New Zealand Medical Services in Middle East and Italy
LESSONS LEARNED FROM THE GREEK CAMPAIGN
LESSONS LEARNED FROM THE GREEK CAMPAIGN
The Greek campaign was the first active campaign in which the 2 NZEF took part. Fortunately, all three echelons had had fairly long periods of training overseas, and the medical units had sufficient experience to enable them to face the campaign with confidence in themselves and their Division. The Second Echelon had not only arrived in Egypt in time, but it had had rigorous training in England at the time when invasion was thought probable. The medical units were keen to do their best and proved very capable in adapting themselves to the difficult conditions, both of the terrain and the harassed retreat.
The observations made by senior officers stressed the difficulties of the campaign and the capacity of the New Zealand medical units to improvise and deal with unprecedented conditions, as well as their capacity to learn from their experience. Naturally, the main recommendations dealt with the necessity of being fully mobile, and, to ensure this, the provision of adequate transport for all field medical units; but there were other very important lessons learned by the Medical Corps from the campaign. They are dealt with separately.
1.Need for Advanced Medical Planning
It was felt by the ADMS NZ Division that he should have been instructed to go to Greece with the GOC on 6 March, so as to have extra time to make medical arrangements for the Division, especially as it was going to a new country, with no previous arrangements for foreign troops and with its own special medical problems of endemic disease. There was little time to gain knowledge and to make plans and to site the field units, especially as the divisional area was far removed from Athens, where Medical Headquarters and all base units were stationed.
The DDMS 2 NZEF did not visit Greece until a month later and was out of touch with the conditions there.1 The difficulties that arose in the siting and utilisation of 1 NZ General Hospital might have been obviated by his presence in Greece at the outset of the campaign.
Early Arrival of Medical Units: It was considered by the senior medical officers that a higher priority should be given in the future to the medical units, so that they would be available from the beginning to service the troops and have time to site and establish their dressing stations before active operations commenced. Representations to this effect were made on 7 March by DDMS 2 NZEF, but were not supported by DMS MEF on the ground that the medical units were unlikely to be urgently required.
Consultants: There were no consultants attached to the forces in Greece. It had been planned to have the Australian consultants, Colonels N. H. Fairley and Hailes, attached to headquarters at Athens, but they did not go to Greece. Their advice would have been valuable in the placing of the hospitals and the co-ordination of the clinical work of the medical units.
1 Colonel MacCormick states that transport was not available sooner for him.
2. Undesirability of 600-Bed General Hospitals as L of C Units
In the opinion of senior officers in the New Zealand force, the placing of the highly organised and elaborately equipped base hospitals as L of C units 200 miles from Athens was undesirable. The New Zealand General Hospital was adequately staffed, and very well equipped, as a stationary base hospital, with a full quota of sisters and a special bacteriological laboratory. The only location where this hospital could service the New Zealand force as a base hospital was in the region of Athens, where it would have been handy for the evacuation of cases by hospital ship.
It is likely that the decision to use the hospitals as L of C units was influenced by the difficulty of evacuation by a single-track and page 144 very vulnerable railway, and by the possible inability of the two CCSs to cope with the work in the forward areas.
The authorities were influenced, no doubt, in their decision to place the two 600-bed hospitals in 81 Base Sub-Area, by the fact that there were no other hospitals available, the smaller units of the old 200-bed type being no longer considered of value in the Army. There were also only two CCSs, so that no unit of that type was available on the L of C over and above what was required to carry out the urgent surgery. The 26th General Hospital was well established in Athens, and 2/5 Australian Hospital was to arrive later and would be available to supplement 26 General Hospital at the base.
It was therefore decided that 1 NZ General Hospital and 2/6 Australian General Hospital should be used as L of C hospitals, and, however unfortunate the decision may have been, especially for the New Zealand unit, perhaps it was inevitable. There was no CCS in 2 NZEF at the time available for use as a staging unit on the lines of communication.
It must be realised that the DDMS BTG had been in Greece only a short time and that the only advice available to him was that of an advance body, including a physician but no surgeon. As to the 2 NZEF, the ADMS NZ Division had no control over 1 NZ General Hospital, and the DMS 2 NZEF did not arrive in Greece until some time after the question of the disposition of the hospital had been settled. The siting of 1 NZ General Hospital in 81 Base Sub-Area made it impossible for 2 NZEF to handle its own casualties at the base, and relegated the hospital itself to the role of an L of C unit, its main function being the staging of cases not able to be sent direct from the CCS to Athens, and the retention of minor cases able to be discharged back to the Division. Only in case of the interruption of communication by possible bombing or sabotage of the railway would the hospital have functioned as a base hospital, and then its own supply and communications would have been difficult. Realisation of this situation caused a great deal of discontent among members of the unit, to whom were not explained the reasons which determined the decision of the Higher Command.
The surgical divisional officer of 1 NZ General Hospital gave as his opinion, following the Greek campaign, that the 2 NZEF should have as medical units under such circumstances: (1) Field ambulances as then constituted; (2) a CCS, with extra teams from base hospitals, or with the Mobile Surgical Unit as a light section; and (3) a base hospital where medical boarding and reclassification could be carried out.
He further recommended that all surgical units situated away from the base should be small units, as mobile as possible, and should not page 145 be called upon to deal with large numbers of minor cases. Adequate transport should be provided and, if possible, units should be self-contained, either individually or in groups, as regards transport.
He suggested that the minor cases on the lines of communication should be dealt with by a much less elaborate medical unit, and that an advanced base camp was desirable where cases could be held following discharge. (At one time patients who would have very soon been fit for return to their combatant units were discharged from 1 General Hospital, Pharsala, to Base Camp, Athens.)
3. Mobility of Forward Medical Units
It was stressed by all the divisional medical officers, especially the field ambulance commanders, that the transport on their ordnance equipment was not sufficient to enable the unit to carry all its personnel and equipment, as well as to provide room for casualties to be evacuated during the retreat. The unit had often to be moved in relays by sending back unit transport, and with the congested condition of the roads, crammed with the retreating army, this was very difficult. Although the position was greatly relieved by the detachment of ambulances to all the units by the Australian MAC, yet further transport was deemed to be essential for the future. No. 1 New Zealand General Hospital had no transport and, though a few trucks and ambulances were attached at Pharsala, the unit was in a helpless position at the time of the withdrawal, being entirely dependent on the unstable railway system. It was strongly held that all forward medical units should be self-contained as regards transport, and that no medical unit should be placed in the forward areas without it.
4. Rapid Establishment of Field Ambulances
Fortunately, all the field ambulances had had considerable practice in setting up and dismantling their units and this stood them in good stead in Greece. If proof of the desirability of their training had been required, it was quickly given in Greece. In this connection the tarpaulin shelters attached to the 30-cwt trucks, as designed by 4 Field Ambulance in Egypt, proved to be eminently suited to the conditions in Greece, being readily handled and particularly adaptable to blackout conditions.
5. Grouping of Medical Convoys
It was quite impossible to separate the medical from the other convoys on the crowded roads and the Red Cross markings on the ambulances were too small and indistinct. This meant that the medical units and their patients were subjected to the harassing and page 146 dangerous attention of the German air force, and it was found imperative to rely on darkness for protection. A great strain was thus thrown on the drivers, but they came through the ordeal satisfactorily. Large Red Crosses on tops of vehicles were found to be necessary for protection against air attack.
6. Wireless Communication between Medical Units
At times patients were sent off by ambulance from the MDS to a CCS or other unit and it was found on arrival that the unit had moved back, with no indication as to the subsequent location. It was felt that wireless communication between units would have been of great assistance.
7. Unreliability of Civil Employees in Foreign Countries
There was a complete breakdown in the railway administration early in the retreat, and this might have led to very serious consequences. In future, this probable eventuality must be taken into account.
8. The Geneva Convention
At the outset of the campaign there was a very general opinion that the German Army would not respect the Red Cross if displayed by our medical units. It is difficult to trace the origin of this belief, but it undoubtedly existed and led to unnecessary difficulties in the forward medical units. Partly because of this, the forward ADSs and MDSs were placed in positions chosen for their obscurity and camouflage value and the possibility of sinking the tent floors below ground level. There were no large Red Crosses displayed on the roofs of ambulances. As a result medical units were subjected to bombing and machine-gunning from the air. As the short campaign proceeded it was learnt that the Germans did respect the Red Cross.
Fifth Field Ambulance stated that on 15 April the enemy appeared to recognise the Red Cross, and that the MDS was untouched, but the ADS—purposely not marked because of the proximity to combatant units—was bombed and machine-gunned. The hospital at Kamena Voula was not molested. This so impressed the commanding officer that he left a supply of medical equipment, with a note to the German airmen thanking them for respecting the Red Cross. Fourth Field Ambulance did not make use of the Red Cross, but dug in its dressing stations efficiently. Sixth Field Ambulance did not use the Red Cross until south of Thermopylae. No. 1 General Hospital did not display the Red Cross except on the page 147 unit flag. The unit was bombed and machine-gunned. No protection was possible to such a unit except the Geneva Convention.
There can be no doubt that the Germans did respect the Red Cross if it was adequately displayed, and that was the most important lesson learned from the campaign.
9. The Stabilisation of Medical Units
The necessity for the medical arm to have full appreciation of the strategical possibilities, and not to stabilise medical units unless conditions warranted it, was fully borne out in Greece.
There was an unreal atmosphere at 81 Base Sub-Area at the beginning of the campaign. Arrangements were being made for work to be done by the Area engineers, and contracts were let to Greek civilians, on a basis which visualised a stable front for a very long period. At 1 NZ General Hospital arrangements were made for permanent buildings built of stone, including a complete operating and X-ray block, and a contract was let to a Greek builder. There seemed to be a complete lack of appreciation of the possibilities that lay ahead of the British forces. Possibly the same lack of appreciation was present to some extent at the base, and maybe it was brought about by the secrecy of the Higher Command in a delicate diplomatic situation.
10. Base Organisation of 2 NZEF
There appeared to be some lack of proper organisation as far as the base in Athens was concerned, and there was no medical representative on the New Zealand base organisation. The Australians had a medical officer at Base Headquarters who proved of great value.
Under instructions from DDMS BTG, personnel of 1 NZ General Hospital were detailed for duty at 26 General Hospital and also to staff a convalescent depot at Voula, at a time when the evacuation of Greece had been decided upon. The evacuation had been definitely determined by Generals Wavell and Wilson on 19 April. The decision was kept secret because of the fear of its effect on the morale of the Greeks, especially the civilian population, and the possibility that there might be some interference with the arrangements for evacuation. The Greek higher command, however, was in favour of the evacuation in order to save unnecessary damage and loss of life. The attitude of the Greeks when evacuation was actually taking place belied the fears of the British staffs.
The main body of 1 NZ General Hospital embarked on 19 April in the afternoon, yet part of its personnel was left behind to run a page 148 convalescent camp under command of 80 Base Sub-Area. The New Zealand Reinforcement Camp was also situated at Voula.
In retrospect, it might have been possible, if the base authorities could have been informed of the position earlier, to have evacuated from the Athens area both the New Zealand personnel in the reinforcement camp and the convalescents and medical staff from the convalescent camp by the same convoy on which the staff of 1 NZ General Hospital was taken to Egypt.
Evacuation from Greece—Action taken in Egypt
On 19 April DDMS 2 NZEF offered DMS MEF medical officers for duty on ships which were being sent to help in the evacuation of the troops from Greece. The offer was declined, but it was repeated on the 20th and again on the 21st. Colonel MacCormick stressed the importance of having New Zealand personnel on the evacuation ships and of providing comforts for the troops when they landed in Egypt.
On the 22nd he was informed of the decision to evacuate Greece, and at a conference at GHQ MEF that evening the whole position was discussed and arrangements made for the despatch of medical officers and other ranks on the troop-carriers. Later, the DDMS Alexandria area asked for six medical officers and twelve medical orderlies at Alexandria, and DMS MEF requested that six medical officers and twelve medical orderlies be sent to Port Said. Both groups were promptly despatched to the ports and were embarked for duty on transports. Medical posts were set up at the disembarkation camps at Amiriya, and at Tahag on the Ismailia road; a large reception station was also set up at Port Said and a small port section at Alexandria.
1 There were only 50 survivors out of 1000 personnel, naval and army.
At the conference at GHQ MEF on 22 April it was decided that, owing to lack of transport facilities, it would not be possible to deviate from arrangements that severe casualties of all forces, including New Zealanders, would be held in hospitals at Alexandria or the Canal area. Light cases would be sent to Cairo area as soon as transport arrangements permitted.
For the New Zealand casualties it was arranged that all officers and surgical cases would be admitted to 2 NZ General Hospital and all medical cases to 3 NZ General Hospital. Following this decision, some 130 medical cases were transferred from 2 General Hospital to 3 General Hospital, the first patients that hospital had received. No. 2 General Hospital was thus prepared to receive battle casualties as soon as they were transferred from hospitals on the coast. The 1st NZ Convalescent Depot was emptied as far as possible and extra tentage erected so that light cases could be admitted.
In view of the fact that most of the New Zealand troops, including lightly wounded, went to Crete, and that seriously wounded men remained in hospital in Athens, these arrangements for the reception of troops proved ample. There was a low incidence of wound infection and no strain was thrown on 2 General Hospital, the only properly equipped New Zealand general hospital in Egypt at the time, as 3 General Hospital was still awaiting the arrival of its equipment from England. The New Zealand troops evacuated to Egypt were mainly from 6 Brigade, with 4 Field Ambulance attached, all three artillery regiments, and the anti-tank regiment. Most of the battle casualties were taken directly to British hospitals in Alexandria and the Canal Zone. The first patients from Greece received by 2 General Hospital (apart from the injured nursing sisters of 1 General Hospital who arrived on 1 May via Crete) were a convoy of 131, mostly transferred from British hospitals in the Canal Zone on 20 May. Altogether, some 300 casualties were ultimately admitted to 2 and 3 NZ General Hospitals from Greece.
Contrary to expectations the condition of the troops themselves on arrival was remarkably good, and there were few cases of exhaustion and nervous breakdown. A divisional rest station was established at Helwan Camp and allowance made there for 600 cases, but only some thirty were admitted.
Red Cross stores sent by the Joint Council from New Zealand had proved invaluable at the ports of disembarkation and in the medical units for the tired men, just as they were to do later for the more severely exhausted men from Crete.
As they left Greece the New Zealanders were very tired—mentally and physically exhausted by long days and longer nights of constant strain. They were bitter about the tragedy they had been unable to prevent, the enemy occupation of Greece. But they were not beaten. Only once in the campaign had they withdrawn before the scheduled time, and on that occasion they were overwhelmed by superior numbers. Unfortunately, the struggle to hold Crete was to take place on even more unequal terms.
The campaign in Greece put our medical units and personnel, as yet inexperienced in active warfare, to a severe test. They were called upon suddenly to cope with very difficult conditions of terrain and with a rapid and continually harassed withdrawal before an enemy infinitely superior in numbers and equipment, and with unchallenged command of the air. They had to be evacuated under cover of darkness from many beaches in southern Greece, taking their patients with them as they went and leaving behind their valuable equipment. They were called upon to improvise and evolve new methods of coping with the unusual conditions. They did this with great success, and laid the foundations for their future efficiency which was unquestioned throughout the war.
Fortunately, there was little or no disease to cope with and the wounded could all be evacuated to the base, and many were taken off with the units to Crete. There were some errors of judgment, due to ignorance, such as the failure to display the Red Cross adequately, but no lack of meticulous attention to the wounded men.
|Unit||Killed||Wounded||Prisoners of War|
|4 Field Ambulance||1||2||(1)16|
|5 Field Ambulance||2||20|
|6 Field Ambulance||1||7|
|1 General Hospital||2||(4)57|
|2 General Hospital||(1)*|
|Maadi Camp Hospital||(1)4*|
|4 Field Ambulance||1*|
|Killed (including died of wounds)||261|
|Prisoners of war (including died of wounds while p.w.)||1856|