The state of native health care spoke volumes about government allocation of resources and chronic underdevelopment. The war called attention to these deficiencies but it also presented the administration with an opportunity to offer care and establish itself in the hearts and minds of people in desperate need of medical attention and supplies. As such, the SAS often were met with little resistance and embraced by local communities, a fact that French military publications used for propaganda purposes.
The native population had largely been excluded from medical training when the war broke out. Despite facing extreme hardships, the nationalist leadership watched the French implement the SAS programs and capture the hearts and minds of the population through health-care campaigns. They witnessed the powerful effect the SAS had in rehabilitating the French colonial state and how the French military used medicine as a propaganda tool. The FLN emulated these programs and did so by creating its own health-services division, which did not take off in earnest until 1956 (discussed in more detail in Chapter 3).
This chapter examines the genesis of French colonial medical pacification campaigns, dating back to the nineteenth century, and shows how the French military resurrected these ideas and practices a century later during the war for national liberation. The Special Administrative Sections were one of the largest French wartime initiatives and yielded an unintentional result. The nationalists developed their own domestic medical services to care for the Algerian people, thus taking their first steps toward acting and performing like a state.
Medicine and Imperialism in Nineteenth-Century North Africa
Thousands of French soldiers and military physicians disembarked from ships in the 1830s, 1840s, and 1850s in Algeria, armed with what they considered a potent tool of conquest, la mission civilisatrice. These men firmly believed they were more enlightened and that they were “charged with a universal mission” to spread civilization to less developed peoples and places.18 They viewed themselves as missionaries and apostles who were engaged in a global project of elevating civilization.19
The French conquered Algeria first during a period of military rule (1830–1870) and then administered the country for nearly a century under civilian rule. During the former, military personnel targeted the coastal cities of Algiers, Oran, and Constantine, and by 1848, they established thirty-three hospital facilities that primarily serviced the European population. Although the doors were open to the local Arab inhabitants, many hesitated to cross the threshold due to uncertainty and fear. Several French physicians developed medical initiatives that aimed to gain the confidence of chiefs and marabouts, inspire belief in French medicine, and attract Algerians to hospitals.20 These military medical efforts were part of a larger pacification campaign to reduce Algerian resistance and demonstrate French superiority.21 Even though the physicians strongly believed in the efficacy of their treatments, important discoveries in bacteriology and immunology had not yet been made.22
Upon their arrival in Algeria in the mid-nineteenth century, military doctors noted how rare it was to see hospital establishments.23 They remarked how medicine and religious practices were often associated with one another and how “European medicine was often unconvincing” to Algerians.24 The physicians hoped their tools of empire—medical care and other social services—would ease Algerian resistance and suspicion to the colonial project.25 If their medicine was effective in treating disease, Algerians might be grateful and share their success stories with friends and family, and the French might be better prepared to penetrate into the heartlands of Algeria without encountering resistance. The early administrators recognized that conquering a foreign territory could be difficult. They encountered many barriers—unfamiliar geography, unknown territories, cultural and linguistic differences, shortage of supplies—and were unable to swiftly implement their social programs. Officials tried to overcome these challenges by establishing hospitals or clinics in more populated areas and treating Algerians in these facilities. French medical personnel hoped that after receiving medical care, Algerian patients would go home, eager to relay their positive experiences with others, consequently establishing French rule and authority in the process.26
Confronted with rampant disease and poor public health measures, the military regime prioritized “maintaining the health of the soldiers” and “bringing the benefits of our civilization to the Arabs.”27 The language used to describe medicine and health was often moralistic and judgmental. Those involved in the early settlement of Algeria witnessed local medical practices and concluded that they were backward, outdated, or nonexistent, and typically based on notions of fatalism.28 Fatalism was one reason why many Algerians did not want to be vaccinated or interact with French physicians.29 In other cases, fear and resistance to the colonial project explained why the French were able only to administer twelve vaccinations from 1845 to 1848.30 These explanations exonerated the French of responsibility for the effects of their violent settlement campaign, including the seizure of land and massive local displacement.31 If the Algerians would not take advantage of their offerings, it was not France’s fault. Rather, it was the fault of the Algerians whose actions were informed by an inferior worldview.
Doctors played a central role “in creating Algeria” and enabling effective colonial governance.32 Initially, they were sent to look after the troops settling the colony but the French medical corps’ responsibilities soon extended beyond this primary objective as they began interacting with indigenous populations. They were often the first contact Algerians had with the French and would therefore serve as an extension of the emerging colonial state, an idea and practice that was resurrected during the war for national liberation. The physicians wanted to make a positive lasting impression, and they assumed bringing free medical care would be an easy way of psychologically disarming the Algerians. These early interactions and the written observations about the Algerians shaped colonial and metropolitan perceptions of the indigenous population and later served to categorize and marginalize them. Seldom were their observations and conclusions impartial; rather, they were wrought with racism and prejudice.33 Much of the military corps’ work in the first four decades of French rule laid the foundation for future colonial attitudes and policies in Algeria.34
Providing medical treatment to the Muslim population was an integral part of the colonizing process in Algeria. However, due to budgetary constraints, insufficient personnel, and growing Algerian and settler populations, colonial officials did not devote equal or consistent efforts to medical training and care throughout the first half of the twentieth century. This does not mean that French administrators ignored the strategic value of providing medicine and health care, as evidenced by governor-general Charles Jonnart’s 1903 speech in Tunis. In his remarks, he noted “the doctor is the true conqueror, the peaceful conqueror…. If [the French] wish to penetrate their hearts, to win the confidence of the Muslims, it is in multiplying the services of medical assistance that [the French] will arrive at it most surely.”35 This is the same explanation the government used in Algeria during the period of military rule and identical to the justification it would employ a century later when it sent teams of physicians and nurses to rural areas during the Algerian war. The image of the doctor as conqueror resurfaced quickly in the 1950s. The nineteenth-century French pacification efforts provided the historical and intellectual tradition that later made the Special Administrative Sections possible and informed Algerian nationalist health-care efforts.
Medicine, Training, and Facilities, 1900–1954
After the initial conquest of Algeria and the transition from military rule to civilian rule, the French continued to erect medical