Introduction
Social scientists have long examined the question of the relationship between war and state formation, especially in Europe and Latin America (Centeno Reference Centeno1997, Reference Centeno2002; Rodríguez-Franco Reference Rodríguez-Franco2016; Tilly Reference Tilly, Evans, Rueschemeyer and Skocpol1985, Reference Tilly1992). This “bellicist” literature argues that war brings territorial expansion and builds an institutional apparatus some of whose parts – like tax-collecting institutions – support further war- and state-making. Successful war-making drove the creation of bureaucratic structures that eventually turned into nation-states (Tilly Reference Tilly, Evans, Rueschemeyer and Skocpol1985, Reference Tilly1992).
Alternatively, studies of colonial and settler colonial contexts question the significance of war for state formation and the applicability of the bellicist argument (Herbst Reference Herbst2014: 13–21, 256; Loveman Reference Loveman2005: 1652, f.n. 4; Owen Reference Owen2004: 2). Colonial wars were bloody and disastrous for local populations. But unlike wars in Europe, they were conducted with limited manpower, funds, and equipment – and did not necessitate similar institutional-administrative development (Frymer Reference Frymer2017: 23; Osterhammel Reference Osterhammel2005: 43–44; Thompson and Lamar Reference Thompson, Lamar, Lamar and Thompson1981: 9). Instead of war, settler colonial scholarship views the creation of institutions and policies that secure settlers’ control over land, guarantee a supply of labor, and support economic development as key to state formation. Cases such as the United States, Australia, and Israel show that establishing institutions and policies that facilitate territorialization was a critical part of building the settlers’ state. In addition, these cases demonstrate that territorialization was supported by technology, medicine, and scientific knowledge and practice that enabled settlers to establish themselves in the new land (e.g., Anderson Reference Anderson2003; Baker Reference Baker2018; Carroll Reference Carroll2006; Elkins and Pedersen Reference Elkins, Pedersen, Elkins and Pedersen2005; Frymer Reference Frymer2017; Good Reference Good1976; McMichael Reference McMichael1984; Shafir Reference Shafir1996; Quinn Reference Quinn2019).
However, a recent contribution departed from social scientists’ tendency to deemphasize the war-state relationship in colonial or imperial contexts. This work shows that World War I was central to the making of the modern Middle East (Wyrtzen Reference Wyrtzen2022). The collapse of the Ottoman political order allowed new global-imperial actors to enter the region but also opened opportunities for local forces to pursue their own political projects, desired identities, and imagined futures. The struggles and war between local and global forces shaped the region’s borders and political order, with lasting consequences. Therefore, war did drive state formation in formerly Ottoman territories, although its dynamics and scale were different than in bellicist accounts (Wyrtzen Reference Wyrtzen2022: 20).
This article contributes to bellicist scholarship and settler-colonial scholarship by demonstrating a novel way in which war shapes state formation in a colonial context. Using the case of Zionist state formation in British-ruled Palestine, I, too, argue that war does shape state formation in the colonies (in line with Wyrtzen Reference Wyrtzen2022). However, I contend that the relationship between war and state formation is mediated by crisis (or crises) that invite new actors to intervene in state formation, allocate resources, and produce social-structural change.
Building on existing work (Clemens Reference Clemens2015; Desai Reference Desai2023), I suggest that a crisis might be theorized as a historical event (Sewell Reference Sewell1996, Reference Sewell2005) with a potential to bring significant structural transformation. However, I also draw on Marx’s (Reference Marx1926: 23; Reference Marx and Tucker1978: 595) insights regarding the importance of past patterns during times of “revolutionary crisis” to offer a theoretical critique of eventful analyses. Specifically, I depart from the existing view of crises as historical events that entail a radical rift or rupture in space and time (e.g., Clemens Reference Clemens2015). I show that war-induced transformative crises and subsequent state formation are shaped by preexisting patterns and conditions. It is exactly the intersection of transformative crises with existing patterns that invites new actors to intervene, makes available new streams of resources, and produces significant social-structural change.
Empirically, I show that one of the main obstacles that hampered Zionist colonization and state formation in Palestine was the country’s bad health conditions and lack of medical services, conditions that World War I seriously worsened. Following the war, American Jewish organizations worked to heal the country’s Jewish population. By improving Palestine’s health conditions, these organizations removed important, longstanding obstacles to colonization and state formation. I show that the critical work of these public health organizations stemmed from the local and global crises caused by the war.
I demonstrate my argument by examining public health activities organized by US-based American Jewish bodies after 1918. I focus on three organizations: (1) the American Zionist Medical Unit (AZMU), which was the predecessor of both; (2) the Malaria Research Unit (MRU); and (3) the Hadassah Medical Organization (HMO). Together, these organizations developed much of the Jewish health infrastructure in Palestine. I analyze diverse empirical materials such as reports, newspaper articles, books, pamphlets, and articles published by key actors. I collected these materials at the Central Zionist Archives (CZA) and the National Library of Israel, both located in Jerusalem; the American Jewish Joint Distribution Committee’s (JDC) archive (online); the Center for Jewish History (CJH) in New York City; online libraries such as Internet Archive and HathiTrust; university library catalogues; and an online database of historical Jewish press. Some of the materials I purchased in bookstores.Footnote 1
War, colonization, and crisis
Despite many differences, bellicist scholarship and settler colonial scholarship share a theoretical emphasis on resource extraction. For bellicists, rulers’ ability to extract resources such as manpower, materials, and revenue to support further war-making is highly important since successful war-making promotes state formation (Tilly Reference Tilly, Evans, Rueschemeyer and Skocpol1985, Reference Tilly1992). While cycles of coercion and extraction might foster state building, it is not a necessary outcome. State building occurs if rulers’ sole source of extraction is the domestic economy and the latter is strong enough to sustain these demands (Centeno Reference Centeno1997). If rulers had alternative sources of extraction that replaced the domestic economy, or if a minimal level of local political organization did not exist, war did not prompt state building.Footnote 2
In settler colonial scholarship, resources are significant in a different way than for bellicists. In settler colonies, the colonial state or, where it is formed, the settlers’ independent state, often provides settlers with key resources, especially land, labor, and social services (Elkins and Pedersen Reference Elkins, Pedersen, Elkins and Pedersen2005; Frymer Reference Frymer2017; Good Reference Good1976; McMichael Reference McMichael1984; Quinn Reference Quinn2019). For example, the state may declare a monopoly over all land, expropriating it from the local population and distributing it to the settlers. And unless settlers rely on self-labor (as Jews in Palestine did), the state also provides them with a cheap workforce such as slaves or convicts. Lastly, the state provides the settlers with advanced social services, on par with Europe or other well-developed colonies. Land, labor, and service provision support colonization by aiding economic development and the growth of an established society (Good Reference Good1976). In the Israeli case, colonization was supported by diasporic communities and organizations that allocated resources such as manpower and capital. These resources enabled economic development and provided the needs of a growing political center that could not rely on domestic extraction because of a dearth of resources (Horowitz and Lissak Reference Horowitz and Lissak1973, Reference Horowitz and Lissak1978; Shafir Reference Shafir1996).
While I share bellicists’ and settler-colonial scholarship’s concern with resources, I demonstrate a different relationship between war, resources, and colonization: I contend that war exacerbates existing problems and creates crises that attract new actors to intervene and establish new streams of resources. In Palestine, the importance of war-induced crises for state formation is demonstrated in the convergence of global contingencies and local conditions. Rampant disease and its political implications are important for understanding state formation after World War I. The war exacerbated existing health problems while the suffering of Jewish communities in Europe and Palestine pushed American Jews to respond to the health crisis. Their response included utilizing resources such as capital, manpower, and scientific knowledge and removed a major, longstanding hurdle to state formation: the development of public health institutions that supported colonization and immigration, which were key Zionist goals.
The Israel-Palestine case offers two additional theoretical lessons. First, a war-induced crisis can shape the balance of power between different groups. Postwar public health efforts initiated a process that ultimately increased Zionists’ ability to withstand violent clashes with the local Palestinian population as well as succession wars. The HMO- and MRU-trained personnel played important roles in helping the Jewish community meet the challenges of Palestinian anti-British and anti-Zionist riots and revolt, the projected health effects of World War II, and the 1948 War, which the Zionists won. Since the development of Zionist health infrastructure helped advance colonization and immigration, it was one of several factors that shaped Palestinians’ predicament, although indirectly.
Second, a process initiated by crisis does not necessarily create lasting institutions, as the different fates of the MRU and HMO will show. At least two factors can potentially interfere with institutional development: the multiplicity of actors involved in the process and their differing interests (i.e., the settlers and the colonial state or different groups within the settler community) and the extent to which postwar adverse conditions were ameliorated. These can determine whether institutions will persist or disband. Still, as the MRU shows, the fact that a certain organization ceases to exist does not preclude the critical lasting effect of its operations on colonization or future public health activities.
Crisis
Having noted the significance of “crisis,” a theoretical discussion that focuses on the term itself becomes important. My discussion advances historical social science since scholars often mention crisis casually, without conceptual clarification, which raises questions regarding the term’s significance (Desai Reference Desai2023).
Some historical social scientists conceptualized crisis within the framework of “eventful” historical analysis (Clemens Reference Clemens2015; Desai Reference Desai2023). An eventful analysis sees certain historical events as changing social relations in unpredictable ways, pushing them in unforeseen directions (Sewell Reference Sewell1996: 843). Such events are highly contingent “sequences of occurrences that result in transformation of structures” (Sewell Reference Sewell1996: 843, Reference Sewell2005: 100). They cause dramatic raptures or rifts that break established routines and institutions, bringing about the development of new ones (Clemens Reference Clemens2015; Sewell Reference Sewell1996, Reference Sewell2005). Once a transformative event occurs, it has path-dependent properties so that later events are causally related to it. Not all crises are structurally transformative: Some do not produce change. What makes certain crises “eventful” (and therefore transformative) is that they provide an opportunity to change the configuration of power, resources, and the possibilities for response (Clemens Reference Clemens2015; Desai Reference Desai2023). Transformation takes place when skillful actors turn the potential for change into actual change as they navigate a crisis.
Building on these insights, I, too, suggest that crises might be global, highly contingent transformative events. Yet unlike previous work, I reject the notion that structurally transformative crises necessarily involve a radical break from the past. Instead, I see past patterns and conditions as causally relevant for structural transformation. Eventful crises might cause major ruptures, rifts “in the ordered fabric of a particular place and time” (Clemens Reference Clemens2015: 20; Sewell Reference Sewell1996, Reference Sewell2005). However, patterns and conditions that preceded a crisis converge and intersect with that crisis to produce structural transformation. Furthermore, I contend that it is exactly such an intersection that has the capacity to bring about major transformations.
This theoretical insight is inspired by the work of Karl Marx, who claimed that past structures and occurrences play an important role in times of “revolutionary crisis.” While such a crisis might seemingly create entirely new realities, it is actually shaped by “circumstances directly found, given, and transmitted from the past” (Marx Reference Marx and Tucker1978: 595). Crisis does not entail a radical break from the past: even when crisis seems to bring a revolution and create entirely new social structures, actors must navigate the circumstances they find and “fashion the material handed down by the past” (Marx Reference Marx1926: 23). The significance of past events in shaping social transformation led Marx (Reference Marx1926: 23, Reference Marx and Tucker1978: 595) to claim that actors might make history in times of crisis, but they do not make it just as they please.
Following Marx, I contend that eventful crises, too, might make history, but they do not make it just as they please. Against the idea of major rifts and decouplings from the past that characterize analyses of eventful crises, I suggest that preexisting patterns and conditions shape social transformation.Footnote 3
While I focus on Mandate Palestine, my theoretical insights apply to other cases as well, including another Ottoman province: Lebanon. As in Palestine, Lebanon suffered from extreme famine and diseases during World War I. Wartime horror was not only devastating but also gave way to significant postwar transformations brought about by benevolent relief and welfare operations (Tanielian Reference Tanielian2017). Responses to famine and disease entailed political power struggles as state and non-state, local, national, and international actors tried to reshape the postwar political order. But wartime events were not a historical rapture: they were the result of prewar politics that rendered Lebanon vulnerable to famine while also forming the constellations of actors who would later try to mitigate that famine (Tanielian Reference Tanielian2017: 35). Therefore, Lebanon is another case that shows that war-induced structurally transformative eventful crises are not historical rifts but are shaped by existing conditions.
Another case that demonstrates the significance of my theoretical insights is the US’s involvement in Europe after World War I. There, war-induced crisis opened new streams of resources and opportunities for action and contributed to changes in global power structures (Clemens Reference Clemens2015). With the wartime crisis, the American state collaborated with non-state agencies, including the JDC, to provide relief for sufferers in Europe (Porter Reference Porter2017). This effort was part of America’s rise into a world power. Here too, existing patterns mattered despite the eventful dimensions of crisis: To alleviate suffering, the US used its existing notions of benevolence to influence other countries. The US also utilized established American models of state building that center on partnership with non-state actors, models that it used in its colonial possessions already before World War I (Clemens Reference Clemens2020; Moore Reference Moore2011; Porter Reference Porter2017).
Scholarship on Israel-Palestine
The theory of crisis that I propose shares eventful analyses’ focus on actors’ subsistence and survival (Sewell Reference Sewell1996). I emphasize changes in material conditions. By doing so, I depart from existing scholarship that focuses on Israel/Palestine. These accounts are decree-based, focusing on Zionist diplomatic wins World War I helped bring. While diplomacy is important, it could not, in and of itself, produce actual transformation. Global contingencies and crises might generate several potentially important occurrences, but not every occurrence is transformative in an empirically and theoretically meaningful way (Sewell Reference Sewell2005: 84).
Case-specific scholarship sees the international recognition of the Zionist movement by the British Empire during World War I as a pivotal moment in the history of Israel/Palestine (e.g., Kimmerling Reference Kimmerling2001; Shapira Reference Shapira2012). The Balfour Declaration, issued by the British in 1917, recognized the Jewish right for a “national home” in Palestine at a time the British were preparing to conquer the country from the Ottoman Empire. The Declaration was later ratified in the Mandate for Palestine given to the British by the League of Nations. At the beginning of World War I, Zionists in Palestine were a small and weak community with no real achievements, partially because malaria and hostile Ottoman rule stifled colonization efforts. After the war and under British auspices, Zionist immigration, land purchases, and institution-building progressed. A dynamic Zionist political community emerged, rapidly developing into a proto-state under British colonialism (Kimmerling Reference Kimmerling2001; Pappé Reference Pappé2004; Shapira Reference Shapira2012). On the other hand, Palestinians were not mentioned by name in the Declaration and Mandate texts, and despite the promise to safeguard the rights of “non-Jews,” Palestinian national aspirations were not acknowledged. Guiding British policy, the Declaration helped create an impossible “iron cage” for the Palestinians from which they could not escape as they struggled for the land against the Zionists and British (Khalidi Reference Khalidi2006).
British promises to Zionists became “the standard account” and the starting point of numerous histories of Israel-Palestine (Meiton Reference Meiton2019: 12). The Declaration is often described as a critical, major, highly consequential event (Khalidi Reference Khalidi2006: xxxi; Kimmerling Reference Kimmerling2001: 29; Morris Reference Morris2001: 73; Shapira Reference Shapira2012: 74). A decree-based diplomatic starting point is problematic since it disregards the devastating material effects of World War I and the fact that postwar Palestine was a ravaged country (Pappé Reference Pappé2004: 72–73). Thus, a diplomatic focus is explanatorily weak: It does not actually explain colonization, institutional development, or actors’ recovery from the war. Turning Palestine into a Jewish state necessitated the development of various infrastructures (Meiton Reference Meiton2019: 12–16), including public health institutions, not political proclamations.
By focusing on health, I join previous studies that demonstrated how the development of public health institutions by American Jewish organizations and other actors supported Zionist goals (e.g., Hirsch Reference Hirsch2014; Shvarts and Shehory Rubin Reference Shvarts and Shehory Rubin2012). In Palestine, as in other cases, science, technology, and political power interweaved to create various infrastructures that are central to the making of modern states and settler colonies (e.g., Carroll Reference Carroll2006; Meiton Reference Meiton2019; Scott Reference Scott1998). While I agree science, technology, and medicine are critical for state formation and colonization, I depart from these studies by focusing on war-induced crises as the key for the introduction of critical public health practices and institutions.
Health and state formation
Zionist state formation included forming proto-state institutions in various areas, such as employment, colonization, defense, welfare, politics, and law (Kimmerling Reference Kimmerling2001; Shapira Reference Shapira2012). I focus on health institutions because they were especially prominent within that national infrastructure. Health services were not only comprehensive but also developed relatively early, comprising a key component of Zionists’ proto-state. Furthermore, health services were politically important because they supported key Zionist goals: immigration, colonization, and political economic development.
Health was one of the two most important social services in the evolving Jewish polity, together with education, but the former was of much higher quality than the latter.Footnote 4 By the 1940s, the HMO was a central national institution in Palestine, mentioned alongside colonizing agencies and Jewish political-governmental bodies.Footnote 5 Furthermore, health services were centrally coordinated even before Zionists had a coherent colonization policy: the Zionist health system evolved during the 1920s. Colonization policy remained uncoordinated during that decade, with several Zionist bodies purchasing land, competing for tracts, and hurting their own efforts by causing land prices to rise. Colonization activities were coordinated only after the 1929 disturbances, as Zionists started aiming at creating a territorial nucleus for a Jewish state (Stein Reference Stein1984).
The British colonial state provided some health services, but Zionists could not rely on them even if they wanted to. Although Palestine was officially a mandate, the British treated it in many ways as another Crown colony (Pappé Reference Pappé2004: 99–100; Shapira Reference Shapira2012: 95). Therefore, British health services and initiatives were very partial and limited in scope. Reflecting typical colonial policy, British capital investments in health were very low,Footnote 6 and health services primarily aimed at protecting British interests (Shapira Reference Shapira2012: 95; Sufian Reference Sufian2007: 8–9). Since Zionists worked to develop their own fairly autonomous, relatively well-funded health system, whatever services the British did provide were mostly directed at the Arab sector (Shapira Reference Shapira2012: 95; Sufian Reference Sufian2007: 9–11). Jewish political bodies protested the meager British investments and restricted health services.Footnote 7 Jewish public health organizations outspent the colonial state even though Jews were a demographic minority in Palestine (Hirsch Reference Hirsch2014: 141).
Zionists’ health crisis
The political significance of health services stems from the obstacles disease, particularly malaria, posed to colonization, immigration, and political economic development that were important Zionist goals. For example, malaria’s symptoms include bouts of fever and chills that repeat every few days and make sufferers unable to work. The disease can become chronic. Aside from debilitating sickness, malaria can be deadly and lead to dangerous complications that destroy red blood cells (Kilgler Reference Kligler1930; Sufian Reference Sufian2007). If disease was left unchecked, Jews would not be able to work and develop a viable economy, mass immigration and settlement would be impossible – and state formation would fail. The conditions in Palestine show that Zionists did face a public health and political crisis. But this crisis was not transformational: It denoted a situation of great hardships and struggles generated by objective conditions (Desai Reference Desai2023).
Palestine was an unhealthy country when the first Zionists arrived during the 1880s. Malaria, smallpox, and cholera epidemics were common. Typhoid, dysentery, trachoma, and measles were also rife (Borowy and Davidovitch Reference Borowy and Davidovitch2005; Sufian Reference Sufian2007). Palestinian doctor and nationalist Tawfiq Canaan (Reference Canaan2020: 66) described Palestine’s sanitary conditions as “very primitive.” The Turkish government operated only three hospitals: in Jerusalem, Jaffa, and Nablus. The medical services provided by religious bodies were often insufficient and unscientific (Canaan Reference Canaan2020: 66).
Given these health conditions, Zionist work in Palestine suffered. Jews purchased lands for settlement in the fertile, well-watered areas along the coast and valleys. These areas were good for agriculture and were more easily purchased but had swamps, streams, and other sources of mosquito breeding, which caused high malaria morbidity (Kligler Reference Kligler1930; Smilansky Reference Smilansky1935). The cities were also malarious. Jerusalem’s morbidity rates reached 50 percent, while the Jewish settlements around it experienced higher endemicity than some spots on Africa’s western coast (Cropper Reference Cropper1905: 461).
Because of malaria, some Jewish settlements had to be abandoned. Others suffered heavy financial losses as the disease made settlers unable to work and increased medical expenses (e.g., Kligler Reference Kligler1930: viii; Smilansky Reference Smilansky1935). In one Zionist agricultural farm, almost all workers fell ill, despite having access to a pharmacy.Footnote 8 Agricultural workers’ writings are full of references to malaria’s debilitating effects on Jewish labor. Figures such as David Ben Gurion (Reference Ben Gurion1970: 50–53) and Shemuel Dayan (Reference Dayan1961), who eventually became prominent Israeli leaders, were either incapacitated by malaria or had to work despite sickness. Ben Gurion (Reference Ben Gurion1931: 266) recalled that during certain periods, he spent more time being sick than working. These were common experiences among the workers. Some of them suffered from malaria for years (e.g., Harpaz Reference Harpaz and Habas1947: 229; Horwitz Reference Horowitz and Habas1947: 206, 214).
Zionist officials involved in colonization came to understand malaria’s detrimental impact on political and economic development. Without fighting the disease, settlement would fail, and land would be a useless, unproductive “dead object” of no economic value (Granott Reference Granott1951: 134–35). Zionist activist Arthur Ruppin claimed that besides the death toll, malaria’s repeated attacks incapacitated settlers to the extent that “every third working-day was wasted by disease,” which risked settlements’ economic viability (Ruppin Reference Ruppin1926: 62). Malaria and poor sanitation also discouraged wealthy Jews who could invest private capital in colonization from immigrating to Palestine (Ruppin Reference Ruppin1926: 161, 164). Removing the danger malaria posed was the most important condition to improve settlements’ material situation and ensure both life and livelihood (Granovsky Reference Granovsky1926: 80; Ruppin Reference Ruppin1926: 61).
The importance of health for colonization is evident in other cases as well. The introduction of medicine to a colony is often “one of the most powerful and penetrative parts of the entire colonizing process” and is inseparable from the budding political order (Arnold Reference Arnold1993: 4). In Australia, doctors aided settlers who struggled to break into new territories and establish a white workforce because of disease (Anderson Reference Anderson2003). In the United States, westward expansion was inextricably tied to concerns with and attempts to secure American soldiers’ health (Baker Reference Baker2018). In Ireland, England drained bogs to advance colonization and economic development and created a robust network of hospitals and sanitary institutions, a network that was more developed than in England itself. The government was heavily involved in these developments, which extended state power over the colony (Carroll Reference Carroll2006: 132–35, 145–47). Zionists’ creation of medical infrastructure and the problems disease posed to their colonization are not unique and speak to broader patterns of state formation in colonial contexts.
Health conditions and resources during World War I
If epidemics and disease were prevalent before the war, hostilities made matters worse. The deterioration of health conditions shows that postwar social transformation does not stem from any radical break from past patterns but from the aggravation and persistence of existing ones.
Hospitals closed because of the war, and many doctors were either drafted for military service or died from the diseases they tried to cure (WZO 1921).Footnote 9 Additionally, the country faced a locust invasion in 1915–1916, and the starving population became even more susceptible to disease. Serving in the Ottoman army, Canaan described wartime sanitary conditions as “awful” and the death rate as “dreadful.” He fell gravely ill himself, wishing death at times (Canaan Reference Canaan2020: 76). Disease was one of the factors that caused a sharp population decline.Footnote 10
Available data show the severity of wartime malaria. In 1916, even before Palestine became a battleground, a Jerusalem-based Jewish health station that was still operating found that 30.5 percent of the people it tested carried malaria parasites.Footnote 11 Among children under ten, morbidity was almost 50 percent. British military statistics also paint a terrifying picture. In 1916, before the British entered Palestine, there were 1,000 malaria cases among troops stationed in Egypt. In 1918, after the British Palestine campaign began, the number of cases exceeded 28,000 (Macpherson et al. Reference Macpherson, Herringham, Elliott and Balfour1922: 248). British soldiers feared malaria more than they feared Ottoman bullets (Dolev Reference Dolev2007: 131–32). The army had to treat the sick and perform some antimalarial measures amid the fighting, or the soldiers “would have simply melted away.”Footnote 12 Morbidity among Austrian, German, and Ottoman war prisoners reached 60 percent.
Zionist agricultural workers also felt the effects of war and were very concerned since the stream of resources on which Jewish Palestine depended was cut off. In 1915, an article titled “A Year of Crisis” appeared in a leading workers’ newspaper. Its author claimed the war caused an unprecedented crisis in the history of Palestine’s Jewish community.Footnote 13 The latter depended on assistance from Jewish diaspora communities even before the war. However, Palestine was cut off from the diaspora because of the war, which imperiled the Zionist project. Palestine’s Jewish community survived only because some aid from American Jews still made it into the country.
Despite its historical magnitude, in terms of health, the wartime crisis did not involve a radical rupture from the past but a deterioration of existing conditions. Another article from the same issue of the workers’ newspaper was titled “Medical Aid Among the Workers of Judea During the Crisis.” This article’s author wrote that malaria was always a part of workers’ lives, but during the war, it became “a constant visitor” that “stroke a deep root” in workers’ bodies.Footnote 14 Aside from the workers who were already sick, Jewish settlements had large numbers of malaria “candidates:” workers who were about to fall ill but gathered their remaining energy to “work another day or half a day” and earn some extra income to cover their basic necessities.Footnote 15
In the settlement Merhavia, war’s effects on disease progressively undermined Jewish labor and economic viability. Merhavia suffered from malaria and other diseases since its founding. In the summer, when both agricultural work and diseases peaked, Merhavia’s sick members had to be replaced with inexperienced workers who fell ill themselves. Health conditions were a major contributor to the settlement’s financial losses (Rabinovitch Reference Rabinovitch and Lubrani1961: 75). In 1916, the settlement, numbering about 140 people, counted 1,043 sick days and 2,519 visits to the local hospital, which impeded its economic development. By 1917, malaria wreaked havoc on the workers, and Merhavia counted a total of 1,701 sick days, one-eighth of all workdays for that year. By 1918, Merhavia counted 3,525 sick days out of a total of 14,336 yearly workdays (about 24 percent), with medical aid costing a whopping 19,342 French francs. Eight children had died by disease during that year (Rabinovitch Reference Rabinovitch and Lubrani1961: 82–84).
After the war, health conditions remained abysmal. In 1918, a veteran settler who surveyed health conditions in the war-torn country claimed that the existence of the Jewish community hinges on healing the country.Footnote 16 In 1920, Palestine saw a horrible malaria epidemic stimulated by heavy rainfall. In certain areas, the death rate was almost seven percent.Footnote 17 Hadassah leader and founder Henrietta Szold, who was involved with the AZMU, described the situation among the workers as “malaria madness.”Footnote 18 Newly arrived Jewish immigrants who looked for employment in the rural areas fell ill with malaria almost immediately after arrival, and the existing medical facilities could not care for many of them.Footnote 19 The trend continued in 1921, when workers’ groups from all over Palestine besieged the AZMU for help because of malaria. As more immigrants arrived, Szold described the situation as “unbearable.”Footnote 20
“Set in motion through a great calamity:” War, crisis, and health
The intensive involvement of American Jewish organizations in public health in Palestine stemmed from wartime crises. These crises created an opportunity for new, powerful actors to enter Palestine and established transnational alliances and streams of resources.
With war and devastation, American Jewry scrambled to assist Jews in Palestine. Existing American Jewish organizations sprang into action, and new organizations were formed. Hadassah Women’s Zionist Organization, founded in 1912, was already modestly involved in Palestine, having sent two nurses to Jerusalem before the war. As war broke out, the nurses were forced to leave the country. The American Jewish Joint Distribution Committee (JDC) was formed in 1914 out of wartime Jewish plight, with the provision of medical-sanitary aid being a core concern. The initial plea for help that brought the apolitical, non-Zionist JDC into being came from Palestine, but the organization worked mostly among Jewish communities in Eastern Europe.Footnote 21
Turning to American Jewry for help stemmed from the war’s impact not only on Palestine but also on Europe. The World Zionist Organization (WZO) initially looked in European countries for doctors who could aid Jews in Palestine, but these doctors were recruited to the war effort. The US was still neutral when the WZO turned to American Jewry.Footnote 22
Wartime crisis opened opportunities for action that could lead to social transformation (Clemens Reference Clemens2015): It helped American Zionists grow in numbers and take a more central position in general Zionist affairs. One prominent American Zionist wrote, “Those very forces that were set in motion through a great calamity, afterward became the means of forceful, constructive action. For the moment, the center of gravity shifted to America” (Sampter Reference Sampter1920: 80). Later, they added that as the Ottomans entered the war, “the people [in Palestine] began to feel the rope tightening around their necks, and they turned to foreign Jews with an appeal for aid. The first and practically the only ones to answer” were American Jews in general and American Jewish Zionists in particular (Sampter Reference Sampter1920: 218). American Jewish aid was crucial. Without it, Jewish settlements in Palestine would either collapse or suffer terribly (Sampter Reference Sampter1920: 219; WZO 1921: 14).
Skillful action: Louis Brandeis
Crisis might create opportunities for action, but understanding how action unfolds and how resources and possibilities for creative action are reconfigured during crisis remains an analytical challenge (Clemens Reference Clemens2015). Overcoming this challenge demands attention to the subjective frames that inform action (Sendroiu Reference Sendroiu2024). In this section, I focus on the role of Supreme Court Justice and Zionist leader Louis Brandeis in initiating the process that led to the development of public health institutions in Palestine. Brandeis’s response to war-induced crisis illuminates an important relationship often missing in scholarship, between the disruptive event itself and social transformation that follows (Clemens Reference Clemens2015: 2). It also shows that what sparked transformation was the worsening of existing illness patterns and health conditions, not a rift in time and space.
As World War I ended, Zionists were preparing to renew immigration and settlement in Palestine. In 1919, Brandeis toured the country with other Zionist leaders and was able to personally assess local conditions. Palestine impressed him, but he was alarmed by postwar malaria. Seeing children suffering from the disease disturbed Brandeis and reminded him of his Kentuckian boyhood when he personally experienced malaria’s impact (de Haas Reference de Haas1929: 116).
Brandeis realized malaria was the main obstacle for the country’s political-economic development and decided that uprooting it would be a central task of American Zionists (de Haas Reference de Haas1929: 116–17). Speaking to fellow Zionists after his return from Palestine, Brandeis stunned his audience by focusing not on his idealism but on malaria. Some of Brandeis’s colleagues were so astonished by this centering of disease they later attributed his eventual withdrawal from Zionist politics to continued shock over Palestine’s malaria problem (de Haas Reference de Haas1929: 121–22).
In 1920, Brandeis declared that the opportunity for developing a homeland afforded by British rule must be seized upon. The mandate was a new beginning in Zionist politics, where diplomacy declined in significance compared to concrete work, organization, and “the politics of action” (Brandeis Reference Brandeis and de Haas1929: 242–43). A key component of these politics of action was ensuring that Jews would be able to work and earn a living in Palestine and secure the physical and financial well-being of Jewish settlement. Therefore, eliminating malaria was critical (Brandeis Reference Brandeis and de Haas1929: 252). Brandeis (Reference Brandeis and de Haas1929: 242) noted that American Zionists have some financial resources to develop Jewish Palestine, but “except as through the Medical Unit [AZMU] … we have not advanced a step towards the developing the homeland.” Speedy colonization was essential, and Brandeis (Reference Brandeis and de Haas1929: 262) suggested making immediate expenditures to develop Palestine. As part of the lessons of his 1919 visit, Brandeis personally furnished the means to initiate a study of the malaria problem (Kligler Reference Kligler1930: viii).
War, crisis, and state formation I: From the AZMU to the HMO
The wartime crisis brought actors to direct resources and intervene in Palestine in ways that supported Zionist goals by developing health institutions. Hadassah and the JDC organized the ZMU that arrived in Palestine in 1919. The unit included over 40 doctors, nurses, pharmacists, and other health workers. It also carried medication and equipment, including ambulances.Footnote 23
The AZMU demonstrates how measures taken in the aftermath of war translate to the development of national proto-state institutions. The first mission of the AZMU was to provide emergency medical relief and deal with the burning issues caused by the war. Immediately after its arrival in Palestine, the AZMU treated cholera, malaria, dysentery, and eye diseases. AZMU also surveyed the country with local doctors to understand how to improve sanitary conditions.Footnote 24 But besides relief, AZMU was supposed to prepare the ground for more comprehensive health services as part of the national project. Essentially, it was to use postwar action as groundwork for the development of national public health institutions.Footnote 25 This transition happened when Hadassah in the US formed its “offspring” – the HMO – as a more permanent health organization that evolved out of the AZMU.
Szold explained that for Hadassah, the AZMU was “an instrumentality fashioned by the war,” giving the organization’s members “the opportunity of beginning to realize their plan of a medical establishment for Palestine.”Footnote 26 Thus, “the unit was fashioned as the foundation of an establishment.”Footnote 27 Szold aptly summarized this transition, writing that Hadassah “came into the country as a war organization” and “remained in the land as a peace organization.”Footnote 28
The transition from war to peace and, by the early 1920s, from emergency relief to establishing comprehensive health services, is evident in the expansion of HMO activities. This expansion was also related to the increase in Jewish immigration and settlement. Expansion of services began with AZMU. For example, after its arrival and initial operations and as colonization recovered from a wartime halt, the AZMU extended its sanitary activities out of the cities and into the rural areas – the loci of Jewish labor camps and settlements. As mass Jewish immigration began in 1920, the AZMU paid special attention to immigrants and began their medical inspection, fumigation, and disinfection. There was also a school hygiene service that was initially planned for Jerusalem but eventually expanded to other cities and to some extent to colonies and settlements. Footnote 29 Around 1921, when the AZMU turned to the HMO, the latter further expanded and developed its activities to meet the needs of the Jewish community in the country. By the late 1920s and into the 1930s, a country-wide system of hospitals, clinics, and various departments served the population. The number of beds in the hospitals steadily grew. The HMO also maintained health centers in Jerusalem and Tel Aviv dedicated to preventive medicine and health education services, including nutrition, “tooth hygiene,” and marital and sexual consultation.Footnote 30
When intercommunal violence erupted in Palestine, the HMO rendered important services to the Jewish community. During the violent events of 1929 and the Arab Revolt of 1936–1939, Palestinians clashed with Jews and with the British colonial state over British policies and the advent of Zionism (Morris Reference Morris2001: ch. 4; Shapira Reference Shapira2012: ch. 3). HMO participated in the emergency efforts, treating the injured and adapting its institutions to the needs of the hour.Footnote 31
During World War II, HMO undertook emergency measures once again. Although Palestine was not a battleground, the fighting reached close enough, and the Jewish community prepared for the possibility of war in the country. Among these emergency measures were actions to prevent epidemic outbreaks and, again, efforts to ensure Jews received adequate care during the hostilities.Footnote 32
Importantly, the HMO played a major role in the development of proto-state institutions by transferring its institutions to local Jewish communities and Zionist political bodies. This practice stemmed from one of the HMO’s fundamental principles: that Jews in Palestine should carry the burden of medical work once the community was strong enough politically and economically.Footnote 33 Starting from the 1930s, hospitals began to transfer to municipal authorities. Hadassah continued to support them on a diminishing scale. HMO’s preventative services and some of its hospitals were to be transferred to the General Council of the Jewish Community in Palestine (called Vaad Leumi) and its health department, which was effectively the health department of the emerging Jewish state.Footnote 34 The HMO did maintain other activities. Together with medical bodies such as the Sick Funds, these health enterprises were placed under the supervision of Vaad Leumi and its health department and later under the Israeli Ministry of Health (Grushka Reference Grushka1952: 10).Footnote 35 The “war organization” the HMO started as not only turned into a “peace organization;” many of its institutions later became a part of the state.
Although postwar public health activities helped bring territorial and institutional gains for Zionists, it was not a smooth process that simply created a state. Interests of different Zionist groups caused power struggles that threatened AZMU and HMO operations. Power struggles were especially fierce from 1919 until the late 1920s. For example, groups affiliated with Zionist Labor, perhaps the most important group involved in state-building (e.g., Shapiro Reference Shapiro1976), accused and attacked the AZMU and later the HMO for their condescending approach and for operating against national interests. Among the charges Labor made was the claim that AZMU-HMO channeled too many resources into work in urban areas instead of supporting rural colonization. Labor also argued that the AZMU and HMO operated as a separatist organization, which hurt Zionist political centralization. There were even calls for a boycott and for the American organizations to leave Palestine. Criticism of Hadassah was at least partially justified. Hadassah strived to maintain autonomy from other Zionist bodies and groups, which it deemed inferior and disorganized (Hirsch Reference Hirsch2014; Shvarts and Shehory Rubin Reference Shvarts and Shehory Rubin2012). After several tumultuous years filled with power struggles, Zionists in Palestine and Hadassah were able to establish working relations. By the end of the 1920s and into the 1930s, the HMO cooperated with Zionist political bodies, and Hadassah representatives participated in some of them. Relations with labor also improved, and the HMO became an important part of the evolving polity and later the state (Grushka Reference Grushka1952).Footnote 36
War, crisis, and state formation II: From the AZMU to the MRU
As with the AZMU and HMO, the MRU was one of the means of alleviating the postwar crisis. The unit was formed in 1922 and was disbanded around 1931. It evolved out of the preliminary study of the malaria problem that Brandeis funded following his 1919 visit to Palestine, when he was distressed by the effects of the disease. Doctor Israel Kligler, a Zionist, was appointed to head the study that was undertaken under the auspices of the AZMU (Kligler Reference Kligler1930: viii). After the study yielded encouraging results, it was decided to form a country-wide antimalarial organization that will focus on Jewish rural settlements with Kligler as its head (Kligler Reference Kligler1930b). The JDC provided the necessary funds, and the MRU was formed (Kligler Reference Kligler1930: ix).
The MRU became part of the British colonial state’s department of health. The unit was the most important malaria research agency during the early mandate period (Sufian Reference Sufian2007) and quickly covered all areas of Jewish colonization (Kligler Reference Kligler1930: ix). The MRU studied the various factors that caused malarial morbidity, produced statistics, examined the efficacy of different control measures, and developed and supervised antimalaria schemes.Footnote 37
The MRU made critical contributions to Zionist colonization, and Kligler himself explicitly connected malaria control and the advancement of Zionism in Palestine.Footnote 38 The unit conducted important antimalarial work by itself but also influenced and collaborated with Zionist colonization agencies that undertook their own antimalaria work, such as the Jewish National Fund (JNF).Footnote 39 The collaboration led to the amelioration of large territories and to important changes in colonization practices.Footnote 40 Kligler (Reference Kligler1930: 202) wrote that the colonizing agencies that collaborated with the MRU were stimulated to action by the unit’s organized antimalarial campaign. Evidence suggests he was correct. For example, Avraham Granovsky of the JNF wrote that the organization did not consider reclamation work to be important until after World War I. Then, reclamation “came to represent an important item of the budget” (Granovsky Reference Granovsky1926: 81). A 1936 report established the time sequence in which large-scale antimalarial work began during the mandate. The report mentions that Jews
Attacked [malaria] in a planned and systematic manner. In the first place, the Jewish Joint Distribution of America attached a Malaria Research Unit to the department of health … In the second place, the Jewish colonizing agencies–the Jewish National Fund, the PICA and others, adopted a policy of drainage reclamation.Footnote 41
Between 1922, when the MRU was formed, and 1932, a year after the MRU disbanded, Zionists added some 212,500 acres of land, almost tripling the land in their possession. All these areas had to be drained (Elazari Volcani Reference Elazari-Volcani1932: 84–85), and in all of them the MRU worked by itself or with the colonizing agencies.Footnote 42
It seems that Kligler was also able to influence colonization practices and policies (Sufian Reference Sufian2007: 198–203). Ruppin and Granovsky argued that World War I constituted a watershed in Jewish reclamation works. Before the war, “too little attention was paid to the subject” despite malaria’s effects on colonization and economic development (Granovky Reference Granovsky1926: 79). There were no attempts to remedy malaria before settling. After the war, “a radical change was made,” and antimalarial work preceded settlement (Granovsky Reference Granovsky1926: 80). Ruppin wrote: “It has become a principle of colonization that all marshy land must be subjected to drainage and sanitary work before the final settlement. Many advantages ensue from this system” (Ruppin Reference Ruppin1926: 61, italics in original). This approach was advocated by Kligler as he hoped Zionist colonizing agencies would make the land habitable before settlement (Kligler Reference Kligler1930: ix–x). Kligler was able to win the attention of colonization agencies and make sure health and sanitary matters are considered in the process of settlement.Footnote 43
Created out of a war-induced crisis, the MRU was tightly linked to the bodies that orchestrated Jewish colonization. The unit made settlement safer and assured it could advance. Though it began to dissolve in 1926 and disbanded in 1931, the MRU provided a lifeline for early settlements, enabled further territorial consolidation, and laid the scientific foundations of malaria control in Palestine and later in Israel (Sufian Reference Sufian2007: 217). Prominent MRU personnel and inspectors began working for institutions like the JNF after the unit disbanded, continuing their battle against disease and for colonization (Saliternik Reference Saliternik1979).
The fate of the MRU shows that organizations and institutions created out of crisis do not necessarily last. At least two important factors determined the MRU’s demise: first, the differing interests of the groups involved in state building; and second, the amelioration of postwar conditions. The reasons for the discontinuation of the MRU were cutbacks in the colonial state’s department of health as well as British refusal to maintain a special section dedicated to malaria control in the Jewish rural sector. Zionist political institutions called to keep the MRU, arguing that the government could not organize a rural antimalarial service that would be as efficient and effective. The government was not impressed. Additionally, the JDC withdrew its support and stopped funding the unit (Sufian Reference Sufian2007: 194–95). Lastly, the British thought that as time passed, postwar malaria morbidity declined and reached a manageable level. By 1928, existing antimalarial measures were deemed sufficient, and the British reported that there had been “much progress … In dealing with the rural malaria problem” – which was the focus of the MRU.Footnote 44 Thus, the unit was dissolved.
As with the HMO, the outcome of postwar efforts made Jews in Palestine better prepared to meet challenges caused by other wars. Former MRU-trained personnel sprang into action when World War II threatened to increase malaria morbidity because of manpower shortages and because developments in irrigation and fish-farming provided potential breeding grounds for malaria-spreading mosquitos. Together with other Zionist bodies, former MRU inspector Zvi Saliternik formed and led the Central Antimalarial Committee that made sure to keep Palestine free from epidemic outbreaks during World War II (Saliternik Reference Saliternik1947: 11). He also led the Zionist-turned-Israeli efforts to keep morbidity low during the 1948 War (Saliternik Reference Saliternik1979: 124–34) and later headed the Israeli antimalarial department in the ministry of health.
Palestinian society and Jewish health
When the first Zionist settlers arrived at Palestine, the country was ruled by the Ottoman Empire and inhabited mostly by Arabs. While Palestinians saw Zionists as European intruders, the latter were still too weak to pose any real threat (Shapira Reference Shapira2012). However, during British rule, Palestinians witnessed a growing Zionist presence in Palestine as the number of Jews in the country and the scope of Jewish territorial possessions increased dramatically. Immediately after World War I, there were only some 56,000 Jews in Palestine. By 1927, the number grew to an estimated 150,000 and then to around 174,610 in 1931. The rise of the Nazis and the Jewish predicament in Europe brought more immigrants, and the number of Jews in Palestine jumped to about 384,000 in 1936 and then to 484,000 in 1939 (Shapira Reference Shapira2012: 115). As mentioned above, land purchases also advanced as Jews added hundreds of thousands of acres to their possession during the 1920s and early 1930s.Footnote 45 Starting from 1930, these purchases were better planned, guided by the Zionists’ wish to create “a strategically defensible geographical nucleus for a state” by buying contiguous tracts of land (Stein Reference Stein1984: 177. See also 65–67, 175).
Intensifying Zionist presence and activity intersected with older trends of Palestinian rural impoverishment, divided and factionalized leadership, internal inequality, and the structure of the land market, all dating back to the mid-nineteenth century, before Zionists even arrived in the country (Khalidi Reference Khalidi2006; Krämer Reference Krämer2008; Pappé Reference Pappé2004; Stein Reference Stein1984). The combination of the threat posed by Zionism and the British with the existing Palestinian social structure made matters far worse for Palestinians as those trends hampered effective resistance.
Coupled with the confines imposed on them by the Declaration, Palestinians saw the country change before their eyes. Some Palestinians claimed their people were “a nation threatened with disappearance by this Zionist tide” (‘Isa al-‘Isa, quoted in Khalidi Reference Khalidi2020: 26). Palestinian anger at the situation exploded in the 1929 riots, which lasted about a week and left 133 Jews and 116 Arabs dead (Morris Reference Morris2001: 116). Then came the Arab Revolt of 1936–1939. Palestinians turned to arms and boycotts to resist the British and the Zionists. The Revolt and its repression by the British wreaked havoc on Palestinian society. Many died, were arrested, or fled the country, and the Palestinian economy suffered a major blow. The Revolt’s repression had long-term repercussions. When Palestinians began their confrontation with Zionists in 1948, they were already disadvantaged because of the Revolt’s aftermath (Khalidi Reference Khalidi2020: 42–47; Krämer Reference Krämer2008: 294–95; Morris Reference Morris2001: ch. 4).
Jewish public health institutions, born out of crisis, enabled Zionists to break new ground in colonization, increase immigration, and develop an institutional apparatus. By 1939–1940, when Palestinian society anguished under the effects of the revolt, a Jewish state was just a matter of time (Stein Reference Stein1984: xvi).
Postwar public health indirectly contributed to the development of the intercommunal conflict. A previous contribution traced the seeds of conflict to the economic arena, focusing on labor competition between Jews and Arabs during Ottoman rule (Shafir Reference Shafir1996). However, many in early twentieth-century Palestine were less concerned with politics and more with troubles like diseases. Despite the advance of both Jewish colonization and Palestinian nationalism during the last years of Ottoman rule, the annual epidemics that frequented Palestine “remained a much more significant part of life” than politics (Pappé Reference Pappé2004: 61). Since postwar public health activities made critical contributions to Zionist territorial and political consolidation and helped transform Palestine into a Jewish state, they also indirectly made the threat of Zionism more palpable to Palestinians.
Conclusion: Calamitous states
The relationship between war and state formation received much attention from social scientists. On the one hand, scholars studying Europe and Latin America argued that successful war-making fosters state formation by driving territorialization and administrative development (Centeno Reference Centeno1997, Reference Centeno2002; Rodríguez-Franco Reference Rodríguez-Franco2016; Tilly Reference Tilly, Evans, Rueschemeyer and Skocpol1985, Reference Tilly1992). This is especially true when the local economy can support the extraction of resources needed to fund war and when no alternative funding sources are available. On the other hand, scholarship on settler colonialism shows that developing institutions and policies that support territorial control and political economic development as well as providing settlers with necessary social services were often key to state formation. Wars in the colonies might have been devastating to local populations but did not necessitate the same institutional-administrative development as in Europe (e.g., Frymer Reference Frymer2017; Herbst Reference Herbst2014; Kimmerling Reference Kimmerling2001; Loveman Reference Loveman2005; Owen Reference Owen2004; Osterhammel Reference Osterhammel2005: 43-44; Quinn Reference Quinn2019; Shafir Reference Shafir1996).
My findings challenge the tendency to deemphasize the significance of war for state formation in colonial contexts. In line with recent work on the Middle East (Wyrzten Reference Wyrtzen2022), I showed that war does shape state formation in a settler colonial context, and that it includes interventions by imperial actors and transnational allies, as well as the establishment of new streams of resources. But unlike this work, the Israel-Palestine case shows that the relationship between war and state formation is mediated by crisis (or crises). It is that war-induced crisis that brings transnational interventions and helps establish new resource flows.
As a concept, “crisis” is mentioned very frequently but also very casually, so it often remains inadequately theorized (Desai Reference Desai2023). Offering more rigorous theoretical work, some historical social scientists conceptualized crisis as a historical event that might bring major structural transformations (Clemens Reference Clemens2015; Desai Reference Desai2023; Sewell Reference Sewell1996, Reference Sewell2005). This eventful theorization sees crisis as entailing historical ruptures, rifts, or decouplings in space and time. These major disruptions produce transformation by opening new opportunities for action and strategic response, and they also allow for reconfiguration of resources (Clemens Reference Clemens2015).
My own theory of crisis acknowledges the importance of contingencies and disruptions in time and space. However, it challenges the view of crisis as including major historical rifts by emphasizing continuity and exacerbation of past patterns and conditions. Following Marx (Reference Marx1926: 23; Reference Marx and Tucker1978: 595), I suggested that while crisis seemingly creates entirely new structures, actors facing crisis must reckon with “the material handed down by the past” and the influence of that material on current circumstances. Furthermore, it is exactly the intersection between contingency and preexisting patterns that produce change. To paraphrase Marx (Reference Marx1926: 23, Reference Marx and Tucker1978: 595), I suggest that eventful crises might make history, but they do not make it just as they please – because past patterns may shape potential structural transformations.
Empirically, I showed that the developing public health institutions helped change Zionists’ dire situation in Palestine and therefore the country’s history. Developing public health institutions came at the heels of a war-induced crisis that transformed the distribution of resources, organization of power, and future possibilities (Clemens Reference Clemens2015). But this major transformation did not necessarily include a rapture or decoupling from past patterns and occurrences. Exacerbating existing (morbidity) patterns and issues was what brought actors to develop public health institutions, which removed a major threat to colonization, immigration, and state formation more generally. This intersection between existing health problems and an eventful crisis immensely shaped political development and the trajectory of the country.
Crisis is not an autonomous force that magically creates structural transformation. The development of health institutions and that development’s political implications were clearly understood by skillful actors working to implement desired futures (Clemens Reference Clemens2015; Wyrtzen Reference Wyrtzen2022), actors such as Louis Brandeis and Henrietta Szold. Whatever openings the eventful crisis provided, these actors sought to make the most of it and produce transformation. Thus, this article follows existing work in suggesting an important analytic distinction: the distinction between crisis that creates an opportunity for action and the conditions and ways in which actors innovate or draw on existing resources and institutions to respond to that opportunity (Clemens Reference Clemens2015).
I have also shown the importance of two additional factors involved in state formation. First, there are the multiple actors involved in the process and the differing interests these actors might have. As the case of the MRU showed, the interests of the settler community and the colonial state diverged during the late 1920s and early 1930s. The struggles of the HMO showed that different groups within the settler community also might clash. The second factor is the extent to which post-war conditions have been ameliorated. This factor might help determine if institutions will cease to exist, as was the fate of the MRU. But even when dissolution was the case, public health bodies have lasting effects on territorial consolidation and institutional development.
The response to the crisis of World War I helped Zionists weather other wars. Activities aimed at relieving the postwar crisis increased settlers’ capacity to handle clashes with the local population, like the riots of 1929 or the Arab Rebellion of 1936–1939. They also increased the settlers’ capacity to meet challenges caused by other wars such as World War II and the 1948 War.
While my theoretical arguments are based on Israel-Palestine, other cases suggest they have broader utility. In Lebanon, the famine and disease of World War I and the attempts of local and global actors to alleviate suffering after it were not solely the result of any war-induced rapture in time and space: They were also the result of social, economic, and political changes in Lebanon, stretching back to the nineteenth century, that rendered the country more vulnerable to famine before the war began (Tanielian Reference Tanielian2017). Another instructive case is the US’s humanitarian efforts after World War I. These efforts opened new streams of resources and helped transform global power structures. But it was rooted in preexisting understandings of benevolence and models of state-building through partnership with non-state actors that the US already implemented in its overseas colonial territories (Clemens Reference Clemens2020; Moore Reference Moore2011; Porter Reference Porter2017). In both cases, crisis did not create a rift or decoupling from the past despite its eventful dimensions.
Lastly, focusing on the postwar crisis as key to Israeli state formation also means that it is relevant to the development of the Israeli-Palestinian conflict. The work of the AZMU, HMO, and MRU reduced the prevalence of disease and helped Zionists advance and, by doing so, made the threat of colonization more palpable to Palestinians. The events of 1929 and 1936–1939 are a testament to that. Since developments in public health supported settlement, they were also indirectly related to the rise in inter-communal tensions.
Acknowledgments
I want to thank Rebecca Jean Emigh, Joan Scott, Jim Mahoney, Veda Kim, Yasemin Bavbek, and Sertac Sen for very helpful feedback on this article. In addition, SSH anonymous reviewers and editors provided excellent comments that greatly improved this article. I also benefitted from presenting a very early version of this manuscript at the American Sociological Association’s 2020 Annual Meeting. I thank the audience for their comments and suggestions. All errors are, of course, mine.
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