Healthcare in Eastern Siberia during the Great Patriotic War

Semenov Mikhail Aleksandrovich PhD in History Scientific Associate, Institute of History of Siberian Branch of the Russian Academy of Sciences 630090, Russia, Novosibirskaya oblast', g. Novosibirsk, ul. Nikolaeva, 8 pihterek@yandex.ru Other publications by this author

The development and activity of civilian healthcare during the Great Patriotic War is not the most spoiled topic of research attention, largely remaining in the shadow of the history of military medicine of this period. At the same time, the medical care provided to the population played an equally significant role during this period. It was civil healthcare that managed to prevent the disorganization of the rear in the most difficult conditions as a result of the mass spread of infectious diseases, reducing mortality in the rear regions of the country allowed saving the lives of millions of our fellow citizens, preserving the health of workers played an important role in the development of industrial production, saving millions of working hours, etc. Thus, without full coverage of civil healthcare, the history of the Great Patriotic War will be incomplete.

The results of the study of health care during this period are extremely uneven in territorial terms. Thus, the history of healthcare in such a large economic region as Eastern Siberia, which played the role of an important industrial and agricultural center during the war years, remains relatively little studied. Among the works covering the development of healthcare on the scale of Eastern Siberia, it is worth noting the works of A.V. Shalak ^[1,2]. The works of E.V. Banzaraktsayeva ^[3], L.E. Mezit ^[4], S.I. Sivtseva ^[5], V.Y. Zolotareva ^[6] and others are devoted to the history of medicine of individual regions. Nevertheless, the study of healthcare as a related topic, the territorial scope of these works, the use, mainly, of clerical sources, leads to insufficient reflection of general trends in the development of East Siberian healthcare on the basis of consolidated statistical data. The elimination of this gap is the purpose of this article.

The article is based on statistical data of the USSR People's Commissariat of Health Fund (Fund R-8009) of the State Archive of the Russian Federation (GARF), extracted from the "Annual statistical reports on the network of activities and personnel" (form No. 90obl), as well as from information on the movement of acute infectious diseases in statistical reports on forms No. 85 and No. 87. These statistical materials were prepared by regional health authorities on the basis of statistics of medical institutions. The reliability of the data contained in them was checked both by the People's Commissariat of Health and by the Central Statistical Office. This circumstance allows us to consider the information provided in them reliable to the extent that the collection of medical statistics on the ground has been established.

In methodological terms, the main role was played by methods of quantitative analysis.

First of all, it is necessary to consider the dynamics of the number of medical institutions in Eastern Siberia.

Table 1

Dynamics of the number of medical inpatient institutions in the regions of Eastern Siberia in urban settlements

Compiled by: ^{[7, L. 2-3.; 8, L. 2-3.; 9, L. 2-3.; 10, L. 2-3.; 11, L. 2-3.; 12, L. 2.; 13, L. 16.; 14, L. 2.; 15, L. 2.; 16, L. 2.; 17, L. 2.; 18, L. 2.; 19, L. 2.; 20, L. 2.; 21, L. 2.; 22, L. 1ob.-2.; 23, L. 1ob.-2.; 24, L. 1ob.-2.; 25, L. 1ob.-2.; 26, L. 1ob.-2.; 27, L. 1ob.-2.; 28, L. 3ob.-4.; 29, L. 1ob.-2.; 30, L. 1ob.-2.; 31, L. 1ob.-2.; 32, L. 1ob.-2.; 33, l. 1ob.-2.; 34, l. 1ob.-2.; 35, l. 1ob.-2.; 36, l. 1ob.-2.; 37, l. 1ob.-2.]}

As we can see, in 1941, the total number of medical inpatient institutions decreased in the cities of Eastern Siberia from 243 to 221. At the same time, the decline is almost entirely due to the healthcare system of the Krasnoyarsk Territory, in which the number of hospitals has decreased by almost a third from 107 to 72 institutions. First of all, this reduction is due to the deployment of numerous evacuation hospitals in the region. The deployment of hospitals negatively affected the dynamics of the civilian medical network, both directly, in cases when the hospital was deployed on the basis of hospitals of the civilian medical network, and indirectly, due to the transfer of health resources, primarily personnel, to ensure the operation of hospitals, which forced to reduce the network of civilian institutions.

In 1942, the reduction in the number of medical inpatient institutions was much slower. It was based on a reduction in the number of maternity hospitals. The decline in the birth rate led to a decrease in the demand for this type of institutions and, in conditions of lack of resources, they were subjected to "optimization".

In 1943, the growth of financing of the social sphere and, in particular, health care began. By the same time, the network of evacuation hospitals, massively relocated closer to the front, is significantly reduced. All this made it possible to strengthen the network of civilian medical inpatient institutions and their total number by the end of 1943 was equal to 1940, amounting to 243 institutions.

At the same time, the Krasnoyarsk Territory has not been able to replenish the number of its medical inpatient facilities. The situation was leveled due to the growth of the hospital network in the Chita region and the Yakut ASSR.

In 1944, the number of institutions was somewhat reduced and again at the expense of the Krasnoyarsk Territory. Apparently, this was the result of the consolidation of a number of institutions.

Finally, in 1945 there was a relatively small increase in the number of medical inpatient institutions in Eastern Siberia. Thus, in general, in the cities of Eastern Siberia, the number of institutions increased slightly during the war years – by only 6 institutions. But in the context of individual regions, the situation is changing dramatically. If by the end of the war the Krasnoyarsk Territory had almost a third fewer medical inpatient facilities than in 1940, then in the Irkutsk and Chita regions their number has grown significantly, and in the Yakut ASSR it has become more than 50%.

Table 2

Dynamics of medical inpatient institutions in the regions of Eastern Siberia (rural areas)

Compiled by: ^{[7, L. 2-3.; 8, L. 2-3.; 9, L. 2-3.; 10, L. 2-3.; 11, L. 2-3.; 12, L. 2.; 13, L. 16.; 14, L. 2.; 15, L. 2.; 16, L. 2.; 17, L. 2.; 18, L. 2.; 19, L. 2.; 20, L. 2.; 21, L. 2.; 22, L. 1ob.-2.; 23, L. 1ob.-2.; 24, L. 1ob.-2.; 25, L. 1ob.-2.; 26, L. 1ob.-2.; 27, L. 1ob.-2.; 28, L. 3ob.-4.; 29, L. 1ob.-2.; 30, L. 1ob.-2.; 31, L. 1ob.-2.; 32, L. 1ob.-2.; 33, l. 1ob.-2.; 34, l. 1ob.-2.; 35, l. 1ob.-2.; 36, l. 1ob.-2.; 37, l. 1ob.-2.]}

The situation in rural healthcare is different. In rural areas, evacuation hospitals were not opened en masse. Even in conditions of staff shortage, institutions tried not to close, as this would leave a significant part of the population without medical care. As a result, we see that the network of rural medical inpatient institutions has been steadily growing throughout the war years: slower in 1941-1942, faster in 1943-1945. In general, during the war years, it grew by 36% in the number of institutions. It is characteristic that the network of rural medical inpatient institutions of the Krasnoyarsk Territory is developing at a pace similar to the rest of the regions, which also serves as confirmation of the cause of the crisis of the urban health of the region due to the need to locate hospitals and evacuated enterprises in the cities of the region.

It is obvious that it is impossible to exhaustively characterize the situation with the provision of medical and inpatient care to the population only by analyzing the number of institutions. In this connection, let's consider another key indicator – the movement of the bed stock, showing the capacity of hospitals.

Table 3

Dynamics of the bed stock of medical inpatient institutions in Eastern Siberia

Compiled by: ^{[7, L. 2-3.; 8, L. 2-3.; 9, L. 2-3.; 10, L. 2-3.; 11, L. 2-3.; 12, L. 2.; 13, L. 16.; 14, L. 2.; 15, L. 2.; 16, L. 2.; 17, L. 2.; 18, L. 2.; 19, L. 2.; 20, L. 2.; 21, L. 2.; 22, L. 1ob.-2.; 23, L. 1ob.-2.; 24, L. 1ob.-2.; 25, L. 1ob.-2.; 26, L. 1ob.-2.; 27, L. 1ob.-2.; 28, L. 3ob.-4.; 29, L. 1ob.-2.; 30, L. 1ob.-2.; 31, L. 1ob.-2.; 32, L. 1ob.-2.; 33, l. 1ob.-2.; 34, l. 1ob.-2.; 35, l. 1ob.-2.; 36, l. 1ob.-2.; 37, l. 1ob.-2.]}

Here we see a sharp decline in 1941 by 27%, mainly due to the Krasnoyarsk Territory, where the number of beds was reduced by more than half. Then, until the end of the war, a smooth increase in their number begins. Nevertheless, even by the end of the war, the number of beds does not reach the level of 1940. At the same time, the Krasnoyarsk Territory acts as a laggard again, the bed fund of which was significantly less than the level of pre-war years. In other regions, the situation was much better, for example, in Yakutia, the bed fund by the end of the war was 58% higher than the level of 1940.

Separately, it is worth dwelling on the dynamics of maternity hospitals. In 1940, there were 73 maternity hospitals in Eastern Siberia. In 1941, their number increased, due to the implementation of pre-war plans to increase the availability of maternity care, to 104 institutions. At the same time, virtually all of the growth falls on the Krasnoyarsk Territory (growth from 16 to 43 maternity hospitals, respectively). Then their number in Eastern Siberia is decreasing, because in conditions of lack of resources and a decrease in the birth rate caused by the war, they became the first target for reduction and in 1942 they were already 79 institutions. In the future, the number of maternity hospitals fluctuates slightly, amounting in 1943 to 82 institutions, in 1944 to 74, in 1945 to 84 maternity hospitals [Calculated by: 7, l. 2-3.; 8, l. 2-3.; 9, l. 2-3.; 10, l. 2-3.; 11, l. 2-3.; 12, L. 2.; 13, L. 16.; 14, L. 2.; 15, L. 2.; 16, L. 2.; 17, L. 2.; 18, L. 2.; 19, L. 2.; 20, L. 2.; 21, L. 2.; 22, l. 1ob.-2.; 23, l. 1ob.-2.; 24, l. 1ob.-2.; 25, l. 1ob.-2.; 26, l. 1ob.-2.; 27, l. 1ob.-2.; 28, l. 3ob.-4.; 29, l. 1ob.-2.; 30, l. 1ob.-2.; 31, l. 1ob.-2.; 32, l. 1ob.-2.; 33, l. 1ob.-2.; 34, l. 1ob.-2.; 35, l. 1ob.-2.; 36, l. 1ob.-2.; 37, L. 1ob.-2.].

Thus, we see that the network of medical inpatient institutions has developed differently in Eastern Siberia. The Krasnoyarsk Territory received a serious blow as a result of the deployment of a network of evacuation hospitals in the region and was unable to recover from it until the end of the war. The hospital network of other regions of Eastern Siberia suffered significantly less and gradually developed during the war, seriously surpassing the level of pre-war time, both in terms of the number of institutions and the capacity of their bed stock.

Table 4

Dynamics of outpatient clinics in the regions of Eastern Siberia

Compiled by: ^{[7, l. 4-6.; 8, L. 4-6.; 9, L. 4-6.; 10, L. 4-6.; 11, l. 4-6.; 12, l. 3-3ob.; 13, l. 17-17ob.; 14, l. 3-3ob.; 15, L. 3-3ob.; 16, L. 3-3ob.; 17, L. 3-3ob.; 18, L. 3-3ob.; 19, L. 3-3ob.; 20, L. 3-3ob.; 21, L. 3-3ob.; 22, L. 3ob.-4.; 23, L. 3ob.-4.; 24, L. 3ob.-4.; 25, L. 3ob.-4.; 26, L. 3ob.-4.; 27, L. 3ob.-4.; 28, L. 5ob.-6.; 29, L. 3ob.-4.; 30, l. 3ob.-4.; 31, l. 3ob.-4.; 32, l. 3ob.-4.; 33, l. 3ob.-4.; 34, l. 3ob.-4.; 35, l. 3ob.-4.; 36, l. 3ob.-4.; 37, l. 3ob.-4.]}

Outpatient polyclinic institutions are developing similar dynamics to the hospital network (see Table 4). In 1941, there was a decline, also, if we consider the situation in the regional context, caused by the reduction of the medical network of the Krasnoyarsk Territory. In the future, their smooth growth begins. It should be noted that fluctuations in the number of outpatient clinics were less intense. So in 1941, the reduction of this type of medical institutions was only about 7% compared to the previous year in Eastern Siberia as a whole and about 26% in the Krasnoyarsk Territory. The growth in their number by 1945 relative to the number of institutions in 1940 was also only about 9% in Eastern Siberia.

At the same time, the dynamics of certain types of outpatient clinics has undergone more serious changes. Thus, the number of women's and children's consultations in 1941 decreased by 32% in Eastern Siberia (from 245 to 167 institutions), and in the Krasnoyarsk Territory almost tripled (from 125 to 47 consultations). In general, there has been a systematic increase in their number in Eastern Siberia since 1941. In 1942, the number of women's and children's consultations was 191 institutions, in 1943 – 208, in 1944 - 233, in 1945 – 266. In some regions, by the end of the war, their number had increased significantly compared to the pre-war level. So, in Buryatia by 1945 there were 1.5 times more of them than in 1940, in Yakutia – 2.7 times. The only region in which the number of consultations was lower than before the war was the Krasnoyarsk Territory, in which in 1945 there were 77 women's and children's consultations [Calculated by: 7, l. 7ob.-9.; 8, l. 7ob.-9.; 9, l. 7ob.-9.; 10, l. 7ob.-9.; 11, L. 7ob.-9.; 12, L. 5.; 13, L. 19.; 14, L. 5.; 15, L. 5.; 16, L. 5.; 17, L. 5.; 18, L. 5.; 19, L. 5.; 20, L. 5.; 21, L. 5.; 22, L. 6ob.-7.; 23, L. 6ob.-7.; 24, L. 6ob.-7.; 25, L. 6ob.-7.; 26, L. 6ob.-7.; 27, L. 6ob.-7.; 28, l. 8ob.-9.; 29, l. 6ob.-7.; 30, l. 6ob.-7.; 31, l. 6ob.-7.; 32, l. 6ob.-7.; 33, l. 6ob.-7.; 34, l. 6ob.-7.; 35, l. 6ob.-7.; 36, l. 6ob.-7.; 37, l. 6ob.-7.].

Separately, it is worth considering the dynamics of sanitary and epidemic institutions responsible for anti-epidemic control (see Table 5).

Table 5

Dynamics of sanitary and epidemic institutions in the regions of Eastern Siberia

Compiled by: ^{[7, l. 11-12ob.; 8, l. 11-12ob.; 9, l. 11-12ob.; 10, l. 11-12ob.; 11, l. 11-12ob.; 12, l. 6-6ob.; 13, l. 20-20ob.; 14, L. 6-6ob.; 15, L. 6-6ob.; 16, L. 6-6ob.; 17, L. 6-6ob.; 18, L. 6-6ob.; 19, L. 6-6ob.; 20, L. 6-6ob.; 21, L. 6-6ob.; 22, L. 9.; 23, L. 9.; 24, L. 9.; 25, L. 9.; 26, L. 9.; 27, L. 9.; 28, L. 11.; 29, L. 9.; 30, L. 9.; 31, L. 9.; 32, L. 9.; 33, L. 9.; 34, L. 9.; 35, L. 9.; 36, L. 9.; 37, L. 9.]}

The fight against epidemics was considered by the Soviet health care as one of the priorities during the war, so in 1941 their number decreased slightly, even in the Krasnoyarsk Territory. Later, their network was strengthened and by the end of the war exceeded pre-war figures by 18%.

At the same time, there was a significant qualitative transformation of the anti-epidemic network. Modern complex institutions – sanitary and epidemic stations - took the place of small institutions: malaria, trachomatous points. During the war years, their number increased in Eastern Siberia by 44% compared to 1940. Thus, the network of sanitary and epidemiological institutions has been actively developing not only in quantity, but also in quality.

Obviously, the medical network itself means little. It is not medical institutions that provide assistance, but people who work in them. Therefore, it is worth considering the situation with staffing of the East Siberian healthcare (see Table 6).

Table 6

Number of doctors in the system of the People's Commissariat of Health by regions of Eastern Siberia (individuals)

Compiled by: ^{[7, L. 13-14.; 8, L. 13-14.; 9, L. 13-14.; 10, L. 13-14.; 11, L. 13-14.; 12, L. 7-8.; 13, L. 21-22.; 14, L. 7-8.; 15, L. 7-8.; 16, L. 7-8.; 17, L. 7-8.; 18, L. 7-8.; 19, L. 7-8.; 20, L. 7-8.; 21, L. 7-8.; 22, L. 10ob.-12.; 23, L. 10ob.-12.; 24, L. 10ob.-12.; 25, l. 10ob.-12.; 26, l. 10ob.-12.; 27, l. 10ob.-12.; 28, l. 12ob.-14.; 29, l. 10ob.-12.; 30, l. 10ob.-12.; 31, l. 10ob.-12.; 32, l. 10ob.-12.; 33, L. 10ob.-12.; 34, L. 10ob.-12.; 35, L. 10ob.-12.; 36, L. 10ob.-12.; 37, L. 10ob.-12.]}

Since the beginning of the war, the number of doctors in Eastern Siberia has been sharply reduced. The Krasnoyarsk Territory was in a particularly difficult situation, where there was a critical situation – the number of doctors, as a result of mobilization in the Red Army, staffing of evacuation hospitals, decreased threefold.

In 1942, there was a slight increase in the number of doctors, while the Krasnoyarsk Territory was again in the lead, where their number doubled compared to 1941. This was largely due to the influence of two factors: the disbandment of some evacuation hospitals in the winter-spring of 1941-1942, accompanied by the referral of staff to a civilian medical network, and the arrival of evacuated doctors.

However, since 1943, the decline in their numbers has begun again – mobilization into the army continues, many evacuated doctors seek to leave Eastern Siberia. As a result, in 1943-1944 their number continues to decrease. The Krasnoyarsk Territory suffered the most from these processes, where the proportion of evacuated doctors was high.

Only since 1945, a slight increase in their number has begun again. Nevertheless, in 1945 there were 35% fewer doctors in Eastern Siberia than in 1940. Thus, the war became the hardest test for the East Siberian healthcare in terms of staffing. The health care of the Krasnoyarsk Territory was the most affected. The only region that managed to keep the number of doctors above the pre-war level during the war was the Yakut ASSR.

Despite the difficult state of health care, the East Siberian doctors did not stop their work to help the population for a single day. Tables 7 and 8 give an idea of the scale of the medical activity carried out.

Table 7

The number of patients admitted to medical inpatient institutions in the regions of Eastern Siberia (thousand people)

Compiled by: ^{[7, L. 2-3.; 8, L. 2-3.; 9, L. 2-3.; 10, L. 2-3.; 11, L. 2-3.; 12, L. 2.; 13, L. 16.; 14, L. 2.; 15, L. 2.; 16, L. 2.; 17, L. 2.; 18, L. 2.; 19, L. 2.; 20, L. 2.; 21, L. 2.; 22, L. 1ob.-2.; 23, L. 1ob.-2.; 24, L. 1ob.-2.; 25, L. 1ob.-2.; 26, L. 1ob.-2.; 27, L. 1ob.-2.; 28, L. 3ob.-4.; 29, L. 1ob.-2.; 30, L. 1ob.-2.; 31, L. 1ob.-2.; 32, L. 1ob.-2.; 33, l. 1ob.-2.; 34, l. 1ob.-2.; 35, l. 1ob.-2.; 36, l. 1ob.-2.; 37, l. 1ob.-2.]}

As we can see, despite the restoration and even some growth of the hospital network, the number of treated patients decreased by one and a half times by the end of the war, and in the Krasnoyarsk Territory - by half. The reason for this was primarily the lack of medical personnel.

Table 8

Number of visits by patients to outpatient clinics in the regions of Eastern Siberia (thousand visits)

Compiled by: ^{[7, l. 4-6.; 8, L. 4-6.; 9, L. 4-6.; 10, L. 4-6.; 11, l. 4-6.; 12, l. 3-3ob.; 13, l. 17-17ob.; 14, l. 3-3ob.; 15, L. 3-3ob.; 16, L. 3-3ob.; 17, L. 3-3ob.; 18, L. 3-3ob.; 19, L. 3-3ob.; 20, L. 3-3ob.; 21, L. 3-3ob.; 22, L. 3ob.-4.; 23, L. 3ob.-4.; 24, L. 3ob.-4.; 25, L. 3ob.-4.; 26, L. 3ob.-4.; 27, L. 3ob.-4.; 28, L. 5ob.-6.; 29, L. 3ob.-4.; 30, l. 3ob.-4.; 31, l. 3ob.-4.; 32, l. 3ob.-4.; 33, l. 3ob.-4.; 34, l. 3ob.-4.; 35, l. 3ob.-4.; 36, l. 3ob.-4.; 37, l. 3ob.-4.]}

The situation was similar with the provision of outpatient care. It is worth noting that statistical reporting in 1941-1942 was not even conducted, which in itself indicates a critical situation in this area. In 1943, we see the number of visits by 2 million less than three years earlier. Moreover, in the following years, the number of visits will decrease even more. The reason for this is that outpatient polyclinic care was considered by the health authorities as a kind of internal reserve and personnel from the outpatient polyclinic network smoothly flowed to maintain the efficiency of medical inpatient institutions.

It would seem that in such conditions the health situation of the population should be deplorable, but the overall mortality rate of the population of Eastern Siberia decreased from 20.6 ppm in 1941 to 9.8 ppm in 1945 ^{[38, p. 118.]}. Despite the difficult conditions of the war years, residents of Eastern Siberia began to die half as often.

Naturally, the question arises about the reasons for such success, against a generally unfavorable background with medical care for citizens. A significant share among the causes of death by the beginning of the war was mortality from various kinds of infectious diseases. In this regard, let's consider the situation with the morbidity of the population of Eastern Siberia during the war (see Table 9).

Table 9

Morbidity of the population of Eastern Siberia in 1940-1945. (number of cases per 10 thousand population)

Thus, in terms of the development of the healthcare system, Eastern Siberia was in a rather difficult situation during the war years. If the medical network gradually increased, then the situation with its staffing remained difficult throughout the war. The Krasnoyarsk Territory was in the most difficult situation, which was due to the deployment of a wide network of evacuation hospitals in the region. The reduction of healthcare opportunities has led to a reduction in the medical care provided to the population in Eastern Siberia. However, due to the clear and correct definition of priority tasks, the competent use of available human and material resources, the healthcare of Eastern Siberia managed to maintain the provision of medical care to the population at the minimum necessary level, and also managed to deal a serious blow to a group of gastrointestinal infections. Thanks to this, despite the most difficult conditions of wartime, he managed to significantly reduce the mortality of the population.

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