Haakon A. Ikonomou shows how the compulsory population exchange between Turkey and Greece served as a catalyst for the reorganisation of the Greek public health sector by the League of Nations.

In November 1922 the Greek government called on the League of Nations to assist them in the sanitary control of the massive influx of refugees resulting from Greek military defeat and the ensuing humanitarian disaster in Asia Minor. While several cities and towns saw their populations double ‘overnight’, the League was asked by Greek health authorities to set up quarantine stations and coordinate mass vaccination campaigns against smallpox, cholera, and typhoid fever. 

To make the most of limited funds and facilitate the eventual taking over of tasks of the national authorities, the League worked almost exclusively through local health administration. [1] The League had a close relationship with the Rockefeller Foundation, using the promise of Rockefeller funds as leverage in its negotiations with local authorities. [2] By 1 April 1923, over 1.5 million individuals had been immunized against typhoid, cholera, and smallpox. After this initial success, the League’s activities in Greece wound down towards the end of 1923. 

From Emergency Relief to the “Sanitary Re-organization of Greece”

The health challenges facing Greece were of a more profound nature, however. [3] The situation became precarious when, between late 1927 and the summer of 1928, an epidemic of dengue fever affected some 1.3 million people. [4] Accordingly, towards the end of the 1920s the League stepped up again, this time on the invitation of the Greek statesman Eleftherios Venizelos, during his last stint as Premier of Greece (1928-32). Venizelos was pushing major public reforms through the administration with the help of foreign loans and interventions from the League and other international agencies. [5] His approach to the “sanitary reorganization of Greece” suited the League’s working methods nicely. [6]

Venizelos was pushing major public reforms through the administration with the help of foreign loans and interventions from the League and other international agencies.

(Dimitra Giannuli)
M. Venizelos

Early in 1929, a League-led research group conducted a thorough survey of the Greek health services and sanitary conditions. This Commission’s conclusion was far-reaching: “[T]he Commission cannot consider that satisfactory results could be obtained by any mere expansion of the existing organisation. The public health service, to be effective, should be arranged on a new basis and should have new objectives.” [7]

The report proposed a detailed scheme for the re-organization of the sanitary administration which would transition into a permanent public health service around 1933. 

At the heart of this process was the objective of creating a corps d’élite of well-paid, highly educated and fully committed men and women that could form the nucleus of a new generation of medical staff entrusted with the responsibility of building a brand-new public health service. Venizelos was relatively quick to prepare the necessary legislation and shepherd it through the Chambers. The Greek government decided to “entrust the technical control to three foreign experts, all administrative functions being, however, carried out by Greek officials”. [8] At the League’s invitation the Rockefeller Foundation agreed to send specialists to oversee the reforms, provide partial funding and set up a fellowship programme, which would train a new cadre of Greek medical personnel. [9]

League of Nations Archives (LONA), C-162-M-63-1929-III_EN. League of Nations Health Organisation. Collaboration with the Greek Government in the Sanitary re-organisation of Greece (Geneva, April 1929).

A Post-mortem on Technocracy and Crisis

There were clear limitations to the reform efforts, however. In the face of sustained criticism from Greek medical professionals and authorities, the League defended its policy of a centralized health administration and a highly skilled, foreign-trained, and well-paid medical elite. [10] This would create a backlash as the League-led reforms were increasingly hampered by the deterioration of Greece’s finances, the defeat of the Liberal Party and Venizelos, and the onset of a period of political turbulence from 1932 onwards. In this climate the strong professional and administrative resistance within the Greek public health institutions won through. With no firm political leadership and starved of state funds, the reforms stalled. [11]

It is striking how the League was initially invited to build the entire health apparatus of Greece. This was partly due to its technocratic approach and attached funds, which softened the potential resistance against direct sovereignty-infringing interventions. It was also due to the severity of the humanitarian crisis: The government would accept the assistance first and ask the critical questions later. In the end, it was the onset of another crisis – the Great Depression – that halted the efforts at ‘modernization from above’.

* Cover Image Secrétariat de la SDN: Section d’Hygiène, S18. Source: The League of Nations Archives


[1]  Marta Balińska “Assistance and not mere relief: the Epidemic Commission of the League of Nations, 1920-1923”, in Paul Weindling (Ed.) International Health Organisations and Movements, 1918-1939 (Cambridge: CUP, 1995), 81-108, 81.

[2]  Balińska “Assistance”, 89-94.

[3]  Balińska “Assistance”, 99-102; Vassiliki Theodorou and Despina Karakatsani “Ηealth policy in interwar Greece: the intervention by the League of Nations Health Organisation”, Dynamis 2008 (28), 53-75, 59-60.

[4]  Theodorou and Karakatsani “Ηealth”, 53-75.

[5]  Dimitra Giannuli “‘Repeated Disappointment’: The Rockefeller Foundation and the Reform of the Greek Public Health System, 1929–1940”, Bulletin of the History of Medicine, Vol. 72, No. 1 (Spring 1998), pp. 47-72, 51.

[6]  League of Nations Archives (LONA), C-162-M-63-1929-III_EN. League of Nations Health Organisation. Collaboration with the Greek Government in the Sanitary re-organisation of Greece (Geneva, April 1929).

[7]  LONA, League, 6.

[8]  LONA, League, “Note by the President of the Delegation of the Health Committee” (Annex to Report C.162.M.63.1929.III), 4.

[9]  Giannuli “‘Repeated”, 54, 67-68; LONA, Aghnides Private Archives (P1), Monsieur le Chargé d’Affaires et Cher Ami (Monsieur D. Bikelas), 5.11.1928, Geneva; From Aghnides to Doxiadès, 23.02.1929, Geneva.

[10]  Venizelos Archives (VA), Veniselos to Aghnides, 15.09.1929; VA, Dear Mr. President, From Aghnides, 19.09.1929, Geneva; Theodorou and Karakatsani, “Ηealth policy in interwar Greece”, 66-67.

[11]  Theodorou and Karakatsani, “Ηealth”, 73-75; Giannuli, “Repeated”, 69-70.

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