August 10, 2017, by lzzeb

Scoping disease records at the WHO and the ICRC

Matthew Smallman-Raynor blogs about his visit to the library and archives of the World Health Organization (WHO) and the International Committee of the Red Cross (ICRC), Geneva

Today, global epidemiological security is promoted by internet-based disease monitoring and surveillance systems that provide a near-constant feed of electronic information to disease surveillance centres around the world. Effective public health interventions are time-critical and, viewed in historical context, international disease surveillance systems have sought to exploit the cutting edge communications technologies of their day. In the latter decades of the nineteenth century, the electric telegraph formed the basis of an intercontinental disease surveillance system that was established by the US Marine Hospital Service, forerunner of the US Public Health Service. Somewhat later, in 1925, wireless technology served a similar function when the fledgling Health Organisation of the League of Nations pioneered an international disease surveillance system through its Eastern Bureau. From offices in Singapore, the Eastern Bureau was tasked with regular wireless broadcasts that furnished listeners with information on the occurrence of plague, cholera, smallpox and other infectious diseases at hundreds of seaports and, later, airports in the so-called ‘Eastern Arena’ – an immense geographical area that extended from Africa to Asia and the Western Pacific. In some ways, these broadcasts were akin to the daily shipping forecast on today’s BBC radio, albeit forewarning of the threats posed by infectious diseases rather than by meteorological events.

Although the Eastern Bureau was pivotal to the maintenance and promotion of regional (and, indeed, global) epidemiological security in the inter- and early post-war years, there has been no major study of the Bureau’s remarkable disease records. These records – many of which are housed in the library and archives of the World Health Organization (WHO) in Geneva – are to form the basis of the first transnational disease atlas of the Indian Ocean and Western Pacific regions. This atlas is broadly similar in concept to the Atlas of Epidemic Britain which I co-authored with Andy Cliff from the Department of Geography, University of Cambridge, back in 2012. A month ago, Andy and I visited the WHO to scope the Eastern Bureau’s records. Much of the core material is captured in the 15,000 or so pages of the Bureau’s Weekly Fasciculus, effectively a printed record of the information communicated in the Bureau’s regular radio broadcasts. A series of challenging research questions have emerged from our inspection of these records. How did communicable diseases travel along the spatial networks of international communications that linked the seaports and airports of the Eastern Arena? What were the principal channels of transmission within these networks? How did these transmission channels, and the networks in which they were embedded, vary by disease, season, environment and time period? In what ways did the ascendency of air travel impact on disease transmission networks in terms of direction, speed and seeding of epidemics, and how did these developments challenge existing disease control protocols? These and related questions will be developed in the new atlas.

Although the principal purpose of the visit was to scope the Eastern Bureau’s records, the archives of the International Committee of the Red Cross (ICRC) are situated close to WHO-HQ and the ICRC’s archivist was kind enough to welcome us for a brief visit. Among the ICRC’s remarkable records is a collection of 180 reports of ICRC delegates on the health conditions of North Korean and Chinese prisoners of war (POWs) at transit and detention camps in South Korea during the Korean War of 1950–53. The reports provide a unique window on the health and social conditions of the detainees as political tensions among the communist and anti-communist contingents in the camps rose to crisis point in the spring of 1952. These records will form the basis of a research article on the epidemiological history of the infamous UN POW Camp No. 1 (Koje-do) – one of the largest POW camps ever to operate in accordance with the Third Geneva Convention.

The WHO and the ICRC welcome health-related researchers who wish to make use of their extraordinary library and archival resources. As ever, it was heartening to see the resources being used to capacity by researchers from around the world. In addition to the preparation of journal articles and books, I’m looking forward to sharing the insights from my own work at the WHO and the ICRC with students on my Medical Geography module in the upcoming session.

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