HHH column: Medicine is an instrument of war: Indonesia 1946-1949 as pars pro toto by Leo van Bergen

The HHH column is a monthly blog in which History, Health & Healing members share their thoughts on research, current affairs, or anything to do with medical history. Each edition is written by a different member – in due time, we hope to offer everybody a chance to publish a contribution. This month, the floor is for Leo van Bergen, medical historian and editor of Medicine, Conflict and Survival, an international journal on the health aspects of violence and human rights. In this column, Leo argues against the view that Western medicine benefitted colonised populations. On the contrary, Western medicine was integral to Dutch colonial oppression in Indonesia. Medical aid did not have the well-being of the Indonesian population as its goal, but was motivated by political and military reasons.

Content warning: this column includes an image depicting a malnourished child.

Medicine is an instrument of war: Indonesia 1946-1949 as pars pro toto

Leo van Bergen

Recently, a grand research project[1] ended on the topic of what now, completely justifiably, are called ‘structural violence’ and ‘war crimes’ during the war of decolonisation/war of independence in Indonesia 1946-1949 – deemed necessary by the Dutch government after the former colony in the Dutch Indies had declared itself independent on 17 August 1945. As a result of this research, one book after another is getting published about the different aspects of the war. Medical aspects, however, aren’t among them. Assuming that they have been thought of at all, the perhaps unconscious reasoning of the commissioning ministries and/or of the KITLV, NIOD and NIMH – the departments undertaking the project – must have been that Western medicine stands outside war and colonialism; that whatever you think of war and colonialism and all the hardships they have brought, without Western medicine they would have been even worse. How else can it be explained that the ideas and activities of physicians and nurses haven’t been investigated? That medical historians haven’t played a part in this project whatsoever?

The truth is that medicine didn’t make colonialism better or less bad. Medicine was an integral part of the colonial system, as it was of the war of 1946-1949. Medical care in the archipelago wasn’t the success-story it often is said to be. It didn’t soften the blows of medical disasters. One could even say: medicine in Indonesia was a disaster itself because it was an important pillar of a system responsible for many of the illnesses it combatted (or did not). It mainly served the interests of Dutch entrepreneurs and researched diseases endangering the Dutch and their laborers. When it came to diseases that mainly befell the autochthonous population, physicians and health authorities kept a keen eye on finances. For these diseases the inherent and hereditary lack of ratio and hygiene of this population (and of the Chinese, these ‘leprosy ridden coolies’) was to blame. Not for nothing, to the satisfaction of all, two Nazi-doctors contributed to malaria research at the Eijkman-institute around 1930.

The plague epidemic of 1911-1915 wasn’t combatted by Dutch medics in the Indies but by ambulances shipped in from the Netherlands. Why, the Dutch in the archipelago reasoned, waste our precious money if only filthy, autochthonous inhabitants were struck by it? At last, in the 1930’s the autochthonous way of combating leprosy was embraced – homecare instead of institutionalization – but not because it was more effective (which it was) but because it turned out to be cheaper as asylums, even though care in asylums was mostly left to religious orders. Again, not because they had the knowledge (they hadn’t), but because they were cheap.

These aspects all came together in the medical care given during the 1946-1949 war, recently still hailed in a book on the Red Cross because of the aid given to the sick Indonesian civilians (only proving the authors lacked knowledge of the existing literature).[2] This care was given not because it was the doctors’ medical, Hippocratic duty, but because it was thought that the trust-giving doctor-patient relationship would drive the population back to the Dutch side and make them reveal information about movements of the Indonesian army. Reports on this are scattered with racial prejudice, uttered by Dutch medics, such as wondering if the Indonesians’ lack of knowledge of Western medicine was only to be attributed to racial characteristics, or also the result of the gap in education between them and the Dutch. Another doctor compared the Indonesian youth with the Hitler-youth, making uncompromising violence by Dutch forces the only and at the same time most humane way to restore peace and order.

The positive judgment Western medical-colonial aid has been given this far should be changed radically, and in particular when it comes to the war of 1946-1949. That aid wasn’t of a medical, humanitarian nature, but of political-military importance, also because the health problems were far too big and the number of patients far too great for care to have any measurable positive influence. In 1953 even one of the medics themselves wrote ‘that such massive medical aid by people only superficially trained, could itself be superficial at best’.[3] Nevertheless, he justified the caregiving because, after all, doing something is always better than doing nothing. But does this judgment follow? Is poor, superficial medical assistance indeed to be preferred above no medical assistance at all? This question only becomes more pressing if this poor, superficial care is provided for political and military aims. It is a question that perhaps could have been answered if the medical aspect of the war had been given the same, ample research time and means as the military and political aspects, if only because medicine in times of oppression and war – all wars – is as much military and political as guns and diplomacy are.

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[1] Onafhankelijkheid, dekolonisatie, geweld en oorlog in Indonesië, 1945-1950

[2] Ad van Liempt, Margot van Kooten, Hier om te Helpen. 150 jaar Nederlandse Rode Kruis (Balans 2017)

[3] Frans Doeleman, De Medische Geschiedenis van een Infanterie-bataljon der Koninklijke Landmacht gedurende drie jaar actieve dienst op Java 1946-1950 (Assen 1953) 107