American Muslim COVID19 Loss Survey
AsSalaamuAlaikum/Peace Be Unto You
We pray this message finds you and your loved ones safe and well.
On March 11, 2020 the World Health Organization declared the Coronavirus a global pandemic. Tragically, since that time, many community members have passed away from COVID-19, the disease caused by the Coronavirus.

Recent data shows a clear and undeniable racial disparities in the rates of infection and fatalities such that in major American cities like Chicago, Detroit, NYC and Milwaukee, many Black/African American community members are dying at alarming rates. Further, many in Muslim communities around the country are considered "essential" or "frontline" workers which also places them at greater risk of exposure to the Coronavirus. At this time, we do not have sufficient information regarding the number of Believers who have tested positive for COVID or the number of people who have returned to Allah. We believe that it is important to have an accurate assessment of how this crisis has impacted us. We are striving to ensure that the American Muslim community is counted in understanding the toll this pandemic is having on our community, and in particular the services, support, resources we will need in order to heal from the grief and loss we are experiencing. 

The goal of this survey is to gather this information about deaths in American Muslim communities as a result of the COVID-19 pandemic. If you have lost a loved one, please answer the questions listed below. The information will be treated with the utmost sensitivity and confidence. You can complete this survey even if your loved one was not *formally* diagnosed with Coronavirus or COVID-19.

This survey will remain open for the duration of the pandemic. Please find more information and resources at:
blackmuslimcoalition.com/loss


This effort is currently being spearheaded by:
National Black Muslim COVID Coalition

with collaboration and support from:
Institute for Social Policy and Understanding (ISPU)
Islamic Society of North America (ISNA)
Muslim Alliance of North America
Muslim Anti-Racism Collaborative
Muslim Health Consortium
Muslim Wellness Foundation
National Muslim COVID-19 TaskForce
Stanford Muslim Mental Health Lab
United Muslim Masjid of Philadelphia

We ask Allah (swt) to shower his mercy, comfort, & strength on those who are in pain & mourning. We pray that our grieving community members are embraced with love and an abundance of care. For more info/resources on grief, trauma & loss: Muslim Wellness Foundation Community Trauma toolkit is an excellent resource (www.muslimwellness.com/communitytrauma)
What is your relationship to the deceased? *
For example: is the deceased an immediate family member, extended family member, friend? etc.
Required
Date of Death *
MM
/
DD
/
YYYY
Race/Ethnicity of the deceased *
Please describe in your own words the racial/ethnic/cultural heritage of the deceased *
Gender of deceased *
Age of deceased (or best approximation) *
Marital status of deceased *
Required
Religious affiliation of deceased *
Required
If the deceased was Muslim, did they identify with a specific community or particular sect of Islam? Click ALL that apply *
Required
Was the deceased an "essential" or "frontline" worker? *
Required
If you answered yes or no to the question above, what was the profession of the deceased?
Please select the description that best fits the deceased profession as we seek to understand which professions in our community have experienced losses.
Clear selection
What was the overall level of health of the deceased prior to contracting COVID-19? *
Poor
Very Good
Did deceased have one or more of the high risk indicators? (select all that apply) *
Required
Cause of Death Listed *
Was there a Janazaa service performed? *
What was the date of the Janaza? *
MM
/
DD
/
YYYY
City of residence of the deceased (optional)
State/Commonwealth of residence of deceased *
Is there any additional information you would like to include?
Have you sought counseling or grief support?
Clear selection
Zakat Foundation of America has created a COVID Memorial Wall to "honor your loved one(s) in a way that brings you some solace and comfort." If you would like to submit your loved ones name, see: https://www.zakat.org/covid-19-memorial-wall/
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