Women's Health in the Ghettos of Eastern Europe
One of the main effects of ghetto life on individuals was the deterioration in their health. Overcrowded living conditions, malnutrition, poor sanitation, hard labor, along with harsh weather and the absence of any reasonable health and nursing care all contributed to making the ghetto fertile ground for the spread of disease and the decline in the health of the individual.
Isaiah Trunk (Trunk, 1953) states that this was deliberate German policy, meant to bring about the gradual extermination of the Jewish population via the spread of disease. Also, the supposed need to protect the non-Jewish public in occupied areas from the “disease-bearing” Jews gave the occupation authorities a convenient pretext for forcing the Jews into ghettos. Ghetto living conditions, which caused the accelerated spread of disease along with the prejudiced, racist attitude toward the Jews as spreaders of disease, became a self-fulfilling prophecy in the end.
For a description of the health of the ghetto population of Eastern Europe, and for the purpose of this article, the health of the women there, we must rely on several diagnoses that unify specific ghettos and that had ramifications on the Jewish population’s ability to cope with medical problems. Factors such as location of the ghetto, the time it was established, how long it existed, its submissiveness, and its goal had a decisive influence on residents’ lives and their ability to withstand the depredations of that time and place. However, among the findings that will be detailed here, which deal with the physical situation of women in the ghetto, one may state with certainty that no characteristic particular to any one place can blur the general picture common to all the ghettos.
In many Eastern European ghettos, both those set up in countries occupied in 1939 and those set up in 1941 under Russian control, we find that the number of women in the ghetto population was greater than that of the men. In the Warsaw ghetto, for example, there were 211,492 women and 157,410 men (the number of boys and young men aged 0–19 was about four percent higher than that of girls and young women in the same age group). Census data for the Lodz ghetto from June 1940 show that of a population numbering 156,402 Jews, women accounted for 54.4 percent while men accounted for 45.5 percent. The gap between the sexes was greater in the 20–45 age group. According to an internal report of the Ältestenrat (Council of Elders) in the Kovno ghetto, the population of the ghetto during March and April of 1942 was as follows: men—7,469 (forty-three percent); women—9,898 (fifty-seven percent). From a weekly report that the Kovno ghetto’s labor department submitted to the German authorities, covering March 29 through April 4, 1943, the number of people living in the ghetto was 15,888. Of them, 6,936 were men and 8,952 were women. The report indicates that as the age of the population rose, the gap between men and women increased to between forty and sixty percent. The Shavli ghetto in Lithuania contained 4,775 people in 1943, of whom 57.6 percent, 2,754, were women. In Poland, which was occupied in 1939, this phenomenon is due, among other things, to the drafting of many men to the Polish army, their seizure for forced labor and the fact that many Jewish men fled in fear of their lives when the Germans entered the occupied zones. In the areas under Soviet control and those occupied in 1941, it was because Jewish men were among the first targets for mass murder by local nationalists along with the German occupiers.
Yet as time went on, the gap between men and women in the ghettos continued to increase, mainly because of the persistent increase in mortality, which was especially prevalent among men. Dr. Emanuel Ringelblum (1900–1944) described in his journal the great increase in mortality in the Warsaw ghetto, which was especially common among the poor. At the end of August 1941, he noted in his journal: “It often happens that an entire family dies in one day or over a few days. The number of orphans is increasing since the adults die first, especially the men.” In July 1942, the following was written in the chronicles of the Lodz Ghetto: “There is a marked increase in the number of women in relation to that of men. This is because the mortality among men is double that of the women, and because of the labor transports.” Michal Unger says, therefore, that transports to labor camps outside the ghetto continued during the entire period of its existence, and the vast majority of the eleven thousand people forced to move there were men, but along with that was the marked increase in mortality among the men as opposed to the women.
Despite the reservations expressed by researchers concerning the exactitude of the data on mortality in the Warsaw ghetto which, they claim, are apparently higher, it turns out that the mortality rate for women in the Warsaw ghetto was lower than that of the men. Yet among the refugee concentration points (“punkti”) in the ghetto, which ranged between nine thousand five hundred (recorded) to twenty thousand residents, the official data indicate that during the months of November and December 1941 and January 1942, 518 children, 458 men, and 528 women died. This was because of the high percentage of women in the refugee concentration points. In June 1942, for example, the ratio between the sexes in all the “points” in the Warsaw ghetto was as follows: forty-one percent women as opposed to twenty-one percent men and thirty-eight percent children. One of the most extreme cases was the refugee shelter on 14 Ostrovsky Street where, in January 1942, only women and children lived, since the men had died. The reasons for the high mortality rate among the refugees were starvation, tuberculosis and various kinds of typhus, which spread throughout the ghetto and claimed many victims.
In 1942, 264 people (not including all those who died in the ghetto) died in the Vilna ghetto hospital. Of them, 152 (fifty-eight percent) were men and 112 (forty-two percent) were women. Most of the dead were children aged four and under and elderly people over sixty years of age. The highest concentration of deaths occurred during the winter months, with September showing a marked decrease in mortality, which stood at twenty-two Jews: fourteen men and eight women. In November of the same year twenty-eight people died, of whom eighteen were men and ten were women, most of them adults over fourteen years of age. In the Kovno ghetto, 235 people died between November 1, 1941 and May 1, 1942, from among a population of 17,360 people, including 104 women out of a total population of 9,898 women in the ghetto, in contrast with 134 men out of a total population of 7,469 men who lived in the ghetto at the time. The highest mortality rates were among men aged 30–79 and male infants up to one year of age, and among women aged 50–79 and female infants up to one year of age.
It appears, then, that despite the fact that men were a minority in ghetto populations, their relative and nominal proportion among those who died was higher than that of the women. However, it should be pointed out that in the Lodz and Warsaw ghettos, death became a routine matter. The mortality rate in the Lodz ghetto stood at twenty-one percent of the residents and was the highest of all the ghettos in Poland. The mortality rate in the Warsaw ghetto was also high, with an average of seventeen percent. Most of those who died succumbed to starvation and weakness, and could not resist the wave of disease that raged in the ghetto. Naturally, the proportion of women who succumbed was also high. Despite that, mortality rates were lower in the Krakow, Bialystok, Grodno, Vilna, Kovno and Shavli ghettos. In addition to the unusual living conditions, the local Jewish council and medical staff managed to prevent the spread of disease to uncontrollable proportions and stave off death as much as possible.
How to explain the gap in mortality between men and women in the ghettos? Even under ordinary circumstances, women’s life expectancy is higher than that of men, as Michal Unger points out, so this would apply even more to ghetto living conditions. Also, men’s work, according to Unger, was in many cases more physically difficult, causing weakened resistance and accelerated mortality. However, in the Kovno ghetto, the proportion of women in forced-labor groups who worked outside the ghetto was not significantly lower than that of the men, even if it was less. Even so, according to journal testimonies written in the ghetto, Unger finds that women’s ability to adapt to the surrounding reality was better, as was their ability to cope with hunger and the changing conditions. As the researcher Felicia Karai (Karai, 2000) found, “Women grasped, more quickly and intuitively, that ‘this was another sort of war,’ and they had to save all whom they could. … Several feminine traits made it easier for them to cope with the difficult situation better than the men: resignation in the face of helplessness, greater adaptability, feminine charms and the ability to develop contacts with their surroundings (sometimes even with the Germans), and all this in addition to their physical advantages: biological strength, more attention to their physical appearance and to cleanliness.” Indeed, a study of the patients’ roster in the Vilna ghetto hospital for December 1942 shows that the number of women admitted is greater than that of men (188:131). During 1942, 3,001 patients were hospitalized in the ghetto, of whom 1,382 were men and 1,619 were women. The mortality rate among male patients was eleven percent, while that among female patients was seven percent. A report submitted by the First Aid organization in the Vilna ghetto shows that from January to March 1942, they treated 321 women and 259 men. The treatment centers for scabies also had a higher number of women patients. One of the conclusions is that in contrast to the mortality rate, the incidence of disease was not lower among women than among men. Moreover, women knew how to make use of the health services that the ghetto’s health department provided to the public.
Two main factors were responsible for the increase in the incidence of disease in the ghetto. One was existence in the ghetto itself, and the other was forced labor. From journals and memoirs written by physicians in the ghetto, we cannot unequivocally determine what specific factor, other than physiological injury, decreased the immune capacities of the ghetto population and rendered them vulnerable to disease. To these factors we must add the unusual living conditions in every ghetto, the makeup of the population and its characteristics, and the conception of productivity as a main component of continued existence. In the Warsaw ghetto, where residents suffered from long-term starvation, mostly among refugees, who made up close to thirty percent of the population, there was a dramatic increase in hunger-related diseases and tuberculosis, which developed as a result of the persistent hunger. This also occurred in the Lodz ghetto. The severe living conditions affected the spread of various kinds of typhus. In the Lublin ghetto in 1941, ten percent of the population contracted typhus. In the Kutno ghetto during 1941, the spread of the disease reached 14.3 percent of the Jewish population. On the other hand, in the Lithuanian ghettos, which contained mostly young people who had survived the aktions of the beginning of the occupation, and whose existence depended on work and manufacture, it happened, except for the sealed ghetto, that the incidence of disease and its factors had different causes. This reality affected the health of the women in these ghettos and on the ways they had developed to cope with the new circumstances and the subsequent change in their physical health.
Dr. Yaakov Nakhimovsky, chairman of the medical committee located near the labor office in the Kovno ghetto, conducted medical observations during 1942 and 1943 among the workers in the ghetto, with emphasis on the relationship between work and the incidence of disease. Nakhimovsky also dealt in his studies with diseases common to women. Because of their light clothing and work in open areas, to which they were not accustomed, women suffered from burns, severe skin infections and high fevers. During the winter, the long marches to and from work in the severe cold, in wet clothing and damp, unsuitable shoes, caused complications due to becoming cold and the absence of the proper nutrition necessary for recovery. Yet despite this, Dr. Nakhimovsky determined that these diseases were not fatal.
The physicians’ surveys show clearly that one of the outstanding physiological effects on the health of women in the ghettos (and afterward in the camps) was amenorrhea, the cessation of menstruation. Nakhimovsky finds that during the first period of time, with the move to the ghettos, most women of child-bearing age suffered from it. Dr. Aharon Peretz, who served as a gynecologist in the Kovno ghetto, claimed that emotional stress, worries and hard labor caused changes in the function of the endocrine systems of women in the ghetto and the cessation of their monthly cycle. Dr. Mark Dworzecki, a physician in the Vilna ghetto, said that the explanation for amenorrhea caused heated arguments among the doctors. Some believed that it was due to emotional experiences, changes in the secretion of hormones and lack of vitamins. Some believed that it was irreversible and stable, while others believed it was temporary. Indeed, Dworzecki found that with improvement in nutrition and a reduction in aktions, incidence of amenorrhea decreased for some women.
From a wide-ranging survey of starvation-related diseases conducted by physicians in the Warsaw ghetto, it appears that during heavy bombardments of the city and the subsequent collapse and system failures, many women ceased to menstruate. According to the physicians, these occurrences were temporary under ordinary conditions, but during an extended period of malnutrition they became permanent. The prevailing belief among the medical staff in the Warsaw ghetto was that lack of vitamin A was responsible for amenorrhea, and studies of young girls in orphanages proved that menstruation returned when vitamin A was administered. Dr. Nakhimovsky determined that over time, menstruation returned to normal for some of the women but was accompanied by pain and other physical ailments because of women’s deteriorating physical health in the ghetto.
Nakhimovsky emphasized that the hormonal disturbances women suffered in the ghetto affected their thyroid gland. The Bazedow condition (a disorder of the thyroid gland), as he called it, was prevalent among them. It was possible to diagnose this condition in all its stages, from light cases to more severe ones, and it persisted all the time the ghetto existed. “The main sufferers were mainly girls and young women. There were irregularities in heart function and the nervous system; hair loss, excessive sweating and high fever, which were caused mainly by emotional shock.” In addition, Nakhimovsky found that there were no few incidences of false pregnancies. Tetanus was prevalent among young girls in the ghetto, though it passed in time. “It is difficult to determine whether it was caused by poor nutrition or by poor functioning of the thyroid gland,” he wrote in his survey. Research on starvation done in the Warsaw ghetto found that starvation harmed the thyroid gland, and this blurred the physiological characteristics of both sexes. Young girls developed hair on their upper lips and cheeks, and the development of their pelvic areas was delayed.
In the Lodz ghetto, starvation and disease also caused amenorrhea in women. In addition, they developed a strong desire not to bear children in such a cruel and unstable world, according to Michal Unger. Because of this, birth rates in the ghetto were extremely low, and while it existed (1940–1944), 2,306 babies were born in the Lodz ghetto. In the ghettos of Vilna, Kovno and Shavli, in the beginning of 1942, the occupation authorities issued a decree prohibiting the birth of children in the ghetto. This order corresponded with statements written in December 1941 by Karl Jäger (1888–arrested in 1959; suicide), commander of the third Einsatzkommando unit. (He was appointed to command the security police and the local SD [Security Service of the SS] when the civil authority in Lithuania came to power.) Regarding the Jewish labor force that remained in Lithuania after the mass murder actions, he wrote: “I believe that we should begin sterilizing male Jews from among the Jewish laborers to prevent future increase. If a Jewish woman should become pregnant, she should be killed.”
The decrees against pregnancy and childbirth, along with the fatalistic attitude in the face of uncertainty, left their mark on gynecology as it was practiced in the ghetto. The gynecological department of the Vilna ghetto operated mainly to terminate pregnancies, according to Dr. Shadowsky. In cases of advanced pregnancy, the women were brought to the hospital forcibly by the ghetto police. Data on the operation of the gynecology department in the Vilna ghetto until its official closing show that in 1942, 429 women were hospitalized there, which accounted for 4.3 percent of all patients. Of these, more than sixty percent were abortion cases. Dr. Moshe Figenberg, a gynecologist in the ghetto, stated in his testimony: “Because the death penalty loomed over any woman who gave birth in the ghetto, the women’s department in the hospital where I worked was loaded down with abortion cases.” Because of the large number of pregnancies, the Vilna ghetto’s health office helped with various forms of birth control. In the beginning, they evaded the decree by means of false records. In time, a campaign began that included lectures by ghetto doctors on various ways to prevent pregnancy. In addition, the health office opened a counseling center for women where they could obtain birth-control devices developed locally by one of the ghetto physicians.
In the Kovno ghetto, the health department arranged the required medical services for terminating pregnancies. In addition, the medical staff was also responsible for public-relations efforts and warning women of what awaited them. Moreover, quite a few women refused to give in to the decree. They went underground in order to evade the prohibition, and with the help of the medical committee located near the ghetto labor department, they were released from their work obligations until they delivered their babies in secret. Dr. Aharon Peretz, one of the gynecologists in the ghetto, said that the widespread incidence of pregnancy was the result of amenorrhea among women who were unaware that they could still conceive. Another reason was the absence of birth-control methods. According to him, because of the intensive abortion work and the shortage of proper hospitalization and treatment supplies in the ghetto, some of the operations were performed in the strangest and most dreadful conditions. Deliveries were performed in secrecy mainly by specially trained midwives, while doctors were called only in cases of severe complications.
In the Shavli ghetto the decree caused much anxiety, and therefore the senior gynecologist of the ghetto, Dr. Josef Luntz, developed a special system for terminating pregnancies and speeding deliveries via “primitive” mechanical means, as he put it, and via special medications. According to Luntz, his methods worked, the women did not become ill and the babies were born without harm. But Dr. Aharon Pick (1872–1944), a senior physician in the Shavli ghetto, reported in the journal he left behind many incidents where women submitted complaints to the ghetto court about severe complications they suffered as a result of negligence in abortions. Indeed, some of the women of the Shavli ghetto, who testified about their personal experiences following the decree forbidding childbirth, mentioned the terrible conditions they had to endure when they gave birth or terminated their pregnancies.
As time went on, enforcement of the anti-childbirth decree in the Kovno and Shavli ghettos became extremely radical, and women in advanced pregnancy were forced to deliver early. The sources show that many times, ghetto doctors were forced to kill infants just born for fear of the punishment that would fall upon the general public if a live baby was found among them. These wretched episodes happened while the ghetto population was being herded into barracks as part of the process of transforming the Kovno and Shavli ghettos into a sort of concentration camp and their placement under the SS authority.
The state of women’s health in the ghetto was dictated in most cases by the unusual circumstances under which every ghetto existed. The prolonged starvation from which the Warsaw and Lodz ghetto populations suffered, in addition to the hermetic disconnection from the environment outside the Lodz ghetto, left their mark on the general state of health, including that of the women, of whom a sizeable proportion sickened and died following the prolonged weakening of their physical resistance. In ghettos where there was a younger population and nutrition was relatively reasonable, mortality rates were inestimably lower than those in Warsaw and Lodz, and the women’s lower mortality rate stands out as well. A unique and tragic topic was how the women coped with pregnancy and childbirth in extreme deprivation, forced labor, disintegration of the family unit and, in other cases, real risk to their own and their families’ lives if a baby should be born. However, it seems that in comparison with men, women managed to cope better with the adverse circumstances under which they labored, and despite the level of physical harm they endured and their exposure to disease which was not always less than the men’s, we can see that their wise use of the ghetto medical services, by which they maintained their health, contributed significantly to their well-being.
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