The Battle for Algeria. Jennifer Johnson
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and provide some free health-care services such as medical consultations.36 However, the primary objective of these projects was no longer to pacify the Algerians but rather to protect and serve the growing European settler population and effectively govern the population.37 Hospitals and clinics were built in major cities, thereby largely neglecting rural areas. These facilities were so far removed from the majority of the Algerian population who lived outside of the major urban centers that they were unable to travel to receive medical assistance. While some colonial administrators and doctors attributed their absence in the clinics to superstition or indifference, some understood that the physical distance between the Algerian communities and the clinics in urban locations prevented them from coming in for checkups and medicine. Dr. E. L. Bertherand of the Algiers Bureau Arabe recognized that Algerians were less likely to leave their families and travel great distances to French-run hospitals. He suggested traveling to meet the natives in the same way that the military physicians had decades before them.38 Moreover, some French doctors noticed contesting medical epistemologies that required negotiations between themselves and their patients.39
The authorities also hoped to recruit local medical auxiliaries to ease the load of French physicians and establish permanent contact with Algerians.40 The Native Auxiliary Medical Corps was created in 1901 to provide doctors with local assistants.41 In the decade following its creation, Algerians between the ages of nineteen and twenty-four were recruited to attend a two-year training program at the School of Medicine and Pharmacy of Algiers and complete an internship at Mustapha Hospital, after which they would assist doctors in distributing and administering certain medications, vaccinating patients, and preparing them for medical procedures.42 By 1912, when its population was roughly 5.5 million (4.75 million Algerians and 750,000 Europeans), Algeria had fifteen civil hospitals, five military hospitals, and three hospices in Algiers, Constantine, and Oran. Seventy-eight physicians, surgeons, and pharmacists worked in these establishments. It is unclear how many, if any, of the seventy-eight were Algerian.43 These statistics indicate that the facilities were understaffed and the medical personnel were overworked, which led to insufficient or otherwise poor care.
Despite the limited and inadequate care the French were able to administer, they remained optimistic in light of recent scientific discoveries and medical advances made at the Pasteur Institute. The government proceeded to build hospitals and training facilities in the interwar period, the most notable of which included the Hygiene and Colonial Medicine Institute (1923) and several auxiliary hospitals. The number of civil hospitals and hospices grew from twenty-one in 1920 to forty-five in 1932.44 World War II delayed most projects of this nature, including education initiatives.45 Immediately following the war, the planned expansion of medical facilities was temporarily suspended. The government conducted studies and surveys and discovered serious hospital deficiencies. These results spawned initiatives to reorganize and expand medical services in Algeria. With a renewed interest in reform, the French government invested in structural improvements. Following World War II, it increased the number of hospital beds from 16,000 in 1944 to 26,166 by March 1955.46 But the number of hospital beds in Algeria paled in comparison to the number of beds in the metropole. The former had one or two beds per one thousand inhabitants, while the latter averaged twelve beds per one thousand residents.47 Yet, the administration continued its expansion projects. Between 1947 and 1955, construction began on seventy health centers, of which fifty-six had been completed at the end of the period. Of seventy-one consultation rooms planned, fifty-five were completed. The administration also turned its attention to fighting tuberculosis and distributing vaccinations. The number of beds for tuberculosis patients grew from 800 in 1944 to 5,000 in March 1955, and by January 1954, 1.3 million people had been vaccinated.48
Looking at these improvements would suggest that the colonial regime was dedicated to extending medical services to Algerians. However, when the growth of the population is factored into these statistics, the expansion of medical care is less impressive. Following World War II, the Algerian population had reached 8.5 million and yet the country was only equipped with twenty-eight civil hospitals and nineteen auxiliary hospitals.49 It would have been physically and financially impossible to properly service the medical and health-care needs of the population in these limited facilities. The southern regions of Algeria had been mostly neglected before World War II and remained so during the government’s planned expansion. Although the number of physicians in the area nearly doubled between 1943 and 1955, from twenty-five to forty-five, this increase kept pace neither with the growth of the region’s population nor with the expansion in medical care elsewhere in Algeria.50 Even with a renewed commitment to providing more doctors, these statistics highlight how much of Algeria and its population lay beyond the reach of the colonial state.
After 1945 French health administrators took a proactive step toward expanding the medical corps by issuing a series of ordinances and decrees updating rules and regulations regarding who was permitted to practice medicine in France and Algeria.51 They generally stipulated that physicians, dentists, and nurses were required to have a diploma issued by the French state, have French citizenship, or have recognized diplomas from Morocco or Tunisia. Vaccines and preventative care were regulated through the Public Health Code, which discussed methods for staying healthy for those living in France and Algeria. The Public Health Code also included details about hospital operations, the ways in which the regional, departmental, and national medical profession should be organized, and the nature and role of hospitals and public clinics.52 As of 1953, the French did not differentiate between how medical institutions and their staff members were expected to operate in France and in Algeria. Even though the medical infrastructure varied greatly in the two places, the government conceptualized them as similar and subject to the same rules.
One way to help further alleviate these stresses would have been to train more Algerian doctors in the new medical schools and institutes the French were erecting around the country. But as one prominent doctor who participated in the national liberation struggle remembered, in his medical school class of more than thirty students only one or two of them were Algerian in the early 1950s.53 Algerian women were even less likely to enter medical school, as one of the few trained female doctors of the time recalled.54 High illiteracy rates and poor early education excluded most Algerians from becoming competitive medical school applicants and often relegated them to inferior positions such as medical assistants. On the eve of the war for national liberation, Algerians had been marginalized in the medical sphere for decades. But they witnessed the power, both literally and ideologically, that medicine could have over the population.
The French had created a significant gap in knowledge and access to information, leaving them ill-equipped and unprepared to deal with the medical crisis that would erupt during the war. The medical sector in colonial Algeria was seriously underdeveloped and in need of significant financial resources, as well as training opportunities and staff. These conditions set the stage for French medical campaigns to take advantage of the health-care vacuum, the result of decades of colonial failure, when the war for national liberation began and attempts were made to use them for political gain. The FLN watched closely and gained inspiration from them, implementing nearly identical medical programs in Algeria after 1956.
The Sections Administratives Spécialisées
As the war forged ahead and tensions escalated between the two sides following the August 1955 Philippeville massacres, a turning point in the war, Soustelle began implementing social and economic programs he hoped would mitigate Algerian resentment and combat nationalist propaganda.55 Even though the administration’s initial response to the FLN attacks was simply to reinforce police efforts, by 1955, and especially after Philippeville, it became clear that a larger, less conventional conflict was under way. Soustelle knew winning the battle for Algerian hearts and minds would be critical to winning the war, a fact to which many military officers recently returned from Indochina attested.56 He realized that the French army, once again, faced an unconventional opponent in Algeria and would need to use different methods to vanquish the enemy. As such, he drew from French military strategies that assumed the nature of war had become increasingly “subversive, fought not with regular armies but with bands of guerrillas or people’s armies … finding