Famine and Nutritional Deficiencies during World War II
Between 1942 and 1946 a series of studies devoted to assessing the negative effects of World War II on the nutritional situation of the European population were published. Some of them were direct contributions from the experts of the League of Nations. John Lindberg played a main role as the coordinator of a number of surveys discussed in the Financial Section and Economic Intelligence Service of the League of Nations. When the third volume of the Lindberg reports went to press in 1946, the President of the United States, Herbert Hoover, had already warned in Chicago (May 17, 1946) that: “Hunger hangs over the homes of more than 800,000,000 people, over one third of the people of the earth”. Consumption and rationing had a strong economic dimension and therefore several issues of the World Economic Survey published by economy experts of the League of Nations and FAO dealt with this matter.
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Shortly after the start of the international conflict, Jose Puche, the aforementioned Spanish physiologist, specialist in nutrition and head of the Spanish Instituto de Higiene de la Alimentacion during the Civil War, wrote a survey about hunger in Europe and its influence on the evolution of the war. This was written just after he went into exile in Mexico. In February 1939 the German Institute for Commercial Research had published data about self-sufficiency in the provision of food, but the records were immediately altered by the negative effects of the war. According to Puche’s calculations, Germany and the invaded countries were to suffer strong shortages in wheat and corn, quantified as being between seven million and 8.5 million tonnes, reaching ten million tonnes if the deficit on rice were added and multiplied considering the lack of fertilizers, fuel and other goods. His forecast was for a strong shortage in many European countries such as Poland, Belgium, the Netherlands, France, Denmark, Norway, Spain, Austria, Italy, Czechoslovakia, Albany and Germany. He drew a very negative picture just as the World War broke out.
From the beginning of the conflict an evaluation of the nutritional problems in Europe was required, but a complete and accurate survey was not possible until some time after the end of the hostilities. But the health authorities and relief organisations needed some type of helpful information to be able to overcome the harsh wartime situation regarding both nutrition and epidemics. The League of Nations’ Health Organisation made two principal reports public in 1943. One of them was published under the title “Health in Europe” by Yves M. Biraud, the Head of the Service of Epidemiological Intelligence and Public Health Statistics of the League of Nations. The second one was a technical report on “Famine disease and its treatment in internment camps”. Both painted an appalling picture of the health and nutritional situation in Europe in the early 1940s.
Biraud’s report was preceded by a series of articles in the medical literature pointing out “the shortcomings of rationing, losses of weight of children and adults; increase in the incidence of certain communicable diseases; changes in the prevalence and character of tuberculosis; the increase in both infant and general death rates”. Notwithstanding the usefulness of those partial approaches, no comprehensive study had been published based on a large body of statistical records and therefore his aim was to furnish a first approach to a series of materials collected from many reports at the Service of Epidemiological Intelligence and Public Health Statistics of the League of Nations in Geneva. Biraud was aware of the limitations of those records: they did not adequately cover countries like Poland or Greece, which were suffering from severe nutritional deficiencies and famine in those days. The makeup and size of populations and cities in many European countries were deeply altered by conscription, refugee migration, deportation, attraction towards war industries and evacuation, thus making it difficult for any sort of epidemiological rates to be satisfactory.
But Biraud’s memorandum was accurate enough to give a general picture of the dimensions of health impairment and nutritional problems in Europe in 1943. Divergence in the trends of general mortality in different countries, for instance, gave a measure of the influence of insufficient feeding. Although his main target was to report on the consequences of the war on the health situation, Biraud aimed to “give a measure of the influence of insufficient feeding”. To estimate the food situation in Europe, he made use of computations concerning the normal consumption of staple foods in European countries. These were based on documents issued by the Economic Intelligence Service of the League of Nations, including documents on wartime rationing and consumption, and a series of monographs published in 1939 for the European Conference on Rural life, which covered the agricultural situation in European countries. He also collected data on food restrictions, taken from the daily press, medical periodicals, private studies and reports from national health administrations and relief organisations, both official and private.
Notwithstanding the methodological limitations caused by the exceptional circumstances of the war and the scarcity of reliable records, Biraud offered a convincing landscape of the nutritional situation in most European countries. According to his memorandum, food availability in Poland varied enormously depending on the location and social circumstances, ranging from practical sufficiency in some agricultural areas to acute shortages in cities and famine in ghettos. The effects on health were different: from mere deficiency diseases such as rickets to mass starvation. In 1943 relief efforts had been greatly reduced, due to the opposition of the German occupation forces, and they chiefly concentrated on children.
In the Balkan area there were also considerable local differences in terms of the effects of the food shortage, which was something fairly general in the south west of the region. In the absence of reliable vital statistics, the situation for the USSR was no better, especially considering the negative effects of the German seizure of a large part of its most fertile agricultural land. The situation of the besieged population of Leningrad was dramatic and millions of refugees had been evacuated from the war zone. According to Biraud, “[...] The hugeness of the food stores sent to the USSR under lend-lease agreements is an indication of the extent of the need”.
Special reference was made to the food shortage in post-war Spain: “Food shortage was severe during the civil war in a large part of the country, indeed acute for two winters in Madrid and among the large number of prisoners. The economic and social consequences of the civil war were prolonged and aggravated by the European war, so that in 1941 the serious nature of the nutritional situation of the country appeared to be second only to that of Greece”.
In the early 1940s actual famine and subsequent starvation hit many population groups across Europe: inmates in internment camps, prisoners of war camps, Jews in ghettos, civilians and soldiers of besieged cities, patients in hospitals and prisoners. A considerable loss of weight and deficiency diseases had been detected in great numbers of people in the cities of occupied countries, but the lack of food had been nowhere as intense and general on a nation-wide scale as it had been in Greece. Even in the peacetime period before the war, only a small portion of the staple foods needed to meet the population’s dietary requirements were grown, according to official records. Famine affected the towns first and then extended to the countryside. The situation became much worse in 1943-44 due to the negative effects of inflation. In addition, the limited relief supplies that were allowed to enter the country were insufficient and could hardly transform the extended famine condition into a situation of chronic and severe shortage.
In its milder but chronic form, food insufficiency was considered to have caused a definite increase in tuberculosis mortality and in the general mortality rates of several countries. It was the main cause of many deaths, but also an effective contributory cause in a much greater number, particularly among elderly people and certain population groups living under exceptional circumstances.
As far as mortality is concerned, rates indicated that infants had been spared, generally speaking, although they suffered from many forms of non-fatal malnutrition, as many adults did. On the other hand, food shortage and malnutrition prevailed far more severely in cities than in rural areas, a fact that showed the capital importance of planning food relief. Prospects were uncertain for prompt and adequate relief which - if followed by rapid economic improvement - would result in a comparatively rapid physical rehabilitation of population groups suffering from malnutrition, with a quick fall in tuberculosis mortality rates. Experience gained in the aftermath of the First World War reinforced this perspective.
But the health situation at the end of World War II was not optimistic. Increased contacts due to community life and migrations resulted in a fairly marked rise in diphtheria, scarlet fever and meningitis in Central, Northern and Western Europe. A similar effect was caused by typhus fever in Eastern and South-Eastern Europe. Destitution in terms of lack of food, soap, home and body linen, had contributed to the increase in typhus fever in endemic areas and among prisoners and inmates of relief institutions. However, those epidemics did not influence the incidence or severity of traditional and other epidemic diseases at the end of the war. Typhus fever was probably a threat, since its prevalence in eastern and southeastern countries of Europe could be the origin of a breakdown that was eventually extended to other regions by troops coming from those areas, as well as from North Africa.
Biraud tried to fight exaggerated fears among the public and medical professionals regarding the spread of epidemic diseases during and after the war. The diseases with the heaviest toll in the past had been mostly controlled: typhus fever, smallpox, enteric fever and malaria. After the Great War rural populations in Russia had a low degree of acquired immunity to common infectious diseases and migration contributed to the spread of contagion and epidemics. According to this, the danger of dissemination of infection under the circumstances in 1945 was infinitely smaller than in 1919. The United Nations’ Relief and Rehabilitation Administration had benefited from the pioneer work of the Inter-Allied Relief Committees in London, as well as that of national health administrations, to prepare plans for the repatriation of refugees and prisoners. National Red Cross Societies were also prepared for emergencies, and the collaborative commitment of health and statistical authorities from different countries with the Epidemiological Intelligence Service of the League of Nations was expected to tackle epidemic diseases and keep health administrations and relief organisations informed.
-  Bourne, G.H., Starvation in Europe, Allen & Unwin, London, 1943; FAO, Standingadvisory comite on nutrition. First report to the director-general. Nutrition Division,Copenhague 23-31 August, 1946, FAO, Washington, 1946; Food Rationing andSupply, 1943/44, Geneva, League ofNations, 1942; [Lindberg, J.] Wartime rationingand consumption, Geneva, League of Nations Financial Section and EconomicIntelligence Service, 1942; Malnutrition and starvation in Western Netherlands,September 1944-July 1945, The Hague, 1948; [Lindberg, J.] Food rationing andsupply 1942/43, Geneva, League of Nations Financial Section and EconomicIntelligence Service, 1943; [Lindberg, J.] Food, Famine and Relief, 1940-1946.Geneva, League of Nations Financial Section and Economic Intelligence Service,1946; Muehel, W., “Ill effects of food restrictions in Europe, 1940-1944”, League ofNations Bulletin of the Health Organisation, 1945-1946, Vol. 12; Orr, J.B., The roleof food in post-war reconstruction, International Labour Organisation, Geneva, 1943;Puche Alvarez, J., “El hambre en Europa”, Ciencia (Mexico), Vol. 1, 1940, 6 p.;Rationement alimentaire et ravitaillement 1943-1944, Societe des Nations, Geneve,1944; Rosen, J., Wartime food developments in Switzerland, Stanford, Cal., StanfordUniversity, 1947.
-  Puche Alvarez, 1940.
-  Biraud, 1943-1944.
-  Ibidem, p. 559.
-  Ibidem, p. 561.
-  Ibidem, pp. 561-562.
-  Ibidem, p. 694.
-  Ibidem.
-  Ibidem.
-  Ibidem, p. 695.