This blog post by David Brydan is part of, and has been cross-posted from, Remedia blog which examines the history of medicine in dialogue with the present. The project focuses on areas of the history of medicine with particular contemporary relevance. The original post can be accessed here.
In November 1941, health officials and experts from 20 states attended an international tuberculosis conference in Berlin, founding a new international association to fight the disease.[i] On the surface, it appeared to be a straightforward example of the type of international health cooperation that had become increasingly common since the mid-nineteenth century.
The reality, however, was very different. The conference was organized by the Reich Health Office, and involved only Axis, occupied, or neutral states. It took place in the context of a European public health crisis provoked by the Nazi war effort and occupation, a crisis which witnessed the deliberate starvation of millions of Soviet prisoners, restriction of food, fuel and medical supplies across the occupied territories, and the unchecked spread of disease in Jewish ghettos.
In the midst of this political, military and public health crisis, experts from across Europe continued to cooperate under the rubric of the Nazis’ European ‘New Order’, working together on tuberculosis, typhus, health insurance, and other issues.[ii] Their conferences and meetings consciously echoed the language and practices of pre-war international health. Participants emphasized the technical and humanitarian credentials of international cooperation, and their shared interest in tackling diseases which transcended national borders.
But what, if anything, was distinct about these forms of fascist international health? And how do we square them with the implacable hostility European fascists felt towards the internationalism embodied by organizations such as the League of Nations?
Totalitarian Public Health
For many of those involved, the restructuring of European political life under Nazi dominance provided the opportunity to forge a new, more effective form of international health. Speaking at the 1941 conference, the president of the Reich Tuberculosis Committee, Otto Walter, lamented that international efforts to tackle the disease in the past had not always been effective. The war, he argued, had brought the people of Europe into much closer contact than ever before, ushering in a new era of ‘intimate collaboration’ which would allow them to move beyond the sterile debates of the past and implement real change.[iii] Under the Nazi New Order, the talking shops of pre-war international health would be replaced with vigorous, effective action to stamp out disease.
The flip side of this argument was that cooperation between health experts would act as a stepping-stone towards wider European integration under Nazi dominance. For Walter, public health was the ideal vehicle for strengthening international cooperation, because ‘no state wishes to become better than the others in preserving the health of its own people.’[iv] The Reich Health Minister, Leonardo Conti, compared the new anti-tuberculosis organisations to the political mission of the Anti-Comintern Pact, which reflected the unity of ‘intimately connected peoples, who constitute a bloc with a common destiny.’[v]
Some participants argued that this unity was underpinned by a shared commitment to a new form of ‘totalitarian’ public health. Spanish experts in particular argued that the totalitarian states of the New Order had rejected the individualistic medicine of pre-war liberalism. In its place, they argued, these states were creating health systems geared towards the ‘imperious necessity to attend sufficiently to the multitude’, harnessing the power of the state in the interests of the Volk or pueblo as a whole, rather than the priorities of individual patients and doctors.[vi] Others identified a new ‘totalitarian theory’ of health insurance emphasizing labour and the family, which had ‘come to fill a void and resolve a problem which has never, until now, been solved within the framework of national legislation.’[vii]
Widely shared enthusiasm for the idea of totalitarian public health in part reflected the political sympathy many of Europe’s health experts felt towards fascism and the Nazi project. But not all of those involved in these forms of wartime international health cooperation were fascist fellow-travellers. Many had worked with groups such as the League of Nations Health Organisation and the Rockefeller Foundation before the war, and would go on to cooperate with the WHO and UNICEF after it.[viii] Others, including Spanish participants in the 1941 tuberculosis conference such as José Palanca and Gerardo Clavero, belonged to more conservative factions within authoritarian national regimes, and consciously distanced themselves from fascist politics.
For these individuals, however, cooperating with Nazi Germany on public health conveyed a range of benefits, including professional prestige, access to international networks, and the opportunity to negotiate with German authorities for scarce supplies of drugs and vaccines. These professional and practical benefits outweighed political concerns about collaborating with the Nazi regime.
‘The Nazis despised me’
Perhaps unsurprisingly, these forms of fascist international health were beset by tensions between the nations involved. Some of the tensions stemmed from ideological differences, including over Nazi attitudes to race, religion and eugenics. Experts in Italy and Spain were more comfortable with the idea of a ‘positive’ Latin eugenics underpinned by Catholic values than with the hard, biological eugenics of the Nazi regime.[ix] This was reflected in patterns of international cooperation in the fields of population policies and racial hygiene. Generally, Spanish, Italian and Portuguese experts were keener to work with each other rather than with their counterparts from Nazi Germany.
These ideological differences, however, should not be overstated. Far more significant were the tensions stemming from the hierarchical nature of the Nazi New Order. International health under the New Order was largely planned and coordinated from Nazi Germany, and was designed to cement German leadership within the new European scientific community.
Although Italy remained a relatively equal partner until Mussolini’s fall from power in 1943, other countries were emphatically subordinate. The head of the Italian Anti-Tuberculosis Federation, for example, was appointed president of the new International Association Against Tuberculosis established in 1941, but the organization was based in Berlin and run by German health officials with only minor roles reserved for Spanish and Hungarian experts.
Like many of the Europeans who visited Nazi Germany during the war, non-Germanic health experts were conscious of their subordinate status in Nazi racial hierarchies. ‘As a southerner and Mediterranean’, wrote one Spanish expert in his memoirs, ‘I knew at the end of the day that the Nazis despised me.’[x]
The Politics of International Health
International health cooperation during the Second World War represented an effort to forge a new European health system under German control, part of a wider attempt to establish a New Order for science and culture in Europe.[xi] At its peak between mid-1941 and the end of 1942, the future of this New Order seemed assured, attracting the willing participation of health experts and officials from across the political spectrum of the European right. The project failed, however, and left little lasting trace on the international health landscape. Despite the tensions between the participating countries, this failure was the result of Axis military defeat rather than inherent scientific or ideological contradictions.
The history of fascist international health suggests that we should be wary about the rhetoric which often surrounds cross-border medical cooperation. The humanitarian and scientific benefits of effective international cooperation cannot be denied. But as the recent case of the British medical students who volunteered to serve with Islamic State in Syria suggests, such work can be harnessed to a wide range of political and ideological projects, from liberal internationalism, to fascism or religious fundamentalism. International health is indeed a technical and humanitarian endeavour, but it is also a deeply political one.
[i] ‘La fondazione dell’Associazione Internazionale contro la Tubercolosi’, Lotta Contro La Tubercuolosi, 13:3 (1942): 236–59; ‘L’associazione internazionale contro la tubercolosi’, Rivista Italiana d’Igiene, 2:1 (1942): 78–9.
[ii] David Brydan, ‘Axis Internationalism: Spanish Health Experts and the Nazi “New Europe”, 1939-1945’, Contemporary European History 25:2 (2016): 291–311.
[iii] ‘La fondazione dell’Associazione Internazionale contro la Tubercolosi’, Lotta Contro La Tubercuolosi, 13:3 (1942): 244.
[iv] Ibid. 242.
[v] Ibid. 241.
[vi] Laín Entralgo, ‘Medicina y Política’, Sí, (1 Feb. 1942): 3.
[vii] Pedro Arnaldos Gimeno, Los Seguros Sociales en los Estados Totalitarios (Madrid: Publicaciones del Instituto Nacional de Previsión, 1941).
[viii] Brydan, ‘Axis Internationalism’: 299-300.
[ix] Marius Turda and Aaron Gillette, Latin Eugenics in Comparative Perspective (London: Bloomsbury, 2014).
[x] Pedro Laín Entralgo, Descargo de Conciencia (1930–1960) (Barcelona: Galaxia Gutenberg, 1976): 295.
[xi] Benjamin G. Martin, The Nazi-Fascist New Order for European Culture (Cambridge, Mass.: Harvard University Press, 2016).