AS THE RESULT OF AN unusually prolonged and heavy rainfall in the late spring and early summer months of 1931, signs of flood conditions in Central China began to appear early in July. The level of the Yangtze and the Hwai Rivers and many of their tributaries rose with unprecedented rapidity, the water overflowing into the numerous lakes which are connected with these water-courses. Toward the end of July breaches in the dykes confining these waters began to appear and large areas of cultivated land on which the crops had not yet ripened were flooded… .
The peak was reached during the second half of August, the level of the Yangtze River being three feet higher than any previously recorded level and nearly ten feet above the average high level for that season…. Many cities and villages were completely submerged, others only partly flooded…. Over large areas, barns, cattle and agricultural implements were swept away… .
The extent of the area actually submerged… equals England in size and is at least twice the area affected by the Mississippi floods in 1927. One of the most serious consequences of the floods was the almost complete destruction of the growing crops on which the people depend during the autumn and winter. The very heart of China’s agricultural and commercial activity has been submerged for months. One was faced with the greatest natural disaster of modern times… .
In view of the seriousness of the situation, the National Government of the Republic of China set up, at the end of August, a National Flood Relief Commission…. The National Flood Relief Commission’s Department of Hygiene, Medical Relief and Sanitation confirmed by official reports from all parts of the flooded country that the cultivators did not move far from their farms or villages. Many remained on the nearest high ground or on the roofs of their houses. Others placed their families and any goods they had been able to save in boats, either remaining afloat near their villages or moving to the nearest hills… .
Reliable epidemiological statistics are difficult enough to collect in China even in normal times…. It is scarcely surprising, therefore, that the disorganization of administrative machinery entailed by the flood made it impossible accurately to estimate the ravages caused by infectious diseases. We will accordingly content ourselves with a summary of the observations made by the medical officers who visited the various refugees’ camps.
One preliminary remark should, however, be made that while the inclination of a large majority of the flood victims to remain near their homes made the problem of medical relief almost impossible to solve, on the other hand in all probability it prevented epidemics from reaching dangerous proportions. Large concentrations of refugees in the bad sanitary conditions which are bound to prevail in flooded territory would doubtless have favored the rapid spread of such diseases as smallpox, cholera and dysentery; this was the case in the Wuhan section, where the care of 200,000 refugees would have presented a difficult sanitary problem even under normal circumstances. The incidence of gastro-intestinal diseases was very high in every camp, accounting mainly for the abnormally high infant mortality among the refugees.
Amoebic and bacillary dysentery being endemic in the Yangtse Valley, it is not surprising these infections spread rapidly among the refugees. Cholera, which has occurred regularly in Shanghai for a number of years during the summer, with occasional sporadic cases in ports of the Yangtze, broke out toward the middle of September in several camps in the Wuhan area. At Hankow, for instance, the number of cases among refugees is estimated at 1,600, with a case fatality rate from 15 to 20 per cent. At this time, the town was under four feet of water, rendering it impossible to bury the dead. Typhus and smallpox of severe type occurred in all the provinces affected by the floods.
The existence of malaria was reported by all the medical and health units, in spite of the fact that apparently the first effect of the floods was to wash away larvae and thus diminish the risk of transmission—for example, the number of cases in the mission hospital at Wuhu at the commencement of the flood period was lower than usual for that season of the year. Subsequently, however, malaria constituted a grave problem… .
It is evident that the existence of these epidemic diseases constituted difficult problems for the small staff working under the Department of Hygiene, Medical Relief and Sanitation. The hardest task was, however, to provide this mass of refugees, scattered in comparatively small groups over a vast area, with food, shelter and medical relief, when the normal administrative machinery was thrown out of gear by the magnitude of the disaster. The work performed by the medical and health units is best illustrated by the conditions in the Wuhan area… .
In August and September, out of 200,000 refugees in this area, one-half was living with friends or relatives, the remainder being scattered in sixty camps. These camps were located wherever a dry spot and shelter could be found—in schools, temples, theaters, churches, godowns, on hills, dykes and railroad embankments. With limited personnel it was difficult to supervise so many camps, particularly as transport was restricted to rowing boats moving at the speed of not more than two miles an hour… .
In view of the bad sanitary conditions in the camps, special attention was paid to garbage collection. In view of the shortage of sanitary inspectors in all field units, a short course was started for sixty police officers with a view to training them to carry out these duties. Every camp was provided with a sufficient number of trench latrines, and fly breeding was kept under control by the systematic application of disinfectants…. Refugee labor was used in the organization of garbage-collecting crews in each camp. All wells and ponds used by refugees and also the water drawn from the rivers were chlorinated. In some camps, boiled water was distributed. The burial of the dead became a serious problem in large camps, particularly where all the surrounding country was flooded. Special crews were organized, the Red Cross and other similar associations being unable to cope with the problem… .
As the waters began to recede, the number of refugees decreased and it was possible to reduce the number of camps from sixty to twelve, although, in October, there were still 80,000 refugees in the Wuhan area. Their number rose to 140,000 at the end of November. It was evident that, as winter set in, the refugees would return to the camps when their reserves of food gave out. In fact, on January 26th, 1932, there were again 200,000 refugees in the camps of the Wuhan area and the work of the field units had to be again extended…. Many cases of malaria, dysentery and other gastro-intestinal diseases occurred during the floods. The mortality was particularly heavy among children under five years… .
Ludwik Rajchman, MD, 1881–1965. Source. United Nations Office at Geneva, Switzerland, Library, League of Nations Archives.
The potential danger of further outbreaks of epidemics in the flooded areas is very great, especially if we take into account certain predisposing factors such as shortage of food, lack of shelter and mass movements of the population. Information collected by the National Relief Commission proves that the majority of those affected by the floods does not possess sufficient food for the whole winter. Food and money reserves are already giving out and it is likely that the supply will become exhausted in January or February.
Mass migrations will take place if supplies of food fail to reach the villages in proper time. This has already occurred in Hupeh, where the refugee population rose from 80,000–160,000 in six weeks. There is now an abnormal movement of so-called “seasonal workers,” who are actually refugees from the flooded regions to the large cities. This probable migration of large masses with a low organic resistance due to partial starvation and exposure, and which may carry the seeds of epidemic disease, will constitute a very real danger. The existing medical and health services, already handicapped by the lack of funds and supplies, are putting forth their maximum efforts, but these will be wholly insufficient for the larger task which they will be called upon to face… .
In September 1931, the League of National Assembly called upon the public in all countries to show its sympathy for the flood victims in China, by appropriate action, and the attention of the Governments was drawn to the international danger which might arise from the spread of epidemics in the flooded areas…. This appeal was implemented by the League Council inviting the Health Organization to comply with the request of the Chinese Health Administration that it should undertake the co-ordination of the international antiepidemic campaign. The Council asked the Governments to respond as far as possible to all requests for assistance transmitted to them through the Secretariat, and urged the particular need for contributions in money as well as in medical and health staff and material… .
Valuable as the [received] contributions were, they unfortunately only began to arrive some two months after the appeal was made, so that the Chinese authorities had to cope as best they could with the early and most acute phase of the disaster. From the outset, generous contributions were made by the Japanese Governments and its institutions, in the form of material, personnel and transport facilities. After the end of September, however, the Chinese Government felt compelled to decline any further offers of assistance from this source.
In the aggregate, the League’s appeal produced a response sadly disproportionate to the needs of the situation, only six countries out of twenty-one represented in the Health Committee responding to the appeal; of the nine Eastern countries composing the Advisory Council of the Singapore Bureau of the Health Organization, only three complied with the request for assistance… .
The support received in China herself was such as to enable the National Flood Relief Commission to carry on from day to day. The financial and economic crisis, however, which has not spared China, increased the difficulty of coping with a situation which recent developments have rendered tragic. At the present time, assistance and contributions are more urgently needed than ever.