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ACCESS TO CARE
Planning and Preparations for the European Theater of Operations
Stanhope Bayne-Jones, M.D., and
Thomas B. Turner, M.D.
The Predecessor Commands (1941-42)
Events in the British Isles in 1941 marked the commencement of the active phase of the planning of civil affairs/military government and associated public health activities for future application on the continent of Europe. These events arose against a background of previous developments in the same general field in Washington.
Executive Branches including the War Department.-Even before the United States declared war on Japan on 8 December 1941, the highest offices of the Executive Branch of the Government, including the War Department and the Department of State, anticipated the possibility of the involvement of the United States in the war in Europe. These offices and their chiefs, from the President to the War Department staff officers, became concerned with making plans for civil affairs, public assistance, public health, and administrative control in countries which might at some future time be liberated and occupied by the military forces of the United States and the United Kingdom. The consequent development of ideas, policies, plans, and agencies has been set forth in many publications and reports,1 and has been summarized in chapters I-III. In the event, Civil Affairs/Military Government plans were required for the control ultimately of approximately 100 million people.
Civil Affairs in the ETO an Allied undertaking.-In ETOUSA (European Theater of Operations, U.S. Army) which, from a military point of view included all of Western Europe, Civil Affairs became an Allied enterprise. Both the United States and the United Kingdom made large and important contributions to it. It is natural, in the telling, that British historians are mainly concerned with the British portion of this joint endeavor. Similarly, the main theme of these chapters is the work and contributions of agencies of the United States. The two national contributions were not equal, and the territories and problems within the purview of each differed
in many ways. Donnison, in explaining the reasons for these inequalities, has stated frankly: "It is true that the great Anglo-American headquarters that was later to be set up for the conduct of the war against Germany in north-west Europe was in the event more American than British in character. It could hardly be otherwise in view of the comparative resources which the two countries would in the long run bring into the common pool."2
On 19 May 1941, the War Department established the nucleus of a theater called SPOBS (Special Observers Group) in London, under Maj. Gen. James E. Chaney, USA. The name of this organization was changed to USAFBI (U.S. Army Forces in the British Isles) in January 1942. The title continued until ETOUSA's activation on 8 June 1942. It should be recalled that USAFBI included no special section to handle civil affairs.
In May 1942, USAFBI received a civil affairs unit by transfer. Into its area came the Civil Affairs Section of the V Army Corps. This Corps (Reinforced) composed the MAGNET FORCE which was transported from the United States to relieve British divisions then garrisoning Northern Ireland. Advance headquarters of V Corps was established near Belfast on 23 January 1942, soon became known as USANIF (U.S. Army, Northern Ireland Force), and formed a part of USAFBI. When the main headquarters arrived on 20 May 1942, Maj. Gen. Russell P. Hartle, USA, assumed command. With the main headquarters, V Army Corps, came a small Civil Affairs Section which had been established on 4 February 1942 when the Corps headquarters was staging at Camp Beauregard, La.; Lt. Col. (later Col.) Arthur B. Wade, FA, served as chief of the section.3 This was the first Civil Affairs Section in the U.S. Army in World War II, and Colonel Wade became the first Civil Affairs Officer in the European theater when, on 8 August 1942, he was assigned to Headquarters and designated Chief, Civil Affairs Section, ETOUSA.
Reports of the activities of Colonel Wade and the Civil Affairs Section in England during this period are meager. Apparently, these activities arose chiefly from the presence of U.S. troops in England and Northern Ireland. The small Civil Affairs Section at ETOUSA headquarters from August 1942 until January 1943 was "almost exclusively concerned with relations between the U.S. forces and the people of Britain and liaison with U.K. authorities."4 These involved public health matters such as housing, water supply, waste disposal, sewerage, venereal disease control, and hygiene and sanitation. Colonel Wade was relieved as Chief of the Civil Affairs Section on 30 May 1943 and returned to the United States.
Civil Affairs Section, ETOUSA (1942-43)
From the beginning, the European theater was disturbed by disputes over organization, jurisdictional authority, conflicts of ideas, and clashes of personalities. Effects of these trials and tribulations of the overall command permeated its subordinate parts. Among these, civil affairs in general, and its public health department in particular, suffered frustrations, confusion, and definite disabilities.5
Activation of ETOUSA and planning for BOLERO.-When the European theater was activated on 8 June 1942, superseding USAFBI, it was placed under the command of General Chaney. On 24 June 1942, the command passed to Maj. Gen. Dwight D. Eisenhower.
At this time, in England, there was active concern with the relation of the war effort of the United States to future European developments. In April 1942, the British and American Governments agreed that, for the complete defeat of Germany, an overwhelming Allied invasion of western Europe, across the English Channel, was required. The first tentatively approved plan for the buildup, designated BOLERO, developed during the next 2 years into Operation OVERLORD, the actual invasion, which struck the Normandy beaches on D-day, 6 June 1944. Planning along many lines was intensified by BOLERO, but the Civil Affairs Section, ETOUSA, did not take a significant part in these matters.
Invasion of North Africa (TORCH).-On 24 July 1942, the heads of government and the Combined Chiefs of Staff decided to proceed with the planning for the invasion of northwest Africa (Operation TORCH) with an Allied Force of all arms, to be led by an American commander. On 8 August 1942, President Franklin D. Roosevelt and Prime Minister Winston Churchill agreed that General Eisenhower should command TORCH. For the next 3 months, General Eisenhower and his staff in London had the additional task of organizing and landing this Allied Force. As one consequence, other planning and operations in progress were made more difficult, or diverted, and many activities in the European theater were affected, including work in preventive medicine and public health. At Allied Force Headquarters, General Eisenhower was engaged in the campaigns in North Africa, Sicily, and Italy from 5 November 1942 until 16 January 1944 (except for a short visit to Washington). On the latter date, he returned to London and assumed the post of Supreme Commander, Allied Expeditionary Force. In his absence, a succession of commanders had had charge of the affairs of ETOUSA, a progression of top-level personnel which added variables to an already hectic situation. Ultimately, however, General Eisenhower's experiences during the period 1942-44, when he was in the
North African and Mediterranean theaters, had some far-reaching effects upon Civil Affairs and its related public health activities in Europe. He was deeply impressed by the importance of Civil Affairs/Military Government, which he readily understood embraced "providing government for a conquered [or liberated] population," and that this included the supervision and direction of "public health, conduct, sanitation, agriculture, industry, transport, and a hundred other activities, all normal to community life." He recognized that the task for the Army was new and difficult, "but vastly important, not merely from a humanitarian viewpoint, but to the success of our armies." He insisted that civil affairs/military government in a combat theater of operations must be under the control of the theater headquarters. In assessing the accomplishments he wrote: "* * * in spite of natural mistakes it [the new job] was splendidly done. We gained experience and learned lessons for similar and greater tasks still lying ahead of us in Italy and Germany."6
Another outcome of this experience had a bearing on a strenuous controversy in planning Civil Affairs in G-5 SHAEF (Supreme Headquarters, Allied Expeditionary Force): bringing to London (in January 1944) for a high position Brig. Gen. Frank J. McSherry, USA, who had been concerned with the policies and operation of AMGOT (Allied Military Government of Occupied Territory), particularly in Italy.
By January 1943, some 6 months after its establishment, the Civil Affairs Section in the European theater expanded its staff and was able to undertake some planning for future operations on the Continent. In July 1943, the section was enlarged further, and Col. (later Maj. Gen.) Cornelius E. Ryan, Inf, USA, became the Civil Affairs Officer. In August, Lt. Col. Carl R. Darnall, MC, was assigned as Chief of the Civilian Relief Branch, which included departments of public health, welfare, and agriculture. On 4 August 1943, Colonel Darnall submitted to his superiors a memorandum proposing alternate plans for the organization of civil public health activities for the forthcoming operations. One plan called for an elaborate Public Health Department, a largely self-sufficient group operating more or less independently of the Chief Surgeon's office. The other plan called for a small public health group in the Civil Affairs Section, using the existing technical and operating facilities of the theater and lower echelon medical services in applying public health measures to occupied territories. The latter plan was favored by Colonel Darnall and also by Brig. Gen. (later Maj. Gen.) Paul R. Hawley, MC, USA, Chief Surgeon, ETOUSA.
While these plans and policies were being debated, the headquarters of the Chief of Staff to the Supreme Allied Commander began to assume a degree of responsibility for overall planning for Civil Affairs, including the public health aspects.
Civil Affairs Section, COSSAC
At the Casablanca Conference in January 1943, the Combined Chiefs of Staff concluded that the time had come to begin the detailed development of the European invasion plan, OVERLORD. Lt. Gen. Sir Frederick E. Morgan, KCB, was selected to head the Allied Staff, composed of British and American officers who had assembled in London for this work. His title was Chief of Staff to the Supreme Allied Commander (designate), and the initial letters of this title, COSSAC, came to stand for his headquarters, which was established in London on 23 April 1943. As the Supreme Commander had not yet been appointed, the difficulties of the tasks assigned to General Morgan and his subordinates were increased by the necessity to anticipate decisions of a future commander and to convince the military and political heads of two governments of the soundness of those decisions. Civil affairs began to be considered extensively in the staff studies of the RANKIN C Plan (complete collapse and surrender of Germany). General Morgan has written that the problems of Civil Affairs, "the active service forerunner of Military Government and the Control Commissions," included "problems of refugees and Displaced Persons, of disarmament and of post-hostilities business generally. We had begun to become aware of the vast problems presented by the liberation of all our various Western European friends."7
Upon the establishment of the Civil Affairs Section of COSSAC in April 1943, there began an interval of uncertainty, jurisdictional conflicts, and off-the-record arguments concerning the responsibilities of the various headquarters with reference to civil public health. Regrettably, the troubles of this period, in one form or another, beset the undertaking until the end of the war.
Opinions and actions strongly influenced planning, such as the following:
1. Visit of Colonel Hiscock; views of the Chief Surgeon. On 16 September 1943, Col. Ira V. Hiscock, SnC, Public Health Officer on the staff of the Civil Affairs Division, War Department Special Staff, arrived in England for a month's visit and study at headquarters of the European theater. This relatively new division8was becoming increasingly concerned with plans for Civil Affairs in Europe and needed information that could be collected on the spot by its public health representative. Many conferences were held by Colonel Hiscock, among them a particularly significant one with the Chief Surgeon, ETOUSA. At this meeting, General Hawley made it clear that, if he had no control over Civil Affairs medical policies and no additional personnel and facilities to carry out the work, he could not assume
the responsibilities.9 The questions involved in this difference between the Office of the Chief Surgeon, ETOUSA, and the Civil Affairs headquarters with respect to medical and public health activities were never entirely, or satisfactorily, settled during the war.
2. The low estate of Public Health in COSSAC. In the initial organization of Civil Affairs Section, COSSAC, and indeed until the end of October 1943, Public Health was accorded a relatively minor position. It was grouped in a relief and supply branch along with welfare, rationing, and fuel distribution. Colonel Darnall protested vigorously against the subordination of Public Health in this organizational plan.10
In the important planned reorganization of COSSAC Civil Affairs on 30 October 1943, Public Health was inadvertently left out entirely, to the profound shock of the Public Health Department. The 3 weeks of planning in which this omission occurred had been carried out during October by an exclusive group under the direction of Col. Karl R. Bendetsen, Chief Civil Affairs Officer (U.S.) at COSSAC, who had been connected with Civil Affairs in the European theater since early in 1943. Apparently, the omission was an oversight of the exclusive planning group; nevertheless, it was protested strongly by both British and American representatives. Notably, on 31 October 1943, Colonel Darnall wrote a forceful memorandum11 to Colonel Bendetsen, outlining public health functions in civil affairs, and emphasizing that the dismemberment of public health and medical activities would cause irreparable damage. He recommended, as he had in the past, that a separate Public Health division or branch be established in COSSAC Civil Affairs. The error was corrected and, ultimately, Public Health became established as a separate Branch of G-5 SHAEF.
3. Some consequences of the President's concern with relief. On 10 November 1943, President Roosevelt wrote a letter to the Secretary of War. He called attention to the possibility of the collapse of Germany, to the resulting demands the United States would have to meet in supplying the needs of the liberated peoples, and the need to provide for a certain amount of their care and rehabilitation. This letter authorized and directed the War Department to formulate and effectuate a large program for relief activities in Europe. It stimulated extensive activities in organization and planning in the Army; and in the efforts to implement the War Department's portion of the program, existing agencies were strengthened and new ones were created.
The Civil Affairs Division Board, which had been established by The Surgeon General on 28 June 1943, became increasingly engaged in matters of civilian supplies for use in Europe.
Brig. Gen. James S. Simmons, MC, Chief of the Preventive Medicine Service of the Surgeon General's Office, recommended the establishment of a Civil Public Health Division in that Service. This was done on 1 January 1944,12 and Col. Thomas B. Turner, MC, was appointed Director, influencing the planning, organization, and staffing of Civil Affairs Public Health in the European theater.
Ultimately, COSSAC absorbed most of the personnel and functions of the Civil Affairs Section, ETOUSA, and what informal liaison there had been between the public health group in this Section and the Office of the Chief Surgeon largely lapsed. On 28 November 1943, the Civil Affairs Section was discontinued and all civil affairs activities were transferred to the Civil Affairs Center established on 1 December 1943 within the American School at Shrivenham, England. Colonel Darnall was transferred to headquarters of the First U.S. Army on 6 December 1943. The situation remained essentially unchanged until after the establishment of SHAEF in January 1944.
Office of the Chief Surgeon, ETOUSA
In the late summer and fall of 1943, there was a close liaison in the European theater through Colonel Darnall between the Civil Affairs Section and the Chief Surgeon (General Hawley) and the Deputy Surgeon (Col. (later Brig. Gen.) Charles B. Spruit, MC). The prevailing philosophy among planners during this period was that a small nucleus of medical officers would advise the Chief Civil Affairs Officer in policy matters pertaining to civil public health, but that the major planning and operational activities would be carried on through the facilities provided by the Office of the Chief Surgeon, ETOUSA. No directive was issued by higher authority to confer upon the Chief Surgeon the necessary powers of control, and no additional personnel or facilities were provided for such work; consequently, the Chief Surgeon could not assume the responsibilities.
With the establishment of COSSAC, the transfer of Colonel Darnall, and the breakdown of effective liaison between the Public Health Branch, COSSAC, and the Office of the Chief Surgeon, ETOUSA, little attention was given in the latter headquarters to matters of the officially designated category: Civil Affairs Public Health. Certain questions regarding supply were an exception to this as was also a detached but natural interest on the part of the Chief of Preventive Medicine Division, Col. John E. Gordon, MC.
Later, with the establishment of the Public Health Branch, G-5 SHAEF, liaison improved, and on 1 July 1944, a Civil Affairs Branch, with Lt. Col. Walter L. Tatum, MC, as Chief, was activated in the Office of the Chief Surgeon. Eventually, a rather hazy division of responsibility was worked out between the two headquarters. It is interesting to speculate on what might have been the results of a full implementation of the proposal
which was originally recommended strongly by Colonel Darnall and concurred in by General Hawley.
ESTABLISHMENT OF G-5 SHAEF
On 15 January 1944, COSSAC was redesignated "Supreme Headquarters, Allied Expeditionary Force," and on 16 January, General Eisenhower became Supreme Commander. In point of time, the COSSAC staff came under the control of SHAEF, and COSSAC was transformed into SHAEF, on 14 February. On that date, General Eisenhower received the directive of 12 February from the Combined Chiefs of Staff on "his duties as Supreme Allied Commander, Allied Expeditionary Force, which will invade the European continent to destroy German armed forces. Target date is set as May 1944."13
Organization and top staff-In February 1944, the Civil Affairs Division was designated "G-5," in accordance with U.S. practice, and its chief was titled "Assistant Chief of Staff for Civil Affairs, G-5." The first incumbent was Maj. Gen. Sir Roger Lumley (British). The central portion of the former Civil Affairs Division of COSSAC, with advisory and policymaking functions, became the General Staff Division, the first head of which was Brig. Gen. Julius C. Holmes, USA, Deputy Chief of Staff, G-5 SHAEF. The remainder of the establishment (operational units, training schools, and the country sections or country houses which became the SHAEF missions) was designated as the Special Staff and was placed under the command of General McSherry, Deputy Chief Civil Affairs Officer, G-5 SHAEF. Lt. Col. Leonard A. Scheele, MC, USPHS [later, 1949-56, Surgeon General, USPHS], was in charge of the Public Health Subsection, Government Affairs Section, Special Staff, G-5 SHAEF. These three officers had had previous experience in civil affairs in the Mediterranean theater.
The AMGOT concept-Early in 1944, the development of Civil Affairs "machinery" was complicated by strong differences of opinion among responsible officers and between British and U.S. representatives. Drawing upon their experience in the AMGOT operations in Italy, General Holmes, and General McSherry especially, attempted vigorously to establish a separate Civil Affairs channel of communication and command, a system of military government which, in operations on the Continent, would be to a great extent independent of the normal military structure. The proposed arrangement was based upon a territorial organization rather than upon the military formations. "This conception of military administration as an organism standing on its own feet and divorced from military command
except at the highest level was known as the 'AMGOT theory of Civil Affairs' or the 'AMGOT concept.' Differences in points of view on this question led to a cleavage between the G-5 General and Special Staffs that seriously hindered agreement or decisions on important issues."14
In March 1944, after strenuous debate, this proposal was rejected by Lt. Gen. Walter Bedell Smith, USA, Chief of Staff, SHAEF, and Lt. Gen. H. M. Gale, Chief Administrative Officer, SHAEF. Some time later, a renewed attempt was made by General McSherry to get the AMGOT concept established. It was rejected again by Lt. Gen. W. B. Smith, and Maj. Gen. (later Lt. Gen.) Sir Arthur E. Grasett (British) who, on 22 April 1944, had succeeded General Lumley as Assistant Chief of Staff, G-5 SHAEF.
Report and recommendations on Public Health-At about the time Generals Holmes and McSherry arrived at G-5 SHAEF, in February 1944, the unsatisfactory condition of Civil Affairs Public Health in the European theater had come to the attention of the Office of the Surgeon General, U.S. Army, in Washington. To determine the facts and to secure advice, The Surgeon General arranged to have Colonel Turner go to England, study the situation, and report his findings and recommendations. Colonel Turner arrived in London on 24 February. During the next 2 weeks, he held many conferences with most of the officers and civilian officials, British and American, who were concerned not only with public health affairs in G-5 SHAEF but also with broad aspects of civil and military public health. Colonel Turner's report to The Surgeon General was rendered on 9 March 1944.15
From this long and detailed report, the following excerpts were selected by its author to present the main ideas and substance of the document.
2. a. I have to report that the situation as regards civil affairs public health in this theater is in an exceedingly unsatisfactory state at the present time. It is expected that the Supreme Headquarters Allied Expeditionary Force (SHAEF) will have to assume, through its civil affairs sections at various echelons, responsibility for decisions and actions affecting public health in most of western Europe. It is unprepared to assume that responsibility. This is not intended as a reflection on present directing personnel, since many of these officers have only been recently assigned. Nevertheless, prompt action is imperative.
b. In Great Britain and in the United States public health is administered by eminent specialists who devote full time to the task, yet at the moment there is no one qualified specialist charged with responsibility for planning or operation in these matters for the Allied Forces. At neither the G-5 level nor the special staff level is public health accorded the status of a major division. * * * Yet on the basis of history and present knowledge of Europe there is a real threat of serious epidemics of contagious or of nutritional diseases occurring in the wake of returning refugees and forced laborers in hygienically deteriorated environments.
c. The War Office in London and the War Department in Washington have shown
foresight in assembling medical supplies with which to implement public health and medical care in occupied and liberated countries, but the organization to ensure that these supplies will be used effectively does not exist.
d. Local physicians and medical facilities must be relied upon largely in caring for the civilian population, but until governmental stability is achieved the Allied Army must provide a minimum of directing personnel, in public health as in other main fields. Medical personnel is extremely short in both Great Britain and the United States. It is essential therefore that the few physicians available for civil affairs be wisely used. This can best be insured by establishing a clear cut chain of technical responsibility for those who must shape public health policy and influence action at various levels. The utilization of medical personnel in non-medical fields cannot be justified.
3. I have just recently had the privilege of reviewing civil public health activities in the North African Theater of Operations. [Report of this review was attached as Inclosure 2.] After much field experience and some mistakes a comparatively satisfactory pattern of civil public health activity has gradually been evolved. It seems imperative that we profit by this experience. The following comments and recommendations are based upon the Italian operation modified to fit anticipated conditions in Europe in the light of overall policy and plans as known to me at this time. If some of the recommendations made seem to conflict with present concepts of Civil Affairs as a whole, it is respectfully suggested that what may be sound organization for the civil public health field may also be sound for certain other aspects of civil affairs.
4. Organization on a functional basis.
a. Most of the difficulties in organization arise from the fact that civil affairs must be administered through existing civil organizations which are deployed according to territorial boundaries, while the different echelons of the Army often function without respect to political boundaries. This makes it necessary to conceive of the Civil Affairs organization as one paralleling the field forces and supply services. Although it must be tied in administratively as tightly as possible with those forces, its functional operation is determined primarily by territorial needs.
b. Public health inevitably will be an important aspect of civil affairs. It should therefore be accorded major status in the civil affairs organization. This will make it practicable to assign well qualified officers as advisors to the Chief Civil Affairs officers and give the public health officer direct access to his Chief.
c. The health of the Army is dependent in part on the health of the civilian population among which it operates. The two cannot be entirely separated and the field force surgeon rightly has an interest in civil health. It is absolutely essential that the civil affairs public health officer at every level maintain the closest possible liaison with the field force surgeon, and recognize a degree of technical responsibility to him. Some mature officers hold that the civil affairs public health officer should be on the staff of the field force surgeon and assigned to civil affairs activities. I believe that this would create more problems than it would solve and would limit deployment of these officers on a territorial basis. However, we all belong to the same Medical Department and must work in harmony and good will. [The remaining subdivisions of the above par. 4, and the pars. 5, 6, and 7 are omitted.]
8. Specific recommendations.
a. That at every level of the civil affairs organization public health be designated as a major division (coordinate with Legal and Fiscal) with the chief public health officer directly responsible to the chief civil affairs officer.
b. That instructions be issued to the effect that at every level, the chief public health officer will initiate and maintain the closest liaison with the surgeon of the field forces.
c. That a request be made to the War Department for the assignment of a highly qualified medical officer to be director of the public health division and principal advisor
to the top operating officer of Civil Affairs SHAEF; that this officer be responsible in technical matters to the Chief Medical Officer, SHAEF, and that the Surgeon General honor a request for such an individual at the earliest practicable date. This officer should preferably be a general officer.
d. That the director of civil public health be provided with an adequate specialist staff, * * * [The detailed staff list which was attached as an inclosure is omitted here.]
e. That a request be made by SHAEF for the following key personnel for civil affairs: [Details omitted.]
f. That SHAEF issue a directive that except under very unusual circumstances Medical Department officers or officers of the R.A.M.C. will be used only in bona fide Medical Department activities. This will apply to members of the Veterinary Corps but upon approval of the director of public health these officers may be assigned for duty with groups other than medical, such as agriculture.
g. That the assignment of all civil affairs public health and medical officer personnel be made only upon the advice of the director of public health or his designated representatives at various levels.
h. That for any country technical responsibility for civil public health be centralized at the earliest practicable date after occupation in one individual, regardless of whether he is attached for administrative purposes to the communications zone, to a field army, or to an Allied Mission.
i. That increased attention be given to training in technical matters for public health personnel awaiting field duty, and that this training be developed with the advice of the director of public health or his representative.
j. That close liaison be maintained between the medical staff of the United Nations Relief and Rehabilitation Administration and civil public health officials in both England and America.
k. That in the presence of heavy louse infestation with a threat of typhus in any area for which SHAEF is responsible, the USA Typhus Commission be requested to survey the situation, make recommendations and if necessary initiate a control program.
1. That medical supplies for civil affairs be handled through separate requisition and stock control channels under the public health division of Civil Affairs. This will not preclude use of the physical facilities of the civil affairs general storage depots.
Information copies of this report were sent by Colonel Turner to the Chief of Staff, SHAEF (through G-5), the Chief Medical Officer, SHAEF, Maj. Gen. Albert W. Kenner, the Deputy Chief Civil Affairs Officer, SHAEF, General McSherry, and the Chief of Staff, ETOUSA (through the Chief Surgeon, ETOUSA, General Hawley).
Establishment of Public Health Branch
Generals Holmes and McSherry were sympathetic to the points of view and recommendations expressed in Colonel Turner's report, and they set in motion actions which resulted in the reinforcement and elevation of Public Health in G-5 SHAEF. Before the end of March 1944, Public Health was raised to the status of a major branch, the staff was enlarged and strengthened in competence, and civil public health supply planning was transferred from the Supply Section of G-5 SHAEF to the Public Health Branch.
An interesting sidelight is cast on the temporary complexities arising from the joint British-American character of this headquarters. For reasons
related to the equitable distribution of branch chiefs in G-5, General Grasett, Assistant Chief of Staff, G-5 SHAEF (fig. 52), originally proposed that the chief of Public Health should be a British officer. When advised of this by Maj. Gen. John H. Hilldring, director of Civil Affairs Division, War Department Special Staff, The Surgeon General took exception to the move on the basis that, since the overwhelming majority of medical officers assigned to Civil Affairs duties were to be American because of the inability of the British War Office to supply its quota, it would be unwise (and perhaps unfair) to appoint a British officer as chief of this branch. Following an exchange of telegrams, Generals Holmes and Hilldring agreed that the Chief of Branch would be an American general officer, to be recommended by The Surgeon General.
Appointment of chief.-Because all senior Army medical officers with competence in this field were already holding highly important posts, The Surgeon General turned to the U.S. Public Health Service. In a conference
between Dr. Thomas Parran, then Surgeon General of the Public Health Service, and General Simmons and Colonel Turner, of the Office of the Surgeon General of the Army, Dr. Parran agreed to release his Deputy, Dr. Warren F. Draper (fig. 53), for this assignment. This was formalized by an exchange of letters, dated 20 and 26 April 1944, between the Secretary of War and the Administrator of the Federal Security Administration. It was agreed also that Dr. Draper should have a regular officer of the Medical Corps of the Army as Administrative Deputy and Col. William L. Wilson, MC (fig. 54), was selected for this post. These recommendations were acceptable to SHAEF. Dr. Draper was detailed to the Army with the rank of brigadier general on 26 April 1944, and was promoted to major general on 1 July 1944. General Draper and Colonel Wilson reported for duty at SHAEF headquarters in London on 8 May.
Organization.-With the arrival of General Draper at SHAEF, the Public Health Branch was organized on a functional basis as follows:
Other specialists were attached to the branch as circumstances required; for example, three nutrition teams of three members each were recruited by The Surgeon General upon request of the branch and assigned to work under the direction of Colonel Howe for 90-day periods. In addition, 11 enlisted personnel were assigned permanently to the branch. With the reorganization and permanent assignment of specialist personnel, morale
in the Public Health Branch became high and remained so throughout the rest of the war.16
Mission.-Within 2˝ months after the establishment of the Public Health Branch, basic statements of its mission, expressed in terms of the duties of the chief officers, were issued in a directive which reads as follows:17
1. The Chief, Public Health Branch, under the A C of S, G-5, will assure:
(a) Submission of recommendations for and proper establishment of policies and
procedures for coordinated Civil Affairs Public Health operations within the areas for which SCAEF [Supreme Commander, Allied Expeditionary Force] is responsible.
(b) Plans for and coordinated provision of all resources required within areas for which SCAEF is responsible for preventing or controlling those diseases among civilians or animals which might interfere with military operations.
(c) Properly obtained, evaluated, and disseminated authentic data concerning prevailing diseases, existing or threatened epidemics, and available indigenous resources for Public Health operations within areas for which SCAEF is responsible with particular attention to personnel, facilities, equipment, transport and operational systems; military medical services at all levels will be kept fully informed in order to insure maximum safeguard to military forces.
(d) Coordination of Civil Affairs Public Health operations with operations of the military medical services of the Allied Expeditionary Force in all areas by continuous and close liaison with the Chief Medical Officer, SHAEF [Maj. Gen. Albert W. Kenner, USA]; and will insure efficient utilization of all available resources to maximum relief of military forces from attention to or involvement in Civil Affairs Public Health operations.
(e) Timely availability and distribution of medical supplies and advice with reference to nonmedical supplies required for prevention or control of diseases among civilians or animal populations which might be transmitted to the military forces, might interfere with military operations, or might fail to actually promote those operations.
(f) Maintenance of proper relations with, obtaining information or support from, and coordinated activities requested of British and American non-military Government or civilian agencies which might contribute aid to or support SCAEF in all Civil Affairs Public Health plans or operations.
In addition, the directive contained an elaborate catalog of the duties of all the other chief officers and consultants on the staff of the Branch. Listing all for completeness, these were: the Chief; the Deputy, Professional Consultant; the Administrative Deputy; the Chief, Preventive Medicine Section; the Chief, Medical Supply Coordination Section; the Field Operations Consultant; the Sanitary Engineer Consultant; the Nutrition Consultant; the Nursing Consultant; the Veterinary Consultant; additional consultants as required; and personal assistants.
The directive was not entirely clear, specified the performance of some impossibilities, and was interpreted variously. Historically, the most satisfactory and realistic summary of the mission is the one given in a final report of the chief of the branch to The Surgeon General, as follows:18
The more important duties of the Public Health Branch were:
To make field inspections when necessary to insure that SHAEF policies and directives were carried out.
To advise the SHAEF G-5 Supply Branch as to the requirements of the civil population regarding medical, sanitary and food supplies in the interest of military operations, including quantities, kinds, and the times and places at which needed.
To advise the Displaced Persons Branch regarding the medical and sanitary phases of its work.
To coordinate its actions with the Medical Department of the Army through the Chief Medical Officer (Maj. Gen. Kenner) and the Chief Surgeon, European Theater of Operations (Maj. Gen. Hawley).
To advise the Personnel Section SHAEF as to the number and qualifications of personnel required for G-5 public health field activities and the areas where needed.
To aid the Personnel Section in the selection and securing of public health personnel from any source available.
To establish a system of communicable disease reporting throughout the European Theater of Operations.
To disseminate information regarding the incidence of communicable diseases.
To work out agreements and maintain cooperative relationships with other agencies-U.S. [United States of America] Typhus Commission, American and British Red Cross, UNRRA, British Ministry of Health.
It is apparent from the foregoing that the Public Health Branch was in the main a policy forming, advisory, and informational agency. It could control public health operations in the field only to the extent that it was able to convince the over all authorities at SHAEF that policies permitting such control would add materially to the efficiency of military operations as a whole. It was necessary constantly to bear in mind the fact that the success of military operations was the prime objective, and that policies which seemed desirable from the public health viewpoint would not be adopted if they tended to curtail personnel or authority which were deemed essential for the military.
Although the Public Health Branch was, in the main, an advisory agency, it occasionally acted as an operating body. This was ill-advised and accounted for some of the misunderstandings that arose. In fact, G-5 SHAEF was never intended to "operate" by exercise of authority outside its own organization, and its Public Health Branch was regarded as presumptuous in trying to do so.
GENERAL AND SPECIAL STAFFS FOR CIVIL AFFAIRS
Before proceeding with accounts of planning and certain events relative to civil affairs public health activities in the European theater, it is advisable to review the staff structure in which public health came to be recognized as of sufficient importance to warrant the establishment of a separate Public Health Branch at SHAEF headquarters.
Certain staff functions of Civil Affairs, such as policymaking, review, and coordination were General Staff functions. These were incorporated in the organization designated "G-5 SHAEF," under the Assistant Chief of Staff for Civil Affairs, G-5.
Other staff functions of Civil Affairs were technical in nature and, therefore, required a technical Civil Affairs Section on the level of the Special Staff. The field operations would then be performed by Civil Affairs detachments under the staff supervision and direction of these two Civil Affairs Sections (General and Special Staffs), and under the direct authority of a local commander when assigned temporarily to combat units..
The overall scheme of Supreme Headquarters provided for the institution of a Civil Affairs staff structure similar to that in SHAEF in the major commands and formations of the U.S. and British Allied Expeditionary Force; namely, in army groups, armies, corps, divisions, and in communications zones (advance and rear sections or echelons). The staff structures, as they evolved, were not all alike, did not observe the same policies and
practices, and placed different interpretations on identical directives. These differences, together with the climactic events of the campaign in Europe, the enormous burdens suddenly imposed, and the vast and intricate problems to be solved, greatly affected plans, arrangements, and capacities for public health activities by both the SHAEF organizations and the regular establishments within the field forces. In the U.S. components of these forces, one result of major importance was the necessity for the Medical Department to take over those public health functions which the SHAEF groups were incapable of performing among civilians, both in the liberated and the occupied enemy countries in northwest Europe.
During October and November 1943, Col. (later Brig. Gen.) Cuthbert P. Stearns, Cav, USA, who had arrived in the European theater from Africa, was busily engaged in setting up a so-called tactical organization for Civil Affairs in the combat or mobile phase. His work resulted in the establishment of the Civil Affairs Training Center at Shrivenham on 1 December 1943 and the establishment of ECAD (European Civil Affairs Division) on 7 February 1944. This Division was composed of Civil Affairs regiments, companies, and detachments.19
Personnel for G-5 SHAEF Public Health and Medical Activities
Medical personnel pool-In January and early February 1944, U.S. Army Medical Department personnel destined for activities in public health, and in certain organizational medical activities under G-5 SHAEF, began arriving in the European theater. The officers had been selected by the Office of the Surgeon General and trained at the Provost Marshal General's School of Military Government at Charlottesville, Va. They, along with other Civil Affairs officers, were assigned to ECAD, the G-5 SHAEF agency created to hold, train, prepare, and replace Civil Affairs personnel of all categories for active field duty as called for by the military commanders. ECAD maintained its personnel in England in several groups located at Shrivenham (nicknamed "Shiveringham" by medical officers stationed there in the winter of 1944), Manchester, Easthampton, and Eastbourne. Most of the medical officers were assigned to the Civil Affairs Center at Shrivenham. The enlisted personnel were assigned chiefly to the center at Manchester. During the early months of 1944, while organization training was in progress, personnel were transferred frequently between these two locations.
Morale-Before the invasion of France, morale among these medical officers was extremely low, largely because of lack of opportunities for professional work and the "made work" which they were required to do. Many of the same problems existed in the holding center at Tizi Ouzou in North Africa and at the Presidio of Monterey, the holding center for the Far East. While a degree of boredom in similar situations is probably
inevitable, organization, leadership, and better planning would reduce some of these undesirable features in future operations.
Sorting, appraisal, and assignment.-By limiting attention to the handling chiefly of public health personnel, it is possible to cut through masses of records of misconceptions, mismanagement, and final corrections. The concept that Medical Department personnel were in the status of "branch immaterial," and the concept that all medical officers were qualified to perform public health functions, had to be abandoned so that general and special capabilities could be recognized and properly utilized. Sorting and appraisal were the necessary bases for decisions on assignments. At the Civil Affairs Center, three boards were set up to interview all officers for assignment. Furthermore, in consultation with representatives of the Public Health Branch, appropriate authority at ECAD made available certain public health personnel as consultants, selected some for duty as public health advisers to the SHAEF Missions, and placed others as public health staff officers at Army groups and armies. The majority, however, became members of the Civil Affairs Detachments to be deployed by field commanders as operations required. Some officers were designated to furnish medical care and sanitary supervision to ECAD.
European Civil Affairs Division
The European Civil Affairs Division (U.S. contingent) of SHAEF was established at Shrivenham on 7 February 1944.20
The main function of the Division was to serve as a tactical unit for G-5 SHAEF, Special Staff, in relation to U.S. Civil Affairs personnel. It was the agency for holding, training, and preparing all categories of such personnel for active duty under field commanders of U.S. combatant forces. Public health personnel, and some personnel for rendering medical service and medical processing to ECAD, were included in the composition of the Division from the start-somewhat inconspicuously at first but in a compact medical organization by September 1944. The Division maintained its headquarters in England until 14 September 1944, when it moved to France. Before that date, however, starting with the invasion in June, several of its medical detachments had joined units of the First U.S. Army in Normandy.
In addition to its Headquarters and Headquarters Detachment, the Division formed four Civil Affairs Regiments during the 2 months following its establishment: the 6901st, 6902d, 6903d, and 6906th ECA (European Civil Affairs) Regiments. The 6906th was a training and replacement regiment. On 6 June 1944, these units were renumbered 1st, 2d, 3d, and 4th ECA Regiments, respectively, with regimental medical detachments. These detachments with public health functions served in the field in connection
with Civil Affairs Detachments when called for by field commanders. When in the field, they served under the local military commander. The authoritative statement of the plans for their duties and activities was issued on 1 May 1944, as follows:21
122. CA Detachments will work in close cooperation with the Army Medical Services. They will assist in ensuring that measures are taken to organize or re-establish local medical relief and hygiene services so that the health of our forces is not endangered and the military administration is not impaired. They will take such measures in conjunction with the Army Medical Services as personnel and facilities permit, and will endeavour to prevent the spread of disease in occupied territory. CA Staffs will work in close co-ordination with Army Medical Services/Surgeons at Formation HQs/HQs in the development of an inclusive public health plan.
123. Local agencies, both voluntary and official, will be required to render maximum assistance. Reconnaissance of the general public health and hygiene problems will be the duty of CA Detachments. Such reconnaissance parties will include, where possible, engineer and medical personnel. They will collect data on the existence of medical and hygiene stores and equipment in the area; on the number of doctors, nurses and other medical personnel available locally; the location and numbers of distressed persons requiring such aid; and the existence and extent of epidemics and disease. They will then send back through command channels an estimate of immediate medical, hygiene and hospital requirements in personnel and materials.
Medical Group, ECAD
Late in March 1944, a Division Surgeon's Office and Offices of Regimental Surgeons were established in the European Civil Affairs Division, and medical services for ECAD and its four ECA Regiments were developed and organized. The first Division Surgeon was Maj. Stanley J. Leland, MC. Lt. Col. (later Col.) James P. Pappas, MC, Capt. (later Col.) Leonid S. Snegireff, MC, and Maj. Edward V. Jones, MC, were appointed Surgeons of the 1st, 2d, and 3d ECA Regiments, respectively. Within a short time, Colonel Pappas became Division Surgeon.
The Division became increasingly engaged in both medical affairs and preparatory public health activities. Numerous occurrences and consequent problems, described in various reports,22 indicated that, for control and effective action, all the medical and related ECAD personnel should be placed in one compact cohesive unit under the command of a Medical Department officer. Colonel Pappas appreciated this fully; with intelligence, foresight, and vigor, he succeeded in bringing all of the medical and public health personnel of the Division into a single organization which was officially authorized by Headquarters, SHAEF, and established within ECAD as the European Civil Affairs Medical Group on 14 September 1944. The letter of reorganization, dated 27 August 1944, states: "Medical Group-Includes all Medical Department personnel in the division. It will have CA [Civil
Affairs] operational functions in the field of public health, as well as medical care of the command and medical supply. Its personnel will be distributed and redistributed among CA detachments according to changing needs."
On 14 September 1944, Colonel Pappas assumed command of the newly formed ECA Medical Group while retaining his assignment as ECA Division Surgeon. Simultaneously, Group Headquarters was opened and, within 2 weeks, a staff was selected which included Capt. (later Col.) Edward J. Dehné, MC, as Executive Officer. On this date, the ECA Division was located at the Chateau Rochefort, Rochefort-en-Yvelines, Seine-et-Oise, France.23 The account of the activities of the ECA Medical Group in the field will be continued in chapter XIII.
Training in England
In England, training for Civil Affairs/Military Government began before the entry of the United States into World War II and, after that event, was continued by established British schools and by a newly established American military school. The training program comprised both general phases and special professional and technical courses. For U.S. personnel, after 1 January 1944, it was conducted by the European Civil Affairs Division at the American School of the Civil Affairs Training Center at Shrivenham.
Included in the broad program were painstaking research, study, and planning over many months in preparation for operations in conjunction with field forces on the continent of Europe. The branches concerned with matters of public health, law, finance, currency, economics, displaced persons, and other subjects wrote and rewrote their directives; the handbook for Germany underwent nine revisions. Many untested theories were formulated, amplified, and discarded. Absence of a duly constituted medical organization within the European Civil Affairs Division during the first 6 months of 1944, or a central coordinating agency with responsibility and authority for developing policy or for effecting coordination of professional and technical public health matters, left a void that hindered progress and the proper preparation of the scarce medical personnel in duties for which they were intended.
Medical Department officers, assigned to this work soon realized that they would be engaged in considerable staff procedure and in activities of a planning and operational nature, and would be dealing with nonmedical staff officers concerned with such Civil Affairs functions as utilities, law, economics, and food and agriculture-to name but a few. They understood that they would be having official relations with the Medical Department
staffs and other staff agencies of tactical commands. The functions of a Civil Affairs Public Health Officer were not specified in War Department doctrine or directives at that time, but it was generally understood that his primary duty was to coordinate and facilitate the administrative and professional solutions of problems involving the health of civilians in occupied areas.24
The training included indoctrination in Army procedures, elements of drill, and some physical exercises. Information on certain aspects of medical care was provided. Instruction, which often proved to be inadequate, was given in the rudiments of public health practice as it would apply to conditions in Europe, as far as they could be estimated.
Although much was accomplished, there were serious defects in the arrangements and activities of Civil Affairs training, especially with respect to public health. In general, there was a lack of responsibility for the program. There were frustrations, mistakes, and wastage of personnel at a time when medical officers were needed urgently. Competent health officers, then in uniform, were needlessly sidetracked for elementary training. The errors committed in this phase of training in the European theater should not be glossed over but should be analyzed frankly and evaluated for future guidance.
MEDICAL AND SANITATION SUPPLY
Policy.-To all concerned with the relief and rehabilitation of civilians in European countries that would be liberated and occupied by Allied Forces after the invasion of France, it was obvious that vast amounts of medical and sanitation supplies, including food, would have to be made available from three main sources. These would be (1) indigenous supplies, (2) supplies captured from the German Army in military depots, and (3) supplies provided through British and United States military sources. The contribution from the United States was expected to be predominant, especially after President Roosevelt's letter of 10 November 1943 to the Secretary of War, dealing with the obligations for relief activities that would fall upon the United States during and after the defeat of Germany. Consequently, both British and American higher commands and subordinate and cooperating agencies gave serious and effective consideration to matters of medical and sanitation supply for Civil Affairs.
The G-5 SHAEF supply program.-G-5 SHAEF could not, and did not, have any independent control over sources of supply. Naturally, as a part of the military organization, its basic dependence was upon the logistical and supply system of the U.S. Army, the Army's control of captured supply depots, and the Army's relations with relief agencies such as the American National Red Cross and the United Nations Relief and Rehabilitation Administration. In addition, it also received supplies of typhus vaccine,
DDT, and dusters from the United States of America Typhus Commission which also relied upon the logistical and supply system of the U.S. Army for this materiel.
In the organization of G-5 SHAEF, provision was made for a Supply Branch25with sections for procurement, storage, and distribution. This Branch, however, conducted its basic affairs through the regular Army medical supply service. Directives outlined supply operations.26 The theater medical supply service was centered in the Office of the Chief Surgeon, ETOUSA, Maj. Gen. Paul R. Hawley, USA, about whom it has been recorded that he "was not only chief surgeon of the theater, but he also headed the medical service of the Communications Zone. As the war progressed, he had tremendous medical resources-personnel and material-under his control. General Hawley, a man of great ability and drive, was strong enough and wise enough to use them effectively. The fact that the entire medical services for the U.S. forces in the European theater was under one chief aided immeasurably in the successful medical support of the war."27 From the records, it is evident that G-5 SHAEF alone could not have handled its supply problems, and that the planning had been wise, allowing for valuable liaison between G-5 SHAEF and the Office of the Chief Surgeon, ETOUSA, and the medical establishments of armies, army groups, and communications zones.
Inadequacies and changes.-The U.S. Expeditionary Force itself suffered from shortages of supplies and food in the early months of 1945; this affected the capacity of G-5 SHAEF units (European Civil Affairs Detachments) to deal with problems of need, distress, and undernutrition among the many thousands of displaced persons and refugees who had to be cared for after the victorious armies advanced across the Rhine. In brief, by March and early April 1945, it became clear that the G-5 organization, lacking personnel, facilities, and supplies, would not be able to meet its commitments. Because of a cable dated 28 March 1945, a directive was issued on 14 April 1945, which turned over total responsibility within army groups and armies in occupied enemy territory to commanding officers of commands and their staff medical officers in the 6th, 12th, and 21st Army Groups and the Communications Zone, European theater.28
THE SHAEF MISSIONS
Before the United States entered World War II, the planning in England for Civil Affairs in occupied and liberated countries included con-
sideration of problems of relief and rehabilitation among the civilian populations of European states which had been under the control of Germany. From 1939 on, the organization for Civil Affairs contained divisions known at various times as "country houses," in which these problems were studied, among which those of public health were of prime importance, in countries expected to be liberated from German oppression, and in portions of the German Reich that would be occupied through conquest by the Allied Forces. These countries were France, Luxembourg, Belgium, the Netherlands, Denmark, and Norway. Germany was to be handled as conquered enemy territory subject to military government. The Governments of the other countries would be regarded as sovereign and friendly. Upon them, military government by the Allied Expeditionary Force would not be imposed. In other words, the operation of Civil Affairs/Military Government in these countries was to be on the basis of convention, negotiation, and cooperation, in the presence of Allied military units with police powers and powers of requisition and regulation according to military needs.
British 21 Army Group.-The Headquarters of the British 21 Army Group in London was the center of most of the planning for Civil Affairs in Belgium, the Netherlands, Luxembourg, Denmark, and Norway. These countries were almost the exclusive concern of the 21 Army Group. France and a portion of Germany were almost the exclusive concern of the 21 Army Group. France and a portion of Germany were allocated to the Americans and became the responsibility of the U.S. contingent in G-5 SHAEF.
From Country Houses to Missions.-The "country houses," or state-divisions, in Civil Affairs became definitely organized in the early months of 1944 under the designation: SHAEF Missions. The Missions were destined to serve as liaison bodies between the national governments of the liberated countries and the Allied military authorities so that each might help the other to the extent that their common interests required in the prosecution of the war and in works of rehabilitation. Each Mission was administered by an especially selected American or British officer with a staff of expert advisers on the major activities of civil government, including public health.
Directives.-From the time of the invasion of France until after the occupation of Germany in 1945, detailed directives for the conduct of Civil Affairs/Military Government were issued by Supreme Headquarters, Allied Expeditionary Force, by U.S. Army groups, and by other major U.S. military organizations in the combat zone of Europe. They contained direct references to public health requirements and procedures and, in a number of instances, specified the utilization of medical and public health sections of European Civil Affairs Detachments. The directive of 25 August 1944, the result of prolonged study, addressed to field commanders, covered Civil Affairs operations in France and is quoted here because it conveys an idea of the basic philosophy on which these operations were projected and be-
cause it refers specifically to public health. Similar basic directives were issued by other SHAEF Missions on the Continent.29
[From SHAEF Headquarters to Commander in Chief, 21 Army Group, and Commanding General, Twelfth Army Group, 25 August 1944.]
1. You will insure that such measures are taken to control communicable disease among the civilian population as the safety of your Forces and the conduct of your operations require.
2. Civilian Public Health is primarily a matter for French authorities and in general such action as is required, including examination and treatment, will be taken by and through those authorities. In the Forward Zone in emergencies affecting military operations, or where no French authority is in a position to effect the measures deemed necessary by commanders to protect the health of the troops, commanders may as a temporary and emergency measure take such action as military necessity requires. Moreover, in Military Zones, similar action may be taken by commanders when necessary to the conduct of operations.
3. You will be responsible for calling forward and distributing medical and sanitary supplies/stores required for civilian use. The scale/basis of supply will be that necessary to maintain minimum standards imposed by the character of operations.
4. High priority will be given to civilian requirements in the allocation and disposition of captured enemy military medical and sanitary supplies and equipment. Medical and sanitary supplies and equipment which are in the hands of civilians and already intended for civilian use will not normally be requisitioned, but if requisitioned will be requisitioned in accordance with French law and through the French authorities. However, in the Forward Zone, in the circumstances in par. 2, commanders may directly requisition such supplies and equipment.
Germany.-With the exception of Germany, these directives were predicated upon friendly relations between the Allied military forces and the Governments and peoples of the liberated countries.
In planning for Civil Affairs/Military Government and its associated public health activities in Germany, however, this relationship involved a clear difference since civilians of an enemy country were involved. While the directives reflect this difference, as military government was to be imposed and enforced, in practice the ideals of the medical and allied professions tended to make the distinction between friend and enemy largely artificial in matters of health.30