Pandemics and plagues in the Holy Land

The following excerpt is from 
Pandemics and Plagues in the Holy Land
by Rachel Neiman 3/1920 israel121c

Spanish flu and Malaria: A *lethal combination

In August 1916, there was a cholera outbreak among British army troops in transit camps in the Sinai desert.

The mobile malaria diagnosis stations provided rapid diagnosis and treatment to EEF soldiers suffering from malarial fever. Credit: Australian War Memorial

A medical unit – eventually called the ANZAC Field Laboratory – was set up with the mission of stopping the disease from crossing the Suez Canal. Once the cholera threat had passed, the Field Laboratory was tasked with combating malaria. It moved, with equipment borne on horses and camels, across the Sinai toward the Jordan Valley.

General Edmund Allenby, who had assumed command the British Army’s Egyptian Expeditionary Force (EEF) in late June 1917, was ready to go into battle, even in the face of malaria.

The Royal Army Medical Corps was authorized by Allenby to form six small mobile stations which provided rapid microscopic diagnosis followed by quinine chemotherapy. But Allenby hadn’t banked on also battling the Spanish flu.

While there are no exact mortality figures for the 1918 Spanish influenza pandemic, it is generally considered the worst demographic disaster of the 20th century.

According to the US Centers for Disease Control, about 500 million people — one-third of the world’s population then — were infected with the virus. At least 50 million died.

On October 31, 1917, the EEF launched one of the last great cavalry campaigns and defeated the Turkish Army in the Battle for Beersheva.

This victory would soon be overshadowed by twin epidemics of malaria and Spanish Influenza. The synergy between the two diseases appeared to be particularly lethal.

“In the Egyptian Expeditionary Force (about 315 000 soldiers), disease casualties outnumbered those due to combat by more than 37 to 1,” writes infectious disease expert G. Dennis Shanksin “Simultaneous epidemics of influenza and malaria in the Australian Army in Palestine in 1918.

This deadly duo did not spare the 7,000-strong British Army Jewish Legion. According to Kjell Jostein Langfeldt Lind’s “The Impact of the 1918 Spanish Influenza Pandemic on Greater Syria,” The Jewish soldiers that saw action in the Palestinian theatre suffered disproportionately to their modest contribution on the battlefield. Their casualties are usually reported as due to malaria. It is highly likely that the flu virus interacted with the malaria parasite.”

Most British military operations were curtailed before the final battle of the Palestine campaign in September 1918. Success may have been due, in part, to the fact that the Ottomans were also hit by both malaria and influenza.

Deportation, famine and; disease

The civilian population fared no better.

On April 6, 1917, Governor Pasha authorized the forcible deportation of the entire civilian populations of Jaffa and recently established Tel Aviv. During the 1917-18 winter, an estimated 1,500 of the deported Jews died of famine and disease.

After the British conquest, the deportees began returning and the problem of relief became acute. In a 1919 news interview, Dr. M.D. Eder of the British-based Zionist Administrative Commission described a situation in which 6,000 homeless exiles were to be repatriated.

“Following this came the question of hygiene, aggravated by the epidemic of influenza which affected Palestine as it has affected the rest of the world. The weakened condition of the population and lack of proper food made this epidemic particularly disastrous. This was followed by an outbreak of cholera in Tiberias…”

The British Mandate: A new era in healthcare

In 1918, Hadassah established the American Zionist Medical Unit that helped open and reopen six hospitals.

With the advent of British military rule, a new chapter in public health began, combining public services and private organizations, and providing a model for the future State of Israel’s healthcare system.

The Health Department, established in 1922, operated hospitals, clinics, and laboratories. Vaccinations for typhoid, cholera and smallpox were made compulsory. The British army’s anti-malaria campaign that had started with the Field Laboratories continued draining swamps and covering wells.

Eye clinics, school medical services, well-baby and outpatient clinics mainly served the Arab population, while the Jewish sector was given license to provide its own services.


Nurses and physicians from the American Zionist Medical Unit
on camels in Egypt en route to Palestine in July 1918

Hadassah Women, established in 1912 to provide healthcare in Ottoman-ruled Jerusalem, sent two nurses in 1913 to set up a small public-health station for maternity care and trachoma treatment. However, the station was shut down in 1915 as the Ottomans suspected Jews of being enemy sympathizers.

Under British rule, in 1918 Hadassah established the American Zionist Medical Unit (AZMU) that helped open six hospitals. Hadassah ran laboratories, pharmacies, dental clinics and well-baby clinics, as well as sponsoring programs to fight tuberculosis and trachoma, and headed the Zionist anti-malaria campaign until 1927.

Three workers’ “sick funds” founded in 1913, 1915 and 1916 were united in 1921 under the auspices of labor union Histadrut (General Organization of Workers) and renamed Kupat Holim Clalit (General Health Fund). Other HMOs soon followed and by the late 1950s, almost 90% of Israel’s population was insured.

Which may explain how, when the Asian flu pandemic of 1957 circled the earth, Israel’s health system was able to deal with the disease so effectively that it, along with Western Europe, the US and Egypt, placed among the lowest on The Journal of Infectious Disease’s scale of 46 countries ranked for excess mortality due to pneumonia and influenza.

Today, Israel’s health system ranks among the world’s best, with universal basic healthcare, top hospitals, and world-leading medical and clinical research, medical technology and biotechnology. We’ll just have to wait and see how it copes with the latest pandemic to hit the world.

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ALERT
*When the “flu season” of 2020 reappears in the fall, will there be a resurgence of the coronavirus? Again creating a “lethal” brew chv's attacking mercilessly like the 1918 pandemic?? Is this not the threat of today’s CDC and WHO?