Lessons from the Past

15: Tangerian Ghosts and Riffian Realities: The Limits of Colonial Public Health in Spanish Morocco (1906–1921)135 Francisco Javier Martínez Antonio, Postdoctoral Fellow, Laboratoire REHSEIS, Paris Introduction In May 1930, the internationally-renowned Italian parasitologist, Gustavo Pitta- luga, (who had settled in Spain) and one of his disciples, Francisco Ruiz Morote, visited the Spanish Protectorate in Morocco after attending the International Conference on Malaria held in Algiers. They were accompanied by Captain Dr. Joaquín Sanz Astolfi, Director of the Laboratory of Clinical Analysis of the Tettouan Military Hospital, who had also travelled with them to Algiers as repre- sentative of the Protectorate’s Health Services (Sanz Astolfi 1931–1932). During their short trip, Pittaluga and Morote got a glimpse of the Protectorate’s health organisation and institutions, its sanitary conditions as well as the plans and outcomes of the first anti-malarial campaign launched the previous year. After the visit, they published a paper in Pittaluga’s journal, Medicina de los Países Cálidos, which also appeared in África, the journal of the Spanish Army in Morocco. In that paper, Pittaluga claimed that Spanish health initiatives in Morocco had been guided in an excessively military sense, abandoning some of the main scien- tific and public health orientations which must be the base, never to be for- gotten, of every doctor’s actions […] (Pittaluga & Ruiz Morote 1930). But he added “that all prevention has vanished on contact with a cosy, full-of- promises reality” (Pittaluga & Ruiz Morote 1930). Morote confirmed this impres- sion when he wrote that remembering the visit is enough to eagerly wish that the work developed there would become better known in the metropolis and to know to what extent public health work has contributed and is contributing to improving the population health status and to easing Protectorate’s duties. Out of all initiatives, for Morote the most impressive ones are those concerning rural dispensaries [strictly called “dispensaries for natives”]. They are advanced posts of civilization, now 135 This work was begun as part of a research project of the Spanish Ministry of Science and Technology (Ref: BHA2001-2979-C05-03) directed by Prof. Jorge Molero Mesa and has been completed with the aid of a Postdoctoral Fellowship from the Spanish Ministry of Education and Science (Ref: EX-2005 060). I would like to thank Arantxa Martínez Antonio for her translation. 180 enjoying the peace they contributed to sow in such an efficient way (Pittaluga & Ruiz Morote 1930). In fact, by the time of Pittaluga and Morote’s travel, there existed a network of 58 “dispensaries for natives” in Spanish Morocco, ten of them in the towns and 48 in the countryside, spread throughout the Protectorate’s territory. They were run by Spanish doctors and Spanish and Moroccan auxiliary personnel. They generally had exploratory, analytical and surgical equipment and small infirmaries, and they were provided periodically with drugs, vaccines and, when necessary, with disinfection devices. These dispensaries had begun to offer outpatient, clinical and surgical care and were used as the basis for the launching of the first health campaigns against malaria, typhoid fever or syphilis (Delgado 1930). The network of dispensaries may be taken as a symbol of the deployment of a health system in Spanish Morocco. Its presence was represented throughout the 20,000 km2 of territory, and its coverage of a population that overall was estimated at between 600,000 and one million inhabitants. But things had been quite different in the years prior to the Rif War (1921– 1927) and, obviously, in the course of it. Despite a tradition of medical activities in Morocco since the last quarter of the 19th century, Spain was unable to establish more than four urban and sixteen countryside dispensaries in its Protectorate zone before 1921. In this first period of existence, activities of dispensaries for natives were hindered by personnel and equipment problems, by the lack of proper facili- ties and funding, and by the lack of administrative co-ordination between the ministries of State and War and between Tettouan and Melilla. Spain also acted under pressure of measures taken by France in its much larger Moroccan Protec- torate, exhibited in either its inability to match developments there, or in the constant menace of French interference in the Spanish zone (Martínez Antonio et al. 2003; Molero Mesa et al. 2002; Molero Mesa 2003). However, as this paper attempts to show, another major obstacle for the creation of dispensaries for natives during this period was the relative persistence of Morocco’s public health structures and agency. Since the 19th century, Moroccan public health action had been expressed in different forms, ranging from government participation in modern state-wide organs, such as the Sanitary Council of Tangiers, to popular rejection of foreign intervention. Most historiography on the French and Spanish Protectorates in Morocco has tended to ignore or underesti- mate the development of the Moroccan state prior to and after 1912, though as it will be seen, Moroccan agency proved resilient and influenced public health developments in the Spanish and French Protectorates for many years after they were formally established. When this agency is systematically taken into account, the question of the colonial character of the Spanish (and French) Morocco’s health system arises. Many historians have argued that the Protectorate regime was only a façade for direct colonial action (Hoisington 1995; Rivet 1996; Gershovich 2000; Pennell 2000; Villanova 2004). However, the impact of events taking place in Morocco was too strongly felt in metropolitan Spain (and France) to consider them as 181 “merely” colonial. Conversely, Spain (and France) had to display too much direct intervention to control Moroccan authorities and territory to describe their activities as “mere” colonization. In the case of Spain, it seems especially clear that differences were not of such a degree as to explain its relationship with Morocco in colonialist terms. Their interaction resembled more a conflict between countries of similar (weak) power: similarity led to war, not to colonization, and to expro- priation or seizure of local authority, not to its intervention. An attempt will be made to clarify this crucial issue, although present conclusions cannot be but tentative, as they are based almost exclusively on Spanish and French sources. The main hypotheses may nevertheless be taken into consideration while the process of gathering data from Moroccan archives is carried out. Specific public health developments concerning the Jewish community are not addressed in this paper, an absence which should also be corrected in future works. Caring for the Ports and the Army Public Health and the State in 19th Century Morocco Did Moroccan Public Health Exist? In order to understand the weight of the Moroccan “factor” in the creation of dispensaries for natives in Spanish Morocco, it is first necessary to examine the trajectory of Morocco’s public health during the 19th century. In broad terms, the period 1822–1894 was an epoch of relative stability for the country, especially the last twenty years (Laroui 1993). Such stability, however, far from being static, was a fruit of a constant, tension-filled compromise between the numerous forces which operated on the Moroccan stage. Internally, the Sultan and the Makhzan (Moroccan government) interacted with local actors (caïds = governors, zawias = religious brotherhoods), social groups (ulamas = religious experts, commercial bourgeoisie, urban artisans) and certain territories (Rif, High Atlas, Saharan oasis) in order to reach some degree of cohesion for Moroccan society. Externally, the autonomy and sovereignty of Morocco evolved through relationships with several European and Western states as well as other Arab-Islamic countries (mainly the Ottoman Empire and Egypt) and with nearby colonies (French Algeria and Senegal), foreign enclaves (Spanish strongholds in the north and factories on the Saharan coast) and British Gibraltar. The international status quo on the so-called Moroccan question (parallel to other questions d’Orient such as the “Ottoman question” and the “Chinese question”) was maintained to some extent throughout the century. Out of this dynamic and troublesome balance, a number of administrative, eco- nomic, military, institutional, legislative, cultural or political transformations materialised. However, they are usually interpreted as the outcomes of “informal” or direct imperialism exerted on the country, whose only chance was to resist and delay them as much as possible. But in accordance with authors such as Abdallah Laroui or Wielfried Rollman, it could be said that the role played by Moroccan authorities in those transformations seems more active than mere resistance. In the field of public health the following questions must be asked: what was Moroccan 182 in Morocco’s public health, if anything? And what were the effects of such “Moroccanness” in the health system, if any? Based upon this author’s PhD research (Martínez Antonio 2005a) it will be first argued that “Moroccanness” or Moroccan agency consisted of two coupled mechanisms of multiple diversifi- cation and personal/oligarchic authoritarianism. On the one hand, attempts were made to keep unstoppable European intervention in matters of medicine and public health

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