mh ’ICE OF STRATEGIC SERVICES Research and Analysis Branch R L A Ho. 1001 ::utes or air-raid damage a:.d health hi germa::y A survey of recent intelligence concerning the Impact of Alliec air raids on German publ'lc health. 10 March 1944 SUi-IlARY 1. Heed for increosed hospital facilities to care for air-raid casualties has required several emer- gency steps to increase hospital capacity, but it is believed that oven these have not been wholly adequate. 2. Air-raid casualties have aggravated the already serious shortage of medical personnel. 3. Long periods spent in shelters, continual alert- ness, and the mass evacuations have not only in- creased the incidence of many diseases, but have also produced mental disturbances and industrial ailments. 4. Damage to water syste-is and the resulting resort to unsanitary sources of supply, as well as failure to sterilize milk and to maintain adequate sewage and garbage disposal services, have been additional factors in the deterioration of public health. / This document contains information affecting the national defense of the United States within the meaning of the Espionage Act, 50 U.S.C. 31 and 32, as amended. Its transmission or the revelation of its contents in any manner to an unauthorized per- son is prohibited by law. %, I. INTRODUCTION Like other aspects of the Genaan national life, public health 1ms suffered severely from the effects of Allied air raids. The following study seeks to measure the impact of air attack on the following specific aspects of public health, as indicated in recent intelligence: hospital facilities, medical personnel, disease incidence in general, and disease incidence as affected by inter- ruption of oublic-utllitv services. II. HOSPITAL FACILITIES To maximise facilities In the face of Allied air attack, Germany has (1) set up additional hospital services in the basements of presently overcrowded hospi- tals; (2) established emergency hospitals in schools, hotels, and similar buildings; (3) organized so-called "evasion hospitals" {Ausv/e 1 chkrankenhflaser) in regions believed to be less exposed to air raids to care for those from the more heavily bombed areas; (4) sent to military hospitals such civilian patients as could not otherwise receive medical attention. In more rocent months, these measures have proved Inadequate. The press lias stated tiiat the "evasion hospitals" v;ero no less endangered than the regular facilities. The Organization Todt was there- fore instructed to build hospital "bunkors" on a large scale. First, press reports spoke of these bunkers as bomb proof, I loro recently they have proved to be wooden barracks which are built to fit into the natural environment;. are camouflaged, and consist of one story only. They are said to hold an average of 500 patients and are inter- connected. i'acillties completed in IJovember were reportedly concentrated in the western and northwestern parts of Germany, and on extension of the program designed to cover the rest of the country was said to be In preparation. Though much is iiade In the press of this innovation. It.la also stated that such one-story buildings arc useful as makeshift arrangements only, to afford maximum protection from air raids. The permanent hospital of the future, it is pointed out, will consist of buildings larger than these one-story facilities. It is mentioned, but only occasionally, that still other facilities are under construction in exposed regions; underground ’’operating bunkers/* which allegedly are com- pletely protected from air damage. It is reported that in one hospital of this type the walls are covered with lumi- nous paint, enabling nursos to carry out their duties even if oloctrlc lighting breaks down. in. uldical Tlie requirements for medical car© of air-raid casualties have seriously aggravated the shortage of medi- cal personnel. Various stops have been taken to increase the supply of doctors and nurses. ' Jewish nurses and doctors, for example, have been accepted by official health orcanlzatlons. Members of the Hitler Youth who have been wiven - a training course of twelve two-hour periods are called upon to emergency first aid. tV. Casualties must generally b® treated first by non-professional personnel, and are then turned over to first-aid stations, which allocate then to hospitals in accordance with available bed space. This procedure Is enforced through the provision that claims for damages and awards of "casualty medals" aro continjont on the entry of the case in the sick bock of a first-aid station. Bombed-out physicians, dentists, pharmacists, and other public-health personnel are under orders tc re- port without delay to the appropriate professional orcan- ization to ensure their prompt allocation to a new cost. IV. DISEASE 3h.CIDhi:CE li. GENERAL There is little doubt that air raids have re- sulted in an overall Increase In disease Incidence. The health effects of breakdowns in public-utility services are considered separately below. Apart from this people In Berlin are reported to suffer from an epidemic of ’’cellar slclmess," a form of influenza causod by long vigils in damp cellars. So;ii-official German reports point out that air-raid damage has resulted in much oyo trouble, causod by heat, smoko, soot, dust, £lass splinters, and phosphorous fogs. The strain under which the people live is reported to have produced a sort of alert-psychosis, which Is widely discussed in the press and has led to on increased demand for sedatives. More indirect health hazards are the dispersion of the population over wider regions, crowding in shelters, and concentration in lodgings left inhabitable. A good deal of the Increase in the incidence of scarlet fever and diphtheria must be attributed to the various evacuation schemes. The increase is likely to be nore severe among natives in the reception areas than among the evacuees. English experience indicates that, on balance, the increase In the incidence of these diseases in the reception areas is not compensated by the decrease in the evacuation areas, even though such a decrease does take place. In-other in- stances, the destruction of plants, and the resulting lack V, of certain products formerly produced in them, lias created health Iiazards of a specific nature. It is reported, for example, that there has been a marked increase in lead poisoning. This may be traced to the fact that it is impossible to repair, or “fettle,11-worn- out furnaces which were manufactured in the Ruhr district, and the difficulties reported may relate to damage done to Denag, Krupp, Gute-IIoffnungs-IIdtte and similar plants. V. DISEASE IhCIDEKCE AS AFFECTED BY IIITEBRUPTION — Numerous reports indicate the effects of air raids on public utilities. The destruction of water-supply facil- ities constitutes a greater threat to health than does the Interruption of gas or* electric power services. Thus, in Berlin, unflltored river water was pumped into - the pipes in order , to Increase the pressure. Faced with shorties of tap water, people have turned to other and loss safe sources of water. Reported vaccinations acalnst typhoid, In a number of localities, are easily understood and It ia safe to assume that this disease, v'llch according to offi- cial iieruan records has increased fourfold since tlie out- break of the war, lias spread farther, official denials notwithstanding. The need for water for fire-fightinc has Greatly increased. This, in turn, lias adversely affected the standards which In normal tines were applied to the utilization of water. By a decree of 30 April 1043, the Reich Ministers for Air and for the Interior authorized the use of water fron rivers, canals, ponds, etc. in the water-supply systems without first purifying it. Certain precautions aro to be taken, c.g., tho water is to be chlorinated v;here possible, the population is to bo warned to boil water before use, and drinking water, in general, to be supplied fron safer sources such as wells or water carts. It will be noted that tho decree was signed by the Minister for Air. In view of tho reported shortace of chlorine and the extent of air damage by incendiary bombs, it is not clear how far these precautionary measures can be enforced. Recent reports Indicate that the people are Instructed to keep bath tubs and other containers filled with water in order to be able tp participate In fire- fighting. / The breakdown of other utility systems has ~lvon rise to other health hazards. Milk which, due to the failure of pov/or systems, cannot be sterilized is dis- tributed with the wamlnc that it should be boiled. Little is known about th* functioninc of sewage and garbage col- lection In bonbed towns, but the fact that Berlin house- holders .were required to lay out rat oolsowing from 20 to 20 I.'ovcmber nay be indicative of difficulties in this field.