by Yasmin Khan
The rapid approach of the Japanese along the Tiddim Road in early 1944 took everyone in that area by surprise; although the Allies were braced for a Japanese move, this route was chosen to try and cut off supply lines further to the north. On the retreat, the British quickly evicted villages, burned paddy and requisitioned livestock as part of the continued denial policy and many villagers fled. Further north in Ukhrul, villagers ran into the forest and waited expectantly for the Allies to recapture the region.4 Others who remained, especially in villages that happened to lie along roads and supply lines, encountered Japanese soldiers passing through, many of whom were ravenous for food, and especially meat. Neipezu-u Chirhah of Chizami village in Nagaland shared her childhood memories of fleeing from the advancing army with Kazimuddin Ahmed:
I lived with my grandmother and my maternal uncle. The Japanese took my uncle to act as a porter for them. Grandmother and I fled the village carrying whatever we could with us. We were very scared when we heard that the Japanese killed our chicken. Even in the forest we had to move around as the Japanese were everywhere. They killed many of our livestock. Sometimes some of the brave ones would visit the village from our places of hiding and returned with the leftovers of those kills, which we would eat. There was so much fear.5
Hungry cultivators watched on while soldiers seized their goods and fed their harvest to their mules. The subsistence farmers in the region of the Manipur plains were completely cut off from the rest of the country from late March until late June 1944 and people deserted their villages, foraged or lived on rations. Barely a single chicken or pig could be found in the whole region and the fields stood empty and untended. Further north, destruction was even more severe, with numerous villages completely ruined by shelling and Kohima itself was burned to the ground by fire before the inhabitants could save their paddy or household goods.6
Local people’s allegiances were uncertain. Much has been written about the determined efforts of British officials and hill chiefs to mobilise local support, to organise the Chin and Kachin levies and to resist Japanese incursions. In the complex, hilly terrain the knowledge, support and guerrilla actions by local indigenous hill tribes, especially the Nagas – recruited to assist the regular troops and known as V-Force – were pivotal to the Allied victories. But among the different ethnic groups of the north-east, including Meiteis, Tangkhuls and Kukis, responses were sometimes ambiguous and although there were incredible instances of loyalty to the British, there was also a smaller core of people who favoured the Japanese. The Japanese carried pictures of Bose inspecting Indian troops and wore armbands in Congress colours and greeted people with ‘Victory to India!’
Although still a matter of controversy among scholars of the region, a number of people sided with the aggressors, especially among the Kukis of the hills, and provided information or supplies to the invaders.7 One man was believed to be a deserter from the Assam Regiment and was identified by many people for his pro-Japanese propaganda. A small but influential pro-INA group worked in the Kabow valley and claimed that the Japanese were coming to bring swaraj. Local people were crucial in this situation as with deteriorating access to food and struck by ill-health, the Japanese desperately needed help with supplies, labour and intelligence in order to survive. Some Kukis resorted to foraging for wild roots, not only for themselves but also to support starving Japanese soldiers.8
By mid-1944, when the Japanese had been pushed back from Kohima and Imphal, local people from the hills and valleys could start to return to their homes. There had been no harvest, while rice barrels stood looted and empty. The British Raj in conjunction with the Allied forces made significant efforts to rehabilitate the region and to protect local people who had been caught up in the battles from famine or destitution. As people gradually returned to their empty villages, ration depots were opened, new varieties of seed supplied to villagers, sums of cash distributed for those who had been looted by the Japanese, agricultural tools and ploughs supplied in their thousands and pigs and chickens sent for restocking. Cash reliefs and compensation were handed out for loss of livestock. Doctors were sent to all the dispensaries of the state and corrugated tin and bamboo sent to Manipur and Nagaland for the building of new homes. This relief and rehabilitation effort meant that the region could recover from the ravages of war, but made a striking contrast to the relief efforts after the Bengal famine, where spending per capita was significantly less.9
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Soldiering was a mental and a physical challenge. The battles that sepoys fought with ill-health, depression and debilitating diseases, particularly malaria and dysentery, were often as extreme as any fought with combatants. As Lieutenant-Colonel B. L. Raina recalled, ‘In the Eastern Theatre of war the diseases threatened the troops more than the enemy’.10 On the Burmese front, health was the determinant of military success. In the 14th Army, as Field Marshal Slim was at pains in his memoir to point out, the ability to treat soldiers and to restore them quickly to service was an ongoing struggle, although one that the Indian Army was winning by the midpoint of the war, and which the Japanese with their tattered supply lines were unable to match in Burma. In Assam and Burma, among some sepoys, ‘loss of weight was so great in a large number of cases that they were reduced to a bag of bones’ and many needed four months or more in hospital in order to recover their strength.11
Along the Burmese front, Allied soldiers pitted themselves not only against the Japanese but against the swampy sickness of the jungle, spending protracted weeks bogged down in ditches in the wet and cold. The stench of dead bodies in the humid battle zone, amidst burned-out trees and scorched foliage and the nervous anticipation of unexpected attacks in the shadows, made this a particularly harrowing campaign, with the nagging feeling for many soldiers that they had been forgotten or given secondary Cinderella status compared to the troops back in Europe.
Across India, military medical services expanded in response. Nehru would later remember as Prime Minister of India that this was ‘the best aspect of war’ for the subcontinent as it acted as ‘a catalyst of change’.12 As in Beveridge’s Britain, public health modernisation escalated in the 1940s, although it would be far-fetched to call it a revolution. This shift had older roots in the internationalism of the 1930s but was encouraged by the sheer military necessity of confronting the medical problems that beset the Indian and Allied armies.
Many recruits were physically depleted on joining up, long before they even saw a battlefield. In fact, the physical health of many recruits in the Indian Army tended to improve rather than deteriorate, especially during training. Sepoys could take advantage of healthcare they would otherwise be unable to dream of back home (and this was noted in a number of letters home) and also benefited from inoculations, malaria control and a regular and regulated diet, often supplemented with multivitamins. Numerous military doctors agreed that the bodies of sepoy recruits were not always in a good state to begin with. Malnutrition and anaemia were not just problems caused by time on the front line; they could be evident in raw recruits. As the official historian of the Indian wartime medical services commented, ‘it was impossible to depend on the old sources of supply of men with characteristically fine physique’ and multiple vitamin deficiencies were due to the recruitment of men with ‘low nutritional status’.13
Some doctors continued to believe in pseudo-science, and that the martial races were more innately suited to military life. There was concern that vegetarian soldiers from South India lacked vital protein. But it was also the case that as the army cast the net ever wider, relaxed its requirements, and recruited boys in their teens, poorly fed peasants and those who paid backhanders in order to circumvent normal rules, the fitness of some sepoys was called into question. Men with lower body weight were particularly susceptible to disease.
British nurses struggled to care for their charges and experienced the effects of jungle warfare at the rockface. They also acted as whistle-blowers, making humane and persistent deman
ds on the authorities, horrified by the conditions of their patients. Lilian Pert, in her mid-forties, slender with boyish hair and a direct manner, was volunteering as a nurse in Indian General Hospitals throughout the war, in Karachi and later in South India, doing, as she believed, ‘the most exhausting work physically and mentally that an educated English woman can undertake in this country’.14 Her husband, Claude, a brigadier in the Indian Army and a polo-player of some repute, had been stationed in the north-east. Lilian Pert asked some tough and persistent questions of her superiors, pointing out the blatant differences between hospitals for Indian troops and hospitals for foreign soldiers.
The numbers of properly trained nurses in the Indian hospitals was negligible. Pert estimated that the ratio of properly trained nurses to beds in the Indian General and military hospitals was 1:100–200 compared to 1:20–30 in the British military hospitals. She was worried by the lack of doctors as well as nurses. On many wards a part-time civilian doctor would show up for a few hours in the morning before going back to his own private practice:
When the Burma show was on trains came in daily packed with wounded and the hospitals didn’t know which way to turn … What will be the conditions in overseas hospitals staffed like this when heavy casualties start coming in from a future Burma campaign? Shall we not get more hospital scandals? … Something must be done before we are swamped with heavy casualties from the far east. I should hate to have it on my conscience that I condemned, by inaction, these future casualties to the same neglect as was suffered by seriously wounded men of the 4th Indian Division at the IGH Karachi and elsewhere in India. This is the only reason I go on struggling with this highly unpopular problem.15
Wounded soldiers lacked good food and company and often found it difficult to communicate with hospital staff or fellow patients because of linguistic differences. Hospitals were chaotic with members of the public wandering in and out, and sometimes lacked even basic bathrooms. When her ideas for encouraging more British women volunteers into Indian hospitals were rebuffed by a non-committal letter from senior military officers, Lilian Pert retorted, ‘By the tone of their remarks [I] might almost have made an improper suggestion by saying that English women should nurse Indian soldiers!!’ The soldiers suffered from the lack of care and Pert carefully recorded particular cases that had occurred in 1942. An Indian soldier with a fractured femur was transferred on a train for a seven-hour journey: ‘head and neck unsupported by stretcher, no pillow, no blanket, no urinal, food or drinks. Given pillow by first class passenger on train also drinks. No orderly or doctor visited cases during journey.’16 Pert’s damning criticisms of her superiors and of the organisation of health provision for Indian soldiers were being echoed by other nurses, arriving from Canada, New Zealand and Britain, who saw the visible discrepancy between the healthcare on offer for Indian and British soldiers.
Mrs G. E. Portal, another nurse who had seen the fallout from the Burma retreat at close hand, when working in the hospital at Ranchi, was equally scathing about the conditions:
The hospital is heart-breaking … It is a shocking crime and may God forever damn the Eastern Command staff, in fact the whole of GHQ … patients touching each other, people moaning for water and sicking up and so on everywhere. 150 of my surgicals are now on the floor … The nursing sepoys and the menials are thoroughly overworked and very Bolshy, but one has to drive them like galley slaves, and this I find the worst of all my jobs … But I hate worst of all having to refuse help to patients in great pain because we haven’t even got aspirin.17
This compassion and readiness by women to tend the bodies of soldiers and to alleviate suffering, irrespective of race, was new and not always altogether welcomed. Again, war was reordering imperial society. As the war went on, Indian and British soldiers were increasingly treated side by side and newer, mixed hospitals emerged. A great push to improve medical facilities accompanied a greater sense of the need to ensure racial equality between soldiers.
In the eastern campaign there was a steady improvement in medical services close to the front line. Field ambulances, field hospitals and casualty clearing stations all radically improved morale and survival rates, and blood transfusions and mobile surgical units saved lives. Base hospitals were threaded throughout the subcontinent with a large number in the United Provinces, others in Ranchi, Poona, Bangalore and Karachi. By 1944 there were even flights out from the battlefield for emergency care in stark contrast to the disorganised rout of 1942. By the last months of the war a patient in Burma with a gunshot wound to the head might reach a specialist neurosurgical unit within a few hours. Penicillin, the wonder drug that was rapidly transforming wartime medicine and could avert amputations, was available in the last two years of the war, although still in short supply even in the best-equipped General Hospitals and ‘therefore as precious as gold’.18
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How much did civilians benefit from these changes? There were some areas in which medical modernisation had a direct effect: in research, in scientific innovation and in the new familiarity with surgical procedures and certain medicines. In the long run, there was a direct effect on civilian healthcare, although much of this would become evident only in the 1950s. Many benefits were transferred to India after demobilisation, when the advances made in the war gradually started their slow osmosis into civilian treatments; for instance, artificial limbs manufactured for maimed soldiers could easily be used for civilians and by August 1944 the artificial limb centre in Poona was fitting 100 a month. Modern dentistry, reconstructive surgery, nutritional therapies and ophthalmic care also received a professional boost because of doctors active in the military. For the rest of the population, military priorities skewed areas of research in some directions while other areas such as maternal and paediatric health remained under-resourced. The Bhore Committee Report pointed out, for instance, how the Indian TB association had been ‘crippled’ by the outbreak of war, how laboratory work had stalled in a number of research institutions as young scientists moved into military employment and existing civilian facilities could not get hold of adequate stocks of equipment, chemicals or other supplies.19
Although charitable acts by the Friends Ambulance Unit, the Indian Tea Association and the Indian Red Cross Society did not necessarily distinguish between men in uniform and needy civilians, there was often still a stark division between the state’s provision for ordinary people and soldiers. In reality, it was a three-tiered system with the best care for the British and other Allied armies, the second-best care for the Indian Army and with civilians left far behind at the bottom of the pyramid. There were about 172,000 hospital beds available for the Indian Army at the end of the war, while less than half this amount, just 75,000, in Indian civilian hospitals for the entire remainder of the population.20 In some areas, the creaming-off of doctors, nurses and resources for the war effort was denuding the scanty local medical provision even further and actually damaging the limited resources available to the Indian peasant or worker. The Bhore Committee Report did not gloss over the widening gulf between the best medicine on offer, the aspirations of the state and the reality of hopelessly ineffective and paltry provision for the majority of Indians. The military’s need for doctors was still insatiable and training was not keeping up with the demand, so that even the army was actively advertising for licentiates, partly trained local healers with a rudimentary knowledge of first aid and drugs.21
The yawning gulf between the best and the worst hospitals widened. Urban hospitals came under duress because of rapidly growing populations, and industrialisation and other schemes faced setbacks. In Madras, a ten-year plan for the rural water supply agreed in the late 1930s faltered because of the priorities and conditions of war. In the civilian population as a whole, health often deteriorated because of poor nourishment. With the proliferation of sexually transmitted diseases soldiers received cutting-edge care but there was little additional treatment for others, except in Calcutta where the government
set up seven clinics in 1944 for civilian men and women because of the seriousness of the epidemic. Over 200,000 people, men and women, made use of these clinics in less than a year.22 Beyond Calcutta, those with sexually transmitted diseases had to make do with clinics of ‘indescribable squalor’, in the words of an untiring consultant venereologist, Eric Prebble, where further infection was more probable than cure, and where there was an embarrassing lack of privacy. Prebble watched on incredulously as over fifty men with suspected cases of syphilis and other diseases, crammed in one room, used old cigarette tins to soak their sores.23
This litany of horrors was not new, and was not eradicated in post-Independence India, but once again the clash between the modern and the antiquated, the well-resourced and the under-funded, was glaring. Compared to the rural poor, the soldiers were materially better-off. The slow improvements and investment in medical treatment in the later part of the war created strains elsewhere which rebounded on civil hospitals; as Slim put it, the army ‘milked the hospitals of India to danger point to help us’.24 The modern colonial state was capable of engineering almost miraculous solutions to some human problems in the midst of the war, while leaving much of the population almost untouched by medical advances.
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There was another new weapon in the armoury of the military: psychiatry. As in Britain, the sciences of the mind were reaching new audiences and shaping the way that people understood mental health. The British Army had begun to recognise the utility of psychiatric treatment to rehabilitate soldiers and to restore them to active duty, to maintain unit discipline and to help men to withstand the stressful conditions of combat. One soldier involved in the Arakan campaign, Gian Singh, recalled, ‘In those days there was no such thing as counselling. A cup of tea and a cigarette was sometimes the best therapy you were offered – if you were lucky.’25 Nevertheless, there was an increased sensitivity to the complex interplay between poor morale, mental health and the conditions of war, and also wider recognition that minor interventions, like rest and recognition of exhaustion, might alleviate symptoms. Wartime neuroses were no longer simply viewed as permanent aberrations. From 1942, within the British Army there was a level of screening for mental health, potential recruits could be referred for psychiatric assessment and men could be assessed on admission to the army for their mental fitness for combat roles. Psychotics would be ejected from the military. Doctors used hypnotic drugs to control aggression, sometimes straitjackets and physical restraint to the bed too. But the majority of mental-health cases were much milder and more readily treatable forms of neuroses and there was a concerted effort to rehabilitate them as quickly as possible in order to return them to active duty.