Despite a policy calling for maximum self-help from the Italians the Allies were compelled to expend a vast amount of effort and resources in civilian relief. This was particularly true in the first phase of the military occupation because planners had underestimated the extent to which, in food supply as well as other matters of vital import to civilian life, conditions of war can create serious emergencies. The documents of this chapter deal with three such emergencies-an unexpectedly severe food shortage, a typhus epidemic, and an unforeseen refugee problem-emergencies that became critical in the winter of 1943-44. In the face of such problems the Italians could not be expected to "stand alone." Aware that civilian unrest and disease threaten the success of military operations, the Allies gave help from a strong motive of self-interest as well as from a sense of humanitarian obligation.

Allied invasion plans for Sicily and southern Italy were based on the assumption that these areas could supply most civilian food requirements, an assumption that proved to be wholly erroneous. The planners seem to have been led astray by unreliable statistics on yields and imports and faulty intelligence on the extent of the black market. The Fascists of course had their reasons for misrepresenting conditions. The Italian economy had been strained by Mussolini's ill-fated schemes of foreign conquests, the loss of Italian workers to Germany, and Allied bombings. The Allied invasion merely furnished the coup de grace to a tottering system. Under normal conditions there would have been enough grain in Sicily but an exceptionally poor harvest, lack of internal transportation, and the collapse of the hated ammassi- the Fascist system whereby farmers had to bring a certain percentage of their grain to the government warehouses- produced a serious food problem where it was least expected.

The food shortage was aggravated by the invasion of the mainland where the retreating Germans destroyed much of the  1943 crop. In October the food situation was serious; by November it became acute. The main responsibility for procurement and shipping of civilian supplies for Italy had been placed by the CCS on the United States. The needed supplies were available, but both shipping and port facilities were inadequate. Military Government Section of AFHQ did not call forward the programed requirements for October and November from the United States on the assumption that sufficient reserves could be found in North Africa. General Smith, the Chief of Staff, AFHQ, acknowledged that this was a serious error. However, the situation was alleviated and actual starvation (though not malnutrition) was averted by securing temporary loans from the French in North Africa and from the Middle East forces.

[306]

Another factor in the food crisis was the administrative confusion arising from divided responsibilities of AMG and ACC. The latter body, it will be recalled, was in the process of formation in October and November and had not organized a Food Subsection. As a stop gap measure AFHQ established a Central Economic Committee at Naples in mid-December to allocate imports, transport, and movement of interregional surpluses between AMG 15th Army Group, Headquarters AMG, and ACC. This organization was under the chairmanship of Maj. Gen. Sir Brian H. Robertson who was also commander of FLAMBO. CEC was abolished in January 1944 when ACC assumed full responsibility for civilian supply.

Aside from faulty plans, limited shipping and port facilities, and overly complicated organization, a basic difficulty in early operations was failure of the fighting forces to appreciate the importance of civilian relief. Civilian needs were considered marginal, to be brushed aside in any conflict of interests. By mid-December the situation had become so serious that General Eisenhower, just before leaving the theater, issued instructions which recognized that in emergencies minimum civilian needs would have to be met even at the expense of the military buildup. Where the consideration involved direct interference with military buildup and maintenance the decision rested with the Commander in Chief of the Fifteenth Army Group. This action, according to Lord Rennell, "put the supply of civilian requirements in its right perspective." ¹

Allied plans for southern Italy were based on medical intelligence no more reliable than the economic data that had been used. A typhus epidemic had been considered possible but was dismissed as unlikely. When the Allied forces entered Naples on 1 October they found the city without water or soap and with its sewage system sabotaged. Furthermore many of the natives had formed the habit of living at night in air-raid shelters, where overcrowded and unsanitary conditions prevailed. In combination these conditions provided an ideal medium for spawning and spreading the louse-borne typhus disease. By December the CCS was being informed that an epidemic was constituting a threat to military personnel. Emergency measures were required to bring the disease under control. These included calling in the U.S. Typhus Commission, transferring jurisdiction over typhus control from AMG to AFHQ's advance echelon in Naples, and "dusting" users of air-raid shelters with D.D.T.

A third problem that reached extraordinary proportions during the fall and winter of  1943-44 was that of refugees-Italians displaced from their homes by the fighting. The flow began into the Eighth Army area in November when the Germans deliberately drove hundreds of civilians southward through their lines or carried out a scorched-earth policy that had the same effect. In February the problem lessened in the Eighth Army area and increased in the Fifth Army area. After the Anzio landing 14,000 refugees a month passed through the Fifth Army and by spring it was feeding 200,000.

As the problem increased in magnitude, organization for dealing with it was steadily improved. Until the Army saw that the flow of refugees was a serious interference with operations, there was no special agency for handling it; the Fifth Army Group in January created. in AMG a Refugee Field Section, represented at Army and Regional Headquarters, for better supervision of the field efforts. Still later, ACC, to coordinate handling of refu-

[307]

gees in the combat zone with that in rear territory, established an Italian Refugee Branch. Finally, when the problem of displaced persons also became urgent, ACC placed the care of refugees as well as of displaced persons under the Displaced Persons and Repatriation Subcommission. The improvement in organization was paralleled by improvement in methods. The crude improvisations by the armies at the outset were replaced by regular dispatching centers and by the use of empty military transport to send refugees to the rear, where Italian authorities were required to find lodging and care for them in Italian communities until large camps could be built. Still later, in the spring, ACC realized that as the movement of refugees-first away from their homes and then back again would always be to some extent uncontrollable, it was better to set up camps closer to their original residence and thus avoid clogging of the roads used by the Army.

Malnutrition and refugees were, of course, problems throughout the occupation and in addition, as the concluding documents of the chapter show, the poor and the sick were always present and in need of help. Even the less urgent problems of civilian distress were dealt with in the light of possible harm to military operations, but in the more routine relief measures a greater attempt was made to limit Aired efforts to supervision of the Italian agencies. The Public Health Division of AMGOT, together with its Welfare Branch, enlisted the help of the still existing Communal Public Assistance Boards or reconstituted them; it did, indeed, determine the standards of public relief and of social welfare care in general. In the immediate wake of battle the CAO's and the AMG public health officers of course had a greater burden than in rear areas either because the local relief agencies were no longer functioning, or because they lacked resources, or because, as was often the case, they were not accustomed to take hold with speed and efficiency, measured by Anglo-American standards. Moreover, as early as September, surveys of operations in Sicily convinced AMGOT of the need of securing greater co-ordination of the services of Italian relief agencies. Later, when ACC came into existence, its subcommissions concerned with public health and relief attacked the problem of reorganization of Italian agencies on a broader scale. They realized, however, that there was "no time for theorizing or permanent social planning until the needy Italian people are better clothed and fed."

1. A SERIOUS FOOD SHORTAGE DESPITE THE ASSUMPTION OF LOCAL SELF-SUFFICIENCY

AMGOT BELIEVES SICILY IS SELF-SUFFICIENT BUT PREPARES FOR EMERGENCIES
[Msg, AFHQ to WD, 5 May 43, ACC files, 10000/100/593]

♦ ♦ ♦ (1) Food. As indicated maintenance project and AMGOT plan, we believe that area as whole produces adequate food stuffs and that when whole area is occupied there should be no need, on the basis of existing standard of living, for import of essential food stuffs. However, believe it wise to establish reserves against following contingencies: ¹

[308]

(a) Local distress if urban centers should be cut off by military operations from surrounding rural sources of supply; (b) wheat shortage due to export or destruction of harvest by enemy. Reserve contingency (a) should be related to population of two principal urban areas....
Against contingency (b) are working out a wheat stockpile from coming harvest. It is estimated that ample surplus will be available for any reserve we may wish to set up. .. .

WASHINGTON SUPPLY AUTHORITIES AGREE THAT LITTLE IMPORT OF FOOD WILL BE NEEDED
[Memo, Somervell, CG, ASF, for Brig Gen Albert C. Wedemeyer, Chief Strategy and Policy Gp, OPD, 18 May 43, ID files, Basic Policy-Italy]

♦ ♦ ♦ After a short period the area would be self sustaining for food, or would be carried by adjacent areas, and such food supplies as might be necessary during the initial period could probably be supplied from North Africa, thus minimizing the shipping problem. ²

TRANSPORT ANTICIPATED AS CRITICAL FACTOR
[Memo, Italy: Discussion of Portion of Civilian Supplies Necessary for Initial 135 Day Period, by G. K. Berkey, Plan Div, Strategic Logistics Branch, ASF, 5 Aug 43, CAD files, 014, Italy (1-25-43) (1), sec. 1]

The statement that we must be very careful not to over emphasize Italy's food deficiency can not be made too strong. . . . Unless we hold firmly to the assumption of furnishing only the bare necessities it may well have adverse effect upon the United Nations' war program in terms of ships as well as supplies. ♦ ♦ ♦
To sum up a fair but not philanthropic appraisement of the situation shows that if transportation can be maintained between producing and consuming areas and sufficient petroleum products are available to move produce from the fields to railheads or markets . . . that the subsistence problem in Italy is not one of more seriousness than the exigencies of war make inevitable. ³

SEPTEMBER: AMGOT-SICILY SEES TROUBLE AHEAD
[AMGOT Hq, Rpt for Sep 43, ACC files, 10000/100/501 ]

18. A continued source of embarrassment is the shortage of supply in the face of statements made by responsible officials of both governments as to what has been done and what is to be done in supplying the civilian population. No one realizes more the difficulties of importing civilian supplies in the face of overriding military demands than AMGOT supply officers who are working daily with the supply and transportation officers of the armies and base sections. The difficulty is rather with the propaganda agencies. These must realize that enemy populations are prone to remember promises made even over the air and that the result of predictions which cannot be carried into effect is the reverse of that intended.

72. Available information indicates that grain for distribution through official channels in Sicily will be exhausted at the end of the year ⁴  Local shortage, of course, will be felt sooner and in grain deficient provinces the shortage will be accentuated by transportation difficulties. Various plans were in effect in the provinces for forcing the surrender of hoarded wheat. In view of the prospective shortage, requisitions were made for imports to provide a reserve against a break down of transport in the various grain

[309]

deficient provinces and to take care of the island wide shortage prior to the next harvest.

73. The average daily ration on 30 September was approximately 165 grams of bread and 15 grams of pasta. Some provinces were receiving the maximum permitted ration of bread of 300 grams and 40 grams of pasta, while in one province (Messina) the ration was as low as 100 grams of bread. The largest portion of the ration in Messina was supplied from imported stocks which were practically exhausted at the end of the month. Interprovincial transportation complicated the problem, which was solved in part by coastal shipment.♦ ♦ ♦

OCTOBER: TROUBLE AT HAND
[Civ Sup and Resources Div, Hq AMGOT, 15th AGp, Report on Operations in Sicily, for Jul-Oct 43, ACC files, 10000/154/317]

5(c). . . . Early in October ... the three "surplus" grain-production provinces began to realize that their production would not carry their own population through to the next harvest, and so cut down their supplies to the deficiency provinces. Problems arose in consequence in Trapani, Syracuse, and Catania. This had been foreseen early in September and imports bid forward, but the bulk of these did not arrive; and a general reduction in the bread ration resulted, in most cases of 200 grams, in two or three towns to 150. By the end of October the nonarrival from AFHQ of promised imports gave cause for anxiety to the military commander, who foresaw a potential source of civil unrest in our total lack of food reserves, combined with the growing difficulty of transport by road owing to the diversions around blown bridges, which ran across the river beds, being impassable when streams filled up. Civilians employed by the armies on dock work, etc., were moreover not capable of sustained effort on the low rations available. ♦ ♦ ♦

[Memo, McSherry, DCCAO, AMGOT Hq, Considered at 14th Mtg of Exec Council, AMGOT Hq, 15 Oct 43, app. B, Grain Supplies, ACC files, 10000/143/447]

6. In considering what action can be taken, it is as well to set out in detail the fundamental facts governing the situation. They are as follows:

(1) Before the date of commencement of effective control, considerable quantities of wheat disappeared into hoards and particularly into the hands of the black market operators.
(2) The quantities amassed since that date have been exceedingly disappointing. This is largely due to continued black market cornering and to withholding by producers.
(3) The quantity of wheat available from controlled sources will not support even an inadequate ration for more than a month or two. Black market sources are, under existing conditions, available for those who can afford to pay. They will probably continue to be available but the price is likely to increase considerably and the number of people supplied from this source will be correspondingly reduced.
(4) Plans for stepping up the rate of amassing are for various reasons, weak and ineffective.

NOVEMBER: SITUATION IN SICILY CRITICAL
[Memo, Maj Archibald S. Alexander, Actg Chief, Econ and Sup Div, AMG Sicily Rgn, for RCAO, Sicily Rgn, 13 Nov 43, Spofford Rpt, ex. IV-h]

12. e. The medical aspect of the situation will become serious by mid-winter if no improvement in food imports occurs. Malnutrition will entail susceptibility to epidemics which in turn will bring a serious risk for the Allied armies in this theater of operations.

f. The possibility of having to recall troops needed elsewhere to control the civilian population should not be overlooked. It need not be emphasized what a confession of failure would be involved. It has already been necessary to transfer troops into critical areas and also to use air force personnel for the maintenance of law and order.

15. . . . since, existing stocks are so low (under 800 tons of flour for over 1,000,000 people in the four largest cities) and since there is no unused resource left for obtaining any large additional amount of grain in the island, imports must begin at once in order to prevent such a deterioration in the situation as might involve total failure  of the occupation of Sicily and the unforeseeably wide repercussions on actual combat operations, on the people of countries still under enemy domination, and on the population of the United States and Great Britain, who have had promises made on their behalf which will not have been kept.

DECEMBER: FOOD CRISIS HAS NOW REACHED MAINLAND
[Hq AMG, Rpt for Dec 43, ACC files, 10000/101/501]

42. The heart of the problem in the economic field continued to be that of feeding the civilian population. Civilian morale continued to depend on the size of the bread ration received. During the month the most acute shortage was in Region II [Mainland], rather than Region I [Sicily] as heretofore.

[310]

45. Before the middle of December it appeared that no flour or grain whatever was left in Reggio, Catanzaro and Cosenza Provinces and that only 100 grams a day had been issued during the previous two weeks. Nothing had been received from requisitions and bids totalling some 22,000 tons. The situation was temporarily relieved with the transfer of 1500 tons from Sicily and 3800 tons received from the middle east. The desperate situation was in part caused by the similar situation in Region I in November as a result of which 1200 tons had been diverted from Reggio to Sicily by AFHQ. Arrangements had been made to move 500 tons of flour from Naples and 2500 tons of grain from Foggia. By the end of the month 320 tons of flour and 1150 tons of grain had been shipped, but since the combined consumption of the three provinces at 180 grams is 6000 tons of flour per month, more was needed. Promises were made of further shipments but at the end of the month actual stores were nonexistent. The provinces of Matera and Potenza are considered self-sufficient until March 1944. The province of Salerno on 21 December was only receiving 50 grams of bread a day.♦ ♦ ♦

[Public Health Dept (PHD), AMG Rgn III, Rpt for Dec 43, ACC files, 10000/159/1087]

6(1) The food situation throughout December has been grave and by the end of the month when any hoards may have been exhausted, it had become acute and an important contributing factor to both typhus and V.D. [venereal disease]. Due to reasons which this Division is not competent to assess, the people have only been able to get through Alimentazione, i.e., the Food Control, 125 grammes of bread and ½ kilo of pasta. . . . The humble bean (fagioli) for generations scorned by everybody but the lowest classes has risen to a delicacy which can only be afforded by the rich at 150 lire per kilo as compared with a lira or less in normal times. It is not for this Division to discuss the political effect which this acute shortage is having and is likely to produce but it is necessary to emphasize the seriousness of the situation from the medical point of view. ♦ ♦ ♦

2. EXPEDIENTS WHICH ARE TRIED BUT FOUND WANTING

RATIONING ATTEMPTED BUT CONDITIONS NOT RIGHT FOR IT
[Civ Sup and Resources Div, AMGOT Hq, 15th AGp, Rpt, Jul-Oct 43]

5(e) In accordance with instructions, the existing rationing system was continued; indeed, there was no alternative. It was not very successful, however, for several reasons: lack of sufficient reserves of food to honour the ration regularly, thereby causing loss of confidence in the ration; the black market; the large number of people who claimed to have lost their ration cards during the fighting; the breakdown of the rationing machinery among bakers and retailers; and the amount of forged ration cards in circulation (estimated at 2,500 in Palermo alone)....

THE STOCKPILE IN NORTH AFRICA FAILS TO YIELD ENOUGH HELP
[Civ Sup and Resources Div, AMGOT Hq, 15th AGp, Rpt, Jul-Oct 43]

6(a) ... The Civil Supply Division was made responsible for estimating requirements of essential civilian supplies and for requisitioning such supplies through the appropriate military channels. Before the occupation began the planning staff had estimated requirements of foodstuffs to cover the first go days; it was thought that this food might be required in the three largest towns, Palermo, Catania, Syracuse, owing to the expected breakdown of the normal supply system during the battle. Accordingly stockpiles were established in North Africa amounting to 13,600 short tons of food, to be shipped theoretically as follows:

D + 15-2300 tons
D + 30-3500 tons
D + 45-4500 tons
D + 60-3300 tons

In addition a reserve stockpile of 32,000 tons flour was to be built up in North Africa from French resources. These stockpiles were to be called forward by the task force commanders as required.
In fact, no urgent need for them was felt in the first 60 days; but it was not known how long it would take to get them after calling them forward, and it was felt very early that a reserve of food in Sicily was necessary. Consequently the D30 stockpile was called forward on I August; about 3200 tons of it arrived on a coaster on 30 August, and when about 500 tons were unloaded it was diverted to Reggio di Calabria where Allied troops had just landed. On 8 August the

[311]

D15 stockpile was called forward; 1200 tons of this were received on 5 September (the remainder was never received). It thus appeared that one month was the gap between calling forward and receiving supplies. On 2 September, therefore, the D45 stockpile was called forward, and on 9 September the D6o stockpile; at the same time the anticipated worsening of the food position made it necessary to bid forward (out of the 32-000 tons reserve flour stockpile) 2000 tons flour to arrive by 25 September and 15000 tons to arrive by 15 October. In spite of the fact that normal convoys still called in Sicily, and that at the end of September a large part of the Italian merchant navy had become available to the Allies, only a small proportion of these bids was received up to the end of October. In fact, 3600 tons flour arrived at Palermo on 10 October, and 2000 tons more on 30 October, this latter shipment having been scheduled for Catania; it was therefore necessary to transport over a half of these two shipments across the island to Messina, Catania and Syracuse. Fortunately some use of the railways was permitted for civilian needs about this time, and the transfer was effected by rail.

The responsibility for effecting shipment to Sicily lay with AFHQ, once the proper bidding procedure had been completed by Headquarters AMGOT. A visit to AFHQ by the Deputy Director of Civilian Supply early in October elicited the information that (a) much of the stockpile was at ports at which normal convoys did not load, and therefore any tonnage allotted to us on those convoys was forfeited; and (b) that the French had not yet been persuaded to collect together, much less to mill and bag, the 32000 tons emergency stockpile of flour. ♦ ♦ ♦

POLICE ACTION AGAINST HOARDERS IS CONSIDERED
[Memo, McSherry, considered at 14th Mtg., Exec Council, AMGOT Hq, 15 Oct 43, app. B, Grain Supplies]

12. With regard to the question of the discovery and collection of supplies outside controlled channels, much remains to be done, and it is almost entirely to this sphere of action that attention must be directed. Some help can be obtained by the reduction in the quantity which farmers are allowed to retain. The main effort must, however, be directed against hoards in the hands of farmers and black market operators. This problem has been discussed at length, but, with the exception of sporadic efforts in various provinces, no positive general vigorous action has been initiated. The position indicates that the matter is now one of the gravest urgency. It is essentially a police matter and the choice of actions which ultimately rest with the Public Safety Division is whether they will now take action to deal with this present problem or face the eventual one of handling the grave and growing food disorders, which may certainly be otherwise anticipated.

IT IS NON KNOWN WHY THE BELIEF IN SICILY'S SELF-SUFFICIENCY WAS WRONG
[Ltr, Maj Alexander to RCAO, Sicily Rgn, 13 Nov 43]

1. On the basis of facts known prior to the invasion of Sicily, it was believed that after the emergencies due to the Allied invasion, the destruction in combat zones and the disorganization of governmental and transportation agencies, the island would be self-supporting, insofar as food was concerned, well into the spring, or even until the next harvest if rations were reduced.

2. Three factors have changed this belief. First was the fact that the Fascist government, in order to make its self-sufficiency program appear more successful than it was, is stated by most Sicilian experts to have published wholly false figures as to yields and imports in the island in recent years....
Second, scarcity of fertilizer for two years and considerable destruction of or interference with harvest, due to military operations, heavily reduced the yield in some parts of the island and decreased the crop as forecast by from 10% to 25%.
Finally, the extent to which the black market flourished before the invasion was naturally minimized by the Fascist government and the effect which this factor would have on the situation was not fully foreseen by the Allies.

3. In consequence of the foregoing factors it was inevitable that the problem of feeding Sicily would be more difficult than appeared to be the case in the summer of 1943. What has happened since the invasion and the harvest has aggravated the situation. ♦ ♦ ♦

NEW PROGRAM TRIED IN NOVEMBER
[Ltr, Maj Alexander to RCAO, Sicily Rgn, 13 Nov 43]

10b. As of 1 November, a three-fold program was ordered throughout the island (see Regional Order No. 13 and Administrative Instructions No.9)....

(1) The maximum bread ration was reduced to 200 grams per person per day and pasta rations were prohibited, thus bringing the consumption in producing provinces down nearer the level elsewhere and conserving dwindling stocks. This has produced much resentment in producing provinces and at least one instance of

[312]

violence when grain was being taken out to another province, resulting in looting of the grain, burning of the truck and disarming of an AMG officer.

(2) The amount which producers may legally keep was reduced about 20% and they were ordered to deliver this 20% to their ammassi for purchase at the August price of 500 lire per qli [ quintale ] . This order was implemented by forbidding the issuance of a milling permit to producers who had not obtained a certificate that they had turned in their 20%. Without this permit they cannot mill flour from their own grain, and they have no ration cards for bread purchases. If this order is effective, by 20 November, about 400,000 qli should be turned in. It is not believed possible, however, on the basis of amounts turned in to date, to obtain as much as half the total due.

(3) Each AMG officer in a grain-producing area was ordered to spend at least four days a week, until further notice, exclusively on searching for and confiscating illegally-held grain. (Under G.O. No. 3, after 31 October all grain held in excess of seed and family food allowance is subject to confiscation). AMG officers in non producing areas were ordered to help, themselves and with their trucks, when requested. Surprise road blocks, especially at night, were ordered. ♦ ♦ ♦

THE ITALIAN MULE MUST GIVE WAY TO MOTOR TRANSPORT
[Memo, Maj O. A. Spencer, Sup Officer, AMG Eighth Army, for Maj James J. P. Todd, Chief, MGS Adv Ech, 20 Nov 43, ACC files, 10000/159/1087]

3. No action can be really effective unless civil motor transport is provided. . . . Present efforts directed at stimulating the Consorzio and making the best use of mule transports. This however is inadequate statistically and unsatisfactory in practice as the mules are now wanted for plowing, etc., and the Army object to them on the roads anyway.♦ ♦ ♦

USE OF BARTER GOODS CONSIDERED AND REJECTED
[Telecon, Hilldring and Gen Smith, CofS, AFHQ, 10 Dec 43, CAD files, 400.38 (2-20-43), sec. 6]

♦ ♦ ♦ Hilldring-We have made several suggestions with regard to this thing, and as I said in my radio to you it is not possible for us brass hats to sit here in Washington and to tell you people what to do, and I avoid it. However, there is one avenue which we think here has not been sufficiently explored-that is to utilize barter goods, that is trade goods, to get these people to release the food that they are hoarding. We believe over here that you cannot get this stuff out of hoarding at the point of a bayonet. We think it is better to use calico cloth and jingles to attract the farmer's wife than to try and buy the stuff into the market. In other words, the reason that the farmer does not release his goods is because when he goes to market with his money there is nothing for him in the market to exchange that for.

Smith-Well, as a matter of fact, you would be simply astonished at the things you can buy in Italy. Pure silk stockings-you can buy as many as you want. The prices have gone up now, they were at $3.00 a pair when I first was over here, and you could buy them by the gross if you wanted them. You could buy all the . . . hats you wanted for $1.50 a piece, I got six to give away. You could buy wrist watches and things of that sort in any quantity. The shops are rather well stocked. It is far different from the situation in North Africa. Italy does not seem to have suffered from any shortage of supply except in the way of leather goods. I think probably the fact is that luxury items are plentiful and the cheaper commodities are a bit thin.♦ ♦ ♦

3. FOOD IMPORTS TO PREVENT STARVATION BECOME THE NUMBER ONE PRIORITY

HOARDING IS A RESULT NOT A CAUSE
[Clabaugh, Chief, Econ Branch, CAD, Rpt to Dir of CAD, 28 Feb 44, CAD files, 319.1, Foreign (3-28-43) (1)]

We went into Italy thinking that hoarding was a greater factor in the shortage of wheat than we now conceive it to be; that hoarders and black market operators should be vigorously prosecuted; that lack of confidence in the currency and lack of consumer goods for which to spend it were largely responsible for the hoarding of wheat. These are not unnatural surmises. But we had not been in Sicily and Italy very long before we realized that the shortage was actual and acute; that hoarding was more a result than a

[313]

cause of the shortage; that while violations should be prosecuted vigorously, no amount of prosecution would correct the trouble. The amassing of grain was unpopular and unsuccessful under the Fascist control. It is estimated that only one third of the available crop was distributed legally. That is not to say that the difference is now hoarded, but rather that it was sold through the black market.

APPEAL FOR FLOUR
[Msg, Eisenhower for CCS, 21 Nov 43, CCAC files, 475, Italy (9-30-43), NAF-525]

Immediate urgency exists for flour for Italian civilians in occupied territory. . . . Request immediate arrangement . . . 10,000 tons for earliest possible shipment.... Conditions in Sicily and Sardinia have required immediate relief to avert an acute situation thereby exhausting existing reserves. . . .

A LARGER FOOD PROGRAM IS SENT TO WASHINGTON
[Ltr, MGS, AFHQ, to CCS, 26 Nov 43, CCAC files, 433 (10-7-43), sec. 1 ]

1. Object:

To move into this Theater, on schedule, amounts of grain or flour adequate to provide minimum bread rations for the Italian population and to establish a stockpile for the provisioning on a similar basis of other areas which may be invaded by the Allied Force.

2. Assumptions:

(a) Population to be fed with imports. Fifty percent of the population of Italy south of Rome and in Sicily and Sardinia will have to be fed with imported grain or flour. Of the population north of Rome, 70 percent will have to be so fed. [Only 10 percent was estimated in earlier programs. ]
(b) Daily ration. The daily minimum ration will be set at 20o grams of bread per day. ♦ ♦ ♦

3. Discussion:

(a) Data are now available on the basis of which it is possible for the first time to estimate the minimum amounts of flour which will have to be made available for Italian consumption during the first six months of 1944 if we are to prevent civilian starvation and resulting disorder which will interfere with military operations and will provide propaganda for the enemy.
(b) It is proposed to rely primarily on grain and flour for this minimum provisioning of Italy because (1) the diet of Italians is based on bread and other flour products and (2) grain and flour are the most convenient foods for our purposes. Prior to the invasion the effective basic ration in Italy was 220 grams . . . per day, bread and pasta combined. It is proposed that under existing world conditions we cannot undertake to supply more than the bare minimum ration, which is taken to be 200 grams per day (two fifths pound), with increase for medium and heavy workers.
(c) The grain and flour situation in Italy, which we expected prior to our invasion of Sicily to be bad but not intolerably so, has deteriorated rapidly. The principal causes are: (1) Harvests were about 25 percent below normal. (2) Ordinary war damage, to which now must be added the virtual certainty of widespread and systematic rural devastation, confiscation and disorganization as the Germans retreat. (3) Extreme reluctance of producers to deliver to the legal market or even sell in the black market except at extremely high prices. This reluctance is due to such factors as . . . little incentive to sell because of lack of goods to buy in return. (4) A well-established and deeply rooted black market system, which is proving extremely difficult to choke. There is probably enough grain in Sicily to supply to the population of this island a basic ration somewhere between 200 and 300 grams . . . per day. But the conditions just enumerated, plus the difficulties arising from the disorganization of the Italian governmental machinery, make it doubtful if enough of this grain can be brought onto the legal market to provide bread for half this population, on a ration of 200 grams. On the mainland and in Sardinia the prospects are that an actual and serious deficit in grain confronts us.

(d) Imports of flour on a large scale will be necessary during the first half of 1944-i.e., until the next harvest begins to be available. Contrary to original estimates, we are currently providing imported flour to about 75 percent of the inhabitants of both Sicily and Sardinia. It will not be safe to assume that more than, say, 40 percent of the Italian population will be fed from local foodstuffs.♦ ♦ ♦

(e) This policy of provisioning Italy by import of flour or grain calls for two related steps: (1) Stronger and more determined practicable measures must be taken to bring domestic grain out of hoard, however disappointing past efforts have been. (2) Responsibility of provisioning the civilian population will be turned over to the Italian Government as soon as possible, because

[314]

the continued attack on hoarding and the black market can best be carried out by that government with Allied sanction behind it and because in this manner the Allies will be relieved of the full onus of a situation which is a legacy of Fascism. ♦ ♦ ♦

4. Recommendations:

(a) It is recommended that grain or flour shipments for civilian consumption in Italy be scheduled for the first six months of 1944 (including existing requisitions) as follows:

In month of                    Metric tons
January                         70,000
February                       80,000
March                           93, 000
April                             120,000
May                              147,000
June                              190,000
Total, six months           700,000

(b) It is recommended that an additional 134,000 metric tons be accumulated within the period i January-3o April 1944 as a stockpile to meet operational contingencies, calculated on the basis of four months' consumption by 5 million people on a basic ration of 200 grams per day ⁵

WHATEVER IT COSTS WE CAN'T LET THEM STARVE
[Telecon, Hilldring and Gen Smith, CofS AFHQ, 10 Dec 43, CAD Msg files, WDTC-91]

♦ ♦ ♦  Algiers: Well I tell you, I am not worried about the immediate situation which is all right because we have got some wheat from the French, and also we have dug up a little in the Middle East which we can get if we have to. I am very much worried on the long range viewpoint, because I am convinced that we have greatly underestimated our commitments, about feeding the civil population and also for taking care of such military persons as we may have to keep from starving, in order to keep them from being a burden on the countryside. . . . I did file with the Combined Chiefs of Staff at that meeting in Cairo a revised list of tonnage which we anticipate will be required for taking care of that Italian population.

Washington: Yes, I saw that, and it almost knocked me out of my chair.
Algiers: Yes, it is rather startling, isn't it? Washington: Yes, it is.
Algiers: Well to be absolutely honest, and I don't care how you manipulate the thing, the fact still remains that regardless of military operations, number one priority is to provide a minimum of food for the Italians.
Washington: That is right. You can't starve them.
Algiers: And I don't care how you work it, that still remains first priority. After we have done that, then we can use what is left for military purposes and I think that we are going to find that it very definitely limits the size of forces that we could use on the peninsula. There isn't any other way to figure it. ♦ ♦ ♦
Washington: In any case it is apparent that the advance information that we had about the ability of the Italians to feed themselves was highly inaccurate. [Sec. 2, above] That is, the information here and in London and in Africa and everywhere else is certainly inaccurate if the figures that apply in this last paper represent the real need for food because we were satisfied from the record over a long period of years that with respect to food, the Italians were practically self supporting. ♦ ♦ ♦

OUR FOOD REQUISITIONS ARE BASED ONLY UPON MILITARY NECESSITY
[Msg, Eisenhower to WD, 14 Dec 43, OPD Msg files, CM-IN 9014]

It should be understood that our requisitions for food are not based on humanitarian or any other factor but that of military necessity. Conditions in Southern Italy and Sicily are such that unless reasonable quantities of food are supplied very promptly, we will experience sabotage, unrest, and a complete cessation of all those activities considered necessary to our advance. ♦ ♦ ♦

AN AVOWED MISTAKE WILL BE RECTIFIED BY TEMPORARY EXPEDIENTS
[Msg, Gen Smith, CofS, AFHQ, to Chief, CAD, 14 Dec 43, OPD Msg files, CM-IN 9363]

Our postponement of November shipments of flour into December, because of anticipated availability of North African wheat, and limited shipping and port facilities for large ships was a serious mistake and it has caused acute shortage both because of increased requirements over estimates, and failure of North African wheat to be made available on schedule.
The loan of an additional 20,000 tons of wheat now agreed by French from North Africa and 7,000 tons expected from Mid East, should take care of our needs until arrival of convoys. ♦ ♦ ♦

[315]

OTHER TEMPORARY EXPEDIENTS: CENTRAL COORDINATION AND DIVERSION OF ARMY SUPPLIES TO CIVILIANS
[AFHQ Admin Memo 92, 19 Dec 43, ACC files, 10000/105/360]

I. Establishment of Central Economic Committee (Italian Mainland)

I. To insure the necessary co-ordination and control of civilian supply and economic matters in occupied or controlled territory of the Italian mainland, there will be established in Naples a Central Economic Committee under the Chairmanship of the Deputy Chief Administrative Officer or his Deputy, responsible direct to this headquarters. In addition to the chairman, there will be one senior representative of AMG 15th Army Group and one senior representative to be designated jointly by the Allied Control Com mission and AMG Headquarters. ♦ ♦ ♦

II. Civil Food Controller (Italian Mainland)

1. The situation in regard to supply and distribution of food for the Italian civil population is grave, and is liable, if unremedied, to have an adverse effect on our ability to conduct operations. It may be desirable in certain cases to accept some diversion of military transport and/ or supplies in order to alleviate situations which would result in internal security commitments, rather than to allow such internal security commitments to arise. The primary interest of this headquarters in meeting the minimum food requirements in Italy is to avoid interference with military operations. It is an over-riding military consideration that the civil population be fed. In emergencies where this consideration involves direct interference with military build-up and maintenance, the decision of the General Officer Commanding in Chief, 15th Army Group, will govern. Machinery for dealing with such matters is, therefore, being established immediately.

2. The machinery for the execution of this policy will be that of the Central Economic Committee established by Section I, above, under the Chairmanship of the Deputy Chief Administrative Officer, AFHQ Advanced Administrative Echelon (FLAMBO).♦ ♦ ♦

MANY TROUBLES BUT FEW THAT FLOUR WILL NOT CURE
[Ltr, Joyce to Hilldring, I9 Dec 43, CAD files, 400.38 (2-20-43) (1), sec. 3]

♦ ♦ ♦ This is some job! There are 57 varieties of grief, but only about 7 of that number that some flour would not cure. These people are hungry and I hate to see such with co-belligerents.
Please do your best, and bring our best go getter Bill Somervell into the picture. He will get flour shipped or else!

4. THE FOOD SHORTAGE IS AT LEAST ALLEVIATED

FOOD ARRIVALS BRING IMPROVEMENT
[Hq AMG, Rpt for Dec 43, ACC files, 10000/101/501]

43. On 10 December three ships arrived in Palermo, Siracusa and Catania carrying some seven thousand tons of flour or wheat. The receipt of this flour and wheat sent the black market price of bread from 120 lire down to between 7o and 89 lire a kilogram. . . . The ration of bread was maintained at 150 grams a day except that in the three producing provinces it never went below 200 grams. This ration was substantially supplemented at Christmas. It is intended to raise the island ration to 200 grams as soon as it is possible to ensure the continuance of such a ration.

INCREASING ARRIVALS BRING FURTHER IMPROVEMENT IN JANUARY
[Hq ACC, Rpt for Jan 44, ACC files, 10000/101/502]

(37) The improvement in the food situation occurring at the end of December continued in Sicily, due to the adequate imports of wheat and flour, until the last week of January. It then became serious in Catania and Siracusa in Region I, due to the diversion of a vessel containing about 5,000 tons of flour, sent to Reggio Calabria instead of to Siracusa as scheduled.

(39) During the month the bread ration remained at 150 grams in Region I except in Enna, Agrigento and Caltanissetta, the grain-producing provinces, where it was 200 grams. An order was issued in Sicily authorizing a uniform scale for non-producers of 150 grams of bread per day throughout the island and an additional zoo grams of bread for heavy workers and of 250

[316]

grams of pasta per person per week after 14 February.

(40) In Region II the supply of grain and flour also showed a great improvement. Rail shipments from Foggia to Region II, initiated in December, were completed. Three ships with cargoes of 6174 tons of flour and grain arrived at Reggio and two ships with 5407 tons at Crotone. Unloading proceeded as rapidly as possible, but the extremely limited amount of motor transport and the shortage of railway cars for transshipment are still serious handicaps. It has been possible to give a ration of 150 grams of bread daily in Reggio Province, but shortage of transport has made it impossible to raise the ration above 100 grams in Cosenza and Catanzaro.♦ ♦ ♦

LACK OF TRANSPORT IMPEDES DISTRIBUTION OF WHAT LITTLE IS AVAILABLE
[Gen Hume, SCAO, AMG Fifth Army, Rpt for Jan 44, ACC files, 10000/154/204]

13. a. . . . [transport] is the most vital and difficult of all the problems which have to be faced: it is not too much to say that the transport available is so inadequate that it is seriously impeding this organization from performing its correct functions in a satisfactory manner. . . . Transport is not available in sufficient numbers for the various commitments with which AMG is charged by the Army authorities, e.g. evacuation of refugees from combat zones, evacuation of seriously wounded civilians from battle areas, distribution of food and medical supplies.

At present there are insufficient trucks to distribute the flour ration which is laid down by Headquarters ACC. . . . It is estimated that over 4000 tons of food will be lost in the Venafro district because transport is not available to bring the seed and fertilizer which are ready in the Foggia district for spring sowing. ♦ ♦ ♦

IMPROVED RATION SCALES ARE SET
[Memo, Food Subcom, Hq ACC, for All Concerned, 16 Feb 44, ACC files, 10000/136/384]

I. The following Ration Scales have been laid down:

CHIEF COMMISSIONER SEES IMPROVEMENT BUT IS NOT COMPLACENT
[Memo, Mason-MacFarlane to GOCinC, Hq AAI [Allied Armies in Italy], CMF [Central Mediterranean Forces Group], 28 Apr 44, ACC files, 10000/136/116]

3. The report ⁷  shows up one side, and one side only, of the picture. Such a report could be written in the second phase of any occupied country. It is notorious that the initial enthusiasm of a population towards the Army which has liberated them diminishes if that Army remains in occupation of their country, particularly if operations do not progress with the rapidity anticipated.

7. In the fifth paragraph of his report the Rear Admiral infers that humanitarian considerations are not taken into account in dealing with the civilian population. The inference is entirely false and I resent it.

[317]

8. No member of this Commission, least of all myself, can view the situation with complacency, but I think that you are probably satisfied that the condition of this population has improved considerably in the last three months.♦ ♦ ♦

URBAN CENTERS SUFFER MOST
[OSS, AAI, Report on the Economic Situation in Italy, 13 May 44, ACC files, 10000/136/302]

6. . . . In general, the lower and middle classes of the urban centers of Naples are not far from starvation. This situation is somewhat alleviated by the fact that the Allied armies are the largest employers of manual and industrial labor and that their civilian help is generally given some kind of hot meal at noon. The average middle class family is somewhat better off, though their fixed incomes are generally insufficient to satisfy the essential requirements in housing and clothing even if sufficient for food. Of the city population, only the wealthy have a satisfactory diet. On the other hand the rural population, which constitutes 70 percent of the total, fares much better. . . . The peasantry is always able to hold on to a minimum food supply. In the provinces the chief sufferers are refugees from the north, especially where relief organizations have not functioned well.♦ ♦ ♦

TARGET FIGURE HAS NEVER BEEN MET
[Col W. J. Legg, Chief, Food Subcom, Econ Sec, ACC, Report to Advisory Council for Italy, 25 Aug 44, ACC files, 10000/132/477]

2. . . . the original intention of the planning staff prior to invasion was to import supplies of essential basic commodities to furnish a minimum daily diet of 1000 calories for normal consumers plus an additional 200 gr. of flour for heavy workers. No allowance was made for hospitals, institutions, prisons, refugees, etc. The balance required to raise the level to 1500 calories was to be made up from local resources.

3. The standard of imported supplies has not, at any time, permitted the attainment of the planned figure. Similarly the availability of local resources, except in the producing. and rural areas, has not permitted the attainment of 500 calories. ♦ ♦ ♦

BUT IMPORTED FOOD SUSTAINS ITALIANS UNTIL NEXT HARVEST
[Econ Sec. ACC, Rpt, 1 Sep 44, Feeding Southern Italy, ACC files, 10000/154/3z8, PP. 73, 78]

♦ ♦ ♦ A. Fall and Winter, 1943-44

5. It was clear that dependence could only be placed on imported foods if the people in Southern Italy were to survive through the winter. Large tonnages of food were sent to Italy. In the five months August-December 1954, a total of 83,000 tons of flour and wheat had arrived in Liberated Italy, but in the next three months a total of 250,000 tons arrived. There was a corresponding relative increase in the other foods, from August-December to January-March: Dehydrated soup increased from 2,000 in the first period to 16,000 tons in the second period; sugar from 6,000 to 15,000 tons; meats and vegetable stew from zero to 9,000 tons.

6. In computing the requirements for the food to be imported into Italy, the Allied Force Headquarters in the Mediterranean used as a basis that 1,000 calories per day of imported food would be supplied to 50% of the population south of Rome. AFHQ also operated on the assumption that food for the rest of the population plus an additional 500 calories for those to whom imported food was being supplied would come from local resources. The 1,000 calories were to come mainly from a 200 gram flour ration (707 calories) and the rest from dry vegetables, dehydrated soup, sugar, meat or cheese. Actually, it proved necessary to supply a minimum ration not to 50 percent but to over 80 percent of the total population in Southern Italy. It proved necessary to feed not only the large cities but the small towns and the villages.

7. During the winter and spring of 1944, 84% of the population of Liberated Italy received probably half or more of the food they ate from imports brought in by ACC. ♦ ♦ ♦

B. Spring 1944

I. At the end of the winter, and with the new wheat and other crops, the situation in Southern Italy has become considerably better. As the armies moved northward, and the government organization has improved, food conditions in the rural areas have been relatively easy. The food situation in Southern Italy now largely becomes one of the large cities. ♦ ♦ ♦

[318]

5. THE INITIAL FOOD EXPERIENCE TEACHES VALUABLE LESSONS

GENERAL HILLDRING LETS GENERAL STAFF KNOW THE FACTS OF LIFE IN ITALY
[Memo, CAD, Incl with Ltr, Hilldring to Handy, ACofS, OPD files, 10 Jan 44, CAD/400.38 (2-20-43), sec. 4]

1. The Civil Affairs Division is constantly encountering on the General Staff a state of mind which instinctively resists the advance procurement or shipment of supplies to support the civilian populations in the wake of the Army. If prompt action is not taken to counteract this condition, the successful conduct of our military operations will be seriously impaired. I am not reciting a theory. My statement is founded on experiences which we have already had in Italy.

8. We have now prepared estimates of requirements designed to provide minimum relief and rehabilitation for Europe, and it is estimated that between four and seven million long tons of supplies must be moved in ocean-going vessels to continental Europe from the Western Hemisphere, England, North Africa and other outside sources to satisfy the minimum relief requirements during a six months period of military responsibility. Imports for England, Russia and the neutrals are not included in this estimate. In addition, there may be an additional coal requirement of as much as four million tons, if inland distribution is severely curtailed.

9. Quantities of supplies which I have just stated are minimum estimates of the probable needs of the civilians in the wake of our armies. They are not based on estimates as to what it would be nice for those countries to have. They are based on the application of those standards established by the Combined Chiefs of Staff in CCS 324/1 [Ch. V, sec. 4]. They are military supplies. They will be required to support the troops in the U.S. Army in the accomplishment of planned military operations.

10. These facts point up one of the great lessons of modern warfare which we have learned the hard way in Italy, and which, if disregarded in the future may materially dislocate operations.

A THEATER STOCKPILE IS AGAIN PROPOSED
[Msg, AFHQ to CCAC, 12 Feb 44, MTO, HS files, CAD/701, CM-OUT 3367]

To meet emergencies arising from changes in the tactical situation, shipping difficulties and to offset losses due to enemy action also to cover the 10 percent milling loss and normal shrinkage through handling it is recommended that there be authorized: A stockpile of 100,000 tons of wheat/flour of which 50,000 tons be stockpiled in the theater and 50,000 tons on the eastern seaboard of the U.S.♦ ♦ ♦

The 50,000 tons to be stockpiled in the U.S. should be flour, preferably go percent extraction to permit immediate use upon arrival.
The total of 100,000 tons ⁸  is sufficient to feed approximately 13,000,000 people for thirty days on the present basis of the Italian ration scale. This is equal to the civil population to be fed in Sardinia, Sicily and the mainland including Tuscany, Umbria and Marches.
The proposed stockpile is intended for allocation anywhere in the theater at the discretion of the Commander in Chief and is not intended as an excessive reserve for Italy. Commodities for stockpiling other than wheat /flour will be commented on later.

NEED OF IMPROVEMENTS IN LOCAL STORAGE, PRODUCTION, AND DISTRIBUTION
[Grady, Vice President, Econ Sec, ACC, Rpt to the Secy of State, 28 Mar 44, p. 8, CAD files, 334, ACC (3-28-44), Bulky]

A. The Emergency Food Problem

♦ ♦ ♦ Beginning with January 1944 increasingly heavy imports of grain and flour began to arrive, and a very large food import program stood on the books for the first six months of 1944. It was urgently necessary, however, to establish an efficient system for the receipt, warehousing, internal transportation, milling, and distribution of these supplies. Following the reorganization of the AMG/ACC and the clarification of channels of authority and responsibility, this task was placed in the hands of the Food Subcommission, and is being efficiently dealt with. Warehouse space has been found, physical checking arrangements instituted, and plans for milling and internal distribution are being developed, and large quantities of food supplies are being moved from the docks with minimum strain upon the port's congested facilities, together with a substantial reduction in the leakage which develops in large proportions if the

[319]

receipt, transportation and warehousing is not effectively policed.

The provision of imported food to meet the present emergency is however only the first step in meeting the emergency food shortage, which will grow as additional heavily populated areas are liberated. It is also necessary to find means of unlocking hoards and other supplies existing within the area, of driving out the costly system of black market distribution through the re-establishment of legal marketing channels, and to revive and promote the restoration of local food production. The substitution of open distribution for the illicit black market involves the problem of reviving responsible local commercial initiative as well as of restoring transportation facilities sufficiently to enable the local supplies which are discovered from time to time in various parts of the mainland-six hundred tons of beans in one place, thousands of tons of oranges and lemons in another-to be brought to the centers of consumption. These problems are receiving from the Food Subcommission attention only second to that of arranging the handling of the current and prospective food imports.

In brief, it is necessary not only to handle the heavy volume of emergency food imports, but also to stimulate local food production and to foster and control the marketing of present stocks and future crops. Interwoven in this is the problem of stimulating the revival of local commercial initiative and governmental responsibility which is the core of the problem of liberated Italy. [See also Chapter XVII.] ♦ ♦ ♦

THE WISDOM OF HINDSIGHT: WASHINGTON EXPERTS CRITICIZE THEATER PLANNING
[Combined Sup Gp for CCAC/S, Rpt of Survey ⁹ , Civilian Supply in Italian Theater, Mar-May 44, ASF, ID files, dr. 3424]

III. Role of Food in Military Government

That food for civilians was considered an important part in preinvasion plans for this area will not be questioned, although there seems to be some doubt as to how important relatively that part was considered. That food for civilians could become the key-note in the success or failure of military government after occupation, was certainly not anticipated prior to the landings in Sicily. In fact, every observation made by the Supply Group on this aspect of pre-invasion planning in this theater indicates that many other phases of military government responsibilities were given priority over civilian food supply in the preparation of the campaign. ♦ ♦ ♦

[Comments of Lt Gen John G. W. Clark, Chief Admin Officer, AFHQ, on Rpt of Combined Sup Gp, 2 Jul 44, ACC files, 10000/136/427]

♦ ♦ ♦ The "careful study" which the Group gave to the problems of AMG on the basis of which it condemned the AMG planning, did not include an examination of the AMG plan or any of documentation underlying the planning of food requirements, nor did it involve consultation with any of the officers concerned with that function at that time. . . . Recourse to the plan itself and to the planning files and records would have indicated to the Group the following facts which are at substantial variance with its conclusions:

a. That a stockpile of 23,000 tons for Sicily was recommended by the planning staff for the Sicilian operation in May of 1943 and accepted and authorized by AFHQ, such stockpile to be created out of the North African harvest, which it was then thought would have a substantial surplus.
b. That it was foreseen in August and early September 1943, by the responsible AMG officers, that the wheat supply in Sicily would be exhausted in the six deficient provinces by the end of the year. A program, therefore, was established to bring forward the stockpile.
c. That the critical shortage which developed in December was due to the failure of the stockpile and the rapidly increasing demand resulting from the development of operations which were not contemplated at the time of the original plans, as well as to organization difficulties which interfered with the execution of the program.

Whether the AMG officers had a true appreciation of the role of food is a matter of opinion. It is, however, wholly inaccurate to state that not until months after the invasion did AMG officials awaken to its importance....

ACC BLAMES MILITARY PRIORITIES
[Econ Sec, ACC, Rpt, Organizational Problems, 1 Sep 44, ACC files, 10000/154/328]

4. The dominant fact about supplying food to the cities in Liberated Italy was that it was taking place in an area which was primarily the rear supply area of the Allied armies. Naturally, army interests predominated. All the usual military difficulties of operation were accentuated in

[320]

the case of ACC as ACC was regarded as "marginal"-i.e.., as the organization which should bear the brunt of any unexpected difficulties. Military considerations were always dominant.

5. It was never possible to know how much food was actually going to arrive. ACC would be advised that certain quantities of food were on the way. The quantities of food shown on the ships' manifest on arrival were almost never in agreement with the quantities advised. Furthermore, the supplies actually received often did not agree with the quantities on manifests. The discrepancies between advices and manifests were such that the advices could not be used in planning. ACC never knew exactly how much food it was going to get for Italy until it was actually unloaded....

6. The diversion of ships for military reasons also complicated the problem. Subsistence supplies were frequently loaded on ships which also carried strictly military equipment and supplies. Sometimes only in this way would supplies secure some shipping space. These ships were diverted frequently from their original destination for reasons of military necessity. Supplies scheduled to arrive at certain ports at certain times would arrive at other ports. There the supplies might have to be unloaded to make the ship available for some other military purpose, and then came the problem of getting the supplies to the place where they were actually needed. There was scheduled to arrive in Cagliari, Sardinia, during January 1944, 3,000 tons of supplies. These supplies were actually unloaded in Oran, North Africa and coastal shipping had to be procured to get the supplies to Sardinia. Though five grain ships were scheduled to arrive in July 1944, only one arrived. One was overdue and two others were scheduled to arrive on 3 August. ♦ ♦ ♦

SUPPLY LESSONS LEARNED FOR FUTURE OPERATIONS
[Combined Sup Gp for CCAC/S, Rpt of Survey, Mar May 44]

XXIII. A. The Importance of the Supply Aspect of Civil Affairs

An outstanding lesson gained from the Italian experience, and which it is expected will be applicable to all liberated countries, is the importance of the economic and supply aspect of civil affairs. It is the opinion of the Group that the quantity of supplies needed for the relief of Europe can be influenced to a large extent by the importance assigned to the supply function in the administrative organization, and by the technical qualifications of the personnel assigned to the task.

In the civil affairs organization as originally instituted in this theater, the importance of the economic and supply roles appears to have been underestimated both in preliminary training and in field practice. It is believed that the population could have been maintained at the same health level, with far lesser quantities of imported supplies than were actually requisitioned, had the civil affairs organization been built around men selected on the basis of knowledge of and preferably experience in the Army Technical Services, and experience in civilian occupation concerned with agricultural and industrial production, control and distribution.

B. Relationship Between Civil-Affairs Organization and the Army Technical Services

In the planning for future areas the Group suggests that procedures be developed for achieving a closer integration of the civil-affairs organization with the other branches of the military establishment. In this theater, the Group has observed a sharp line of demarkation between the army technical services and the organization dealing with civilian supplies. There is on the part of many army supply men in Italy no realization that when requisitions for civilian supplies reach Washington they are in effect military requisitions from this area. It is suggested that in future operations steps be taken to bring home to the technical services their direct responsibility for ensuring adequate handling of civilian supply matters such as transportation, warehousing and engineering maintenance until civilian facilities become available.

It should be realized that in areas under active military jurisdiction the army technical services indirectly govern almost all aspects of civilian economy through the control of ports, railroads, roads, public utilities, communications, and such supplies as petroleum products and coal. In addition, the military employs large numbers of civilians required to operate and maintain these facilities. It is believed that the increased burden on the technical services would not be excessive if charged with additional responsibilities in connection with civilian supply. Actually, it is considered that in the long-run the military would profit by the more rapid reorganization of the civilian economy that could be achieved through their active co-operation with civil affairs work in the early operational phases.

C. Personnel

During the survey, the absence of technically trained personnel was apparent. The most prevalent background among provincial supply officers

[321]

seemed to be that of police experience. Supply officers have been severely limited in number and are usually of junior rank. Still they have been called upon to assist trained Italian civil administrators through a period of severe economic dislocation and to supervise the warehousing, distribution and rationing of large tonnages of supplies. ♦ ♦ ♦

In planning personnel for future operations, the Group recommends that every administrative unit should include one technically-trained officer for each of the following economic divisions concerned with supply matters: (1) Agriculture, (2) food distribution and rationing, (3) transportation, (4) fuel, public works and utilities, (5) commerce and industry, and (6) public health. In addition, at each port there should be at least two Port Officers for the supervision of port handling and warehousing of civilian supplies.

D. Attitude of Supply Officers

In the opinion of the Group, officers at all levels of the ACC, have not been sufficiently impressed with the necessity of keeping import requirements to a minimum. The easiest means of satisfying Italian officials and maintaining tranquility within an area is to accede to all demands. There will always be organized groups pressing for special interests. ♦ ♦ ♦

Another difficulty is to impress upon supply officers the need for uniform rationing in order that supplies in surplus provinces may be available for distribution in deficit areas. It is difficult in an area of surplus grain production to keep the population on a low bread ration and at the same time export the locally produced wheat to other areas. In a number of instances in surplus areas, supply officers were found to be so interested in the welfare of their own province that no positive action was being taken to hold down consumption within the province and to make surplus products flow into deficit areas.

E. Liaison between CCAC and the Theater

It is the opinion of the Group that for Italy and for future theaters as well, it is essential to have a system of liaison with CCAC to ensure that problems of supply and of distribution are properly co-ordinated. This can best be achieved by officers travelling regularly from Washington and London to the theaters. . .. It is considered that many of the supply difficulties which arose in the early stages of the Italian operation and are still current could have been avoided by this means.

6. EPIDEMIC KNOWS NO NATIONALITY

ANOTHER PLANNING ASSUMPTION WHICH WAS To PROVE SADLY ERRONEOUS
[MGS, Plng Comm. on Migration, Rpt, 20 Jul 43, P. 13, ACC files, 10000/164/805]

♦ ♦ ♦ It is not expected that typhus will occur in serious proportions during 1943. Although it unquestionably existed in Italy during the winter of 1942-43, its precise extent is not known. It was certainly less prevalent than in the Balkans and Central Europe. An increase is not to be anticipated before the winter of 1943-44.

INITIAL DANGERS TO PUBLIC HEALTH IN NAPLES
[AMGOT Hq, Rpt for Sep 43, ACC files, 10000/101/ 501]

143. When our forces entered Naples they found that there was an almost total failure of the water supply. People were carrying water in pails, jugs, bottles and every type of container. There was a small trickle of water from some of the hydrants, but many persons standing in line were unable to receive enough to quench thirst. The Germans had blown up the main aqueduct in seven places and all the reservoirs save one had been drained. By chance an Italian had saved one reservoir by cutting the fuse after it had been lighted by departing Germans. AMGOT took charge of the remaining reservoir and by rationing to the long queues of people made the supply go as far as possible....

144. The work of restoring the water supply was begun at once, but it was ten days before water flowed in part of the city taps, and two weeks before the entire city was served.

145. The lack of water, plus the destruction of sewer mains, created a most hazardous threat of epidemics. But even if water had been available the sewers could not have functioned in the absence of pumping facilities, which were sabotaged by the enemy, and of power. Naples' sewer system is in large part constructed so as to require pumping from low levels. By a careful instruction of the public, carried out in the daily Italian newspaper published by PWB, and by

[322]

posted notices, sanitary measures were adopted, but it must be stated that severe epidemics of typhoid and dysentery might have resulted but for sheer good fortune and several hard rains providing the people with an opportunity to gather water in pans, and which also served to flush out the sewer systems. Water sterilization supplies were flown in by AMGOT as a precaution against epidemics due to the loss of pressure in the water system and the breaks in the sewage system.

146. The health situation was better than had been expected. Rumors of outbreaks of cholera and typhus had been received before the occupation. AMGOT medical officers made an immediate inspection which showed that there were no epidemics, that the incidence of infectious diseases was lower than in corresponding periods of the two previous years, and that the hospital situation was satisfactory. Medical supplies were landed in Naples from North Africa and in addition 40 tons of emergency stores had been sent forward by coaster from the AMGOT depot in Sicily.

A TYPHUS EPIDEMIC DEVELOPS IN NAPLES
[PHS/C (Public Health Subcommission), AC, Rpt, Epidemic Typhus in Naples 1943-44, ACC files, 10000/163/546, pp. 15-19]

♦ ♦ ♦ The earliest incursion of typhus into the portion of the peninsula open to investigation, and of which there is knowledge at present, occurred in late February and early March 1943. A hospital train bringing wounded and frostbitten soldiers from the Russian front left Prilven in the Ukraine on the 19th and arrived at Foggia on 26 February. . . . On the 12th and 13th March eighty cases of typhus appeared among these repatriated soldiers-44 at Foggia and 36 at Bari....

It was about this same time that the first reported cases of typhus appeared in Naples at the Military Hospital. One was in a soldier returned from the Russian front by train and three others in men brought back from North Africa by hospital ship. ♦ ♦ ♦

It is probably due to the fact that the movements of prisoners are usually better recorded than those of civilians that our knowledge of the pre-epidemic phase of the Naples outbreak is concerned largely with the prisons and the part they played in the seeding of the civil population. Of primary interest is Poggioreale prison, a large provincial institution located in the industrial area of Naples. Surrounded by an artillery barracks, airplane and locomotive works as well as soap and textile plants, Poggioreale sits on a military bull's-eye. During the Allied air raids of the spring and summer of 1943 the prison suffered several direct hits which made some of the pavillions uninhabitable. The bathing plant was demolished and hygiene in the prison sank to rock-bottom. There were no air-raid shelters at Poggioreale and while raids were in progress the prisoners were herded together in the space available in the basement. At such times the prison population which normally occupied acres of floor space was crowded into a few thousand square feet. The inmates were almost universally louse-infested. In short, conditions for the transmission of typhus were ideal once the virus had been introduced....

There were plenty of opportunities to bring the virus into Poggioreale with the prisoners, both civil and military, who are known to have passed through the prison during the winter and spring of 1942-43. At this time the disease was unusually prevalent in North Africa and there are records of large numbers of prisoners, both French and Italian, who were evacuated from Tunisian prisons, some by way of Sicily and others directly to Naples. ♦ ♦ ♦

... Of no little importance to the initiation of the Naples epidemic is the fact that in the month of August, while at least 25 cases of typhus are known to have existed in this prison and a part of which time the prison was supposed to be in quarantine, no less than 100 prisoners were liberated, some 40 or more were transferred to other institutions and 25 others escaped. In the mounting confusion of Naples in August and September these potentially dangerous sources of typhus were lost to sight. It is probable that many of these men sought refuge in the air-raid shelters which are as admirably designed to protect runaway prisoners from the law as they are to protect honest citizens from bombs. The ricovero "Tunnel 9th of May," which is the main traffic artery between Naples and Pozzuoli, started yielding cases of typhus in August and September. ♦ ♦ ♦

Due to the vast disorganization of all facilities and services little typhus was recognized or reported in October, but throughout this month and November the infectious charge was building up for the inevitable lightning which was to strike in December. At the time of the Tizi Ouzou conference on 29 September, twenty-four cases of typhus had been officially reported in the city of Naples, but by the time the first control personnel arrived on 8 December this number had increased to 107.

[323]

THE COMBINED CHIEFS ARE TOLD OF A NEW ENEMY
[Msg, AFHQ to CCS, 4 Dec 43, AFHQ Msg files, CMOUT 1156]

Typhus fever is actual threat to military personnel in occupied Italy at this time. .. . Twenty known cases Typhus now in Naples alone. Personnel returning to Italy from Balkans are carriers and will cause spread in civil population.... DDT louse powder and dusters requested in L-9740 of 11 November . . . are in urgent necessity....

THE DIRECTOR OF THE TYPUS COMMISSION OUTLINES A CAMPAIGN
[Min, Conf To Consider Typhus Contl Held by Deputy Military Surgeon, AFHQ, 25 Dec 43, ACC files, 10000/163/7]

Brigadier General Fox stated that General [Everett S.] Hughes, Deputy Theater Commander, has asked Typhus Commission to take complete charge and that he (General Fox) considers this step not only advisable but absolutely necessary. Situation is desperate and outlook is grave for civil population. Military population is threatened. Immediate action is indicated. A.M.G. in Italy should have called for help 60 days ago. It is believed too late to smother epidemic, but proper attack may bring it under control. Fox will assume complete responsibility if War Department authorizes. General Fox considers that no civil agency such as Rockefeller group can possibly function in an active military zone such as Southern Italy without insurmountable administrative and supply difficulties.

A cable on the above lines has been sent by A.G. to War Department asking for sanction for the Typhus Commission to assume responsibility for control of Typhus in Southern Italy, and for attachment of Rockefeller Group to Typhus Commission.

4. Plan of Campaign. Brigadier General Fox explained his proposed Plan of Campaign as follows
(a) Mass delousing of civil population of Naples.
(b) Organization of a complete case-finding service with the co-operation of Italian-speaking Physicians and Priests.
(c) Disinfection of contacts (home and place of work).
(d) Biologic immunisation of key personnel, e.g. Hospital Staffs, Police, Priests, etc.

5. Relationship of Army. Colonel [William S.] Stone stated that 15 Army Group has issued a Directive restricting the Military population in Naples as much as possible, limiting transit passes, and impressing the necessity of immunisation and disinfestation.

6. Medical Supplies.

(a) D.D.T. This is to be the chief means of disinfestation. 60 tons is on the way from U.S.A. on a fast liner. One hundred tons for A.M.G. is coming in installments. Enough MYL powder has been made available for one and a half million treatments. 1,400 pounds of DDT (conc.) enough for 224,000 people at one ounce per head is in transit from North Africa to Naples. Brigadier General Fox pointed out that while Methyl Bromide or steam disinfestation had its place within the Unit or to deal with occasional infestation, it had no place in mass disinfestation for the population got re-infested as fast as disinfestation could normally be carried out. A substance like DDT with a continued action was essential.
(b) Typhus Vaccine. Where surplus required for distribution is considered American Army supplies are just sufficient to cover primary inoculations when necessary, and booster doses for personnel of the Allied Armies. Requirements for civil [population] will have to be obtained in addition.♦ ♦ ♦

AMG MEDICAL SETUP IS CONSIDERED INADEQUATE
[Msg, Maj Gen Ralph Royce, CG, USAFIME, to WD, 26 Dec 43, CAD Msg files, CM-IN 16255]

Part 4. . . . Fox found nothing to co-ordinate on arriving in Naples and therefore he recommends Typhus Commission be assigned responsibility for entire typhus control program. Naples AMGOT medical set-up pitifully inadequate. No active program had been started nor do I believe

[324]

it possible with the medical services available to AMGOT.

AFHQ TRANSFERS CONTROL TO THE TYPHUS COMMISSION
[Msg, AFHQ to FLAMBO (AFHQ Adv Admin Ech, Naples), 29 Dec 43, ACC files, 10000/163/7]

Policy regarding typhus control in civilian population of Naples and occupied Italy will be under the direction of FLAMBO. Initial phase of typhus control programme as far as technical and administrative aspects are concerned should be delegated to U.S. Typhus Commission which has been assigned by AGWAR to this Headquarters. Col. H [arry] A. Bishop member of this Headquarters is being sent to Naples tonight temporarily as assistant to Director U.S. Typhus Commission. Any additional supplies and equipment not available locally if requested will be provided by this Headquarters. AMG will take immediate steps to organize health departments to take over typhus control work when epidemic is under control using civilian and AMG health personnel. Transition of programme to AMG control will be arranged by you in conjunction with U.S. Typhus Commission and AMG. Military personnel temporarily attached to expedite initial programme will be returned to their proper station as soon as AMG is organized to continue typhus control work.

AMG THINKS CURTAILMENT OF ITS MEDICAL JURISDICTION UNWISE
[Memo, Deputy Chief Admin Officer,¹⁰  15th AGp, for Hq 15th AGp, 3 Jan 44, ACC files, 10000/163/7]

2. The removal of Typhus control from the direction of Medical Services, A.M.G., and the placing of it under an operational military organization [FLAMBO] will not only cause complete confusion in medical and civil administration, but places upon the operational military authorities a responsibility which must be that of A.M.G. In fact, A.M.G. has been formed to relieve the military authorities of such responsibilities. This is the second occasion in which AFHQ have removed from A.M.G. a civil responsibility and placed it under FLAMBO. The first was the feeding of the civil population.

4. I am advised and satisfied that Typhus in Naples is not an hyperendemic. The situation is serious but is not out of control. Colonel Cheyne, Director of Medical Services, A.M.G., together with Colonel [E. H.] Crichton, Senior Medical Officer, Region III, have the matter in hand and with the assistance of the U.S. Typhus Commission, whose presence and help I welcome, are the best people, because they are members of A.M.G. and therefore in closest touch with the civilian population and the civilian administration, to deal with the Typhus outbreak in any city or part of the area. I submit that FLAMBO is not in such a position.

8. I shall be glad if immediate action could be taken to put the responsibility for the medical administration relating to the control of Typhus under the proper authority, i.e. A.M.G.

INHABITANTS OF AIR-RAID SHELTERS ARE "DUSTED"
[PHS/C, AC, Rpt, Epidemic Typhus in Naples 1943-44, PP. 50-51]

♦ ♦ ♦ The importance of the air-raid shelters as foci of transmission was recognized early and led, on 27 December, to the assignment of a special squad to the dusting of their inhabitants. The work of this group was carried on in the evening between 6 o'clock and midnight because it was at this time that the ricoveros had their maximum population; relatively few persons stayed in them during the daytime.

The work in the shelters was in many ways the most difficult and certainly the most dramatic of all the services. It was usual for people to start filtering into the shelters in the late afternoon. The women folk could be seen trudging along, some with cots, chairs and stools, others with bundles of bedding or assorted belongings on their heads and queues of soiled and often shoeless youngsters carrying pots and pans, at their heels. These were families who had homes of a sort but who preferred to sleep night after night in the ricoveros rather than risk not being awakened in time to make their Way through the narrow blacked-out streets and alleys in the event of a raid. Inside the shelter these families enjoyed "squatter's rights" for they usually returned to

[325]

the same place among the permanent residents in the ricovero each night. Many of the shelters were great cavernous excavations with cathedral-like chambers accommodating thousands of people. The main passages were commonly illuminated by small lights which rapidly dulled into glowing spots in the smoke of the fires that were built in tubs or buckets for the preparation of the evening meal and a little warmth. The vaulted funereal recesses that led off the main galleries were unlighted except for an occasional candle or small fire which cast disquieting awesome shadows on the high blank walls. Add to this atmosphere a disordered throng of miserable, frightened and soapless citizens and some notion may be had of the conditions in which the ricovero squads worked during the cold rainy months of the epidemic.

Plans had been made as early as October and repeatedly thereafter for the evacuation of the ricoveros, but this never came to pass for the simple compelling reason that there was no other place to which the occupants could be moved. The Ricovero Service was organized to take care of the dusting of approximately 10,000 weekly. Six teams each consisting of a physician and twelve dusters made the rounds of some 80 to 90 ricoveros every seven days, but this interval was finally increased to fourteen days as the number of cases reported from the shelters declined. The greatest single difficulty in ricovero dusting was in maintaining some reasonable degree of order. Immediately an alert sounded the shelters became so packed with people that work had to be suspended. In the event of an actual raid they were usually so crowded for days after that dusting was severely hampered. ♦ ♦ ♦

A WARNING AGAINST FURTHER DELAY IN EVACUATING AIR RAID SHELTERS
[Memo, Col E. H. Crichton, Sr MO, AMG, Rgn III, for All Concerned, so Jan 44, ACC files, 10000/163/1176]

1. The menace to the public health from the continued use of Air Raid Shelters had already been represented. This is a particularly urgent problem in the presence of a large scale typhus epidemic and many of the cases notified have come from "Ricoveri."

2. The strong recommendation made last month that they should be cleared forcibly if necessary and the people using them evacuated from Naples was not pressed further because we had no means, at the time, to ensure that those evacuated could be effectively disinfested before they were allowed to scatter all over the countryside where they could infect other areas.

3. With the arrival of D.D.T. powder and the means to use it, this difficulty has now been removed and there is therefore, no medical reason why the clearing of the "Ricoveri" should not be proceeded with as soon as alternative accommodation can be provided for those evicted. Without in any way wishing to exaggerate, it is the duty of this Office to warn you that further protraction in the carrying out of this recommendation is likely to prolong the epidemic and to accentuate its seriousness.

THE EPIDEMIC NOW SEEMS UNDER CONTROL
[Msg, PBS, Naples, to WD, II Feb 44, CAD files, 710 (8-13-43) (1), CM-IN 7399]

I. Typhus situation in Southern Italy shows remarkable improvement. Control features have proved even more effective than any anticipated....¹¹

After conference with Fox, [Brig. R. W.] Galloway of AFHQ, and Parkinson of ACC it has been decided that typhus control in Southern Italy will pass to ACC as of midnight February 19-20.¹²  While Typhus Commission ceases to be responsible after the 19th, Fox has promised that Woodward and Ecke of commission will remain with ACC for not to exceed twenty days and that Fox will continue in advisory capacity throughout Italian campaign. ♦ ♦ ♦

LESSONS OF THE EPIDEMIC
[Col Thomas B. Turner, Dir, Civil PHD, OSG, Rpt to The Surgeon General, 21 Feb 44, in MGS Rpt 15, 18 Apr 44, CAD files, 319.1, Foreign (3-29-43), sec. 2]

(2) The lessons to be learned from this episode are, first, that military government must have men at the top who understand public health and have authority to act. Second, every effort should be made to anticipate trouble and to initiate preventive measures before the situation becomes acute. Third, since the Typhus Commission has been organized especially for typhus control, its advice should be sought whenever conditions favorable to the development of an epidemic exist. ♦ ♦ ♦

[326]

ROCKEFELLER FOUNDATION STAFF WILL CONTINUE TO BE AVAILABLE
[Memo, Brig Gen James S. Simmons, Chief, Preventative Medicine Serv, ASF, to Chief, CAD, 25 Apr 44, CAD files, 710 (8-13-43) (1)]

3.... It is the opinion of this office that it is desirable that the services of the staff members of the Rockefeller Foundation should continue to be available to the ACC, particularly in view of the expressed desire of ACC. It is believed, however, that individuals so employed should be under military control and that some degree of control should be exercised by the Surgeon General, acting as the principal adviser to the Civil Affairs Division of the War Department in matters pertaining to civil public health.

4. It is therefore recommended: a. That utilization of services of selected staff members of Rockefeller Foundation in public health activities of civil affairs be accepted in principle. b. That such individuals be appointed either as consultants to the Surgeon General or as Technical Assistants to the Surgeon General, depending upon the qualifications of the individual concerned. c. That they be assigned to a Theater of Operation upon the request or with the concurrence of a theater commander. d. That these arrangements be limited to the period during which military authorities are responsible for civil public health in the areas concerned.♦ ♦ ♦

MEASURES FOR MALARIA CONTROL
[ACC Exec Memo S4, 25 Apr 44, ACC files, 10000/154/ 288]

1. Prevention of Malaria in this theater is of fundamental importance to Allied Forces. Experiences of 1943 in Sicily and the notorious history of areas now occupied or which lie immediately ahead, indicate clearly that the Armies will sustain serious loss of manpower if malaria is not effectively controlled. All signs point to a season of unusually high density of malaria mosquitoes and of civilian carriers of the parasite the two main factors in the transmission of malaria.¹³  ♦ ♦ ♦

3. A Malaria Control Branch has been established in the Public Health Subcommission of Allied Control Commission. It has the following functions:
(a) To assist the Army Senior Civil Affairs Officers and Regional Commissioners of Allied Control Commission in restoring and implementing civilian malaria control agencies, and in directing their activities.
(b) To assist in co-ordinating civil and military malaria control activities.
(c) To carry out essential malaria control field tests in co-operation with the Allied Forces.

7. In each province where there is a malaria problem there will usually be found a Comitato Provinciale Antimalarico. If this committee has been dispersed, it should be reconstituted as soon as possible. The malaria committee should be advised that, if it has not already done so, it should immediately prepare malaria control plans and budgets along the general lines of preceding years....

8. So far as Allied Control Commission supplies are concerned, malaria control will be based on drainage, maintenance of drainage canals, canalizing of streams, regulation of water, filling, oiling, and the proper treatment of clinical cases. ♦ ♦ ♦

WHY CIVILIAN HEALTH IS OF MILITARY IMPORTANCE TO SACMED
[Msg, Gen Wilson to CCS, 28 Aug 44, MTO HS files, CAO/301, CM-OUT 6438]

1. Decision has been made by this Headquarters to stockpile typhus control supplies in Central Medical Warehouse, Naples, in order to have them more readily available for transhipment to wherever they are required in the Theater.

2. In view of the shipping situation and the responsibility this Headquarters has in prevention of epidemics in the civilian population it is deemed inadvisable for material to be stored other than in a central location.

3. It is pointed out that the responsibility for the prevention of epidemics in the civilian population rests upon SACMED, that the health of the civilians cannot be considered as being in a separate category from the health of the Military, since the presence of an epidemic in the civilian population constitutes a direct threat to Military Operations. ♦ ♦ ♦

[327]

7. REFUGEES ARE A SERIOUS MILITARY PROBLEM

ITALIAN REFUGEES INTERFERE IN INITIAL ADVANCE UP THE PENINSULA
[AMGOT Hq, Rpt for Sep 43]

(133) .. . At the outset the function of AMGOT consisted largely of aiding the army commander in various ways, including the controlling of vast numbers of refugees who crowded the roads. This constituted a danger to security, since enemy spies might freely mingle with the refugees and obtain information concerning Allied emplacements. ¹⁴

(134) In co-operation with C.I.C. and the army provost marshal, AMGOT prepared an order issued by the Army commander, prohibiting civilian movement across enemy lines, under penalty of death, and also warning that severe penalties would be imposed for cutting of communication wires. Later, when the refugee movement continued on a large scale, a program was laid out by the regional C.A.P.O. for establishing control points at which all civilian stragglers were halted, questioned and after proper investigation given passes of identification.♦ ♦ ♦

EIGHTH ARMY REFUGEE POLICIES AT FIRST ARE AVOWEDLY CRUDE
[Ltr, AMG Hq, 15th AGp, to Col Hume, SCAO, Fifth Army, 25 Nov 43, ACC files, 10000/164/121]

... the refugee problem as . . . met in the Eighth Army area.

We have handled some 7,000 refugees of various sorts. As you know, the Italian very readily becomes refugee minded, especially if there is a bit of free ration thrown in. Therefore we think that the types deserving of our first consideration are these:-(1) the refugees who come through our lines, (2) the foreigners. Others might be (3) those who for military reasons are compulsorily evacuated from towns or country areas and (4) a smaller category, includes those who have been bombed out of their houses and for whom no alternate or local arrangements can be made. ♦ ♦ ♦

At present refugees from Eighth Army are transported to Bari or Lecce in agreement with the Italian Government following various conferences at Brindisi, Bari and elsewhere. . . . Our responsibility is to clear refugees from the forward areas so that military operations are in no way adversely affected by such. Their welfare at all points, while important, must necessarily take a second place. ♦ ♦ ♦

Roughly the plan has been that bonafide refugees are collected in the Divisional areas and are returned to a railhead by returning empty military lorries whose normal work, e.g. collecting supplies and ammunition, takes them back to the railhead. By liaison with the Movement Control people at Army the Evacuation Officer arranges for sufficient rolling stock to be in a siding in anticipation of the arrival by road of the refugees, and thus they are entrained. There has been little opportunity for interrogation by the intelligence people and practically no medical inspection to eliminate infectious diseases, lice, imminent pregnancies or abortions and the like has been possible. ♦ ♦ ♦

... It was not much good thinking of Camp tentage is scarce-hutting is out of the question as railheads will move. Buildings of sufficient size are almost unobtainable in the forward area. Therefore some condemned rolling stock has been obtained and if the road convoys arrive before the trains are actually in position then the refugees are put into the wagons and await the arrival of their train. Sanitation has been provided and it has been our hope to get some arrangements for warming up food or producing a mine stove to warm them up. Weather conditions are becoming progressively more severe. We give them Army rations. ♦ ♦ ♦

IN THE FIFTH ARMY IMPROVISATION TOO
[AMG, Fifth Army, Report for Week Ending 12 December 1943, ACC files, 10000/100/1093]

♦ ♦ ♦ The refugee problem is becoming more serious with the static conditions prevailing on this part of 'the front and the great amount of destruction to civilian property and houses which the Germans are now able to carry out before they are driven back. The final arrangements for setting up an organization for medical and security screening and subsequent evacuation of refugees involve the cooperation of many different

[328]

branches. . . . At present problems are dealt with by improvisation as they occur. On much of the front the problem is solved by local dispersion among communes in Corps rear areas, but several hundreds have had to be moved back behind the Corps rear boundaries. The great number of troops billeted in this area and the shortage of food complicate the problem of housing and feeding refugees [in] large numbers. SCAO's with Corps have managed to obtain army rations for those in forward areas.

MANY ARE ASKED FOR HELP BUT ALL SAY NO
[1st Lt. Theodore W. Liese, Internees and DP's Subcom, Diary, 25 Nov 43, ACC files, 10000/164/314]

The AMG people from the 45th came in with question of moving some 2500 refugees from the forward area for security sake, done so at the request of the division artillery company. The rest of the day was spent talking this over; and with Maj. Jo Chambers going to see Col. [Francis H.] Ox, chief of staff of PBS in respect of rations for these people; Brig. Gen. Carl R. Gray, Jr., of rail transport, to find out if the rail would pick them up at railhead and bring them on back to Naples; public health to find out if there was enough food in Naples to feed this number of people; and Col. Kraege head of Naples city to get his permission to bring them in; the result of which was "no" on all counts. ♦ ♦ ♦

IN SOME PLACES THE SITUATION IS PITIFUL
[Penciled Memo, partly illegible, Seguin, CAO, San Salvo, for SCAO, Chieti Province, 12 Dec 43, ACC files, 10507/115/23]

2. I collected them. They were in the most pitiful state, all ages from six months to 70 years, two pregnant women, one third without any shoes, etc. I found only twelve kili of bread in the communal bakery; luckily I scrounged 28 more kili from private sources. They all were at the point of starvation.

3. At 1130 hours, with the help of CMP, reembarked them on transport going south.

4. It is impossible to receive refugees here. No room, no staff to handle them, no accommodations of any kind. There is also no food. Bread cannot be had constantly on hand to face eventual influx of refugees.

TO IMPROVE ORGANIZATION AN ARMY REFUGEE SECTION IS PLANNED
[Memo, Lush, DCCAO, 15th AGp, for Hq 15th AGp, 8 Jan 44, ACC files, 10000/164/63]

1. The evacuation of refugees from the forward areas is now under review here. In view of the increase in the number of refugees some reorganization seems indicated, and it has been decided to create a new section in AMG 15 Army Group to deal with this.

2. This Section will be represented at Army and Regional Headquarters and all the officer personnel is being found from existing staffs, or from officers whose arrival is imminent. These officers will come under the immediate command of S.C.A.O. and R.C.A.O. of Armies and Regions respectively.

4. Up to the present it has been possible to utilize forward Staging Camps and P.O.W. Camps in Army Areas, but it is felt here that it is desirable that the refugees organization should be completely independent as regards tentage, accommodation stores and camp personnel, from the P.O.W. organizations. It seems certain that with the large number of P.O.W.'s, refugees could not possibly be handled at the same time at the same place unless the numbers of refugees were negligible, which seems unlikely. ♦ ♦ ♦

A COMPREHENSIVE PLAN IS DRAWN UP
[Memo, Col L. R. Hulls, Chief, Refugee Fld Sec, AMG Fifth Army, for DCCAO, 15th AGp, 21 Jan 44, ACC files, 10000/164/63]

The central point around which the refugee organization 5 Army will function is the main camp at Base, the purpose of which is as follows:

I. Transportation of refugees must be done by such empty returning transport from Front to Rear as is available. With numbers unknown it is, of course, not possible to make special arrangements in the way of earmarking transport, ahead.
The unknown factor of numbers will be taken care of by siting camps on the L of C where bottlenecks may develop.

Small camps will be sited in Corps areas, and the flow of refugees from these and elsewhere will come into a main camp at Base. Here the Civil transport system carries refugees south, but the number of trains is limited, and consequently it is at this point that a large bottleneck must be

[329]

provided for. Without this, the plan for handling refugees in anything approaching an orderly manner, cannot function.

2. In order to avoid indenting for large quantities of tentage and accommodation stores, etc., the intention is to make use of-if at all possible-existing buildings (e.g. old barracks, school or convent).
Many are suitable but are being used on requirements with higher priority. ♦ ♦ ♦

THE REFUGEE PROBLEM IS OF DEFINITE MILITARY IMPORTANCE
[Memo, Robertson, DCCAO, AFHQ Adv Admin Ech, for Hq Fifth and Eighth Armies, 23 Jan 44, ACC files, 10000/164/63]

There has recently been a steady increase in the number of Italian refugees evacuated from forward areas. Some of these evacuations result from our advance, others are due to the necessity for clearing certain areas for training and operational purposes. ♦ ♦ ♦

This matter is one of definite military importance. If well ordered arrangements are not made for the evacuation of refugees, our communications will be encumbered, quite apart from the serious political repercussions and humanitarian considerations involved. You are therefore requested to give this matter most serious and prompt consideration and also to assist AMG officers to the best of your means in the execution of their task.

CRUDE DISPATCHING CENTERS ARE SET UP
[Refugee Fld Sec, AMG Fifth Army, Rpt for Feb 44, ACC files, 10000/154/204, app. A]

4. Welfare

a. The Army Refugee Camp at Vairano was established during the month to accommodate the refugees from the II Corps area and to consolidate all the refugees from CEF [Corps Expeditionnaire Français] and II Corps areas for entrainment to camps in the rear. All refugees are deloused and fed the refugee rations of pasta, biscuits, olive oil, dehydrated soup, tinned tomatoes and meat or vegetable stew when time permits. During the month 2,400 cans of "C" Army rations were served. These rations were obtained from the Army Quartermaster-for emergency rations. Over-night accommodation for about 300 is maintained.
b. A refugee camp is set up at Venafro for the care and processing of refugees from the CEF. All the refugees are deloused, given medical treatment if needed, and fed, if time permits, before sending them by truck to the railhead at the Army Refugee Camp at Vairano. Over-night accommodations for about 450 persons is provided. ♦ ♦ ♦

[Maj Raymond Kenny, Welfare Officer, Rgn IV, Rpt, 6 Mar 44, ACC files, 10000/154/204, app. D]

♦ ♦ ♦ At Vairano there is a refugee center which consists of a group of tents in a field secured by barbed-wire. There are no bathing facilities or disinfestation accommodations, and the center, which is at the rail-head, acts merely as a dispatching center for refugees received by lorry and forwarded by railway.

The Sessa refugee center is more adequately organized. It occupies a substantial building and includes departments for reception of refugees, bathing, disinfestation, sleeping rooms, kitchen and messing facilities, property examination and control. About 200 refugees per day are said to pass through the center. Expenses for the maintenance of this facility are said to be paid out of communal funds; since all of the refugees are non-residents of the commune it seems inequitable that the costs should be borne by the commune. This subject should be brought to the attention of financial control.

ACC CREATES A REFUGEE BRANCH To AID IN MOVING REFUGEES TO KING'S ITALY
[Memo, Hulls, Dir, Italian Refugee Branch, ACC, for RCAO, Rgn III, 6 Feb 44, ACC files, 10000/164/121]

1. It is with the greatest difficulty that refugees from the battle zone-and as they are an operational commitment, they are the first that must be dealt with-are being removed and transported South....

2. This Branch which has been officially created to deal with the whole refugee situation throughout the country, has only this week commenced to operate as such.

3. A meeting with a representative committee of the Italian Government took place yesterday, and the first step decided upon was to carry out an immediate survey of the extent to which refugees can be absorbed in Southern Italy and Sicily. ♦ ♦ ♦

LIKE IT OR NOT ITALIANS MUST HELP
[Min, Remarks of Col Hulls at Conf of Rgnl Cmsrs, 4 Mar 44, ACC files, 10000/136/162]

♦ ♦ ♦ (a) As the Transit Camps essential to a successful solution were still not provided, the

[330]

more or less direct flow of refugees from the front to rear (Regions) had to continue.
(b) For military reasons some areas were still banned as reception areas. It was hoped that bans would be lifted but whilst they were on, the accommodation problem was accentuated.
(e) Refugees were known to be unpopular in reception areas. This is understandable but must be surmounted.

The immediate problem was to cater for 50,000.

Suggestions

1. Every household in the reception areas must be obliged to take in some refugees.

2. The numbers to be accommodated in an area would have to be a percentage of the existing population, with variations according to the type of area. Variation from 5 to 10%.

3. Sending refugees abroad was ruled out owing to shipping problems. Therefore, start would be made on the percentage basis at once. Noted that Region II absorption had been 1% only to date. ♦ ♦ ♦

MANY ITALIAN AUTHORITIES DO NOT LIKE TO HELP
[Min, Remarks of Hulls at Conf of Rgnl Cmsrs, 14 Apr 44, ACC files, 10000/101/443]

1. From 1 March to 14 April it has been necessary to move 21,000 refugees from forward areas and disperse them in Southern Provinces. This included 11,000 from the beachhead....

3. Real trouble for refugees commences when they arrive in reception areas and are dispersed in communes. In general the Italian authorities have failed to look after these people, whose condition in certain places is deplorable. It is intended to leave no doubt in the minds of Italian Ministers that this responsibility is theirs. We recognize their difficulties, the main one being food, and intend to assist without allowing them to think that we are assuming their burden. People don't like refugees and it is very difficult to billet them. It is essential that they be kept off the lines of communication. The main requirement from the Italians is personal service. We are making it clear, that if their welfare committees will work, e.g. in setting up soup kitchens, we will make available food supplies which will give refugees a hot meal a day.

Comments of Chief Commissioner: The Chief Commissioner stated that we are now doing our best to set the Italian Red Cross on its feet, which would help the refugee problem.

SEMISTARVED REFUGEES WILL NEVER BE WELCOMED
[Conclusions Reached at ACC Conf as Summarized in Memo, Exec Cmsr, ACC, for Admin Sec, ACC, 20 Apr 44, ACC files, 10000/164/212]

4. . . . (a) Food-Refugees receive a ration equivalent to about X50 calories a day. They cannot take advantage of local produce, as do others, to supplement their rations, as their monetary means do not permit. ACC health authorities have laid down in agreement with other authorities, that a non worker requires 2500 calories a day, whilst light workers and adolescents require more.

5. It is agreed:
(a) To make available to the Italian authorities at all centers and communes, where a specific number of refugees have been sent, foodstuffs in addition to the above mentioned rations, sufficient for one hot meal a day to be provided to these refugees at a soup kitchen to be organized by the Italian authorities.
(b) That this meal is intended to supplement in part, the disparity between the existing ration and the above mentioned 2500 calories.
(c) That the Italian Government sees to it that soup kitchens are set up at once, and run by local committees, and that the food in question reaches the refugees and none others.
(d) That in conjunction with the above, the Italian authorities make available for refugees local resources, such as nuts, fruits, vegetables and wine, in order to make up the remaining shortage in their daily food supply which will still be considerable. It is for the Italian Government to decide how they will do this; whether by a much greater monetary allowance than at present, or otherwise, but it must be done adequately.

6. It is considered that the above measures are essential, because refugees in a state of semi-starvation will never be welcomed amongst other people already short of supplies, and a general billetting scheme will not work until proper food provision for refugees is made. ♦ ♦ ♦

HANDLE REFUGEES WITH PATIENCE
[Memo, Capt R. J. Simpson, ACC Transport Officer, for Italian Refugee Branch, 21 Apr 44, ACC files, 10000/164/212]

1. Never separate Refugee families or their luggage, unless it is absolutely necessary. Even though it may appear at times that the Refugees

[331]

are carrying too much luggage, especially what to us appears as unessentials. Remember these simple people have been taken from their homes, and have carried with them cherished belongings. It will save a lot of wear and tear on your nerves if you do not try to get them to discard any luggage. For if you do, it will only create discord and ill will and loss of valuable time.

2. In the loading or unloading of refugees from trains, ships, etc. give them time to take care of their own belongings. . . . The Italian peasant does not trust any stranger to handle his precious belongings, and will yell to the highest heavens if you do this.

3. Remember that though it might seem harsh treatment to the uninitiated American or Englishman to crowd 35 to 40 people in one truck along with considerable baggage, this is taken as a matter of course by the Italians who have been under crowded conditions all their lives, and do not complain. Of course judgment must be used if the trip is to be a long one.

4. Although it seems no one wants to be bothered with refugees, including the Italians themselves, if you use patience and diplomacy one can generally get the necessary transportation and other supplies to handle the job.

5. The refugee problem is a much greater one than most people imagine. The way it is handled will be one of the determining factors whether the Allies, especially England and the U.S.A., will hold the respect and good will of the Italians or their Nationals after the war is over.

6. Patience is one of the essential virtues one must have in the handling of refugees or refugee problems.

IN THE SPRING ADVANCE FIFTH ARMY FEEDS 200,000 CIVILIANS
[Hq ACC, Rpt for May 44]

♦ ♦ ♦ The Armies progressed rapidly, leaving behind a trail of destruction wherever battles were hard fought. Townships like Pontecorvo, Cassino and Piedimonte ceased to exist as dwelling places, whilst others could accommodate only a small percentage of their inhabitants. As long ago as last September it is recorded that the enemy completely emptied one place, the population fleeing to the neighbouring hills. Considerable movement of the population took place as a result of all this and as examples, Fondi increased from 19,000 people to 30,000 and Terracina from 14,000 to 23,000. Many suffered from exposure and lack of food.

The feeding and medical treatment of all these people, together with the evacuation of refugees, fully extended AMG staffs but presented no new problems. By the end of the month 200,000 people were being fed in the Fifth Army area alone. ♦ ♦ ♦

THE CAMPS ARE Now MORE ADEQUATE
[Min, Remarks by Lt Col F. M. Brister at Conf of Regnl Cmsrs, 30 May 44, ACC files, 10000/101/443]

1. Since the date of the last Conference the activities of the Branch have widened.

2. There are eight forward camps in the Eighth Army area, both mobile and static, with a capacity of 4,600, and a smaller one in the Fifth Army area.

3. Main camps are located at Aversa, Capua, Foggia and Naples, the latter having three camps with a holding capacity of, 11,000. The main camps on the West have handled 45,000 refugees including about 9,000 since the latest Fifth Army push, have dealt with 91 battle casualties, and treated 4,750 in camp hospitals. Each camp has an infirmary sufficiently large to take care of all except chronic and very serious cases. Ten to 30% of all refugees have been treated for scabies. In these camps there have been 25 births, 11 deaths, 14 weddings, 47 christenings, and many confirmations. 90,000 garments have been issued to about 30,000 persons.

4. Social, religious and educational activities have been instituted in addition to the vital ones of food, medical care, disinfestation, innoculation, registration, etc. There are also work facilities for the refugees; these include baking, shoemaking and tinsmithing. ♦ ♦ ♦

A NEW POLICY: RETENTION IN FORWARD AREAS
[Doherty, Chief, Public Safety, AMG Fifth Army, Rpt for May 44]

e. Refugees

There has been a complete change in the treatment of these people. It was realised that to attempt to pass back all the population found in freshly won territory would have meant a complete block of the highways. A policy was determined whereby they were shepherded in Communes, food sent to them and to hold them where found. When a commune became overcrowded and the feeding was over-taxed, organised movement to places in rear were effected by military transport. Generally speaking, the control has worked well.

[332]

It has been the aim to get people back to their regular habitation as quickly as possible. In some cases passes had to be dispensed with in view of the urgency in getting people off roads coupled with the fact that personnel was not available and the numbers so great. There has been no hitch and no complaints. ♦ ♦ ♦

THE MOVEMENT IN REVERSE: REFUGEES STREAM BACK TO THEIR HOMES
[Memo, Hulls for Italian High Cmsr for Refugees, 9 Aug 44, ACC files, 10000/164/189]

1. It appears that the Italian authorities are still encouraging people to attempt uncontrolled self repatriation to their homes.

2. Our attention today is again called to the arrival from the South of 500 civilians at Barletta. Upon arrival, they have no means of proceeding further, no organization to take care of them, and no alternative but to return whence they came.

3. Until the Italian government gives strict and precise instructions to their Prefects throughout Italy, that this movement must be stopped pending properly organized repatriation, this sort of thing will continue. The result, of course, is that much suffering is caused to the people attempting these moves, and much discontent with the authorities responsible for allowing them to attempt these journeys. ♦ ♦ ♦

FUNDAMENTALS OF REFUGEE PROBLEM AS SEEN BY ACC
[Statement of the Displaced Persons and Repatriation Subcom, 30 Nov 44, ¹⁵ ACC files, 10000/136/236]

The primary purpose of the Displaced Persons and Repatriation Subcommission is to prevent interference with military operations by reasons arising out of the massing or mass movement of refugees and thereby also to relieve the Army from using its own personnel and resources for such purposes.

From these primary purposes arise most of the secondary but more obvious tasks which one so easily tends to consider as the real purpose of this Subcommission. A starving population is a centre of trouble; it will thieve, murder and riot in its struggle for existence and is liable to move en masse following rumors as to where food may be found; as it moves, it devastates the countryside, ever increasing in size the number of those starving. It is a breeding ground for disease and as it moves, so it spreads disease.

The first necessity, therefore, is food; then, to keep down disease and to maintain morale, follow housing and clothing. ♦ ♦ ♦

8. THE POOR AND SICK ARE ALWAYS WITH THEM

GENERAL POLICIES OF RELIEF
[AMGOT GAI 6, AGO files, AMGOT Plan, pp. 119-24]

♦ ♦ ♦ 1. Objective. To prevent starvation in the civilian population, and, in so far as practicable, to continue the operation of normal relief and assistance programs which existed prior to Allied Force occupation.

2. Policies:
(a) By definition, the term relief applies to aid granted individuals who have insufficient purchasing power to buy the minimum food, clothing, shelter, fuel, medicines, soap and essential household necessities necessary to support life.
(b) Except in extreme emergencies such as may arise because of refugee congestion or acute food shortages, responsibility for supply and administering aid to needy individuals will wherever possible, remain in the hands of local public or other authorized welfare agencies. AMGOT relief funds or tactical force food supplies will be requested only when there remains no other alternative to acute suffering among the civilian population.

3. Existing Local Agencies and Institutions:
(a) In each commune there exists a Communal Public Assistance Board (Enti Comunali di Assistenza) which has authority to operate free canteens, to issue free milk rations, provide free meals for poor school children and maintain dormitories for the homeless. This board is also responsible for the relief of unemployed and otherwise needy persons. In addition to the End Comunali di Assistenza certain private and religious agencies may be found operating in the relief or closely related welfare fields, e.g. the Italian Red Cross.
(b) Responsibility for determining the relief needs of individual cases will remain with local welfare agencies. If the responsible public welfare

[333]

officials are gone, an acting public welfare officer will be appointed. If no qualified public officials are available a person from a local private welfare agency will be designated. These new appointments will be made by the Podesta or acting Podesta but only after securing the approval of the CAO. All such appointments will be regarded as temporary until approved by the Senior Civil Affairs Officer after clearance with the Welfare Section of the Division of Public Health in AMGOT Headquarters through regular administrative channels.
(c) Certain groups of chronically ill, physically handicapped, and aged adults are normally cared for in institutions operated by either public authority or private welfare groups. As in the case with the general relief agencies, existing arrangements will be continued or other satisfactory arrangements substituted....

4. Form of Relief:
(a) Unless existing local agency practice runs to the contrary, relief will normally be issued in the form of weekly cash payments. However, it is possible that existing relief agencies are operating certain parts of their programs on a commodity or a relief order basis as in the case of mass feeding of refugees and supplying milk to small children and nursing mothers. It may even be necessary to establish new feeding centers to meet temporarily acute situations encountered in first phases of the operation. In this event, requests for emergency food supplies supported by recommendations of P.H.D. will be sent to tactical commanders who have authority to issue army rations provided this can be done without detriment to the military effort.

6. Local Agency Relief Standards:
(a) Relief, whether issued in the form of cash or in kind, will be in amounts necessary to make up the difference between a minimum budget standard necessary to provide the essentials of life and the total available resources of the individual or family group. ♦ ♦ ♦
(c) At the outset C.A.O.'s will accept the standard which responsible local relief and welfare agencies consider to be adequate and will continue existing programs on that basis. In instances where the local budget standards appear too high or too low it should be submitted to the P.H.D. of AMGOT through regular channels for review and recommendations....
(d) Relief budget standards will give first priority to tinned milk for children up to six years of age, nursing mothers, and pregnant women, and a second priority for children from six years to twelve years of age inclusive. It may even be necessary to limit general milk ration entirely to this group. Other essential budget items are medical care, food, soap, fuel for cooking, shelter, clothing, household necessities and, in the cities, utility services: water, light, gas, etc. ♦ ♦ ♦

7. Medical Care for Relief Groups:
(a) Medical care for all classes of the population is a responsibility of the Health Officer of the commune, who may have a number of assistants....
(b) Medical care for the more needy elements of the commune is generally less adequate than for people able to pay for private care and it will be the continuing responsibility of local relief agencies to insure that their cases are not neglected. Relief workers are in a position to discover cases of disease and to refer them to medical services for treatment and care. If medical stores are required they will be included in relief budgets unless supplied by hospital or clinic dispensaries. A relief program which disregards the rehabilitative aspects of medical care simply builds up a permanent load of unemployable individuals. For this reason follow up medical care for the needy sick must have equal priority with food and other essentials in a relief budget.

8. Cooperation with sources of Employment:
(a) Unemployment, a common cause for the issuance of relief, must be reduced to a minimum by the closest possible co-operation between relief agencies, employment agencies, and individual employers. The Army will hire labor either directly or through established labor exchanges and unemployed relief recipients must therefore be required to register at places where people are being hired. Relief will be withheld from those refusing to work for other than reasons satisfactory to AMGOT welfare authorities, such as health, lack of clothing, etc. In some instances it may prove advisable to place men directly from the welfare agencies, but established employment procedure will be followed wherever possible. ♦ ♦ ♦

FREEMASONRY AMONG MEDICAL MEN
[Cheyne, Dir, PHD, AMGOT-Sicily, Preliminary Rpt, Aug 43, ACC files, 10000/100/408]

♦ ♦ ♦ As was anticipated, the "Freemasonry" which exists between all medical men the world over of whatever race or colour came well out and it is gratifying immediately to report everywhere the closest co-operation with enemy medical personnel both civil and military. This happy

[334]

state has continued and has been extended by the higher placed Sicilian medical officers to the senior medical officers of AMGOT. Then the Provincial Health Officers of Siracusa, Catania, Palermo and others have been interviewed and a commencement has been made in meeting ordinary civilian practitioners in the various towns. This fosters good relationship which in turn will be reflected in a higher standard of medical work so influencing the health of both the civil and military population. It is hoped that efforts to expedite the completion of formalities connected with the release on parole to their civil duties of Sicilian military medical officers may be successful, and this will materially affect the medical personnel situation. ♦ ♦ ♦

HOW IMPOSE AMERICAN STANDARDS OF SPEED ON ITALIAN RELIEF AUTHORITIES?
[Memo, Capt Archibald S. Alexander for Col Poletti, 13 Aug 43, ACC files, 10000/100/411]

2. e. It was reported that virtually no bread or pasta, the staple articles of Sicilian diet, had been obtainable for several weeks, even on the black market. In consequence, those who had not hoarded had had only fruit and vegetables, at best, for many days. ♦ ♦ ♦
There were lines outside some bakeries, even though it was Sunday. No bread was available, and members of the crowds to whom I spoke seemed in many cases desperately hungry.

3. a. Early on 2 August, I held a conference at the Municipio with the heads and assistants of the relief organizations and the heads of the city and province bureaus concerned (except for certain of them who had fled before our occupation and in whose places subordinates came). b. . . . I told them that though we expected to exercise supervisory and control powers, with special reference to preventing discrimination for political or racial reasons, and though for the moment we were prepared to lend money to the city for use in starting the relief machinery, the primary responsibility for administration would remain with Italian officials. I then requested their verbal opinions as to the immediate relief needs. ♦ ♦ ♦
d. I told them that Colonel Poletti had decided that immediate relief, to cover present emergency, was to be given on a uniform basis, regardless of status, i.e., old-age, repatriate, unemployed, pensions, family of member of Italian armed forces, bombardment victim, etc., and only in case of immediate want and lack of resources. Former special payments, e.g. "Military Assistance," to families of members of the Italian armed forces were to be discontinued, and no payments made unless actual need was established.
e. . . . I suggested that for the emergency period all persons needing assistance be directed to and handled at the Teatro Massimo, where the combined staffs and files of all organizations would be concentrated. This suggestion was agreed to as an emergency measure, and the C.A.P.O. for AMG Palermo was at once requested to instruct all Carabinieri and police that thereafter the needy be directed to apply at Teatro Massimo beginning at 0830 on 4 August 1943, which was about 44 hours later. I felt that this was the earliest time at which it would be possible for the new emergency organization to function with any efficiency. The Italian officials threw up their hands at the idea of such speed. I told them we would help when possible but would hold them to the schedule fixed. ♦ ♦ ♦

AMG RESTORES PUBLIC HEALTH FACILITIES IN SICILY
[Cheyne, Dir, PHD, AMGOT Hq, Rpt 11 Oct 43, Spofford Rpt, ex. Y-10 ]

2. Health of the People

The Division exists primarily to maintain and improve the health of the people in order that this may never be a menace to the health of the Armies passing through the country or actually engaged in active warfare in the vicinity of such people. With the movement onward of the victorious armies this function may appear to be decreasing in importance, but it is by no means ended.
The health of the people has been good beyond expectation. As mentioned in previous reports, typhoid fever alone has caused concern.♦ ♦ ♦

3. Communicable Diseases
An effort has been made to re-establish reporting of communicable diseases as previously done under Italian health regulations. The disruption of communications between individual physicians and communal health officers, as well as the break in communications between communes and provincial capitals at the time of the invasion, led to a complete breakdown of the reporting system. ♦ ♦ ♦

4. Hospital Organization
... As soon . . . as towns were occupied, immediate steps were taken to assist, by improvisation in the first place, such hospitals as had

[335]

suffered severe damage, and in the second place to undertake as quickly as possible the structural repairs necessary.

It is the policy of AMGOT to provide the funds necessary for re-building and though of necessity, it is a matter which requires time and patience, a definite advance in re-building has been noted. ♦ ♦ ♦

Medical Stores

Medical stores are obtained from two sources (1) Captured Italian materials, (2) Drugs and dressings imported from the United States. Essential medical supplies are first distributed to hospitals and later to selected pharmacies. A central medical store has been set up at Caltanissetta, a town approximately in the centre of the Island, from which all the provinces draw their requirements. These stores are not as yet a free issue and a system of accounting is being prepared, by which each province draws its medical stores upon repayment.

Each province has received initially a 20-ton brick containing such essentials as wool, gauze, iodine, bandages, anaesthetics, suture material, sera and vaccines, sulphanilamides, dentured alcohol, insulin and antiseptics. ♦ ♦ ♦

Once the initial demands have been met, a smooth flow of imported American supplies from the Central Medical Stores is coming into operation to supply the current needs of the provinces. ♦ ♦ ♦

CO-ORDINATION OF SICILIAN WELFARE AND HEALTH AGENCIES
[App. VII, Cheyne Rpt, 11 Oct 43]

I. Administration of Relief

The results of surveys and field trips into the provinces indicated a need of the co-ordination of the services of the various agencies in existence. This co-ordination was recommended to the Provincial S.C.A.O.'s through the Welfare Officers and as a result there are departments of public welfare either functioning or about to function in Palermo, Trapani, Catania, Enna and Messina. The other four provinces are without the service of welfare officers, but recommendations are being made to the S.C.A.O.'s from this Headquarters Section and plans are now underway to integrate the various welfare functions into Provincial Departments. Wherever existent, these departments are under the direction of a civilian director who is responsible for the administration of the entire relief program. The actual granting of family relief is done on a cornmunal basis through the agency of the Enti Comunale di Assistenza. In order to have uniformity in all provinces, this Section has initiated a system of regular monthly reporting of relief granted for each commune, as well as a system of case recording. ♦ ♦ ♦

[Hq AMG, Rpt, for Nov 43, ACC files, 10000/101/501]

♦ ♦ ♦ An important step forward in the administration of public health in Sicily was the issuance of Order No. 9 which established the autonomous Provincial Departments of Public Health, with power to control and co-ordinate all organizations and materials concerned with the administration of public health within their particular provinces. This was well received by the Medical Provinciali and the medical profession as a whole since it centralized and consolidated into one organization what had previously been a conglomeration of different agencies, often working at cross purposes or in duplication. Another very important aspect was the fact that the purchase and distribution of all medical supplies was also controlled through the new organization. ♦ ♦ ♦

PROBLEM OF RELIEF STANDARDS
[Sicily Rgn I, Admin Instrs 6, 1 Nov 43, Spofford Rpt, ex. IV, J-1]

I. a. One of the first actions of provincial departments of Social Welfare will be to issue general policies for the guidance of local communes in the granting of public assistance. There is much too wide a variation in local agency understanding as to which cases are eligible for public relief and the amount of payment allowable. For example, discontinuance of military allowances to families of soldiers (the sussidio militare) and of payments made in lieu of money formerly sent by relatives living in America or other foreign countries, has resulted in serious hardship for many people. It has also created considerable misunderstanding as to whether payments formerly made to these, and other special groups, are to be paid by communal assistance agencies.
b. The AMG policy is that all relief must be granted solely on a need or "means test" basis, regardless of former pension status. Under AMG policy the maximum daily assistance grants (for use in calculating 15 day payments) are L. 25 for the head of the family and L. 5 for other dependent members of the household. This scale is obviously excessive for the average

[336]

relief case in rural communes although there may be exceptional cases in which aid should be granted at this level for specific periods of time. The following points should be considered in establishing standards of public assistance in any commune or group of communes:

(1) Relief grants must not exceed prevailing wages in the locality unless these wages have fallen below a minimum subsistence level.

(2) Relief granted in any individual case should take into account the past or probable future income of the applicant. In instances where persons of good potential earning capacity can be expected to again become self-supporting within a predictable period of time, relief should be granted at a level sufficiently adequate to maintain health and family morale. This does not mean, however, that the stated maximum relief allowance for Region I (L. 25 per day for the family head and L. 5 for each additional dependent) is to be granted as a right to all persons who, in the past, have enjoyed large incomes. Such income may have been greater than they can expect in the future. In these cases the necessity of adjusting to a more simple standard of living must be pointed out and relief payments made accordingly....

(3) In no case will relief be granted to persons refusing to accept employment at work for which they are fitted to perform and such persons, if already receiving relief, will be removed from the rolls. ♦ ♦ ♦

ITALIAN SOCIAL WELFARE DEPARTMENTS AND ACC SUPERVISORY FUNCTIONS
[ACC Exec Memo 58, 13 May 44, ACC files, 10000/109/5]

1. Regional Commissioners (RC's) in Allied Military Government territory will cause all Prefects to establish in their provinces a Social Welfare Department to ensure:
a. the provision of assistance to those in need;
b. the care of dependent, neglected or delinquent children;
c. the institutional care of the aged, crippled or infirm;
d. guidance as to and control of other welfare activities for which provinces are or may become responsible.

2. The Establishment of Welfare Departments in areas under SCAO's Five and Eight Armies is optional.

4. Regional Commissioners in Allied Military Government territory will detail an officer of their Headquarters staff hereinafter referred to as the Regional Welfare Officer (RWO) to be responsible to them for supervising the work of these departments.

5. Regional Commissioners of Italian Government territory will similarly detail an officer to be responsible to them for assisting, guiding and advising Italian officials as to their Welfare responsibilities and functions.

6. The primary functions of RWO's is to ensure the granting of adequate assistance to those whose means of support would otherwise be insufficient to enable them to acquire the necessities of life for themselves and their dependents whether that insufficiency is due to the low standard of wages, personal incapacity, infirmity, age or the number of dependents.
a. In Allied Military Government territory RWO's will ensure that suitable instructions as to the provision of assistance are issued and be responsible for seeing that these instructions are effectively carried out.
b. In Italian Government territory RWO's will watch the working of welfare organizations and use their best endeavours to procure the provision of adequate assistance.

8. The agencies in Italy responsible for granting assistance in money or kind are set out in Appendix "B." RWO's will make themselves acquainted with the scope of these organizations and see that the full and best use is made of their resources and will endeavour to develop and extend their usefulness in their proper spheres.

9. The principal body responsible is the Ente Comunale di Assistenza. This should be developed into an effective and general relief agency which should deal adequately and promptly with every application for relief or advice informing the applicant of the decision made.

11. Schemes for the medical treatment of the necessitous poor will be developed.

12. Effective supervision of institutes and of the machinery of relief requires constant visits and inspections which is the function primarily of Italian officials but RWO's cannot form an opinion of the effectiveness of such inspections unless they themselves are fully acquainted with the machinery and powers and themselves undertake inspections.

13- Schemes for the care of juvenile delinquents and their removal in suitable cases from an unsuitable environment should be developed in conjunction with Regional Legal Officers.

[337]

WHAT AMG MEDICAL AND WELFARE OFFICERS DO WHEN A TOWN IS OCCUPIED.
[Lt Col T. Parr, Sr PHO, AMG Fifth Army (Fld), Rpt, 30 May 44, ACC files, 10700/163/26]

I.... when information has been received from Headquarters Corps that a town or commune has been taken the Corps S.C.A.O. arranges for a C.A.O. or C.A.P.O. to visit it as soon as it is practicable. His duty is to ascertain, in a quick survey, the state of the town, whether any local government, or remnants of it, exists, the number and living conditions of the people and the situation regarding sick, injured or wounded civilians, food conditions, medical supplies, etc. If the town is still under fire he arranges to evacuate its people, if any, through normal channels, but, if firing has ceased, he sends for food and medical supplies. As soon as possible the rest of the `team' i.e.-the Corps Medical Officer, Red Cross Representative, Corps Evacuation Officer, Police Officer and Finance Officer [arrives]. .. .

Soup kitchens, first aid posts or ambulatories, and refugee and food distribution centres are established as soon as possible and available water or food supplies are investigated.

It has been found by experience, especially in recent operations, that, within 12 to 24 hours, the population of such a commune, if it is not too badly damaged, doubles or trebles itself and this has to be allowed for. The sick and wounded may vary from 1or 2 to 50 on the average but these numbers gradually increase as the scattered population returns.♦ ♦ ♦

The Medical Officer having made his survey . . . sends in his report as to prevailing diseases, sanitary and welfare problems and medical facilities. If necessary he treats sick and wounded civilians and where required arranges for their evacuation. The distribution of medical supplies is his responsibility and he establishes first aid posts or ambulatories. All available practitioners or nurses are mobilized to assist in this. The Red Cross representative helps in all these activities and later each commune is visited by the Welfare Officer in turn to assist and advise or settle administrative problems. Local committees are then selected to work under the Sindaco, or the Commissario appointed by the C.A.O. if lie is absent, to carry on the good work. It should be emphasized here that any two of the team such as the C.A.O. and M.O. or C.A.P.O. and R.C. representatives are able to organize these activities leaving the more specialized work of each member to be performed later as they arrive. ♦ ♦ ♦

Naturally when a town has been subjected to the ravages of war it is usually found that water supplies, housing and cooking facilities are nonexistent or severely curtailed. Communal food kitchens have then to be set up. This is done under the supervision of the C.A.O. concerned with the help of the Red Cross representative and Sindaco or a leading citizen appointed as Commissario in his absence. These officials choose some central and convenient place and then form a local civilian committee to assist. The main issues from these soup kitchens are dehydrated soup, for which special recipes in English and Italian have been printed, and biscuits. Later, food as per ration list referred to is issued to each person. Tickets are given to each person and also covers his, or her, dependents. The tickets are presented at the counter and the daily ration is supplied as the people file past.♦ ♦ ♦

The T.C.U. representative at this Headquarters makes a survey of water sources as soon as possible. He has already received the Medical Officer's report as to contamination. He prepares a plan, lists what repairs and spare parts are necessary to get the water in by the quickest means. In the meantime, water has to be supplied by water carts or other improvisation, and wells have to be cleaned. Where no local supply is available water is obtained from Army sources. As this is chlorinated it is not too popular with the Italian who has queer ideas in regard to it.

It has been found from experience that it usually takes three or four weeks to effect temporary repairs in order to get a sufficient head of water. As a rule, reservoir, pipes, pump and other facilities are found to be damaged or wrecked, either by the accident of war or by the enemy. ♦ ♦ ♦

Hospitalization. This has always been the greatest problem from the Public Health and Welfare point of view in AMG Fifth Army. It has been comparatively easy to get medical supplies forward with the ready help of the Economics & Supply Division, and to arrange for first aid in local areas but, to get patients evacuated, and to obtain sufficient and suitable hospital accommodations has always been, and is, an extremely difficult task. With the resources at our disposal it is not a problem easy of solution.

There have been a variety of reasons for this. For instance, (1) No provision was made for motor ambulance cars on the original ACC equipment tables, nor was there for other medical transport for that matter. (2) Owing to depredations, lack of spare parts and damage from use, the Italian Red Cross which, before hostilities

[338]

commenced, used to cater for civilian needs and provide motor ambulance transport was unable to help. (3) Existing civil hospitals have suffered war damage or have had their equipment looted or stolen. (4) The staffs of these hospitals have either fled to safety, or joined, or have been taken away by, the Germans. (5) No beds or blankets and no instruments, or very few have been available from ACC sources. ♦ ♦ ♦

IMPORT AND DISTRIBUTION OF MEDICAL SUPPLIES
[Parkinson, Dir, PH Subcom, AC, Rpt, for Jul-Dec 44, to Advisory Council for Italy, 19 Jan 45, ACC files, 1000/136/228]

♦ ♦ ♦ 1. From the beginning of Allied Military Government activities in Italy, up to 1 January 1945, there have been imported into Italy approximately 3,500 long tons of medical supplies, having an approximate value of 6,000,000 dollars. Practically all of these medical supplies were of United States origin, the bulk of them having been shipped to this theater direct from the United States. A small portion was shipped from U.S. Medical Supply Depots within this theater. A negligible amount was of British origin being principally supplies which were furnished direct from British Medical Depots to AMG installations in emergency.

2. It must be remembered that the amount of medical supplies furnished to Italy by the Combined Chiefs of Staff, is only that amount of supplies that will save life and prevent the spread of disease to Allied troops. For Italy this represents five-thirteenths of the estimated requirements as computed on the status of medical practices in Italy and the numbers of hospital beds. The kinds of supplies allowed, and the quantity are limited by this policy, and it is not possible to fill all requests made by the Italian civilian population. Penicillin is one example of an excellent drug which is not available to Italian civilians because of its short supply to the Allied troops. Medical supplies are therefore furnished on an emergency basis, and first priority is given to the AMG Army areas; second to the hospitals, clinics and ambulatories; third to doctors; and lastly to pharmacies for general sale to the public....

b. Italy was divided into Regions for administrative purposes and in each of these Regions there was a Regional Public Health Officer who was responsible for the distribution of medical supplies within his Region. ♦ ♦ ♦

WELFARE AIMS MUST BE LIMITED TO ESSENTIALS
[Welfare Branch, PHS/C, AC, Rpt, for Dec 44, ACC files, 10700/163/26]

♦ ♦ ♦ It is apparent that there is no time for theorizing or permanent social planning until the needy Italian people are better clothed and fed. Every effort of the Welfare Branch is being bent in this direction.

[339]

Endnotes 

Return to the Table of Contents

	Return to CMH Online
	Last updated 18 February 2004