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$Title{Liberation of the Nazi Concentration Camps 1945, The
Chapter IV: The Medical Personnel - Part I}
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$Subject{camp
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patients
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$Date{1987}
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Title:       Liberation of the Nazi Concentration Camps 1945, The
Author:      Various
Date:        1987

Chapter IV: The Medical Personnel - Part I

Moderator:  Dr. Hadassah Rosensaft (USA):  Survivor of Auschwitz and Bergen-
Belsen; lecturer and author on the Holocaust; member, U.S. Holocaust Memorial
Council.

Major General (Ret.) John Johnston (UK):  British Army doctor who was senior
medical officer at Bergen-Belsen.

Dr. Leo Eitinger (Norway):  Professor of Psychiatry, University of Oslo;
survivor of Auschwitz.

Marie K. Ellifritz, R.N. (USA):  Treated liberated inmates of Mauthausen as
nurse with U.S. Army.

Dr. Douglas G. Kelling (USA):  Participated in liberation of Dachau as medical
officer in U.S. Army.

Dr. George Tievsky (USA):  Participated in liberation of Dachau as medical
officer with U.S. Army.

Institutional identifications are those at the time of the Conference.

Hadassah Rosensaft

     The purpose of this session is to meet and to listen to some of the
doctors and the nurses who served in the American Army during the Second World
War and who came to the concentration camps soon after the liberation. We also
have one doctor who is a survivor of Auschwitz.

     They worked in the camps day and night, taking part in the intensive
rescue operation which resulted in the saving of the lives of tens of
thousands of survivors.  We, the doctors and nurses, saw daily the misery, the
tragedy, the suffering from all the diseases and epidemics; we saw deaths and
recovery.  We shall hear from members of the panel what they saw, how they
felt, what they remember, and how the experience of those days has affected
their lives and careers.

     Before introducing them to you, allow me to introduce myself.  I am Dr.
Hadassah Rosensaft, a survivor of Auschwitz and Bergen-Belsen, and liberated
in Belsen on April 15, 1945, by the British army.  I was fortunate to have
been able to work with the British doctors and nurses in Bergen-Belsen
immediately after the liberation, and therefore it is an especially great
privilege for me today to chair this meeting.

     We all regret that none of the British doctors is with us today.  I would
like to call to your attention excerpts from a statement made by one of them.
It is included in the brochure which you all have received.  It is a statement
by Major General John Johnston, a British army doctor who came to
Bergen-Belsen two days after liberation.  He was appointed by the chief
medical doctor of the Second Army as senior medical officer at Belsen two days
after liberation.  He was appointed by the chief medical doctor of the Second
Army as senior medical officer at Bergen-Belsen.  General Johnson has asked me
to express his regrets that he cannot be with us today.

John Johnston

     Below is the statement written for the Conference by John Johnston, Major
General (Ret.).

     In the early hours of the 17th of April I was awakened by a liaison
officer from Headquarters Second Army.  He informed me that we were to proceed
to Bergen-Belsen where there was a concentration camp which had been liberated
by the 11th Armoured Division on the 15th.  On arrival we were to initiate
action to deal with the very large numbers of sick we would find there.  He
knew that typhus fever was present and that starvation was universal, but he
could give me little information beyond this.

     I decided to set off for Belsen almost immediately and instructed the
unit to follow on behind and rendezvous with me at a point selected off the
map close to where I had been told the camp lay.  Although I had heard of
German concentration camps I had very little idea what I was likely to find
when I arrived there, but it was difficult to imagine how my 200-bed unit
could hope to achieve much with the sort of numbers I envisaged we might
encounter.  Little did I realize that I was about to be faced with the
greatest test of my career, with a situation that would remain engraved on my
memory for the rest of my days and that would instill in me a lasting
abhorrence not only of those who had perpetuated this crime, but also of those
who had condoned it.

     The camp was liberated, as we have already seen, on the 15th of April by
the 11th Armoured Division.  Brigadier Glyn Hughes, the deputy director of
medical services of Second Army at the time, visited the camp shortly after
its liberation.  Just after his arrival and while he was interviewing Kramer,
he heard sounds of firing.  Taking Kramer with him he went to investigate this
and found SS guards shooting at internees by a potato patch.  He ordered
Kramer to have the firing stopped.  Many dead and wounded were lying about
with no attempt being made to do anything for the wounded.  Judging from the
number of dead with gunshot wounds that we came across later, this type of
unprovoked shooting at random was a not uncommon occurrence.

     The dead lay literally everywhere - where they had simply fallen down and
died, where they had been dragged and piled, and amongst the living inside the
huts.  Piles of dead.  Some of these piles were three or four feet high and
covered large areas of ground.  They were most frequently in the women's
Lager.  When I was sent home in June to give a talk on Belsen at the Royal
Society of Medicine I went to see a news film on Belsen which was then showing
in London.  One of the shots showed a pile of dead.  A woman sitting just in
front of me turned to her neighbor and said, "They must have been put like
that for the picture."  I had difficulty in restraining myself.  What had
happened was this.  Until about March the dead apparently had been cremated,
but during this month the mortality rate rose so sharply that the crematorium
could no longer cope.  The dead were then gathered into piles and burned in
the open, but this was discontinued when military personnel in the adjacent
barracks objected to the smell.  Large pits were then bulldozed out and the
dead were dragged to them for burial.  But as the death rate and the physical
incapacity of the internees increased, and this was most marked in the women's
Lager, the dead were simply dragged as far away from the huts as possible and
dumped.  As exhaustion increased, the distance the corpses were dragged
diminished and the piles around the huts grew.  By the time we arrived, even
this had got beyond the power of many hut occupants, and hundreds of dead lay
in the huts amongst the living.

     At first sight the task allotted to my small unit with its handful of
doctors, sisters, and orderlies seemed totally impossible.  At least 70
percent of the internees required hospitalization and one of the first things
I did was to ask Headquarters Second Army for 1,200-bed hospitals although I
realized that, with the war still in progress, there was no possible chance of
getting them.

     It was apparent to us that our capacity to deal with individual patients
would be extremely limited and that our principal effort would have to be
directed to preventing, as far as possible, further loss of life from
starvation and disease.  To achieve this aim there were several priority
tasks.  These were as follows: (a) to institute suitable feeding for all
internees, and (b) to prevent the further spread of typhus and other
infectious or contagious diseases by every available means.

     The last of the sick in the "Horror Camp" were evacuated on the 18th of
May.  They were transferred to the building which had been the Officers Mess
now known as the Round House which we had equipped to receive them.  They were
accompanied by the students and internee nurses who had been running the
temporary hospital in the "Horror Camp" and who now became responsible for the
Round House.  Between the 21st of April when we started and the 18th of May we
had admitted a total of 13,834 patients; of this number 1,844 died after
admission.

     On our recommendation the "Horror Camp" was then completely destroyed by
fire.  This was the only possible end to a place that had seen so much human
misery, degradation, and terror and which was still heavily contaminated with
disease-carrying germs.  The burning was done by flame throwers, which
accounted not only for the huts but for the rags and filth littering the
ground.  We had a ceremony for the burning of the last hut and I had the
satisfaction of directing the flame thrower and pressing the button.

     I have returned to Belsen on two occasions since.  During the last visit
with my wife in 1969, I was interested to see several bus loads of German
schoolchildren being shown around.  I should have been even more interested if
I could have heard what was being said to them and been able to watch their
reactions.  Although it does not quite measure up to the garden of tranquility
that I had hoped it might become, the place is clean and well cared for, a
reasonable resting place for the thousands who lie buried there.

     I have heard it suggested that now, after all these years and in the very
changed international situation prevailing today, Belsen and all that it stood
for should be forgotten and the area closed to the public.

     I am utterly opposed to this proposal.  In my opinion, Belsen and the
other concentration camps must never be forgotten, not only because of the
millions of Jews who suffered and were exterminated in them, but as a reminder
of the incredible bestiality and cruelty which happened once "in this
enlightened age" and which must never be permitted to happen again.

Leo Eitinger

     I would like to say some words about one category of prisoner with whom
I, for obvious reasons, am especially concerned.  Their psychological
reactions have been of extraordinary importance to their own possible survival
and to that of their fellow prisoners.  I am referring, as you understand, to
the prisoners who were medical doctors.

     Even they had to cope with the situation, very often by what we call in
psychiatry "denial."  Without using this defense mechanism, it would have been
impossible for them to do their work and offer their medical help,
insufficient as it was.

     In spite of everything that has been said against becoming accomplices of
the SS, the prisoners who were medical doctors alleviated countless sufferings
and helped thousands and thousands of fellow prisoners to endure their fate.

     The fact that there remained a few hundred thousand survivors at the end
of the war, the fact that not absolutely all prisoners succumbed to the ill
treatment, is partly due to the prison doctors' efforts.

     We did nothing to boast of.  It was the simplest of duties, and those
doctors who were fortunate enough to be able to help were more than grateful
for this opportunity to do so.

     But from a psychological point of view, it was only their denial of the
realities that made it possible for them to act and to work as if their human
and medical activity was a normal one and of real help to their fellow
prisoners.

     This small example will perhaps illustrate what I have said.  A colleague
and I worked as prison doctors in the "infirmary" of a relatively small side
camp of Auschwitz, where most of the prisoners did forced labor in a plant
producing anti-aircraft guns.

     One day a boy with terrible pains was brought to us from the factory. It
turned out that he had a ruptured ulcer of the stomach.  Under the most
primitive of conditions, on the kitchen table, with shoehorns as surgical
hooks, we managed to close the rupture.  Improbable as it was, our patient
survived.

     But, as with other patients that we had to operate on under similar
conditions, whom we could treat, he had to go back to his work and to his
sufferings in the camp.  Unfortunately, I am unable to say whether the
operation was a real success, that is, whether the patient survived not only
the operation, but also the war.

     Fortunately, we have examples of prisoner-patients whom we treated
against all possible odds and who survived not only their disease, but also
the camp, and whom I have met subsequently in different situations after the
war.  These meetings with former patients whose treatment was possible or
meaningful only when carried out under the complete influence of a denial
reaction, while disregarding the realities and facts of life, belong to the
most important and positive experiences in my medical life.

     The fact that one can be of help in the most hopeless of situations and
that this help can have long-lasting, positive consequences for others cannot
be overestimated.

     Another example:  During the relocation of the prisoners of Auschwitz to
an unknown destination, the staff of the camp hospital marched as a closed
group, together with the other prisoners, on one of the seemingly endless and
hopeless death marches.  Late one evening, exhausted, we reached a sort of
barn in which we could stay overnight.

     A prisoner came to the camp hospital group because he had severe pains in
his legs and back and asked for help.  Hopeless as the situation was for
everybody, for us just as for everybody else, he received some consolation and
a pill against the pains.  Without a complete denial of the actual facts of
utter hopelessness and of the knowledge that everybody unfit to march along
with the others was bound to be shot, even this very modest help would have
been impossible.

     Again, I do not know whether this fellow prisoner survived the march or
not.  But I know that the medical profession would have betrayed itself if
this poor fellow had not received this small, perhaps pain-relieving tablet.

     You know that emotional blunting has been described as a practically
universal defense mechanism among concentration camp inmates.  One deep and
unchanging grief is the concern about one's nearest who has either been
arrested at the same time as oneself or whom one worries about with the
unknown murderous behavior of the guards.  The killing of one's comrades, the
floggings, and executions in brief, all of the unvariable and incredible
realities of daily life - had, to a certain degree, to be dealt with as if
they did not exist.  One tried to avoid the awareness of the difficulty of the
situation by a type of psychic withdrawal from the realities.

     It is true that basic psychology tells us that such primitive mechanisms
are not very efficient and that even their moderate effectiveness is achieved
only at great cost.  We know that in norm I life a problem cannot be solved
when there is no awareness of it; but in extreme situations there was no
realistic possibility of solving the problems, and denial of these situations
as the only positive way of functioning.

     Therefore, may I be allowed to say a few words on general coping in the
camps?  The group of people who were able to mobilize the most adequate coping
mechanisms were those who for one reason or another could retain their
personality and their system of values more or less intact, even under
conditions of nearly complete social anomie.

     Those who were most fortunate in this respect were, as mentioned, the
persons who, thanks to their profession, could both show and practice interest
in others and who could retain their values inside the camp at the same level
as outside the camp.  As you know, these few fortunate ones were some doctors
and nurses.  They were more preoccupied with the problems of their fellow
prisoners than with their own and came through their trials in a better mental
condition than the average inmate of the camp.  Only a tiny minority, however,
had this good fortune; the greater part had to find other ways of surviving.

     I think it is necessary to stress that not every kind of denial I had a
positive function.  The most tragic on was a prisoner's inability to assess
how far we could go in using this as a medical excuse order to avoid excessive
hard work.  While denial of the general death sentence could give positive
results, denial of the camp's function was tantamount to being killed
immediately.

     After the first process of selection which took place immediately after
the Jewish prisoners had left their cattle cars in Auschwitz, after their
arrival in the camp, the prisoners were asked if they had some serious
diseases.  Those who really were chronically ill or hoped that they could get
an easier life by stating that they were seriously ill were selected
immediately and sent to the gas chambers.  In other words, the prisoner who
thought that he could gain some advantage by stressing, for example, his
chronic sciatic pains or by aggravating fainting periods was in a very serious
life-threatening situation.

     Prisoners who denied their being in a life-threatening situation, who
escaped into daydreams, who did not accept the grim realities of camp life and
its immediate ghastly demands, and who did not try to find an operative
adaptive mechanism were also selected very quickly.

     In Auschwitz a prisoner who was not able to grasp the total tendency from
the outset or who would try to escape reality by denial and fantasy would
hardly survive the first working day.

     It would be pointless to enumerate all of the situations that would have
a fatal result for a prisoner who was not sufficiently reality-oriented.  From
the time the alarm sounded in the morning and the prisoners had to jump out of
bed and correctly make the bed, stand at roll calls, march, and so on and so
on, until the last distribution of the evening portion of the lukewarm watery
fluid which was sometimes called "soup" and sometimes "tea" or "coffee," the
whole day was controlled, and every moment full of danger.  A fatal blow on
the head was the most probable result of not assessing the bitter and grim
realities of the moment or trying to escape them by any sort of denial.

     Denying death could be life-saving under certain circumstances, while
denying the small, seemingly unimportant facts of daily life and struggle
would result in a certain and premature death.  A more detailed analysis of
the circumstances is involved, however, to enable us to explain the
contradictions showing basic human values and positive human
interrelationships that were of salient importance even under these most
extreme situations.

Marie Ellifritz

     I have been asked to tell you how it was from the medical liberators'
point of view.  Let me try to remember.  After all, it has been 36 years since
I was subjected to that experience.  It will take some effort for me to play
that mental videotape I have stored in my mind and impressed upon my soul and
that has become the emotion I know today, the one that makes me more caring
for others, more compassionate, more loving, and also makes me deplore those
things that threaten the world's freedom - not democracy as Americans know it,
for that is the fabric of our heritage.  We may disagree with your politics,
but we want everyone to have the freedom of choice as we know it.  Perhaps
that is not necessarily what you may want, but it is something we want you to
have, a gift we may have to die for in order to give to you.

     Emotion is one of the strongest complex reactions of man that can
manifest itself as love, hate, fear, and anger.  It is a feeling that one can
be easily moved by.  It causes tears, frustration, depression, or elation.  As
nurses, we attempt to deal with the full gamut of emotions, both in our own
lives and in the lives of the people we try to serve.  The emotional trauma
caused by our medical participation in the liberation of the European
concentration camps was beyond belief.

     As Americans, and as women, we had never before been subjected to such
inhumanity to man, and my initial feeling was of a tremendous job to do.  To
take in 1,500 patients into a 400-bed hospital had to be madness.  That fact
became our madness, and it proved to be a tremendous, overwhelming job.

     Clinically, it was a matter of sorting the dead from the living, deciding
who would live for at least three days or ignore, and to make all those we
found comfortable.  We began the process of treatment by attempting to keep
the patient dry and supplying an air mattress to give him a place to lie down,
a blanket to help him keep warm, pajamas to give him some dignity, a small
amount of food to nourish him, and plasma to preserve the remaining life and
begin him on the road back to living.

     Precautions we threw to the wind; in combat there is little one can do to
avoid danger it is ever-present.  In liberating a concentration camp, you dig
in and start where you are.  The danger of disease and the emotional trauma
you may suffer is not a primary concern, for that will come later. Disease and
emotion can be treated; the saving of human lives from mistreatment and
starvation was the paramount concern.

     Some of us did get sick from the dysentery that the patients had, from
the TB exposure from the emotional trauma, but most of all, it was the
sickness of the heart, of being a witness to the results of man's inhumanity
to man.

     We wondered if we could save any of them, and if we did, what would we
save them for?  Would there ever be the chance that life would be "normal" for
any of them?  We had to try, and we had to succeed.

     Everyone had work to do.  The patients themselves helped as much as they
could.  We deloused them, we moved them out of the camp into our tent city,
and we let fresh air, the sunshine, the space, and, most of all, their freedom
do its work.  Survival was always the name of the game.

     I well remember my reaction to the arrival of my first ambulance of
patients.  I had never before seen a naked man, and I was assigned to the
men's wards.  I did not control my reaction to the scene very well.  The
patients weren't really reactive to me.  Their exhaustion, their apathy, and
their many years of imprisonment made them incapable of reaction.  I was
embarrassed at emotions the patients had not enjoyed for a long time. However,
my recovery time was very short.

     It was a new experience for most of the nurses to begin to understand the
emotional needs of our patients.  For some patients, trust came early. After
all, we were Americans; we had a heritage.  We had an agreement with our
Allies that we would win this conflict, and it was only a question of time.
When would the winning become a reality?  Who among the patients would survive
long enough for the winning to help them make it meaningful?

     It seemed to take one to three days for us to convince some of them that
they were truly free at last, and when that reality came, they simply closed
their eyes and died in peace and freedom.  Some of the patients seemed to know
immediately that they were free once again, and so they were able to rejoice
and begin to make plans for their future.  Life force for these patients had
begun when the camp gates were opened by their liberators.

     Man's inhumanity to man - how far can it go?  You, the victims of the
concentration camps, have been there.  You know only too well.  I can speak
only of our perceptions of the patients' reactions to liberation.

     Liberation.  When will it come, and who will do it?  Where will you go,
and how long will it take?  And then it happens.  The bomb sounds are closer.
The enemy begins to rattle, movement in and movement out.  Something is about
to happen, but what?  Recent rumors in the camp were that liberation was
coming soon, but could you dare believe it?  You had believed the rumors
before, and they turned into your lost hope.  Maybe this time it might be
true.

     And suddenly it happens.  The gates a open, and your liberators are
facing you.  "Is it really true?  Are you really Americans?  Dare we believe
it?"

     "It really is true."  But how long will for the reality to be meaningful
to each of you?  Some of you are too close to death to be able to accept the
enormity of your final freedom.

     I cannot believe it either.  The sights before me are truly unbelievable.
We are hearing rumors, also.  The nurses are hearing them from our medical
personnel.  Are the bodies really stacked four across and four high?

     It was so terrible that our commanding officer called us together.  He
gave us a choice - you can go in and help, or you can stay out and support
your colleagues.  The choice was ours, for he could not bring himself to
subject American nurses to the horrors he had seen and knew would face us.

     How much could he expect us to take?  We had already earned two battle
stars for combat.  We had already nursed the liberated U.S. army air forced
prisoners of war at Moosburg, Germany.

     Americans as individuals are not too good at listening; we must be able
to see for ourselves.  We are travelers, we are survivors, and we are doers.
And so 40 American nurses from the I 30th Evacuation Hospital rolled up
sleeves and went to work.

     If patient experimentation was done at Mauthausen, I was not made aware
of it.  I remember coming home to the United States in August of 1945.  I was
22 years old.  I wanted to tell everything I knew and tell everyone I knew
about the horror I had seen.  They listened politely, looked quizzically at
me, and changed the subject.  Behind my back they told my family that I must
be losing my mind to come home with such stories.  Repression came quickly,
not to my family, for they believed me, but to everyone else.  I smiled and
said my combat experiences were unbelievable, and for them that was enough.

     What we as nurses suffered from is now known as "burn-out syndrome," and
"burn-out" is the result of unresolvable conflict and stress.  It is
exhaustion as the result of making excessive demands on energy, strength, or
resources.  It is the giving of too much, too soon, over too short a period of
time.  It has been experienced, also, by those nurses who served in the Korean
and Vietnam conflicts.  We have a name for it now, but we need to seek help
for those who suffer from it.

     History will attest to the 11 million victims of Hitler's atrocities. Six
million were Jews, and five million were victims of political oppression, of
not being one of Hitler's group, of just not being what Hitler would allow.
Dictatorship was his game, and if you opposed his view, you, too, became a
victim.

     In 1977, I returned to Mauthausen.  The walls of the camp still stand
today, and I'm glad I went back.  My visit was a quiet one.  The birds sang a
cheery greeting in bright rays of sun along the blowing green-grass carpet
there.  Monuments abound in remembrance.

     I found peace for myself upon my return.  Thirty-two years of carrying a
burden of mixed emotions had to be put to rest, so I left them there.  I have
no need to go back again.

     When people speak of concentration camps, they speak of the horror of
man's inhumanity to man, the works of the devil, of hatred, of fear, and of
anger.  I would like to leave with you a more pleasant thought, for some of us
discovered love there.  Love is the nicest of all the emotions, because by
simply being, it causes elation, brotherhood, companionship, and beauty, since
no bride is ever more beautiful than on her wedding day.  But most of all,
love leaves us with a tingling sensation of the heart that can last a
lifetime.

     As patients, as liberators, and as medical personnel there was a post-
traumatic stress disorder that affected us all.  Medically, I would like to
know the answers from those of you who survived.  I would like to know the
average length of your life-span.  I would like to know the cause of your
eventual death.  I would like to know where most of you survivors now live and
what major occupational jobs are now held by former inmates.  Did subjection
to camp life and punishments cause these people to become stronger or weaker
mentally and emotionally?  How much do the children of these camps remember,
and why do they remember?  How much bitterness, and towards whom, do you still
hold in your hearts?

     We know the figures of those who died.  What are the figures of those who
survived?  For how long did they live after liberation?  How much, how deeply,
and how long this post-traumatic stress disorder affects you depends upon the
other traumas that life has dished out to each of us.

     Let us put life's stresses into perspective and move on.  Let us move
from hate, fear, anger and frustration into the emotion of love, for only
there will you find peace for your troubled soul, and only in love can you
forgive.  Survivors we are, so let us be loving survivors.

     It is my prayer for each of you that God in his great wisdom will grant
you peace; love for each other; freedom from want, fear, and loneliness; and
most of all the joy of sharing together the promises He gave.