Defence head Air Chief Marshal Angus Houston said an inquiry into the repatriation found there were weaknesses in Australian Defence Force policy and procedures which created conditions conducive to failure.
He said he had accepted all 28 recommendations of the independent inquiry aimed at improving procedures to ensure, as far as possible, it can’t happen again.
Air Chief Marshal Houston said the inquiry found the mishap occurred as a direct result of fundamental errors in the repatriation process.
“Firstly the wrong body was produced by the civilian mortuary staff for identification. Secondly, the body produced was incorrectly identified as being Private Kovco,” he said.
Private Kovco, a member of Australia’s security detachment in Baghdad, died on April 21 from a single accidental gunshot from his own issue handgun.
Just how that happened is the subject of an ongoing military board of inquiry hearing.
The inquiry, conducted by Brigadier Liz Cosson and Professor Don Sheldon, found Private Kovco’s body was transported from Baghdad to Kuwait airport where it was then moved by ambulance to the civilian morgue at Al-Sabah Hospital.
That was under arrangements by a Kuwait firm sub-contracting for the firm Kenyon International, widely used for international repatriation of bodies.
The inquiry said use of a contractor was a sound and considered decision due to a lack of an integral ADF capability to repatriate bodies.
Air Chief Marshal Houston said that was attributable to absence of recent ADF experience at dealing with casualties.
On April 25, morgue staff produced a body for return to Australia. That was identified by Private Kovco’s platoon sergeant as Private Kovco.
Neither morgue staff nor the sergeant noticed a cardboard tag attached to the hand which would have correctly identified the body as that of Bosnian national Juso Sinanovic who had died of a brain haemorrhage in Baghdad.
The inquiry cited a number of contributing factors.
Mr Sinanovic’s head was bandaged and that was consistent with expectations of the gunshot wound which killed Private Kovco; the morgue was busy and poorly lit; and the sergeant believed the body had been embalmed and that changed its appearance.
Only when Mr Sinanovic’s body reached Australia on April 27 was the mistake detected. The body of Private Kovco returned two days later.
Air Chief Marshal Houston said no action would be taken against the sergeant who had suffered enough from his error.
Under new procedures, bodies of ADF casualties will be transported on military aircraft where practical and accompanied by at least two personnel.