J R Army Med Corps: first published as 10.1136/jramc-92-01-02 on 1 January 1949. Downloaded from f 24

NARRATIVE OF THE MEDICAL EVACUATION OF COMMAND from January 1 to June 30,1948

BY Brigadier A. J. BEVERIDGE D.D.1YI.S. Palestine Command

GENERAL THIS narrative deals with the Medical Evacuation of, Palestine from Jauuary 1, 1948, to the final evacuation. The planning for the evacuation started in November 1947 but it did not affect the rundown of :Medical Units 2021 by guest. Protected copyright. before January 1, 1948. There were four phases : 1st Phase -Evacuation of the. Southern Sector (Gaza) 2nd Phase-Evacuation of the Central Sector (, Samaria and Lydda) 3rd Phase-Formation of Haifa Enclave 4th Phase-Final Evacuation The Medical Plan was prepared by Brigadier O. C. Link, late Deputy Director Medical Services, Palestine Command, and was adhered to-and worked with minor alterations. Hospital provision was based on 2·5 per cent of the Force ana this proved sufficient. The health of the troops was remarkably good and at no time was hospital accommodation taxed to capacity. Iu one instance the reduction in beds went ahead of the estimate and it was necessary to increase the British . Military Hospital, Haifa, by 200 beds for a matter of three weeks till the overall reduction of the number of troops allowed a corresponding reduction http://militaryhealth.bmj.com/ in equipped beds. The system adopted to cover the move of each hospital was to overlap a Field Force Unit (either Field Ambulance or Field Dressing Station) into the buildings of the existing hospital as the hospital moved out. The Field Force Unit then gf1Ve full Medical Cover to its formation (Brigade or Division Headquarters) until such time as that particular formation moved out. These Field Force Units .were supplemented by ad hoc Field Surgical Units which were equipped with X-ray equipment and a blood bank sufficient to give full

surgical treatment to fit the patient to move to a General HospitaL One on September 24, General Hospital (including a full range of specialists) was a1ways available in the Command.. In general it was a most successful system and it was never pushed to the limits for which it was intended. No difficulties were experienced in obtaining volunteer blood donors. J R Army Med Corps: first published as 10.1136/jramc-92-01-02 on 1 January 1949. Downloaded from A. J. Beveridge 25

HOSPITALS On January 1 there were five hospitals in the Command giving a total cover of 1,550 equipped beds = 2·5 per cent of the Force. These units were : Brit. Mil. Hospital, Bir Ya'acov 1,000 beds Brit. Mil. Hospital, Gaza 200 beds Brit. Mil. Hospital, Haifa 250 beds Brit. Mil., Hospital, Sarafand 100 beds Station Hospital, Jerusalem 50 beds No. 3 Convalescent Depot, Nathanya, was closed prior to January 1. Brief notes of these hospitals in the sequence in which they were reduced and evacuated: B.M.H. Sarafand,' This was always a small hospital and was housed in the buildings of the original H..A.F. Hospital at Sarafand. It has been used mainly as a Families Hospital. The Families section was moved to B.M.H. Bir Ya'acov in January. The hospital closed on January 22 and moved to Rafah, where it formed a Station Hospital Rafah. 2021 by guest. Protected copyright. B.M.H. Gaza,' This hospital had 200 equipped beds on January 1. It subsequently closed on February 20 and moved to Egypt for disbandment on February 25, when 61 Infantry Brigade moved out of the Southern Sector. Medical cover for the few remaining troops in the area was provided by the Station Hospital Rafah. B.M.H. Bir Ya'acav,' This was always the principal hospital in the Command and was reduced to 1,000 equipped beds on January 1. It was reduced to 600 beds 'on February 1 and from then on gradually reduced by moving special departments (E.N.T. Orthop~dic, etc.) to B.M.H. Haifa. By Marcll1 it was 300 beds, and finally closed on April 12. It moved to Egypt for disbandment on April 16. Sin. Hasp. Jerusalem,' Originally equipped for 50 beds it was reduced on February 1 to 40 beds and later to 20 beds. Its main function was to act as an emergency surgical centre for Palestine Command Headquarters and for the Jerusalem Garrison. It was most successful as such and provided a full service until May 7 when it moved to Egypt for disbandment. B.M.. H. Haifa,' This hospital had 250 equipped beds and was increased in February to 550 beds. This number was gradually reduced from May 20 till 100 beds remained on June 12, The unit closed on that date and proceeded to Egypt on 15th for disbandment. http://militaryhealth.bmj.com/ HYGIENE General.-On account of the general evacuation the maintenance of a, high standard in regard to hygiene was not possible but a sufficiently high standard was maintained to prevent epidemics. Several incidents of contractor's failing to fulfil their obligations for clearing garbage, etc., occurred but these difficulties were generally overcome. The only major incident was at Haifa throughout April when Jew-Arab fighting led to a complete withdrawal of Arab labour and for approximately ten days between April 20 and 30 when no Municipal Services were available. Gradually the services were restarted but in the meantime the. fly breeding had started and the nuisance became almost on September 24, intolerable. Coincident with this a quantity of flame thrower fuel became available for destruction so opportunity was taken to burn quantities of rub bish and garbage in situ and so sterilize the ground. Whole rubbish dumps were destroyed in this way with' almost dramatic cessation' of the fly nuisance. / J R Army Med Corps: first published as 10.1136/jramc-92-01-02 on 1 January 1949. Downloaded from 26 Narrative of the Medical Evacuation of Palestine Oommand

The incinerated material was subsequently buried with the help of bulldozers. Frequent hygiene bulletins were issued through Staff Channels and hygiene slogans appeared in the Daily Newsheet. Enteric Fever.-One outbreak of enteric fever occurred in the Acre area involving 76 cases. This outbreak started on April 22 and closed on May Hi. lt was mixed ~fection of typhoid and paratyphoid" B " (27 cases showed mixed infection). The outbreak was confined to 1 Coy. of the 2nd Battalion The Middlesex Regiment and to one section of the Palestine Police. The cause of the outbreak was due to the stopping of automatic chlorination of the Acre water supply by the Acre Municipal Authorities who did not inform their consumers of the stoppage. "D" Coy., 2 Bn. '['he Middlesex Regiment, were stationed at Caesar's Cainp, Acre, and the Palestine Police were stationed in the Police Barracks in Acre. The total Europeans at risk were: " D " Coy. Middlesex Regt. 107 = 65 cases 60·74 per cent. Palestine Police 64 = 11 cases 17·2 per cent.

Total 171 2021 by guest. Protected copyright. Total number of cases 76 = 45·5 The water supply for Acre is from natural springs at Kabri, a small town 9~ miles north of Acre, and is brought by an old Crusader aqued~ct through Jewish and Arab 1ands to Acre. This aqueduct was broken on several occasions by and difficulties were experienced in repairing, maintaining and cleaning the aqueduct (police escorted Arab workers for the work while the Jews undertook repairs where the aqueduct passed through their lands). It is not known if the Jews did actually repair the damage but the supply of 'water was reduced and it was necessary to draw in a new supply from the Government Stud Farm about 2J miles from Acre. The municipality ran out of chlorine (cylinders) on approximately March 17, and there was difficulty in getting replacements from Haifa (Jew-Arab tension was very marked at this time with very frequent attacks on either side as well as destruction of . roads). One of the results was the stoppage of chlorination of the water supply. The R.M.O. did routine bacteriological tests on April 13 and as a result of

these tests gross contamination was revealed. Instructions to boil water, etc., http://militaryhealth.bmj.com/ 'were immediately issued but the damage was done and both Police and Middlesex Regt. were moved out of the area to a camp nearer Haifa. The lVLO.H. Acre went to Beirut (his family were suffering from typhoid) and in general chaos reigned in Acre between April 20 and 30. The normal population of 2:3,000 was increased to 40,000 by influx of from Haifa; when it was known to the civil population that there was typhoid in the tOWll the cjvilians left so that on May 10 there were only 4,500 remaining and this was r~duced to 1,500 by May 15. The remainder had taken themselves off to Syria or the small villages surrounding Acre. There was no control of the epidemic amongst the civil population (Acre was outside the Haifa Enclave on September 24, and so was not a Military or civil commitment of the G,O.C.) as the M.O.H. for that Area only paid sporadic visits to his Municipality. The International Red Cross endeavoured to help but got little or no co-operation from the Civil Authorities. J R Army Med Corps: first published as 10.1136/jramc-92-01-02 on 1 January 1949. Downloaded from A. J. Beveridge 27

Malaria.-During tIle period there were 6 Anti-Malaria Control Units in the Command,' of these four were disbanded and two moved to other Commands. The work of these units was frequently interfered with by Jew­ Arab tension and on one occasion in the Acre area a unit was fired-on and one of the escorts and one Arab labourer were killed and one British N.C.O. wounded. Craforce-an independent Force--operated in the area immediately north of Tiberias as far as the Syrian border. The work of the A.M.C.U.s was very specially effective in preventing any malaria in this area. The incidence of malaria in the Huleh Area, where Craforce ollcrated, is very high and produces malaria' from April 1. Craforce was withdrawn on May 14 and during that time no malaria occurred amongst those British troops in that Area. Suppressive mepacrine was instituted in Craforce, in Ramid David Aero-­ drome Area, and in Camp 190 area with very good results. The system of issuing mepacrine through the supply points with the rations was adopted and checks were instituted regarding the consumption of mepacrine with a view to preventing waste. These checks were effective in bringing to light defects in units administration and also controlled consumption oLan item which has 2021 by guest. Protected copyright. a' highly saleable value. In the Kurdani Area, immediately north of Haifa (an extensive swamp area), heavy breeding of the four usual types of malaria-carrying mosquito were found. Twenty-seven cases of malaria occurred in the Command during the period of which only one was fresh infection, twelve of the relapses were in Mauritian troops.' D.D.T.-12,500 gallons D.D.T. residual spray were issued to various Loca~ Authorities in the Haifa area between May 15 and June 30 on repayment.

EVACUATION OF PATIENTS }'ROM PALESTINE No great difficulties were experienced regarding evacuation but it was necessary to have one medical officer trained as an embarkation medical officer. This officer acted as E.M.O. at Haifa till the end of the evacuation and proved a great asset. A. Independent Wm'd Coackes.-I.W.C.s continued to operate from Lydda to Kantara on the daily mail train until March 26. Only on one occasion, http://militaryhealth.bmj.com/ during the last week of January, was it necessary to use more than one coach a day. During that particular period six coaches were despatched in one week. Two on one day. The total number of patients evacuated by train was 465. B. Hospital Ships arid Troop Skips.-When it became evident about mid­ March that evacuation by train would cease to operate it was decided to evacuate all suitable cases by troopship to Egypt or to U.K. In addition there were three lifts by Hospital Ships up to June 15. After that date the Hospital Ship "Oxfordshire" remained at Haifa as a floating hospital until the final evacuation. The total number of patients evacuated by this method on September 24, was 878. C. Evacuation by Air.-Three cases were evacuated to Egypt by Air and cight cases (Arab Legion) to Amman~ The total number by air = 11. Air evacuation was used on three occasions in Palestine to evacuate surgical cases to the main surgical centre. J R Army Med Corps: first published as 10.1136/jramc-92-01-02 on 1 January 1949. Downloaded from 28 Narrative of the Medical Evacuation of Palestine Command

The total number by all means = 1,354. 1110to1' Ambulances.-There were 390 Motor Ambulances in the Command on .January 1. As each formation left the Command it took the full WjE of Motor Ambulances with its Medical Unit to the new destination. Bv June 1 the number of ambulances was reduced to 28 (including 14 for No. V;ji) Field Ambulance). One ambulance had to be destroyed by fire during the evacuation from Jerusalem--it became a non-runner and towage of such vehicles was not permitted. All ambulances were evacuated by June 28, 1948., Te1'I'OJ'ist Activity.-The total number of casualties resulting from terrorist activity admitted to ilOspitals (luring the period were 4Jj6. .

CIVILIAN DETAINEES Up to lVlay 15 the medical care for all civilian detainees was a responsibility of the Government of Palestine. After that date it passed to the Military Medical Directorate when 121 detainees were tahm over. Several attempts were made by the Jewish Agency to obtain release of these detainees on medical groimds. In order to obviate complaints' of this nature a Medical 2021 by guest. Protected copyright. Board of Specialists was held on May 9 when all chronic medical cases ,yere examined and directions regarding treatment, etc., given .. On June 1 the number of detainees was reduced to twelve and these remained a military mediealresponsibility till the end of the evacuation. No difficulties were ex­ perienced in carrying out this commitment.

FOOD SUPPLIES Normal supplies were maintained lmtil the move into the Haifa Enclave, after which difficulty was 'experienced in maintaining fresh vegetables and eggs. The prices of these items rose rapidly till they reached a peak of 14 times normal. Small quantities of vegetables were imported from time to time from CYPl;US and Egypt; tinned vegetables were supplied when fresh items were not available. Fresh meat, potatoes and fruit were available throughout the whole period. It was unnecessary to issue compound vitamin tablets at any time. STORES http://militaryhealth.bmj.com/ Accommodation Stores of Medical Units were returned to the nearest Barrack Store. G 1098 Stores.-Units moved to Egypt or other Commands with their G 1098-any items surplus were returned to the nearest Ordnance 'Depot. JJ1ediwl Stores were all returned to G.H.Q. Medical Stores in Taka. In general the svstem worked weH and the various stores reached their correct ~ destinations. The amount of .Medical Stores evacuated = 1,148 tons. PROVISION OF HOSPITAL ACCOMl\WDATION In planning the evacuation a requirement of 2·5 per cent beds with a on September 24, GO-day holding policy for the force was accepted. In February this requirement was reduced to 2 per cent-this figure was not always adhered to as the static installations moved out of the Command and the Field Force Units provided sufficient medical cover. The average occupied bed state never exceeded J R Army Med Corps: first published as 10.1136/jramc-92-01-02 on 1 January 1949. Downloaded from A. J. Beveridge 29

1·47 per cent so there was' always at least 25 per cent beds available, an indteat.ion that there was a slight over-insurance if anything. To offset any quest.ion of under-insurance the time factor for' evacuation of cases to Egypt was only twent.y-four hours and Field Force Units were never used to full capa,eity. HOSPITAL' BEDS EQUIPPED AS % OF STRENGTHS A verage monthly Beds equipped as strength of the on 1st of each Month Command month % beds

January 61,360 1,550 2·53 Februarv 52,695 1,070 2·03 :March 48,812 921 1·89 April 42,281 571 1·35 May 25,488 336 1·32 June 8,960 250 2·79

HOSPITAL BEDS OCCUPIED AS OF STRENGTHS % 2021 by guest. Protected copyright. Average 1110nthly Beds occupied strength of the as on 1st day MonUz Com111and of each month % beds

JanuaFY 61,360 900 1·47 February 52,695 731 1·39 ::\Iarch 48,812 504 1-03 April 42,281 '291 0·69 Nlay 25,488 234 0·92 June 8,960 1'17 1·31 MEDICAL STATISTICS AND COMMENTS THEREON AD~IISSIONS TO ALL TYPES OF MEDICAL UNITS (RATIO 1/1,000) ALL CATEGORIES OF THooPS - COMPARATIVE FIGURES 1947 - 1948 Disease or January February March April May June 11IjUI')' Adllls. R/100(J Adlll". R/1000 Adms. R/1000 Ad",s. R/1000 Ad",s. R/lOOO Adms. R/1000

Dysentery 47 18 0·26 15 0·21 125 1·63 236 3·00 195 2·39 181 2·16 http://militaryhealth.bmj.com/ (All types) 48 22 0·36 20 0·38 8 0·16 9 0·21 36 1·41 18 2·01

Enteric 47 0·01 0·01 4 0·05 28 0·34 10 0·12 fever (all types) . 48 2 0·03 2 0·04 4 0·08 32 0·76 35 1·37

Mala.ria 47 27 0·38 19 0·26 32 0·42 27 0·34 26 0·32 37 0·44 (all types) 48 9 0·15 4 0·08 3 0·06 2 0·05 3 0·12 7 0·78

Venereal 47 99 1·41 80 1·10 87 1·14 68 0·87 79 0·96 66 0·79 disease (all on September 24, types) 48 4.6 0·75 35 0·66 22 0·45 13 0·31 13 0·51 4 0·45

Injuries 47 398 5·64 326 4·47 428 5·60 287 2·51 356 4·37 274 3·27 (all types) 4S 301 4·91 320 6·07 309 6·33 253 5·98 146 5·73 38 4·24 J R Army Med Corps: first published as 10.1136/jramc-92-01-02 on 1 January 1949. Downloaded from

30 Narrative of the Medical Evacuation of Palestine Commn,nd

ADMISSIONS TO ALL TYPES OF MEDICAL UNITS ALL DISEA~ES 1947 1948 Adms. R/l,OOO ."ldms. Rjl,OOO

January 2,111 29·91 1,533 24·98 February 2,055 28·20 1,298 24·63 March 2,445 31·97 1,074 22·00 April 2,421 30·82 695 16·44 May 2,660 32·62 522 20·48 June 2,609 31·14 191 21·32

AVERAGE CONSTANTLY SICK ALL CATEGORIES OF TROOPS 1947 1948 Av. Const. Sick R/l,OOO Av. Cot/st. Sick 1\'/1,000

January 1,234·47 17·49 832·00 13·56 2021 by guest. Protected copyright. February 1,355·27 18·60 764·00 14·50 March 1,385,20 18·11 515·25 10·56 April 1,452·73 18·49 260·60 6·16 May 1,488·10 18·25 223·00 8·75 June 1,446·00 17·26 65·29 ?·29 The average hospital admission rate and the average constantly sick rate per 1,000 compare very favourably with the corresponding rates over the same period in 1947-there is a slight increase in the figures for dysentery during January and February which is followed by a marked decrease in the following months. Towards the end of the operation the admission rate for diseases fell to half ,the expected rate and the average constantly sick to nearly one-third of normal. The malaria figures are specially creditable and, indicate a high standard of malaria discipline in units. Credit must be given to " suppressive mepacrine control" where it was applied and to the excellent work of the anti-malaria control units . . Enteric fever has already been mentioned and the marked increase in figures is due to one isolated 'incident in April and May. The incidence of http://militaryhealth.bmj.com/ venereal disease has always been low in Palestine over the past three years and this is partly due to racial animosity and that opportunities for infection were not available in that troops were confined to barracks or zones after nightfap. It is the impression of medical officers that the high state of morale of the troops under operational conditions discouraged the average other rank from reporting sick until they could carry on no longer. Previously a trivial cut or abrasion which would appear on sick parade was now delayed until it was an advanced whitlow. To this ,must be added the anxiety on the part of all ranks on September 24, to leave Palestine with their units. The spirit and physical fitness of the troops was an inspiration to alL One cannot close this narrative without a tribute to all members of the Medical Services for their devoted attention, treatment and nursi~g of all those that came under their care.