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
