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 PALESTINE 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 (Jerusalem, 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 Jews 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 Arabs 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.