<p>The identification of deceased individuals is a mandated component of medico-legal death investigations. Due to the unique taphonomic circumstances of decedents retrieved from aquatic environments, identification is often challenging. This study retrospectively examined 289 cases of deceased individuals recovered from aquatic environments that were admitted to Salt River Mortuary in Cape Town between January 2017 and December 2021. Case report data and associated documented information were analysed to evaluate reported post-mortem submersion intervals (PMSI), recovered body segments, and identification methods to inform future procedural improvements and prevention strategies. Findings indicated that 48.4% (140/289) of cases were recovered from the ocean. Overall, 33.2% (96/289) of cases were admitted to the mortuary with unknown identity, among these, 25.0% (24/96) were not identified after the medico legal investigation. The presumed identities of a further two cases were unconfirmed following post-mortem investigation, resulting in 9.0% (26/289) decedents remaining unidentified. Most unidentified decedents were recovered from the ocean 69.2% (18/26). Samples for DNA profiling were collected in 28.4% (82/289) cases and were successfully used in identification for 32.9% (27/82) cases. The average post-mortem submersion interval was less than two weeks for 51.2% (148/289) of cases but was undetermined for 47.8% (138/289) cases. The taphonomic environment of aquatic cases results in rapid and extensive breakdown of biological tissues leading to reduced rates of identification, which requires scientific focus and attention. To enhance identification rates for aquatic cases, further research into methodological and technological adjustments are required. In particular exploring alternatives to visual identification through use of DNA analyses and a better understanding of taphonomic processes in these aquatic environments may improve medico-legal death investigations.</p>