Comparative medical imaging in mass-fatality identification: Evidence from the October 7, 2023 Event

Area of Science:

• Forensic Science
• Radiology
• Disaster Victim Identification

Background:

• Comparative Medical Imaging (CMI) is currently a secondary identifier in INTERPOL Disaster Victim Identification (DVI) guidelines.
• A large-scale forensic response was required following the October 7, 2023, Hamas massacre, involving 1219 fatalities.

Purpose of the Study:

• To evaluate the operational contribution of CMI in a real-world mass casualty forensic investigation.
• To assess the reliability and effectiveness of CMI for identifying victims under challenging postmortem conditions.

Main Methods:

• Systematic analysis of ante-mortem (AM) imaging data from 400 missing individuals and postmortem (PM) imaging of recovered remains.
• Utilized multidetector computed tomography (MDCT) and plane radiography for PM imaging, adapted for various taphonomic conditions.
• Compared AM and PM imaging data across initial recovery and subsequent hostage return phases.

Main Results:

• Radiographic comparison led to the identification of 39 individuals.
• CMI contributed significantly (29.9%) in the later phase involving returned hostages.
• Identification relied on skeletal variations, degenerative changes, medical interventions, and pathological findings, often using multiple concordant features.
• Effective comparisons were achieved despite long AM-PM intervals (up to 17 years) and diverse taphonomic states (skeletonized, saponified, mummified, thermally altered).

Conclusions:

• CMI provides highly specific and temporally stable individualization markers resilient to challenging postmortem conditions.
• The findings support CMI's classification as a primary identification method in DVI frameworks.
• Reassessment of CMI's role within international DVI guidelines is warranted based on its demonstrated effectiveness.