Читать книгу The Battle for Algeria - Jennifer Johnson - Страница 12

Chapter 2

Medical Pacification and the Sections Administratives Spécialisées

On 31 October 1954, nine “historic leaders,” Mourad Didouche, Hocine Aït Ahmed, Mohamed Boudiaf, Mohamed Larbi Ben M’hidi, Ahmed Ben Bella, Mustapha Ben Boulaïd, Mohamed Khider, Rabah Bitat, Belkacem Krim, bound by their belief that independence was only possible through armed struggle and revolution, drafted the Proclamation of the National Liberation Front. This document, released in conjunction with the coordinated attacks of 1 November 1954 the next day, announced the beginning of the Algerian war for national liberation.

The proclamation, addressed to the Algerian people, emphasized that “after decades of struggle, the nationalist movement had reached its final phase…. Our action is solely directed against colonialism, a stubborn and blind enemy who has always refused to grant the slightest liberty by peaceful means. Those are,” its authors believed, “sufficient reasons why our movement comes under the label of the National Liberation Front … offering the opportunity for all Algerian patriots from all social classes … to integrate themselves into the liberation struggle without any other consideration.” The FLN’s primary goal, as defined by the proclamation, was national independence by restoring “the sovereign, democratic, and social state of Algeria within the framework of Islamic principles” and by respecting “fundamental freedoms for all.”¹

The nationalist leaders carefully outlined internal and external objectives that guided their activities through 1962 and that they believed would secure Algerian sovereignty. Domestically, they aimed to restore the national revolutionary movement to its true place by “ridding it of all vestiges of corruption and reformism” and to “gather and organize all the sound energy of the Algerian people to liquidate the colonial system.” The proclamation specified three external goals: internationalizing the Algerian problem, solidifying North African unity within an Arab Muslim context, and relying upon the United Nations Charter to demonstrate and attract solidarity for the principles articulated within it.² This sophisticated and multidimensional FLN platform was the result of decades of political activity and reflected an engagement with contemporary trends such as Pan-Arabism and human rights, broadly defined, in the post–World War II era. Moreover, the platform reflected the central tenets of what Algerian nationalists thought would prove their sovereignty to the Algerian people, French colonial officials, and world leaders.

Despite the FLN’s announcement, the French government of Pierre Mendès-France neither recognized nor acknowledged a war was under way. Just a few weeks earlier, in October 1954, François Mitterand, minister of the interior, had traveled throughout Algeria and concluded in a report to French premier Mendès-France that “the climate is getting worse over there,” and he “recognized the urgent need … to integrate more Algerians into the colonial administration.”³ These cautionary words could not have been more true.

The French administration was not prepared for the long-term political divisions and struggles that would follow between moderates and ultraconservatives who ardently believed in Algérie française and were prepared to take any necessary steps to ensure its survival. For Mendès-France, who advocated a reformist agenda, navigating these factions immediately became a problem after 1 November. At the 12 November National Assembly meeting, he declared his unequivocal support that “the Algerian departments are part of the French Republic. They have been French for a long time, and they are irrevocably French…. Between them and metropolitan France there can be no conceivable secession.”⁴ For the remaining three months that Mendès-France’s government was in power, he grappled with accommodating various viewpoints and trying to find a peaceful solution similar to French policies in Morocco and Tunisia.⁵

One of Mendès-France’s most significant appointments during this period, before his government crumbled and that of Edgar Faure replaced it, was naming Jacques Soustelle as governor-general of Algeria in January 1955.⁶ Soustelle had long been active in French politics, dating back to World War II, when he joined Charles de Gaulle’s Free French Resistance movement. The two men remained close, and Soustelle served as secretary-general from 1947 to 1951 in de Gaulle’s Rassemblement du Peuple Français (RPF) party and he would later prove instrumental in orchestrating de Gaulle’s return to power in May 1958. Mendès-France anticipated that in addition to Soustelle’s World War II credentials his considerable political experience and acumen would serve to quiet opponents concerned that Algeria would be a third humiliating military loss in recent memory. French military defeats in 1940 when the Vichy government came to power in France and in 1954 at Dien Bien Phu in Indochina weighed heavily on the national consciousness, and military officials could not imagine suffering another defeat in Algeria.⁷

Soustelle had a reputation for being liberal and many hoped he would help reshape the contentious politics of the moment in Algeria.⁸ He had publicly advocated for Algeria’s integration with France and in the months leading up to his confirmation as governor-general, he wrote several articles that described “his ideas for a French Federation, in which Algeria would find its place.”⁹ Soustelle knew the settler lobby in Algeria distrusted him but that did not “detract him from accelerating reform that would win over the Muslim majority.”¹⁰ He traveled through Algeria on his first official visit in the winter of 1955 and witnessed the abject poverty and poor conditions in which many Algerians lived. His trip revealed the state’s failure to penetrate the territory after 120 years of colonial rule, but he also learned that the recently formed FLN had not gained the people’s support. With this picture in mind, he went on to develop the Special Administrative Sections (Sections Administratives Spécialisées, SAS), “precisely with the goal of elevating the quality of life of the [Algerian] population” and showing it an alternative for the future.¹¹

The Special Administrative Sections were conceived broadly as a program that would facilitate political rapprochement between the Algerian population and the colonial state. They targeted a variety of areas that would improve the Algerian people’s daily life and relieve dire economic conditions in which many lived. The SAS built roads and bridges and conducted censuses in order to better understand the welfare needs of different communities. They repaired schools and enrolled young boys and girls in primary classes. SAS teams also constructed houses for displaced families, oversaw local elections, and built work camps for unemployed men.¹² These programs went a long way toward pacifying the population and disincentivizing Algerians from joining the FLN.¹³

Medical outreach was a central component of the SAS program; it offered a dramatically different view of the French and their violent military campaigns. Teams of physicians, nurses, and assistants visited rural areas and provided free care, taught hygiene classes for women, and offered vaccinations. In some cases, their visits were the first time state services penetrated the interior, and the administration devoted serious attention toward remedying this neglect through peaceful pacifiers, instructed to conquer with medicine rather than bullets.¹⁴ To be sure, SAS health-care programs and French military counterinsurgency operations shared a common end goal. However, the humane approach to Algerians’ health and well-being transformed the way some Algerians perceived the colonial state.

These programs were not an original idea about how to manage North Africans. The initiative closely resembled the Bureaux Arabes in nineteenth-century Algeria and the Service des Affaires Indigènes in early colonial Morocco.¹⁵ Furthermore, the colonial authorities in Algeria made efforts between 1904 and 1960 to train auxiliaires médicaux who were responsible for providing medical treatment and hygienic instruction exclusively to Muslims. This small group of Muslim men who totaled fewer than three hundred worked under médecins de colonisation and helped administer rural life in the first half of the twentieth century.¹⁶ What makes the SAS noteworthy is the extreme lengths to which Jacques Soustelle and his colleagues went to extend social services in the 1950s. For nearly 130 years, the colonial state did not provide Algerians with adequate education and professional training opportunities equivalent to those offered to French citizens. French administrators did not build vital medical and social institutions that all Algerians could access, nor were Algerians permitted to actively participate in the political sphere. As such, the government found itself needing to “reconquer” and integrate Algerians into what Frantz Fanon has called a dying colonial regime in the 1950s and 1960s.¹⁷

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 infrastructure 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 refuge and support among the population.”⁵⁷ Militias around the world utilized revolutionary warfare as their dominant strategy, and Algeria was no exception.⁵⁸ From its first set of coordinated attacks, the FLN employed guerrilla tactics that were meant to destabilize French rule throughout the country. In response, the French military adopted counterrevolutionary measures that were applied in conjunction with a series of programs intended to destroy Algerian political networks, collect intelligence, and win over the local population.⁵⁹

The Sections Administratives Spécialisées were the cornerstone integration program, and by 1961 more than seven hundred existed in Algeria.⁶⁰ Despite French claims throughout colonial rule that Algerians could become French citizens, few actually obtained citizenship because in order to do so Algerians were required to abandon their Muslim personal status. During the 1950s and 1960s, in an effort to quell the war, French politicians adopted a more flexible approach to officially incorporating Algerians into France.⁶¹ Alongside meager political openings, the government pursued integration policies that officials hoped would “overcome [the Muslim community’s] overwhelming poverty and that independence would be prevented by integrating Muslims fully into modern French society.”⁶² But there was a certain irony to the urgency of the SAS. Had the French previously educated Algerians, granted them political rights, or consistently provided social services, the Pierre Mendès-France and Edgar Faure governments may not have needed Soustelle to devise an integration campaign.⁶³

Nearly six months after his initial trip through the Algerian countryside, a 26 September 1955 decree permitted Soustelle to establish the Special Administrative Sections. In a December 1955 pamphlet he explained that in light of the current situation, he decided to create the SAS “to ensure the retaking of the population in regions where terrorists are active or those at risk of being contaminated.” The heart of the mission was “to reestablish contact with the Algerians, renew their confidence in the French, and report information back to civil authorities.”⁶⁴ To help SAS personnel accomplish these goals, Soustelle authorized them to “exercise certain administrative functions that will permit them to service the population” and help it “recover a taste for and respect of the French presence.”⁶⁵ He divided up the country into zones, and the SAS would operate within those areas that Soustelle believed harbored rebels. Soustelle specified that an Algerian Affaires officer would head each SAS unit and a member of the Algerian Affaires Attaché Corps, medical personnel, a protection force, a vehicle and radio, and construction supplies, would be at his disposal.⁶⁶ This team’s objective, writes Jacques Frémeaux, was to “prevent losing Algeria” and “to construct an Algeria linked with France,” not service the people simply for their own good.⁶⁷

The December 1955 pamphlet obscures the degree to which SAS social programs were firmly subordinated to the military and its larger purpose of fighting the FLN. Its medical sector received instructions from the military and reported its progress and monthly activities back to military superiors. The various programs’ materials and equipment were supplied by the military, and personnel were frequently hired through military channels. Any structural changes or reassignments came from military officials. In actuality, the SAS were simply an extension of the French military and carried out what one scholar calls “police missions.”⁶⁸

However, this new face of the military did not principally guard checkpoints or carry rifles. The SAS personnel arrived with more gentle weapons, medicine and health-care products, and, similar to military physicians who helped settle Algeria during the mid-nineteenth century, they became potent symbols of colonial development to which the French could point as showcasing their commitment to Algeria. How could the government be accused of neglecting the Algerians’ welfare if it was offering free medical care and building new schools? Jacques Soustelle knew the colonial administration needed to concentrate on public relations and focus on strengthening relations with the Algerian population. For French general Raoul Salan, the SAS officers played a central role in this endeavor and were “the driving force behind pacification.”⁶⁹

From the inception of the SAS there was a distinction between the military objectives and the way the SAS portrayed its activities to the Algerian people. The military’s dual mission was to subdue the local population by supplying social services and to collect intelligence for future military endeavors, just as doctors had done during the Algerian conquest beginning in the 1830s. Part of the comprehensive strategy in waging war against the FLN was to engage the population, take hold of it, rally it, and progressively utilize it.⁷⁰ The SAS were dispatched to areas of strategic value and they were supposed to operate with military precision when establishing contact with villages and attempt to neutralize their suspicion and hostility toward the French. SAS visits would demonstrate to the local population that not only could the colonial state provide for them but that it was also committed to improving their quality of life in ways that the FLN could not. At the same time, monthly medical reports about the number of men, women, and children would be sent back to military officials who would then convert the raw data into reliable intelligence about particular regions.⁷¹ With this kind of information, soon the SAS could attempt “to balance in a short time, and with considerable effort, the administrative and social irresponsibility with which Paris had ruled Algeria for more than a century.”⁷² This was how the SAS were ideally supposed to function. As we will see, the reality of how the SAS operated was quite different.⁷³

Recruiting Personnel

The administration turned its attention to finding qualified staff to carry out pacification, many of whom were likely unaware of the depth and breadth of the medical field’s underdevelopment. This immediately posed a problem. Those that were hired came from a variety of backgrounds, including but not limited to Indochina veterans, Arabic linguists and specialists of the region, and regiment officers.⁷⁴ The diverse experience of participants made ideological coherence nearly impossible, and they were constantly caught between contradictory military and civilian priorities. Their “intermediary positions” were a source of tension from the outset and hindered what they would achieve.⁷⁵

When the SAS started, there were fewer than four hundred military physicians working in Algeria and the state of medical facilities remained inadequate to offer comprehensive care to the roughly ten million Muslim and European people living in Algeria at the time.⁷⁶ Public and private hospitals received twelve million francs between 1949 and 1954, and a May 1955 Monthly Bulletin of General Statistics applauded the expansion of hospital beds in that time from 21,218 to 28,018, but this number would hardly temper the devastation ahead and the deplorable conditions SAS teams encountered.⁷⁷ Given the nature of SAS units, officials preferred to place military doctors in designated medical positions; however, too few existed and the leadership began coordinating their efforts with civil physicians in Algeria.

The SAS recruited active officers in the French army and reserve officers at home. They were expected to serve anywhere from six months to three years and were enticed with salaries ranging from 5,000 to 18,000 francs, but even with these incentives, the number of volunteers remained feeble.⁷⁸ Armand Frémont attributes the difficulty of recruiting voluntary military and Foreign Legion enlistees to feelings of doubt and ambivalence about Algeria, some even protesting that “this war [is] not ours.”⁷⁹ SAS medical officers, frequently drawn from the same pool of volunteers, had to temper these sentiments and find ways to continue their medical outreach to the Algerian people.

The SAS program, looking to develop its staff beyond military recruits, may have found a way of supplementing medical personnel with Algerian staff, but a series of applications from 1955 show that colonial officials privileged political allegiance over technical skill. Late that fall, several hundred men and women, the majority of whom were Algerian, submitted dossiers for consideration to work at hospital facilities such as the Psychiatric Hospital of Blida, the Algerian Cancer Center, the Oran Civil Hospital, and the Sétif Civil Hospital. Upon review, which consisted of checking the person’s education, city and address of origin, police record, and personal conduct, a significant portion of the male applicants were rejected because of their political affiliation. The police wanted to know whether the applicant supported the French government and if he or she had any questionable political ties.⁸⁰

Abderrahmane ben Abdelkrim Benzine, a twenty-two-year-old male with no prior police record, applied to work in one of the Algiers locations, but an Algiers prefect questioned his political allegiance. Benzine had been arrested in 1949 for distributing Parti du Peuple Algérien (PPA) tracts, and, even though he had not been formally charged with a crime, the prefect thought this provided sufficient evidence that he could not be trusted.⁸¹ Benzine’s current position at the Office of Public Transport and ability to speak Arabic and Kabyle were insufficient to influence a favorable recommendation. Instead, the prefect labeled him “a propagandist of separatist ideology,” with a “hostile” attitude “toward the French cause.”⁸² The official overlooked Benzine’s useful language skills and social connections in the area based on an event six years prior that may not have had any bearing on his ability to perform a job well.

Abdelkader Zerrouki, originally from Orléansville who moved to Tlemcen after the 1954 earthquake, was another young male whose application was rejected based on his alleged political leanings. In Zerrouki’s file, Orléansville subprefect Platt wrote that he received “good information about the candidate’s conduct and morality.”⁸³ However, Platt noted that the applicant’s father, M’hamed Zerrouki, “is a very active UDMA [Union Démocratique du Manifeste Algérien] militant,” and he believed that Abdelkader “was a member of the UDMA in Orléansville,” whose “politics aligned with those of his father.”⁸⁴ Platt’s general observations about the Zerrouki family led him to conclude that Abdelkader was not a suitable candidate for hire.

Half of the applicants were women, and they were typically recommended for employment. As with their male counterparts, the reviewer vetted their political histories, but unlike many of the men’s applications, the women’s background checks did not reveal a past of organized political activity. In fact, many of the female hopefuls were approved because they “did not express any political opinion,” nor did they generate any concern “regarding their behavior and morality.”⁸⁵ They were considered politically neutral and deemed less likely to bring their politics to work.

In the spring and summer of 1956, hospitals across the country received another batch of applications from doctors in Algeria and in France who requested personnel positions. In several instances, letters accompanied the file, asking that the application undergo further review. The available material did not provide conclusive information about each case, but some of the applicants were refused employment based on technical credentials. For example, Dr. Xavier Maurin applied for a surgical position at the Oran Civil Hospital in May 1956, but Robert Lacoste denied him the job in July 1956 because Maurin had only passed two of the three required exams.⁸⁶ This small series of applications revealed that people were applying for medical jobs in Algeria in 1955 and 1956, but a group of officials were not compelled to hire them. Moreover, it is troubling that candidates with viable skills sought out professional positions two years into the war and were passed over.

The SAS also recruited Algerian women to contribute to pacification and sought individuals who could assist them in practical matters such as translating Berber and Arabic and distributing medicine and emergency goods to their communities. If Algerians saw their own working alongside the French, they might be more inclined to receive medical treatment and send their children to school. The SAS drew upon a tested imperial strategy and relied on auxiliaries to promote medical programs and services.⁸⁷ In the past, they served as crucial linchpins between the indigenous population and colonial doctors, and the SAS recycled the idea in the 1950s.

One major SAS objective was to concentrate on women and the female domain in rural areas, and the Équipe Médico-Sociale Itinérante (EMSI) and Adjointe Sanitaire et Sociale Rurale Auxiliaire (ASSRA) were created in the spring and fall of 1957, respectively, with this aim. In confidential instructional manuals and correspondence, army officials acknowledged that finding trained personnel and providing medical care were “indispensable” first steps “in establishing contact with the Algerians,” but that ultimately “medicine was secondary.”⁸⁸ The “real objective” of these programs, notes Marnia Lazreg, “was to use sociomedical assistance as a medium through which to make contact with women, that is to say, to know, inform, educate, organize and guide them in preparation for their acceptance of the most French solution to the Algerian problem.”⁸⁹ The EMSI and ASSRA staff were not benign agents of social change as the French tried to present them. They were responsible for diffusing French propaganda, educating women about emancipation, and carrying out psychological warfare.⁹⁰ As we will see in the next chapter, the FLN and its health-services division used Algerian women for similar ends.

French government and military officials made frequent mention of SAS recruiting and mobilization challenges that they struggled to address throughout the war. For instance, in 1959, French general Jacques Allard admitted to a serious physician deficit.⁹¹ He estimated that one doctor was needed for every ten thousand inhabitants, and, at the time, there were only 220 French civil physicians in the entire country for a total population well over nine million. According to Allard’s calculations, the medical sector needed nearly six hundred more doctors to meet the demand.⁹² The military knew that even with six hundred more doctors participating in the Assistance Médicale Gratuite (AMG), a companion program created in 1956, and the SAS throughout Algeria, it would still require more staff to fill hospital positions in urban areas. The army counted on seven hundred reserve doctors to help alleviate the physician shortage. These statistics provide some perspective into the many recruitment challenges the SAS encountered and the dire need for more trained personnel willing to participate in the medical campaigns. Without them, Soustelle’s intentions of winning over the countryside could not be realized. If the SAS and AMG units did not have sufficient staff, their visits would become irregular; the lines for consultations would be longer. Those waiting for hours to see the doctor might not make it to the front of the line, and, as one general in Oran noted, this could “diminish [the unit’s] effectiveness” in the area.⁹³ Without continuity and sufficient medicine to distribute, personnel risked losing any inroads they had made with Algerians during previous visits and hampered their chances at fostering support for Algérie française.

Government officials devised new recruitment strategies that ranged from asking friends to temporary contracts. If current medical professionals told a friend or family about their work, perhaps they would be able to convince them that their service was needed. Colonial administrators considered altering the terms and conditions of medical contracts for they thought that shorter contracts might encourage people to work for state-sponsored programs. They debated the merits of a recruitment day and suggested making a tour in Algeria mandatory for sixth-year medical students in France, framing it in terms of national service and duty. They even alluded to financially rewarding doctors for performing more consultations.⁹⁴ All of these ideas could not mask the fact that the medical pacification programs were in trouble and in immediate need of reinforcements.

In response to this acute problem, the colonial administration amended medical decrees governing who was allowed to practice the profession and expanded the parameters to include foreign doctors, a group previously submitted to intense scrutiny when seeking employment in Algeria.⁹⁵ The French minister for Algerian affairs issued several legal amendments, beginning with the 23 October 1958 ordinance and followed by the decrees of 28 March 1960 and 9 April 1960, which stipulated that French nationals in the medical and pharmaceutical professions who had practiced in Tunisia, Morocco, or Indochina were now eligible to practice in France and Algeria.⁹⁶ Another decree issued on 19 April 1961 made additional concessions by authorizing foreign doctors with foreign diplomas to practice medicine in Algeria.⁹⁷ French officials received applications from doctors in Spain and Morocco, and in many instances they were recommended to come to Algeria; the 19 April 1961 decree was often cited as justification for their approval.⁹⁸ The scarcity of medical personnel was never eliminated during the war. However, French officials, realizing the potential advantages of medical pacification, increasingly broadened the health-care field by accepting individuals to serve their cause.

Another way the medical campaigns tried to compensate for insufficient staff and equipment was to improve coordination between military and civilian physicians who were already practicing in the country and did not require additional training. But the two groups, though linked conceptually, clashed over their approach to administering care. The SAS were instructed to visit remote locations and interact with Algerian locals. However, the military gave explicit instructions about guarding SAS safety and treating the population with caution. Due to the “subversive” nature of the conflict, the military inherently distrusted the Algerian people it was charged with helping and grew suspicious of their motives for coming to a mobile clinic; was it for medicine or an ambush? Therefore, the military advised medical personnel to be vigilant at all times. Army officials acknowledged that distributing medical care was an important French propaganda tool, but they insisted that medical personnel still approach Algerian patients as potential combatants. As such, sick Algerians were not to be brought to French hospitals, nor were they to be transported in French military vehicles.⁹⁹ In the event of an epidemic, the SAS were told to notify the closest civilian physician and await his response before responding. Above and beyond their moral responsibilities, the SAS were told to intervene only “in perfect security conditions.”¹⁰⁰

The French military grew increasingly suspicious of medicine and equipment requests submitted by medical teams, and letters and reports from top army officials reveal that they questioned whether doctors prioritized the military’s goals over the patients’ health. In June 1958, French general Raoul Salan wrote a letter stressing that “it is indispensable to recall [medication] requests must correspond to real needs,” and they should never “be simultaneously addressed to multiple establishments.”¹⁰¹ His central concern was that medication and supplies could end up in the wrong hands and benefit the FLN, a situation that did occur. Salan therefore reminded doctors that they should only request products that were not “already in their possession” and cautioned against submitting requests more than once per month.

French Military Propaganda

Decentralized reports and propaganda efforts helped mask the complicated landscape and competing medical and military missions, permitting some program heads and French leaders to think the medical campaigns were more successful than they were. Alongside a voluminous collection of letters criticizing the underfunded and understaffed programs were success stories from medical personnel heralding the number of consultations they performed, progress female assistants were having with local Algerian women, and warm receptions they received from local populations around the country. It is precisely this kind of evidence to which colonial administrators could point to claim that these programs were working and provided a level of care far superior to that offered by the FLN and its health-services division.

An Assistance Médicale Gratuite team that was part of a Tizi-Ouzou SAS unit kept detailed consultation notebooks over a two-and-a-half-year period, which shed light on contemporary illnesses and the nature of relationships between the mobile medical staff and the local population. Every single page of two large notebooks beginning on 9 July 1958 and ending on 12 October 1960 was filled with patients’ full names, their sex, age, date of visit, the town in which they resided, and their physical ailment. The first notebook, which chronicled a twenty-month period from July 1958 through March 1960, kept meticulous records that suggest during that time the AMG unit saw patients every single one of those days, well over five thousand patients in all. The second notebook, entitled Assistance médicale des musulmans: Registre des consultations journalières, begins on 21 March 1960 and ends on 12 October 1960, and, although the bookkeeping is not as consistent as in the first notebook, the records indicate that the medical professionals oversaw a total of 6,000–6,500 consultations, with consultations taking place nearly every day.¹⁰² The most common sicknesses were pulmonary problems, bronchitis, meningitis, eye diseases, diarrhea, and general body wounds. These illnesses were largely unrelated to wartime military assaults but rather derived from poor medical care and impoverished living conditions over an extended period of time. The AMG team in Tizi-Ouzou was not treating battle wounds. Instead their job called for basic provision of care to groups of people previously neglected during the colonial period.

The SAS and AMG doctors improvised when it came to their offices. They set up tables outside and worked in abandoned buildings or from their vans. Their workstations were far removed from the government offices in Paris and Algiers, granting them a degree of flexibility. These doctors saw more men than women and a significant number of children under the age of twelve. The notebooks did not indicate which member of the medical team assisted which patient, but they did show a consistent and dedicated medical team that was able to consult with Algerians every day for fifteen months. They did not report supply shortages that would have prevented them from meeting with patients, nor did they report any Algerian animosity toward them or their medical initiatives. In fact, they demonstrated the opposite. The medical personnel were able to establish a permanent presence in the Tizi-Ouzou community and saw Algerian patients of all ages and genders regularly. What the notebooks do not confirm was whether the same physicians and assistants remained in Tizi-Ouzou for the duration of the time described in the consultation log. Judging by the pervasive shortage of doctors throughout the country, it is doubtful that those seeing patients in July 1958 were the same ones doing so in October 1960. In any event, their steady presence represented a marked departure from the period prior to 1955.

These notebooks, along with numerous others, obscured a reality that French military officials and colonial leaders did not frequently acknowledge.¹⁰³ The SAS targeted poor, hungry, and malnourished Algerians who might never have been to a doctor or interacted with a colonial official before in their lives. Therefore, this interaction may not have been wrought with as much suspicion as the theorist Frantz Fanon described. For him, “the French medical service in Algeria could not be separated from French colonialism in Algeria.”¹⁰⁴ Even though Fanon did not write directly about the SAS, his observations about how connected medicine and colonialism were remained applicable to the wartime project.¹⁰⁵ Jacques Soustelle’s reform initiatives were predicated on inherent power differentials, and the SAS were another opportunity to prove the administration’s moral and physical strength. Medicine was a way for French politicians advocating Algérie française to hold themselves up as the savior and solution to Algerians’ health problems, and they cast doctors and nurses in the role of benefactor to the millions of Algerians who were struggling to survive the war. But Fanon overstated the amount of resistance the French doctors encountered. He described how Algerians “rejected” and “mistrusted” doctors and how “the colonized person who goes to see the doctor is always diffident.”¹⁰⁶ He imagined that every interaction between a French doctor and an Algerian patient was a colonial confrontation and could only be understood in dialectical terms. This was certainly not the case when SAS units drove into town and were surrounded by entire families who eagerly awaited their help.

The military captured these moments and published many of the images for the world to see (Figures 2 and 3). These were the kinds of interactions and benevolent behavior the army wanted to highlight—not the war tactics behind them. In Le Service de santé des armées en Algérie, 1830–1958, the military described its glorious history in Algeria from the time of the conquest up to the war and connected the achievements of the military doctors in the nineteenth century to the current physicians working in SAS and AMG teams.¹⁰⁷ The publication asked where the “native population” would be without the military’s services and credited the military for bringing preventative health care to Algeria.¹⁰⁸ What was more striking than the many chapters that documented the army’s accomplishments was how grateful and happy the Algerians seemed to be when interacting with medical ambassadors of the colonial state. Long lines and crowds of people did not appear to discourage Algerians from waiting their turn to see a doctor. Men, women, and children of all ages gathered around the mobile health unit, their smiles revealing a level of excitement. Doctors cradled infants and caressed little patients who were timid and afraid. Nurses held women’s hands as they waited their turn. Military personnel were seen laughing and at ease with Algerians. These were not the pictures of war, death, and devastation newspapers commonly printed. But that did not make them any less a tool of war. And as Chapter 3 shows, the FLN adopted this strategy and circulated images of their physicians treating Algerian soldiers and civilians.

Figure 2. French medical personnel in Zemoura, Algeria. Dr. Resillot (seated, right) examines an Algerian infant, 1956. (Établissement de Communication et de Production Audiovisuelle de la Défense)

Figure 3. French medical personnel in Mecheria, Algeria. Chief of medicine Dr. Clément and Sergeant Heurtaux treating Algerian patients, 1957. (Établissement de Communication et de Production Audiovisuelle de la Défense)

Conclusion

The Special Administrative Sections were active through the end of the war, but some contend that the program was destined for failure once President de Gaulle came to power in 1958 and changed the political objectives of the war.¹⁰⁹ His advocacy of self-determination beginning in September 1959, and ultimately his willingness to negotiate the Evian Accords, were in direct competition with the policy of integration and thus undermined SAS objectives. In Jacques Soustelle’s memoirs, he recalled how hopeful he felt about the possibility of integration in 1955 and 1956. At the time, he considered “the colonial phase” to be over and was committed to finding different solutions for France and its colonies.¹¹⁰ He firmly believed integration initiatives, such as the SAS, would fuse the Algerian economy with that of the metropole and ensure the “survival and the development of Algeria.” Additionally, “on the moral plan,” he suggested that integration “would put an end to inferiority complexes that fed nationalism.”¹¹¹

When Soustelle created the SAS in 1955, he was drawing not only on his extensive political experience but also on an ideological tradition dating back over a century when French military physicians were sent to settle Algeria through medical pacification. The colonial administration launched the SAS and its complementary programs, Assistance Médicale Gratuite, Adjointe Sanitaire et Sociale Rurale Auxiliaire, and Équipe Médico-Sociale Itinérante, to reassert authority over the population through less violent measures and offer a viable alternative to the FLN. Medical personnel did not wear camouflage uniforms, and they were instructed to present themselves as “peaceful pacifiers.” But at their core, these medical programs were first and foremost a military project whose social services were a necessary means to a desired military end, crushing the Algerian nationalists’ war efforts and keeping Algeria under French control.¹¹²

But this tool of conquest did not lead to its intended goals. Even though the SAS grew to seven hundred units and the number of annual medical consultations exceeded several hundred thousand per year, persistent shortages of equipment, staff, and medicine curtailed the program’s effectiveness and exposed the harsh realities of the French administration’s long-term failure to develop and manage Algeria during the colonial period. The administration’s focus on rapprochement through health was not misguided. However, its intense focus on its own programs led officials to severely underestimate and overlook the FLN’s parallel medical initiatives that emerged simultaneously. The French did not have a monopoly on winning hearts and minds in Algeria. In fact, the FLN took advantage of this strategy and incorporated it into its domestic social outreach and went one step further by exporting it internationally.