting the way we die, but also how we handle the dead and how we
mourn. It has disturbed the livelihood of gravediggers, and the profession of
people associated with it and has generated new reasons for death. Apart from
those who die directly due to the COVID-19 infection, it is leading to the death
of those who otherwise would have survived. They die because of the circum-
stances created by COVID-19 especially due to challenges faced in accessibility
of quality and timely treatment. Due to COVID-19 restrictions and social dis-
tancing measures, those at the end of their life die in isolation without giving
chances to both dying and the families to meet each other. Rituals and practices
that usually follow death of a person are also being taken away from people in
the name of containing the spread of COVID-19. The pandemic has made usual
congregations that follow the death difficult to held, thus robbing mourners of a
conventional farewell, funeral as well as the comfort of near one’s physical
presence. The normal process of mourning is being altered, forcing the bereaved
to mourn in isolation without any kind of support and care. COVID-19 has
added another complicated layer of grief to the already existing loss, thus affect-
ing the overall wellbeing of those affected and furthering the scope of loneliness
among them. It has also increased the burden of work on the shoulders of the
family members of the deceased. Normally, after the death of a person, the
family members of the deceased were supposed to mourn only, and the house-
hold work was performed by close relatives, friends, and neighbours, but due to
COVID-19, everything has been imposed on them despite the grief and loss, and
stigma associated with families of those dying from COVID-19 is yet furthering
these consequences. During investigation, many participants narrated that the
death of a loved one during COVID-19 is less threatening and painful than the
appalling comments of the people, and the way people gaze at them is not less
than a death in itself.
Implications
The present study reveals that COVID-19 has over-burdened the existing health
infrastructure in Kashmir which is leading to the denial of quality and immediate
treatment to people with with ailments other than COVID-19. One feasible strat-
egy to tackle this problem is to expand the existing health facilities by incorpo-
rating more health care professionals so that fast and quality treatment is ensured
to those who are in need of it. This is also highlighted by DAK president, who has
cautioned that there is a need to establish more and more makeshift ICU units
with required infrastructure and machinery as well as proper manpower in order
to save people who are suffering from diseases other than COVID-19 (Kashmir
Hamid and Jahangir 19
News Trust, 2020)). Fear of being stigmatised is leading to increase in mortality
due to COVID-19 in Kashmir. There is urgent need to make people aware of
COVID-19 and do away with the stigma so that Covid-19 symptomatic persons
are encouraged to visit hospitals for treatment. Moreover, there is a need to revisit
the existing protocols for shifting critically-ill patients, after being diagnosed with
COVID-19 to other hospitals which lack necessary facilities for such patient’s
treatment. Our study also highlights that dying in isolation is proving to be mis-
erable for the dying person and the concerned families. In order to overcome this
challenges and provide some relief to dying as well as the bereaved families, it is
the responsibility of the concerned stakeholders to take the necessary steps for
promoting riskless visitation, so that family members (mostly who are not in a
high-risk category) get the chance to be with the dying person even for a short
time by using PPEs and by taking other necessary precautions. In cases where
such visitation policy is not possible, they should work to make the dying persons
and their families see and communicate with each other through online spaces/
electronic devices like smart phones, tablets etc. The efficacy of this method is
documented in many studies like (Luttik et al., 2020; Massachusetts General
Hospital, 2020; Negro et al., 2020; Northern Devon Healthcare, 2020; Shapiro,
2020) where many organizations and hospital administration have/are working to
set up video call facilities for patients admitted in hospitals so that to remain in
touch with their families. This could prove to be beneficial in reducing the pain
and sense of guilt among dying as well as the bereaved.
We also found that the family members of COVID-19 patients are not
allowed to see the face of the deceased person before burial, as their dead
bodies are packed in the wooden boxes in the hospitals and are straightaway
taken to the graveyard for funeral and burial. This goes against the guidelines of
the Government of India, Ministry of Health and Family Welfare (2020) which
recommends that the family members should be given a chance to see the dead
body of their loved ones for one last time. This incompatibility can be nailed out
by strictly following the protocols as prescribed by the Ministry of Health &
Family Welfare. The online streaming of the funeral is another way to overcome
this issue, but the use of this method may be limited due to the frequent internet
shutdowns in Kashmir.
Findings of our study also revealed that social support is important for those
who are grieving and people like relatives, friends, colleagues and other acquain-
tances need to know that despite being not able to have face-to-face interactions
with the bereaved there are ways to be in continuous contact with the family of
deceased person through online spaces. Although speaking over phone and
interacting through virtual spaces can never replace the face-to-face interactions,
however, it can be an effective way of showing care and love and this could also
help the bereaved individuals to understand that they are not forgotten. The
presence of social support groups can also prove to be beneficial for bereaved so
that they can accept the reality in a better way, organize their lives again, deal
20 OMEGA—Journal of Death and Dying 0(0)
with strain, and lessen the pain caused by the loss of their loved ones and can
recompense the normal mourning process. Close acquaintances could also visit
the bereaved personally but by taking proper safety measures like wearing face
masks, and maintaining proper physical distance. The support generated from
this could prove more powerful. In cases where no such provision is possible,
family members should know that they are the only source of support to each
other and should indulge in continuous discussions and never let each other to
mourn in isolation.
Another way out to ease the suffering of the dying person and her/his family
members is to control the politicization of COVID-19 lockdown, because in
Kashmir, no difference seems in between curfew led lockdown and COVID-
19 led lockdown. In many instances, police brutality and damaging of vehicles of
family members of the infected patients were reported which adds to the already
grief they are experiencing. On the other hand the community members or
volunteers who, despite the risks, provide all services to the family members
of the deceased persons in such complex situations need to be encouraged and
acknowledged. There is also scope for Non-governmental Organizations
(NGOs), Self Help Groups (SHGs) and Local committees to come forward
and provide every possible support to the dying individuals and their families
amid this critical situation.
Limitations and Scope for Further Research
Although this study provides deep insights into how COVID-19 is reshaping the
death and mourning in Kashmir, however, this study also needs to be viewed in
light of its limitations. First we used telephonic interviews with participants
which generated many concerns like challenges in establishing rapport, missing
the facial expressions of the participants, and the potential loss of contextual
data. To overcome this limitation, future researches could use face-to-face inter-
views with the participants so that to ensure that data/message is not lost during
communication. Second, we carried out this research on a small sample size,
which reduced generalizability of the results. Future researches should be rep-
licated with a larger sample to enhance the generalization of results and chances
of getting diverse responses. Third we incorporated both the deaths resulting
from COVID-19 and other reasons. Future researches should conduct separate
studies on those bereaved by COVID-19 and those bereaved by natural death to
investigate if any difference exists in their experiences. Fourth, we conducted
this study on Sunni Muslims only. Future researches might consider people
from Shia community and other religious communities in order get diverse
responses and experiences. Finally, there is broader scope to conduct a compar-
ative study on bereaved belonging to rural and urban areas. This will help us in
understanding the different influences of COVID-19 on the death practices and
mourning in rural and urban Kashmir.
Hamid and Jahangir 21
Acknowledgments
The authors would like to thank all the research participants for their valuable
contribution.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.
ORCID iD
Wasia Hamid https://orcid.org/0000-0002-6950-4050
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Author Biographies
Wasia Hamid is currently persuing PhD from the Department of Sociology,
University of Kashmir. She completed her post-graduation from the same
University in 2016. Her areas of interest are death and dying, and gender stud-
ies. She has published many research papers in the reputed journals.
Mohmad Saleem Jahangir senior assistant professor has been working in the
Department of Sociology, University of Kashmir since 2008. Interested in the
field of Globalization and Marxism, he has a book to his credit besides many
research papers published in various reputed journals. Moreover being Macie
Curie fellow for the year 2014 at University of Macerata in Italy, he has also
been to University of Szczecin, Poland in 2015 under 7 Framework Programme,
Marie Curie Actions, People, International Research Staff Exchange Scheme.
26 OMEGA—Journal of Death and Dying 0(0)
... 10,12,14,16,17,23 Residual feelings of guilt stemming from an unsatisfactory farewell as families were unable to physically accompany patients in their last moments, were also pervasive. 2,11,12,[14][15][16][17]19,23,24 Families were also concerned about their own exposure to COVID-19 where logistical barriers to screening left them feeling abandoned by the healthcare system. 2,21,22 The families' grief was accentuated during the immediate post-death and mourning period as a result of inconsistencies in the burial ceremonies, which caused anger at times. ...
... 13,15 They were either altered to "abnormal or unreligious burials" that lacked meaning, or worse, absent altogether. 11,[14][15][16]19,21,22,24 Families thought these "incomplete ceremonies" were the product of "unjustified government policies" dehumanising their loved ones. 2,14,19,21 They were critical of the government for treating their loved ones as statistics in a system rather than as human beings. ...
... 14,21 The loneliness of mourning in isolation, the desolation from multiple losses of family members dying in quick succession, and an inability to fully commit towards work and family, translated to a lack of closure. 13,15,16,19,20,22,24 The cancellation of social events, and difficulty in accessing formal counselling services denied people of outlets for their emotions, further prolonged this grieving process. 15,16,18,20 Beyond this, families were worried about their future. ...
Article
Introduction: The COVID-19 pandemic has brought about multiple losses to various groups, namely patients, families and healthcare professionals. Grief, which is the reaction to these losses, could cause strain on these individuals' physical and mental health if not identified and managed early. This scoping review analysed loss, grief and how they were managed among these groups during the pandemic. Method: This scoping review utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute framework for scoping reviews. Only qualitative studies relating to loss and grief and their management were included. Of 166 studies screened, 69 were included in the study. Qualitative analysis and data coding of each record were conducted through qualitative data analysis software. Results: Losses included the death of family members, patients, colleagues and others. They also included the loss of usual routines, lifestyles and physical health. The grief experienced was multidimensional, affecting mainly the emotional, physical, social and existential realms. Anger, guilt and fear resulted from unsatisfactory farewells, issues with funerals, social isolation, financial strain and stigmatisation. Management strategies could be categorised into 5 themes: communication, finance, counselling, education and spiritual care. Conclusion: Loss and grief identification and management among patients, family members and healthcare professionals are critically important during this COVID-19 pandemic. Current operating guidelines have proven insufficient in managing loss and grief. Innovative strategies are essential to tackle the many dimensions of loss and grief. Nevertheless, further research is necessary to better understand the effectiveness of implemented policies.
... On the one hand, these restrictions effectively halted the spread of COVID-19, but on the other, they altered the entire death, dying, and mourning landscape in Kashmir (Hamid & Jahangir, 2020). Earlier studies, particularly by Hamid and Jahangir (2020), have explored the changing nature of death practices in Kashmir amidst the pandemic. ...
... On the one hand, these restrictions effectively halted the spread of COVID-19, but on the other, they altered the entire death, dying, and mourning landscape in Kashmir (Hamid & Jahangir, 2020). Earlier studies, particularly by Hamid and Jahangir (2020), have explored the changing nature of death practices in Kashmir amidst the pandemic. The present study looks at COVID-19 deaths only via personal interviews with the deceased's family members. ...
... The present study looks at COVID-19 deaths only via personal interviews with the deceased's family members. Individual interviews allowed researchers to undertake an in-depth analysis of the attitudes, beliefs, desires, and experiences of research participants to obtain a deeper understanding of them without undermining the benefits of the study conducted by Hamid and Jahangir (2020). Since interviews allow for the collection of non-verbal data, they can be more advantageous than phone conversations (Barrett & Twycross, 2018). ...
Article
This study examined the changing character of the last honours of those who died of COVID-19 in Kashmir and the life experiences of the families of the deceased. A semi-structured interview schedule was used to collect information from 21 participants. Using qualitative data analysis approaches, five key themes were identified vis-à-vis the impact of COVID-19 on burial rituals and customs; effects on bereaved families, shades of grief, bereavement care, community response, and coping with loss. Based on examining the pandemic-induced changes related to customs and rituals around death, the study found that the bereaved family members were in danger of marginalization, economic burdens, psychological traumas, and overall reduced quality of life. This study would be a credible addition to the existing literature on death practices as there is a shortage of research on funeral rituals during the post-pandemic period in Kashmir.
... The study by Hamid & Jahangir (2020) describes these feelings in several cases of patients dying not only alone but away from their families, and how families feel helpless for going through these difficult moments with their loved ones, providing them calm and reassurance at the time of their departure. These situations have become very common in families of people who have died from COVID-19, and it is clear to see how they can affect the bereaved in the immediate future, becoming a public health problem. ...
... Peru, a middle-income country in Latin America, has implemented the longest and most inefficient quarantine in the region to control the spread of the first SARS-CoV-2 outbreak during political, economic and social crises in 2020. It is possible that during this period, social restriction policies such as strict isolation, lack of public transport mobilisation, fear and lack of information played a significant role in the mourning process (Hamid & Jahangir, 2020;Mortazavi et al., 2020;Carr et al., 2020). ...
... The increase in deaths and confinement has made it impossible to say goodbye to those who have died of COVID-19. This situation is not exclusive to COVID-19 because all families who lost a family member have been affected by the national lockdown (Hamid & Jahangir, 2020). The families of patients who died of COVID-19 have been more damaged as they have lived through a progressive drama mixed with fear, uncertainty and grief. ...
Article
Due to the massive deaths and high level of contagion brought about by COVID-19, burial practices and the way we bury our dead are being affected by SARS-CoV-2 confinement and control measures. Here, we aimed to examine the changing of death, dying, and mourning during the first wave and quarantine applied in Peru with the arrival of COVID-19 in 2020. Using a qualitative approach, 15 participants who lost a family member because of COVID-19 were interviewed by telephone and video call. Our results revealed that death in isolation, the loss of rituals, and the farewell to relatives have dramatically affected family members. Peruvian funeral practices were altered by health provisions, making it a challenge to accompany relatives at the end of life. This way of coping with death can affect family wellbeing, for which no interventions have yet been proposed to improve the quality of life during bereavement.
... Considering social distancing rules, only close family members were allowed to attend funerals. In some cases, the relatives of the deceased were not allowed to attend the burial, and the officers carried out the burial ceremony by wearing protective clothing (Hamid & Jahangir, 2020;Lazzerini & Putoto, 2020;Government of Canada, 2021;Government of Turkey, 2021;O'Mahony, 2020;Omonisi, 2020;Public Health England, 2021). ...
... In this process, individuals might not have the opportunity to say goodbye to the person they lost, as any loss experienced by the individual was fast and sudden. Not being with them at the last moment, not being able to touch them for the last time, and not saying goodbye have made the mourning process, which is already difficult to cope with, more destructive for individuals (Aguiar et al., 2020;Hamid & Jahangir, 2020;Omonisi, 2020;Wallace et al., 2020). Besides, after the loss, individuals need the moral support of their loved ones and be together with them. ...
... Besides, it helps individuals accept the reality of death, provide an environment where they can express their feelings and thoughts comfortably, and give meaning to the loss they experience (Castle & Phillips, 2003;Reeves, 2011). However, ceremonies in mosques, churches, temples, and synagogues or other rituals that bring people together have been restricted or entirely prohibited during the pandemic (Hamid & Jahangir, 2020;Lazzerini & Putoto, 2020;O'Mahony, 2020;Omonisi, 2020). In other words, rituals, ceremonies, and traditions related to mourning and grief have changed with the pandemic in the countries affected by the virus. ...
Article
The measures, restrictions, and death-related rituals in the COVID-19 pandemic have affected the mourning-related routines of individuals. Moreover, mourning processes have been affected by the restriction of death-related cultural rituals, funeral ceremonies performed only by the officials, and the prohibition of visiting graves. This study aims to investigate the experiences of individuals who lost their loved ones in Turkey during the COVID-19 pandemic. For that purpose, the phenomenological method is employed in the design of the study. Individual interviews were conducted with nine participants who lost their relatives during the COVID-19 pandemic. Data were collected through semi-structured interview forms prepared by the researchers. The study participants described the various factors contributing to the grief and mourning process in the COVID-19 pandemic. These factors were categorized into three following main categories: grief and mourning responses of the individuals lost loved ones, including cognitive, emotional, and behavioral responses; risk factors including the expectation of harm, unfinished business, and restriction of death-related religious-cultural rituals; and protective factors including relative support (i.e.
... Similar studies have been published sharing experiences of those bereaved during the COVID-19 pandemic. 15,22,31,34,35 These studies stress the importance of open communication from healthcare providers, allowing the opportunity to 'say goodbye', and provision of bereavement support. This study is the first step towards understanding the impact that COVID-19 restrictions had on experiences of loss, grief and bereavement in Aotearoa New Zealand, in an effort to raise awareness of the needs of those bereaved during this time, so the necessary supports can be provided. ...
... As reported by the Daily Samakal, a female worker Nasima (25) died of COVID-19 in a hospital on 31 May while both the locals of the Tajpur village at Badalgachi of Naogaon district and the relatives of the deceased protested and did not allow to bury at the family graveyard ("None share graveyard", None share graveyard, Police arranged burial at the bank of river, 2020). In many cases, the deceased mostly died in isolation with no one around (Hamid & Jahangir, 2020), even the relatives are not allowed to see the face of the deceased body for the last time due to the fear of deadly coronavirus. These tragic incidents are contributing to the emotional distress of the family (Rao et al., 2020). ...
Article
Full-text available
The global spread of COVID -19 accompanied with the behavioral, psychosocial, and structural elements of social stigma engendered social and bio-medical complexity due to the COVID -19 syndemic. The study aims to explore the process of stigmatization and the extent of social vulnerabilities affected COVID -19 people of Bangladesh. The study used purposive sampling, where a total of 15 different cases were selected from 11 online newspapers in Bangladesh. Results revealed that infected and suspected patients were largely stigmatized through local hatred and eviction, forced quarantining, impeding burial process, hospital and local administration’s mistreating, family-negligence, relatives’ avoidance, and the land owners’ disgracing. The excessive media coverage of maintaining lockdown, quarantining, and physical distance were the major causes of increasing rumor where the poor-income group, female workers, and employees of health-care services were seriously vulnerable. The study findings recommend several guidelines forrecognizing practicability and capability for combatting COVID 19 syndemic.
... The conditions that surrounded Mrs S's EOL phase predispose her to exacerbation of anxiety, fear, distress, and possible guilt. 17,18 ...
Article
COVID-19 has taken 1 million lives as of March 22, 2022. The restrictions and enforced social distancing imposed because of the COVID-19 pandemic adversely affected the way people die, often alone in hospitals without their family members or loved ones by their side. Religious and cultural beliefs predominantly influence every aspect of people's lives, especially during the end of life (EOL). Islam is the fastest growing religion worldwide after Christianity and the third most practiced religion in the United States. The Islamic religion specifies how Muslim practice health and wellness, death, and EOL care. Islamic teachings provide a roadmap on EOL practices and death rituals that must be followed by the practicing individual. Scarce empirical studies exist on practices and rituals of Muslims near death and dying. Therefore, the aim of this case report is to provide a practical framework for health care practitioners to understand essential Islamic EOL practices and provide resources to guide clinical practice.
... In Iran, mourning ceremonies are comprised of specific sequence of customs, namely funeral procession, burial of the deceased in presence of his/ her friends and relatives, the relatives' gathering in the deceased's home to console the bereaved family, hosting a religious ceremony, and doing charity on behalf of the deceased. At the same time, in Iran, like in other countries, newly enforced policies and instructions regarding the management of corpses, funerals, burials and attending other customary rites are being implemented (9). As a consequence of the imposed restrictions, families who have lost loved ones have often been deprived of the chance to attend the person's bedside before his/her death, hence missing the opportunity to bid farewell to the deceased. ...
Article
Full-text available
Background: The way one mourns varies across different cultures. As such in each society, the mourning rituals in accordance with the culture of that society can alleviate the grieving process. During the coronavirus (COVID-19) pandemic, in many parts of the world, restrictions have been imposed on hosting different ceremonies and events to control the spread of the virus. Since the enforced regulations have made changes to the way mourning is done in these times, an investigation of the experiences of people of different cultures in coping with loss during the current crisis seems to be of importance. The purpose of this study was to investigate the mourning experiences in north-east of Iran during COVID-19. Methods: This is a qualitative study which was conducted by using content analysis. The participants were 11 individuals who had lost a family member due to COVID-19 in Bojnurd in 2020. Sampling was purposive and continued until reaching data saturation. Semi-structured interviews and note-taking were utilized for data collection. The interviews were recorded and the notes were then evaluated. Results: After analyzing the collected data and forming semantic units, three main categories and nine sub-categories of unexpressed grief were extracted. Unexpressed bereavement, effects on mental health, and dissatisfaction with services comprise the main categories while lack of farewell opportunity, the emotional burden of COVID-19, strange burial, fear and social stigma, lack of adequate psychological support, emotional trauma and shock, reducing the motivation for life, lack of professional principles in the death announcements, and finally lack of equipment and non-compliance with hygiene standards make up the 9 subcategories. Conclusion: The collected evidence concerning the unexpressed grieving experience ensuing from the COVID-19 induced death of a family member reveals such issue to be one of the most important mental health issues during the spread of the virus, which requires the necessary investigation and intervention of the experts in this field.
Article
Cultures across the globe have evolved time-tested rituals to honor those who die and offer solace and support to survivors with the goal of helping them to accept the reality of the death, cope with the feelings of loss, adjust to life without the deceased, and find ways to maintain a connection to the memory of the deceased. The COVID-19 pandemic has disrupted these rituals and brought significant changes to the way we mourn. Specifically, public health responses to COVID-19 such as social distancing or isolation, delays or cancellations of traditional religious and cultural rituals, and shifts from in-person to online ceremonies have disrupted rituals and thus made it more difficult to access support and complete the psychological tasks typically associated with bereavement. This paper conceptualizes the common bereavement tasks including emotion-focused coping, maintaining a connection to the deceased, disengagement and reframing death and loss, and problem-focused coping. It provides examples of how the COVID-19 pandemic has altered mourning rituals across several cultures and religions and contributed to prolonged grief disorder as defined by the ICD-11 that includes depressive symptoms and post-traumatic stress. Early evidence suggested that the suddenness of loss, the social isolation, and the lack of social support often associated with COVID-19-related death are salient risk factors for complicated grief. As a consequence, psychological assessments, grief counseling, and mental health support are needed by families of patients who died from COVID-19. These services must be essential components of any comprehensive public health response to the pandemic.
Article
The fear of contracting the disease, introduction of practices such as quarantine, social isolation, and curfew to prevent its transmission, and effects of experiencing a loss due to this disease are experienced differently by different people. The empirical phenomenological approach will be used to describe, explain, and analyze the experiences of the family members of individuals who lost their lives due to COVID-19. This study was created in accordance with COREQ Statement Checklist. The themes obtained from the interviews are “death in isolation”, “changing cultural–religious practices that cannot be performed”, “not being able to say goodbye”.This transformed grieving process caused by the pandemic may create unique psychosocial needs among family members. To meet these needs, planning and organizing complex grief therapy, speech therapies, expressive supportive counseling, and grief recovery programs is recommended.
Article
Full-text available
The COVID-19 pandemic is one of the worst public health crises in a century, with an expected amount of deaths of several million worldwide and an even bigger number of bereaved people left behind. Although the consequences of this crisis are still unknown, a significant number of bereaved people will arguably develop Complicated Grief (CG) in the aftermath of this emergency. If the current pandemic is unprecedented, the grief following the coronavirus outbreak is likely to share features with grief related to natural disasters and after Intensive Care Unit (ICU) treatment. The aim of this paper is to review the most prominent literature on CG after natural disasters, as well as after diseases requiring ICU treatment. This body of evidence may be useful for helping bereaved people during the acute phase of the COVID-19 pandemic and for drawing clinical attention to people at risk for CG.
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The COVID-19 pandemic is anticipated to continue spreading widely across the globe throughout 2020. To mitigate the devastating impact of COVID-19, social distancing and visitor restrictions in healthcare facilities have been widely implemented. Such policies and practices, along with the direct impact of the spread of COVID-19, complicate issues of grief that are relevant to medical providers. We describe the relationship of the COVID-19 pandemic to anticipatory grief, disenfranchised grief, and complicated grief for individuals, families, and their providers. Further, we provide discussion regarding countering this grief through communication, advance care planning, and self-care practices. We provide resources for healthcare providers, in addition to calling on palliative care providers to consider their own role as a resource to other specialties during this public health emergency.
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The COVID-19 pandemic has posed an extreme threat to global health and become a leading cause of death worldwide. Loss, as a more encompassing theme, interweaves many aspects of people’s life in this challenging time. Failure to address the pressing needs of those experiencing loss and grief may result in poor mental and physical health. Recognizing the uniqueness of each individual and their loss and grief will provide opportunities to develop tailored strategies that facilitate functional adaptation to loss and promote mental health and wellbeing in this crisis.