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involved in the early settlement of Algeria witnessed local medical practices and concluded that they were backward, outdated, or nonexistent, and typically based on notions of fatalism.28 Fatalism was one reason why many Algerians did not want to be vaccinated or interact with French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
