Water Marginalised: Findings in International, British Colonial, and Post- Colonial Health Discourses c. 1925-1975 Joanna Lunt Greenfield PhD University of York History November 2018 2 Word Count: 87,606 3 Abstract During the twentieth century a range of administrators and specialists were concerned with the place of water as both the origin of public health problems and a substance essential to human life. Taking a chronological approach between 1925 and 1975 this thesis explores the twists and turns as these actors sought to use such framings to shape British colonial, post-colonial and international health policy. Arguing that water was marginalised within fragmentary structures of imperial and international policy making until the WHO, with UN backing, placed it at the heart of public health in the 1970s, this thesis explains the fluctuating visibility of water within colonial, post-colonial, and international health discourse during this period. It focuses on the role of international health organisations and draws primarily upon WHO engagements with the African continent, in particular Uganda and Sudan, to illustrate the plethora of theoretical and practical interactions with water and health. It investigates how scientists and bureaucrats who were operating in international and British colonial spheres used the art of compromise to overcome constraints shaping final policy decisions. The role of water in international public health rarely features in the literature from the 1920s until the 1970s when the UN, the WHO, and other international organisations sought to bring water and sanitation as a pair to the forefront of international debates. Where water is present in the scientific scholarship of the times, it is predominantly treated as an interesting by-product rather than a central feature determining public health outcomes. In using the WHO’s Global Community Water Supply Programme (est. 1959) as a central point for analysis, this thesis explores how international health programmes before and after sought to encourage governments to prioritise investment in water supplies and sanitation. In doing so, this thesis deepens our understanding of twentieth- century engagements with water and sanitation in British imperial, British colonial, and international settings. 4 List of Contents Word Count 3 Abstract 4 Table of Contents 6 List of Tables and Figures 8 Acknowledgements 10 Declaration 11 5 Table of Contents INTRODUCTION 13 1. Literature Review 16 2. Sources and Methodology 42 3. Chapter Overviews 57 CHAPTER ONE: The Water Problem: c. 1920-1945 60 1. Water: An Enigmatic Entity? 1920-1945 63 2. The Bureaucratisation of Empire 1925-1945 74 2.1 Bureaucratic Fragmentation 78 2.2 Medical Departments and their Engagement with Water 84 3. Colonial Development in Uganda and Sudan 1929-1945 96 3.1 The Water Problem 97 3.2 Navigating the Nile 110 4. The LNHO: Disease Control to Social Medicine 1920-1940 118 5. Connecting Colonial and International Histories 1920-1945 134 6. Concluding Remarks and Legacies 139 CHAPTER TWO: A Problem of Underdevelopment? 1945-1963 146 1. A Problem of Underdevelopment? 1945-1963 148 1.1 The United Nations and the World Health Organisation 152 1.2 Britain’s Imperial and Colonial Development Strategies 168 2. Solving the Water Problem in Underdeveloped Territories? 177 3. Concluding Remarks 181 CHAPTER THREE: Weapons of Water: Sudan and Uganda 1945-1963 185 1. Negotiating the Nile: Sudan 1945-1963 186 2. Regionalisation and Departmental Reconfiguration in Uganda 1945-1963 201 3. Concluding Remarks 225 CHAPTER FOUR: Knowledge and Resource Deficiencies 1963-1975 229 1. Knowledge Deficiencies: Water Surveyed 1960-1975 231 2. Resource Deficiencies: Obstacles and Constraints Defined 1963-1975 252 3. Concluding Remarks 263 CHAPTER FIVE: Prioritising and Practicalities: Clean Water in the Post-Colonial Period 1963-1972 265 1. The WHO: Addressing Financial and Political Challenges 1959-1972 266 2. Prioritisations and Practicalities in Uganda and Sudan 1961-1972 275 3. Cooperation and Coordination: Addressing the Divided Responsibilities for Water 287 4. Concluding Remarks 308 6 CONCLUSION 312 EPILOGUE 320 LIST OF ABBREVIATIONS 325 APPENDICES 327 Appendix A: Organisation of Medical Services 1937 328 Appendix B: Epidemic and Endemic Diseases in Sudan 1928-1945 329 Appendix C: Technical Assistance Funds: Regional Distribution 1959-1963 331 Appendix D: United Nations Special Fund Technical Assistance through Specialised Agencies 1959-1963 332 Appendix E: World Health Assembly Community Water Supplies Resolution 333 Appendix F: Agencies Responsible for the Different Aspects of Water Resource Development 335 Appendix G: WHO Survey Responses 1970 336 Appendix H: Population Growth in Sudan and Uganda 1960-1972 337 Appendix I: Percentage Access to Water in AFRO and EMRO 1970 338 BIBLIOGRAPHY 339 7 List of Tables Table 1.1: Colonial Development Act Recommended Assistance 1929-40 98 Table 3.1: Sudan Government Recurrent Departmental Expenditure in order of Financial Priority 1951/52 and 1956/57 193 Table 3.2: Sudan Government Development Programme in order of Financial Priority 951/52-1956/57 193 Table 3.3: Land, Water and Population in East Africa 207 Table 4.1: Percentage and Number of People (‘000) Served Water Supplies in Uganda and Sudan 1962 and 1970 245 Table 4.2: Regional Percentages with Access to Water Supplies and Excreta Disposal Compared 247 Table 4.3: Comparison of Obstacles 253 Table 4.4: Knowledge and Resource Deficiencies 1968 255 Table 4.4: Knowledge and Resource Deficiencies 1968 (continued) 256 Table 5.1: Regional Needs against External Assistance provided for Community Water Supply 268 Table 5.2: Percentage of Funds Available and the Shortfall 269 Table 5.3: Community Water Supply Loans 1958-1971 (millions of US dollars) 271 Table 5.4: Investment in Community Water Supply (1970) against Required Investment to Meet the UN’s Second Development Decade Targets 272 Table 5.5: Sudan and Uganda’s investment in Water Supplies 1967-1972 276 Table 5.6: Expenditure on Selected Social and Community Services in Uganda (Sh, millions) 305 List of Figures Figure A: David Bradley’s Classification of Diseases Related to Water 15 Figure B: Discourse Convergence 43 Figure C: Bureaucratic Levels Focused Upon 44 Figure D: Some Regional Groupings on the African Continent 47 Figure E: Interagency Coordination 53 Figure 1.1: Water Supplies Papers, Books and Investigations in Sudan and British Eastern Africa 1923-1945 73 Figure 1.2: Colonial Government Structures 77 Figure 1.3: Colonial Development Act Fund: Category Distribution 1929-1940 99 8 Figure 1.4: Colonial Development and Welfare: Class of Schemes 1940-1946 100 Figure 1.5: List of Areas Requiring Attention and Their Principal Needs 104 Figure 1.6: Annual Rainfall in Uganda 1935 105 Figure 1.7: Average Rainfall and ‘native’ Population Density in Uganda 1935 106 Figure 1.8: Average Rainfall and Water Development Need in Uganda 1935 107 Figure 1.9: Staff to Population Ratio by Provinces in Sudan 1945 114 Figure 1.10a: Staff to Population Ratio in Sudan 1945, Khartoum & Northern Provinces 115 Figure 1.10b: Staff to Population Ratio in Sudan 1945, Blue Nile and Kassala Provinces 116 Figure 1.10c: Staff to Population Ratio in Sudan 1945, Equatoria and Upper Nile Provinces 116 Figure 1.10d: Staff to Population Ratio in Sudan 1945, Kordofan and Darfur Provinces 117 Figure 2.1: Roles and Responsibilities 150 Figure 2.2: The United Nations, its Organs, and Specialised agencies 153 Figure 3.1: Local Councils’ Investment Expenditure (percentage of total) 191 Figure 4.1: Water Supplies and Excreta Disposal Compared 1970 (‘000) 248 Figure 4.2: Distribution of Countries by Score for Each Factor Constraining the Development of Water Supplies 257 Figure 4.3: Percentage of Population with Access to Water Supplies in 1962 and 1970 (Countries replying both 1962 and 1970) 260 Figure 4.4: Reasons for Prioritising Community Water Supply Programmes 261 Figure 5.1: Total Community Water Supplies Activities 1959-1972 267 Figure 5.2: WHO/UNDP Pre-investment Projects on Water Supplies and Waste Disposal 1962-1974 268 Figure 5.3: Uganda Development Plan 1961/62-65/66 (£ '000) 277 Figure 5.4: Investment in Community Water Supplies 1960-1965 (US$) 283 Figure 5.5: Investment in Community Water Supplies 1965-1970 (US$) 284 Figure 5.6: Percentage of Community Water Supplies Activities as Specific and Component 301 9 Acknowledgements I am grateful for the generous Wellcome Trust PhD funding (Grant Reference: 097737/Z/11/Z) and for the grant-in-aid from the Rockefeller Archive Center (2014- 15), which has made this research possible. Archivists and librarians at the National Archives (London), the World Health Organisation (Geneva), the University Libraries in York, Cambridge and Oxford, and the Wellcome Trust Collection have supported fruitful research for this thesis; I am particularly indebted to A. B. Costa for collecting further material from the WHO Archives (2016-17). The completion of this PhD would not have been possible without the tireless efforts of my PhD supervisors, Dr. David Clayton, Dr. Sabine Clarke, and Prof. Sanjoy Bhattacharya, alongside the pastoral support provided by Prof. Simon Ditchfield and the entire History Department at the University of York. I am also grateful for the support of colleagues within the Centre of Global Health Histories (University of York). I am very thankful for the love and support from family and friends throughout the course of this PhD as they have read and proof-read drafts of this thesis. 10 Declaration I declare that this thesis is a presentation of original work and I am the sole author. This work has not previously been presented for an award at this, or any other, University. All sources are acknowledged as References. This thesis draws on material from dissertations from my BA History Degree and my MA History Degree at the University of York. It also draws on material from my 2016 publication (particularly for sections of Chapter 1): Joanna Lunt.