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Strategic Alliances for a Secure, Connected, and Prosperous Region

World War I in the Holy Land: Microbes and Bacteria Were the Deadliest Enemies

Filed under: Jerusalem in Historical Context

World War I in the Holy Land: Microbes and Bacteria Were the Deadliest Enemies
A makeshift hospital in Heliopolis, Egypt, for Australian soldiers wounded in Gallipoli. The main hall was a converted wooden skating rink in the Luna Park resort, circa 1915. (The Australian Army Medical Corps in Egypt, by James W. Barrett and Percival E. Deane)1

From Secrets of World War I in the Holy Land

The World War I campaign in the Middle East saw more soldiers die from epidemic diseases than from bullets, bombs, or artillery shells. Louse-borne typhus, cholera from contaminated water, and malarial mosquitos were often the lethal agents, but other killer diseases lurked.2 In late 1918, the “Spanish Influenza” landed in Cairo and Jaffa and decimated soldiers and civilians across the region.

The epidemics did not differentiate between their victims. One-third of Jerusalem’s population died from the epidemics that struck before 1918. Hundreds of Jews from Jerusalem, Hebron, and Gaza worked or served in the Turkish army base in Be’er Sheva. They worked as carpenters, cooks, teamsters, builders, shoemakers, tailors, millers, bakers, civilian quartermasters, and more. Jews helped build and manage the Ottoman rail system, a factor that would have essential intelligence implications as the war continued. Some Jews were soldiers in the army, some contractors, and others forced laborers who worked to avoid serving in the military. Among the Jews employed in Be’er Sheva were 78 sent from Jerusalem in June 1916 by a Jewish employment agency. Others came from Gaza or Hebron. The town had an estimated 50 permanent Jewish residents and 150 temporary workers.3 Many died from disease, including pharmacist Eliyahu Rivlin, who died “carrying out his duty” in 1916 in Be’er Sheva. Rivlin was a Jewish Turkish soldier and pharmacist from Jerusalem.

Be’er Sheva was the destination for thousands of Turkish soldiers, crowded into railroad freight cars from all over the Middle East, who gathered before an assault on the British-held Suez Canal in 1915. The Turkish soldiers were disease carriers and spreaders; their clothes, blankets, and train upholstery were breeding grounds for lice. When the Jewish workers returned from the Turkish bases to their homes, the plagues spread like wildfire.

Orphans in Jerusalem in 1918
Orphans in Jerusalem in 1918. “Their fathers and mothers had died from typhus, dysentery, malaria, and exhaustion.” (Red Cross, Library of Congress).4

When the British army entered Jerusalem in 1917, they found 2,700 orphans wandering the streets. By 1918, Armenian orphans were arriving at church orphanages in Jerusalem from Asia Minor.5 The Jewish Palestine Orphan Committee was officially established in 1919 and assumed responsibility for caring for nearly 3,000 needy children in 1919.6

Several years before the catastrophic influenza pandemic struck the world in 1918, disastrous plagues were already killing millions in the Middle East. The region suffered from malaria, typhus, cholera, dysentery, smallpox, bubonic plague, and venereal disease. The disastrous locust plague that struck the Holy Land in 1915 stripped the land of all crops and fruit, and what food the civilians had hoarded was looted by Turkish soldiers.  Thousands of civilian residents died of hunger, “exhaustion,” or disease. When the “Spanish Influenza” hit the Middle East in 1918, carried by British soldiers from Europe to the ports in Egypt and Palestine, hundreds of thousands of civilians died. Thousands of Indian soldiers fought with the British, and their travel back and forth to India guaranteed the spread of influenza, which, ironically, is believed to have originated in Kansas, the United States’ heartland.

World War I Erupts in the Middle East

When World War I erupted in Europe, Turkey allied itself with Germany and dispatched the Ottoman army to the four corners of the Middle East — to Arabia, Mesopotamia (Iraq), Palestine, and the Sinai. From there, the Turks, encouraged by Germany, mobilized to seize the Suez Canal from British control, and tens of thousands of Turkish soldiers flooded into Palestine and the Sinai via cramped train cars or long marches through population centers. The Suez Canal was essential for the United Kingdom to protect its empire, particularly the route to India from where the British secured resources and manpower, including soldiers.

Diseases Came from the East, the Influenza from the West, and They Spread

The Ottoman army was abysmally prepared for the disease and public health challenges it had unleashed. According to Prof. Melanie Schulze-Tanielian of the University of Michigan, “Widespread epidemics consumed Ottoman soldiers and civilians alike during the Great War….Typhus, malaria, and relapsing fever, transmitted via disease-infected lice, mosquitoes, and ticks, were the deadliest assailants, followed by bacterial diseases like dysentery and typhoid.”7

Prof. Schulze-Tanielian continued:

The [Ottoman] empire’s poor infrastructure contributed to the spread of disease. Limited trains to and from the fronts were often packed to capacity, meaning that common soldiers and microbes were crammed under unsanitary conditions into freight cars over long stretches of time… The fact that soldiers often had to march to and from the front made it difficult for Ottoman sanitary officials to maintain adequate hygiene.  It was during these marches that soldiers would at random mingle with civilians, picking up or leaving behind germs and microbes.

Among the civilians mingling with Turkish soldiers were Armenian refugees fleeing for their lives and wracked by disease. Along the sides of the roads lay fly-infested corpses killed in the Armenian massacre or victims of disease or hunger, which accelerated the spread of disease.

The German army medical corps attempted to improve health conditions in Turkish camps, even preparing a hygiene booklet for the soldiers, but many Turks were illiterate. Eventually, the brochures were only distributed to lower-ranking officers who taught their men.  German General Otto Liman von Sanders examined Turkish bases at the start of the war. According to Prof. Schulze-Tanielian, he found:

[P]oor or even non-existing hygiene, vermin infestations, and rampant sicknesses among the troops. There were no bathing facilities in the barracks; military hospitals were in an appalling state. A permeating stench and overwhelming dirt met him as he entered overcrowded hospital rooms. There was no separation between patients with physical injuries and those infected with diseases; men slept in the same beds or crowded on the floor. Sanders reported the misery to the Ottoman military command and issued suggestions to improve the state of affairs. His propositions were ignored, evaded, or met with outright resistance from higher officers of the military.

A Turkish military hospital in Magdabah Sinai, 1916
A Turkish military hospital in Magdabah Sinai, 1916. (Library of Congress)

Ill-clad soldiers took the clothes from dead comrades, not realizing they inherited their germs, lice, and microbes.

A medical report of all nine [Ottoman] armies and enlistment stations, according to Schulze-Tanielian, “shows the total number of military casualties of the Ottoman army as 771,844; 466,759 of whom died of illnesses and 68,378 from battle wounds.”

Photographs of the Ottoman Army on the Move

The Turkish army gathered in the Galilee
The Turkish army gathered in the Galilee before heading south for the attack on the Suez Canal. (Ottoman Imperial Archives, 1914, author’s collection)
Arab crowds cheered the announcement of Turkey joining the war in the Middle East in 1914
Arab crowds cheered the announcement of Turkey joining the war in the Middle East in 1914 and the arrival of (disease-carrying) Ottoman soldiers. (Ottoman Imperial Archives).

Many local Arabs enlisted in the Ottoman army. (See the following picture)

Ottoman officers recruited Arabs from the Tiberias region
Ottoman officers recruited Arabs from the Tiberias region for the Jihad “Holy War” (Library of Congress)
Ottoman troops departed from Jerusalem
Ottoman troops departed from Jerusalem’s Old City for the Suez front. 1914. (Ottoman Imperial Archives)
Ottoman troops marched out of Jerusalem
Ottoman troops marched out of Jerusalem’s Lions Gate, heading for the Gallipoli front [Turkey] in 1915. (Ottoman Imperial Archives)

In all of the photographs, the Ottoman troops were traveling great distances. Schulze-Tanielian pointed out, “Military transfer centers were a particular challenge for Ottoman health officials. Here, soldiers slept crowded on the floor, making it nearly impossible to prevent louse-borne diseases, such as typhus.”

According to an account by a German medical officer, “Of the 10,000 troops serving in the Ottoman division that set off from Istanbul, only 4,635 could make it to Palestine. The rest either became ill or deserted. The ones who reached Palestine were ill and had lost their strength.”8

Ottoman soldiers were deloused and underwent disinfection at Jerusalem’s Shaarei Tzedek hospital in 1914
Ottoman soldiers were deloused and underwent disinfection at Jerusalem’s Shaarei Tzedek hospital in 1914.9 (Cathedra Quarterly)

The German troops in Palestine may have suffered less than their Turkish allies because of their European sanitary standards. Still, they, too, suffered from diseases and parasitic illnesses, such as cutaneous leishmaniasis “Jericho buttons” — caused by the bite of a sandfly. The disease afflicted soldiers on both sides of World War I in Palestine.

A German soldier
A German soldier suffering from the “Jericho buttons” of leishmaniasis, 1917. To this day, this picture appears in medical school textbooks. (Library of Congress)

Treatment of ill Turkish soldiers was impaired after several hundred physicians and pharmacists died while serving in the army. Most of them contracted the diseases they sought to treat.10

Malaria’s Strange Bedfellows

The many water cisterns in Jerusalem were perfect breeding locations for malarial mosquitos, and the disease was rampant throughout World War I. The chief medical officer of Jerusalem’s Ottoman military hospital in the Russian compound was an Armenian, Dr. Vahan Kalbian (1887– 1970), who bore the brunt of the malaria epidemic. Kalbian related to his son, Dr. Vicken V. Kalbian,11 that in late 1917, he was asked to meet with a Jerusalem aristocrat, Raghib al-Nashashibi. The doctor was reluctant, but the Armenian Patriarch also pressured him to meet with Nashashibi. The influential Jerusalemite requested a three-month home leave for a malaria patient, and Kalbian agreed.

American Red Cross doctors
Dr. Vahan Kalbian (far right) and other American Red Cross doctors at a field hospital established to treat Turkish casualties in the Suez Canal campaign in 1915. (Library of Congress)

Within a few days, the Allied armies broke through the Turkish line between Gaza and Beer Sheva, and all soldiers, including those in hospital, were mobilized. The patient, Haj Amin al-Husseini, later to become Mufti of Jerusalem, had been spared. The two men became friends until the 1930s when radical al-Husseini waged war against the Jews and the British, and the moderate Nashashibi was appointed mayor of Jerusalem by the British. The two became mortal enemies.

Nashashibi and the Mufti Haj Amin al-Husseini
Nashashibi and the Mufti Haj Amin al-Husseini (Library of Congress, 1936)

The Impact of the 1918 Influenza Pandemic

The great pandemic of 1918, misnamed the “Spanish” Influenza, actually originated in the United States’ Midwest. Within months, it had spread worldwide. The movement of populations and soldiers during World War I was undoubtedly the engine for the disease’s rapid spread. Mutations of the influenza created virulent strains which killed millions around the world.

From the United States, the plague spread to Europe, and by September 1918, it had permeated the countries of the Mediterranean. The war in Palestine hibernated after the capture of Jerusalem in December 1917 and the rainy Winter season, but by the end of Summer 1918, the war resumed with fury in the Galilee. British troop ships landed in Egypt’s Alexandria port and Jaffa, carrying the unseen influenza plague stowaway. Thousands of Indian troops were shuttled via the Suez Canal between the European, Palestinian, Syrian, and Mesopotamian fronts, spreading the disease to the four compass points: hundreds of thousands of Indians served as combatants and non-combatants in Egypt and Palestine during the war.

In his master’s thesis, Kjell Jostein Langfeldt Lind tracked the advance of the British-led Egyptian Expeditionary Force and the influenza plague throughout Palestine and Syria in the Fall of 1918.12

The influenza virus presumably followed the itinerary of the EEF. The EEF marched into Haifa on September 23, 1918. Amman was taken on September 25, and Deraa September 27. Damascus was taken on October 1; Beirut on October 8; Tripoli October 13; Homs October 16; Hama October 20, and Aleppo on October 25. When hostilities in the Near East theatre ended on October 30 with the [signing of the] Mudros armistice, the EEF – and the Spanish influenza – were in occupation of the whole of Syria as far as Aleppo.

The troops of the Indian Hodson Cavalry Regiment
The troops of the Indian Hodson Cavalry Regiment enter Damascus. (UK National Army Museum)

Incredibly, the influenza plague struck simultaneously with a disastrous malaria outbreak. Indeed, medical staff of the British and Turkish armies and in the hospitals of Damascus could not identify the strains. According to the Review of Military Medical Strategies for Fighting Infectious Diseases:

In the simultaneous outbreak of influenza and malaria in the Egyptian Expeditionary Force in Palestine, out of 315,000 soldiers, 773 died from malaria and 934 from influenza–pneumonia. Disease victims outnumbered those due to combat by over 37 to 1. Moreover, out of 40,000 men of the Desert Mounted Corps, 19,652 sick soldiers were evacuated due to malaria … a condition that caused the interruption of combat operations.13

Chart showing malaria and pneumonia (influenza) incidents and fatalities among the ANZAC troops
Chart showing malaria and pneumonia (influenza) incidents and fatalities among the ANZAC troops. Note that influenza-pneumonia did not appear until October 1918. (The Medical Journal of Australia)14

Perhaps the best witness to the devastation of the pandemic was an Australian “digger” [infantryman].

A Sergeant Major of the 3rd Battalion of the Australian Infantry Brigade retrospectively made the following observation on his participation in Allenby’s dash to Damascus: “Where the divisions had been spared the ravages of shell and machine gun fire during the advance, they were destined to have their ranks decimated by the influenza epidemic that swept over the whole of Syria early in October. Men died like flies. In some of the Australian regiments, there were three and four horses to every trooper.15

Researcher Kjell Jostein Langfeldt Lind also examined the casualties of other armies in Syria/Palestine:

The Turks in the main hospital [in Damascus] died at the rate of 70 or 80 a day and were buried by their fellow countrymen in a great continuous trench. Of about 20.000 Turkish prisoners of war, 3.000‐4.000 died from diseases.16

The Jewish Legions didn’t enter the Palestine theater until the 1918 campaign. They were volunteers in the 38th and 39th Royal Fusiliers battalions, part of the 13,000 men under Brig. Gen. Chaytor’s command. During October and November 1918, the men under Chaytor´s control, including the two Jewish volunteer battalions, lost 8.352 to malaria. After they attacked Amman from the Jordan Valley, Chaytor´s force had to be withdrawn to Jerusalem and Bethlehem. Like the divisions in the north, they suffered from disease.

“The fighting around Amman was scarcely over before malaria, pneumonic influenza, and other maladies ran like fire through the ranks. Indians, British West Indians, and Jews shared in the suffering which followed.”17 The Jewish Legions were dispatched in the summer of 1918 to the malaria-ridden Jordan River Valley, where they faced the malaria parasite and the flu virus. Thereafter, they were assigned the duty of POW escort on several fronts, and an estimated 80 percent fell ill.18

Other Jewish units arrived from overseas, including volunteer units to the Jewish Brigades in the British Army and medical teams from groups such as Hadassah and the American Joint Distribution Committee.

The resilience of the Jewish community was not found in other communities in Palestine recovering from disease and war. 

American Zionist Medical Unit
American Zionist Medical Unit 1918 on the way to Palestine, a mission sponsored by the nascent Joint Distribution Committee.
Nurses and physicians from the American Zionist Medical Unit on camels in Egypt
Nurses and physicians from the American Zionist Medical Unit on camels in Egypt en route to Palestine in July 1918. Note their Star-of-David armbands.

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  3. Ilan Gal-Peer.↩︎

  4. Library of Congress,↩︎

  5. Library of Congress,↩︎

  6. Ella Ayalon, Orphan Relief in the Jewish Community in Jerusalem during and in the Aftermath of the First World War↩︎



  9. (Cathedra Quarterly – A journal for the history of Eretz-Israel, Yad Izhak Ben-Tzvi, “Causes for death among Jerusalem residents during World War I,” by Zalman Greenberg.)↩︎



  12. Kjell Jostein Langfeldt Lind, 1918 Influenza Pandemic↩︎

  13. A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health,↩︎


  15. Kjell Jostein Langfeldt Lind,,↩︎

  16. Ibid↩︎

  17. Gullett, H.S., 1941. The Australian Imperial Force in Sinai and Palestine, cited by Langfeldt Lind.↩︎

  18. Kjell Jostein Langfeldt Lind, Ibid.↩︎