By Dr Chris Sandal-Wilson, Lecturer in Medical History, Department of Archaeology & History, University of Exeter

With the generous support of the Council for British Research in the Levant, I was able to travel to Geneva in 2023 to undertake archival research around the medical history of Palestine during and immediately after the nakba of 1948. This built on my first book, Mandatory Madness: Colonial Psychiatry and Mental Illness in British Mandate Palestine, which was published by Cambridge University Press at end of 2023 and which tracked the history of psychiatry in Palestine up until 1948.

These were hugely productive visits: in particular the archives of the International Committee of the Red Cross turned out to contain a wealth of material relating to the medical history of the critical and chaotic period between 1948 and 1950, and I am deeply indebted to the institution’s archivist Fabrizio Bensi for all of his help and patience.

Tragically, the archival material I was looking at from more than seventy years ago also turned out to contain horrifying resemblances to the Israeli war on Gaza: then as now, neither hospitals nor health workers were spared the wider cataclysm of violence that assailed society, and the Palestinian population suffered the costs of the degradation of healthcare provision – including psychiatric provision.

The collapse of psychiatric provision in 1948

The archives of the International Committee of the Red Cross allowed me to begin to piece together what had happened to psychiatric provision during the 1948 war for Palestine.

Against the backdrop of profound dislocations, including the dispossession and displacement of hundreds of thousands of Palestinians, psychiatric provision – never bountiful under the miserly British mandate which ruled Palestine across the preceding three decades – was decimated.

Scarce resources were redirected to seemingly more critical forms of medical care, with the two mental hospitals at Bethlehem starved of funding and support. One of these hospitals was hastily converted to a general hospital, in order to meet the needs of Arab war casualties and the tens of thousands of Palestinian refugees displaced eastwards to Bethlehem over the course of 1948. The other limped on to the armistices of 1949, only to have its bed strength and staffing slashed by the Jordanian authorities who assumed control of the West Bank in the wake of the war.

Although international humanitarian organisations are usually thought to have become invested in questions of mental health and psycho-social support in crisis contexts only in the final decades of the twentieth century, the archives of the International Committee of the Red Cross reveal a surprising degree of concern for psychiatric provision in Palestine in 1948. The organisation signed agreements pledging to take mental hospitals under its protection in the spring of 1948, and bitterly protested the conversion of one of the hospitals into a general hospital later that year.

They were not the only ones to raise their voices in defence of psychiatric provision at a time of catastrophe, however: the Arabic-language daily al-Baath sharply criticised the cuts proposed for the one remaining mental hospital in Bethlehem in the summer of 1949, cuts which they warned could only result in ‘a serious social catastrophe’.

The psychiatric partition of Palestine

A second key finding from the archives of the International Committee of the Red Cross concerns the fate of psychiatric patients who found themselves on the ‘wrong’ side of partition lines in these pivotal years.

The psychiatric hospitals established under the British mandate at Bethlehem and Jaffa had always admitted Muslim, Christian, and Jewish patients. But as plans for the partition of mandate Palestine took shape, and it became increasingly likely that Bethlehem and Jaffa would end up on opposite sides of partition lines in the future Arab and Jewish states respectively, the families of patients began to try and have their relatives released or at least transferred to the ‘right’ side.

But the separation of patient populations down ethno-religious lines was far from complete by May 1948, when mandate ended, the British withdrew, and the war for Palestine entered a bloody new international phase.

Across the final months of 1948, the International Committee of the Red Cross became involved in the question of the ‘repatriation’ of over seventy Jewish patients from Bethlehem, and of a smaller number of Arab patients at the so-called criminal lunatic section of Acre central prison.

The organisation helped broker an agreement for the upkeep of Jewish patients at Bethlehem, and, in January 1949, their transfer across the armistice lines in Jerusalem to psychiatric institutions under Israeli control.

It is not clear from the archives whether such a resolution was ever achieved for those Palestinian Arab patients at Acre; there is no similar record of a transfer taking place, under the auspices of international organisations.

But what the archive does contain are pleas from the families of patients at Acre, asking for information about their relatives and for support from the Red Cross in arranging their reunification.

Seemingly failed by national authorities and international organisations alike, the archive reveals that Palestinian Arab patients at Acre were neither abandoned or forgotten by their families – families whose own worlds had just been turned upside down by the cataclysm of partition.

New perspectives on the nakba

Although a repository above all of the views and activities of the delegates of the International Committee of the Red Cross, my research trips made clear that the organisation’s archives have the potential to open up new perspectives on the nakba of 1948.

These collections allow us to reconstruct the history of medical provision, and in particular psychiatric provision, across these years of profound upheaval and dislocation. And they contain petitions from Palestinian families whose concern and care for relatives stranded on the ‘wrong’ side of partition lines endured, in spite of the extremities of these years.

If the story of the degradation of healthcare provision for Palestinians seems sadly familiar, these petitions from Palestinian families also serve as a reminder of another thread of continuity in this history: the struggle for humanity and dignity that is ongoing to this day.

Chris Sandal-Wilson is a lecturer in medical history and co-Director of the Centre for Imperial and Global History at the University of Exeter. His first book, Mandatory Madness: Colonial Psychiatry and Mental Illness in British Mandate Palestine, was published by Cambridge University Press at the end of 2023 and was awarded an Honourable Mention in the 2024 Pickstone Prize

All images taken by Chris Sandal-Wilson. More images are available on the audio-visual archive for the ICRC here

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