Chapter Four: Serving the French

Chapter Four

Serving the  French

It is 1906 and Istanbul is brewing with revolutionary fervor. The Young Turks are plotting to bring down Sultan Abdulhamid. Ikdam newspaper, where Rifat worked, has been closed down by the Sultan. The Empire has lost the majority of the Balkans, and an atmosphere of desperation, tension, corruption and uncertainty reigns.  And Rifat is out of work. At this point, I imagine one of the well-known authors at the Ikdam Newspaper where Rifat worked, a famous poet, a fellow alumnus of the Military Medical Academy and a mentor, Cenap Şahabettin (Shahabettin) came to Rifat’s assistance. Cenap had been working for the Quarantine Service since 1896 and had served in Ciddah, Kamaran Island, Mersin and Rhodes. A conversation between Cenap and Rifat might have gone something like this:

“Rifat, my friend, you know the Quarantine Service is looking for doctors willing to go to Hecaz (Muslim holy lands) and monitor the health of hajis (pilgrims) as they travel. There is a huge cholera epidemic and they need more doctors. I think you should apply and I will put in a good word for you”.

Rifat is silent. He knows that going to a far away corner of the Empire may mean that he might never be able to return to Istanbul. It is also quite possible to catch cholera and die while taking care of the pilgrims. But what other choice does he have? He consults with his mentor, Ahmet Mithat Efendi, a well-known author and journalist, who is also the ‘nazır’ (minister) overseeing the activities of the Quarantine Service. Ahmet Mithat is adamant that he should apply. Ahmet Mithat has earned the respect of the European Members of the Quarantine Council by his wide knowledge. He is a nationalist who tries his best to promote the employment of Turkish doctors at every level. He has even tried to make sure that those who worked in the French language did not make more money than in Ottoman Turkish. Rifat applies, passes an oral and written exam in French with flying colors and is offered a position to work in the Hejaz region during the pilgrimage season.

His first appointment is to the Kamaran Island Health Council, off the coast of Yemen and still under the Ottoman Empire’s control at the time. The same year, he accompanies the pilgrims from Mecca to Damascus. He continues his position on the Kamaran Island and is appointed assistant to the Ciddah Health Inspector. In 1908, he is a member of the Mecca Health Council, and in 1909 Damascus and Tabuk Health Council and Quarantine Stations. In 1910, he is promoted to Assistant to the General Inspector of the Quarantine Service, returning to Istanbul on a permanent basis, and in 1914 he becomes General Inspector of the same organization.

The International Quarantine Service

I know practically nothing about the organization where my grandfather spent most of his working life. All I remember is my grandmother saying that her husband worked for an international organization that controlled the ships passing through the straits (the Dardanelles and the Bosphorus). She added that Rifat had a kind of diplomatic status or immunity and he earned a good income.

I research the Quarantine Service and learn that it was established by the Ottoman Government but quickly turned into an international organization of its day, or if you will, one that was dominated by Western powers who exerted more and more control over the Ottoman Empire as the latter got weaker and weaker. Established in 1838, the objective of the Quarantine Service was to prevent infectious diseases from entering Ottoman Empire territories and then passing on to Europe. The nineteenth century saw many instances of plagues and cholera that killed thousands of people and prompted governments to set up health services. Millions died from the spread of cholera pandemics from South Asia. Thus, the control of infectious diseases became a staple of international diplomacy. As it is true today, two major issues were of concern: the reluctance of governments to report disease outbreaks and the lack of capacity in many countries to adequately monitor public health and respond to outbreaks. In 1831, the spread of cholera from Russia instigated the Ottoman Empire’s efforts to impose quarantine against ships coming from Russia. The first attempts were to impose quarantine on ships coming into Constantinople from the south through the Dardanelles or from the north, the Black Sea, to the Bosphorus.

Later the Hejaz region,, where the holy cities of Mecca and Medina are located, became a strong focus of the Service. The Hejaz region received thousands of Muslim pilgrims who went there to perform the Haj, one of the most important obligations of every Muslim. Christians were forbidden to enter Mecca and Medina, considered the sacred land of Muslims. Muslims came from around the world to an overcrowded area with limited water, lack of sanitary services, limited accommodation, making it a prime circumstance for contracting sickness and spreading of plagues. The Hejaz region saw several cholera epidemics starting in 1831. As the pilgrims came and returned to their countries, they also carried the epidemic with them. The Western powers focused their efforts in the Hejaz, claiming that their monitoring and surveillance was necessary to stop the spread of the cholera during the Haj (Pilgrimage) season. In response, the Ottoman Empire stipulated in 1859 that all ships entering with pilgrims must have a doctor on board and established health commissions to serve in this region. But were all these efforts directed to stop the epidemic or was there more to it?

Sariyildiz (1996) explains how behind the stated reason of overcoming the cholera epidemic and making the pilgrimage as comfortable as possible, there were underlying power struggles that motivated the Ottoman Empire, Egypt, France and Great Britain during this time. The Ottoman Empire under Sultan Abdulhamid was keen to maintain its influence over its Muslim populations, as it began to lose its territories in Europe. Good relationships with Arab sheikhs were important to Abdulhamid, since he focused on promoting Islam as the glue to hold the Empire together. Egypt, on the other hand, tried setting up its own health commissions in the region in an effort to demonstrate its independence from the Ottoman court. European powers found the area strategically important and profitable as a result of the pilgrim’s needs and as the Hecaz area turned into a strong trading center. Thus, the French, the Dutch, and the British competed for influence in this region.

At the time that Dr. Rifat began to work for the Quarantine Service, the organization was mostly under French control. French interests were clearly inimical to Ottoman interests. The French were interested in balancing the power of the British in this region, in diminishing the power of the Ottoman Empire, and also in preventing Muslims from coming together to promote their own interests. The French government tried to prevent Muslims from their colonial territories (Algeria and Tunisia) from going on the pilgrimage at various times. There is evidence that the British government also employed the same policy, limiting and at times prohibiting Haj from British colonial territories. Yet, the British government also encouraged the poorest, most destitute people from India to travel to the Hejaz region – to show the world the squalid conditions of the Haj, and by implication, the Ottoman Empire’s inability to effectively oversee this process.

It turns out that my grandfather worked for an organization at the center of international diplomacy and power struggles, and an organization controlled by the French. For a ‘Young Turk’, a young doctor with strong loyalty to his country, what did working  for the French mean? How did he reconcile working for the French with his nationalist fervor? I don’t have any answers. I decide to research what it was like to work as a doctor and inspector for the Quarantine Service in the Hejaz region during those years.

The pilgrims could reach Mecca either on land or by ship. The most important routes by land were from Damascus down to Mecca and from Cairo to Mecca. The travelers met in Damascus or Cairo, having come from many different countries and from those cities traveled together to Mecca on camels in caravans. Traveling by land to Hecaz was a very difficult and long journey. The haji candidates faced adverse climate conditions traveling through deserts, as well as unhealthy conditions, including limited food and water. Furthermore, they encountered attacks by the Bedevi (Bedoin) tribes who controlled the vast desert area. The Bedevi tribes made their living by both providing camels for hire but also by robbing the travelers. The Ottoman government tried to provide a safe passage through police forces, and even paid off the tribal sheikhs. But the bottom line was that the Ottomans did not have much authority over local sheikhs and emirs.  See the map of Arabian Peninsula under Ottoman control

The pilgrims who arrived by sea to Jeddah faced different but equally precarious conditions. The ships that arrived in Hejaz either from the south end of the Red Sea through the Babulmendeb Straits or through the Suez Canal from the North. The ships that brought them to Hejaz mostly belonged to the British, Dutch and French. The shipping lines, however, colluded with each other to keep the fares high and shared the profits with the local governors of Hecaz region. The major concern of the travelers by ship were not the high fares, but the quality and service on the ships themselves. These ships were unsafe, uncomfortable and the number of passengers they took was several times more than the capacity of the ships. In fact, some of the ships were not even passenger ships but tankers meant to transport goods only. What this meant was that the conditions on the ships were extremely unhealthy and unsafe, conducive to the spread of diseases. Meanwhile, the pilgrims generally were willing to take all the risks and difficulties in order to make this pilgrimage and become a ‘haji’.

Dr. Ferrari, a member of the Health Council of Iskenderiye, (Alexandria, Egypt) in charge of health policy in the Suez Canal is quoted as having said the following regarding the state of the ships carrying the pilgrims: (Sarıyıldız, 1996: 44-45)

“The pilgrims are transported in ships that are old and almost unusable. Since they are overcrowded, there is a chaotic circumstance on ships. It is not possible to move around on decks or inside. There are always more people on the ships than what the captain claims on the official lists they provide. Most of the time, there are no tents on decks to protect the travelers from the intense sun. The toilets are connected to the decks by ropes, thus they are very precarious. In stormy weather, there is always the danger to fall into the sea. Those that are inside the ship down below carry their tin potty with them, and throw their poop out the window. But of course, this can only be done in fair weather. Otherwise the windows remain closed and it is hard to go up to the deck to empty the potties. The supply of water is limited and unhealthy. Furthermore, I must admit that I have found discrepancies about what the captains reported to me about the state of the passengers, and my own observations. When I actually entered the ship and walked around, I saw many unhealthy looking people, and many sick people lying here and there. In fact, I saw those that were extremely sick such that it was impossible to even go near them because of the stench. I heard that when such people died that they were simply thrown into the sea.” 

It is clear that Dr. Rifat, along with all doctors appointed to monitor the pilgrims, faced very precarious and difficult conditions. The doctors had to assist thousands of people who arrived tired, thirsty, hungry and sometimes very sick. One of the first solutions that the Ottoman government devised to solve the predicament of the pilgrims was the construction of a tahaffuzhane (Quarantine Station) at the entrance of the Babulmendeb Straits on the Kamaran Island. This center started to operate in 1882, monitoring the health of the pilgrims arriving on ship from the Indian Ocean. A health conference held in Constantinople in 1866 had reached the conclusion that cholera spread from India through the pilgrims to Hecaz.

Dr. Rifat was first appointed to the tahaffuzhane on the Kamaran Island.(See the History of Kamaran Island) According to the Yemenis, the Kamaran Island gained prosperity as a result of the Ottoman decision to build a quarantine station there. From late in the nineteenth century, ships packed with Muslims from India, Africa and all the countries of the Far East, crowded into the Kamaran port during the pilgrimage season. Their human cargoes were off-loaded into camps, medically inspected, disinfested and disinfected before being allowed to proceed to the sacred soil which began at Jeddah, a little further up the coast, and ended before the Kaaba of Mecca. The Ottomans chose Kamaran Island to build the quarantine station because it had a large, protected port and a mild climate. The construction of the station included digging for wells, and constructing an ice factory in order to supply sufficient water to the pilgrims. Doctors who arrived to work on the Island, were advised to bring as much of their own food as possible as it was not easy to find food there. Sometimes, mutton or veal was available but they were not considered very edible. They were also suggested to bring cans of dried food, olive oil, butter. The quarantine station was very large, capable of receiving six thousand or so people. There was a special building for those who are infected, a special section for those with smallpox. The areas for the healthy pilgrims were far away from the clinics and are surrounded by a fence.

I can imagine Dr. Rifat being welcomed by the director of the Station as he arrives at the island. He notices a railway around the whole compound. It is impossible to take care of so many sick people with so few doctors. He is exhausted at the end of the day, and there are still more and more people arriving by ship, sick, hungry, dirty, some close to death. So much misery, so much pain is hard to take day after day. At night, he sits down to write a report in French to be sent to Constantinople. The only saving grace is that the job is short term during the pilgrimage season. His next appointment is to Mecca and he is tasked with accompanying the hajis from Mecca to Damascus. There is a new railway that connects Medina to Damascus, called the Hejaz Railway.

The construction of the Hejaz Railway began in 1900 during Sultan Abdulhamid’s reign and was built with German advice and support. It was built to extend the previously existing railway line between Constantinople and Damascus all the way to Mecca. But it only was able to reach Medina due to the interruption of the construction caused by the outbreak of World War II. The railroad was intended to make pilgrimage relatively more comfortable and at the same time, and more importantly to increase the Empire’s military and political power in the Arabian Peninsula and the Read Sea region. For the pilgrims, the duration of the trip between Damascus and Medina was now reduced from more than a month to less than a week. If there was any attack on this region, the railroad was intended to also serve a strategic purpose, connecting the periphery with the center. Read about the Hejaz Railway.

It is 1909.  Rifat is in Mecca, but his heart is in Istanbul. He is now married and he is also eager to return to academic life. The times are different now. In 1908, a small group of Ittihat ve Terakki  (Committee on Union and Progress) members, a group of young military men took Istanbul by surprise, forcing Sultan Abdulhamid to give up his absolute power and announced Constitutional Rule. They promised to establish an elected Parliament. After thirty years of Sultan Abdulhamid’s despotic rule, there is euphoria on the streets. Finally, constitutional rule has arrived, and the thirty year period of despotism ended. Perhaps now there is a chance to go back to the military medical academy. It is one of those long, languid, hot nights in Mecca. Rifat sits down at his desk to write a letter in French to his beloved professor, Zoeros Pasha: (Mehmet Emin Bilgen, Unpublished biography of Dr. Kilisli Rifat)

Dear respected master,

The Military Academy has been the center of the evolution of Turkish thought and of Turkish nationalism and has been suppressed by the previous regime. As you well know, the academy is ill and needs to be disinfected and reformed. I am now the Health Manager in Mecca. Even though I make 5000 kurush a month here, I still miss teaching. I want to serve my country and I want to repay the Military Academy for my education. However, I am now married, and I need at least 2,000 kurush monthly salary in order to survive. Please let me know if there is a teaching position for at least this amount. I would be happy to enter any exam for an academic position in public hygiene or internal medicine. I would greatly appreciate your assistance in my potential candidacy should there be an open position in these fields. 

I do not know how Zoeros Pasha answered this letter, but Rifat did not return to academia until much later. He continued to work with the International Quarantine Service in Istanbul, rising up in his ranks, and ultimately supervising its transformation into an institution of the Republic of Turkey called Hudut ve Sahiller Sağlık Genel Müdürlüğü (Health Directorate of Borders and Coastlines), and became its first Director between 1924-1927.

A Visit to the Health Directorate of Borders and Coastlines

I am very curious to find out what the present director of the Hudut ve Sahiller Saglik Genel Müdürlüğü might know of its history and of its first Director, Dr. Kilisli Rifat. The office is located in Istanbul near the Karaköy port. One sunny morning, a century later than when my grandfather started working for this organization, I begin my descent from the Galata Tower area in Istanbul down the narrow old streets towards Karaköy. I pass by the Karaköy docks, enjoying a cool sea breeze. I stop in front of a bakery, smelling the freshly baked ‘simit’. It is so tempting to stop, have a simit and a glass of tea. I quicken my steps, as my appointment is just a few minutes away and walk towards a small pinkish building, with colorful glass windows, and a sign “HSSGM”(Hudut ve Sahiller Sağlık Genel Müdürlüğü). I stand in front of it for a few minutes. It is as if time has stopped, I am trembling with excitement. I reach for my camera, feeling like a tourist and start taking pictures of the building. I start chatting with someone in official garb standing outside having a cigarette, asking him where Ömer Bey’s office is. It turns out the main building is not this one, but just one street down. I try to remember: did he say that their building was not on the waterfront but on the street parallel to the waterfront street? I walk a little further, turn left and find myself on the street parallel to the waterfront. What I see in front of me is an old but well-maintained yellow, wood building. Turning around, I see many street vendors in the coolness of the morning, getting prepared to sell mostly hardware and knick knacks. The sea breeze brings wafts of fish and seaweed smells.

Hudut ve Sahiller Genel Müdürlüğü in Istanbul (DIrectorate of Health for Borders and Coastlines). Photo by author

Dr. Rifat must have gone up and down these worn down marble steps so many times. I remember reading that this building was originally right by the sea, and that Sultan Mahmud, the Second, was transported here by boat. The u-shaped entrances on the ground floor of the building seem to have been built for boats. Now this area is being used as a mosque, called Underground Mosque. This building was previously the summer ‘köşk’ (residence) of Sultan Mahmud. In 1842, it became the seat of the Quarantine Service and subsequently used by the Government of Turkey to house the Directorate.

Underground Mosque on the fırst floor of the Hudut ve Sahiller Genel Müdürlüğü. Photo by author.

Ömer Bey, the Assistant Director, is waiting for me and my cousin Ahmet. Generally high-level bureaucrats don’t give appointments to an anonymous caller. But once I mention on the phone that I am the granddaughter of Dr. Kilisli Rifat, I am immediately granted an appointment. Ömer Bey says that he would be delighted and honored to meet the first Director’s granddaughter. Ahmet and I enter the building. The wood floor creaks under our feet. So this is where our grandfather worked every day, in this beautiful wood building with high ceilings, at the heart of old Istanbul. Ömer Bey welcomes us into his office with a broad smile. After ordering tea, he begins to talk:

“Your grandfather was our first Director. He served between 1924-1927. For this reason, he is very important to us and is highly respected. Furthermore, if it wasn’t for your grandfather, this institution was going to be moved to Ankara. When Ataturk wanted to transfer this organization to Ankara, the capital, Dr. Rifat objected that a maritime organization must remain in Istanbul, a port city, and threatened to resign. And after that, Ataturk agreed that it should remain in Istanbul. We are really honored to have his grandchildren visiting us today.”

Ahmet and I are eager to learn more about the history of the Quarantine Service. Ömer bey sighs and says:

“We know so little. During the final collapse of the Ottoman Empire, this organization was controlled by France. Unfortunately when the Republic of Turkey was founded, the French left, taking many of the relevant documents with them, as well as the revenues. Thus, we are an organization without history. Another reason we know so little about the history of this organization is because we are cut off from our own history. We can’t readily read the documents we do have, as they are in Arabic script and Ottoman Turkish. What a pity!”

“We do have some information”, Ömer Bey continues: “That information confirms that what started out as an Ottoman organization, in fact, became an organization controlled by European powers, and part of the capitulations that the Empire granted them.” He explains that once it became clear that the capacity of the Ottoman Quarantine service to monitor and respond to outbreaks was limited, experts from Europe were invited to assist its activities. Soon European doctors became members of the Council, and furthermore, representatives of European powers also became members with voting and decision-making authority. The Council was an Ottoman Council in name only. In fact, foreigners had greater influence in decision-making, as only four members out of eighteen were Ottoman. This effectively meant that the coasts, ports, trade centers and all marine activities came under the influence of Europeans, who now had the power to directly intervene in the Ottoman Empire’s affairs. (Sarıyıldız, 1996)

We learn that most of the revenue of the Quarantine Service came from taxes and fees charged to passing ships. Ömer Bey points out that tahaffuzhanes (quarantine stations) were built to receive and monitor the passengers from ships before they were allowed to embark. The quarantine stations outside of the Hejaz region became the focal points to receive, care for and resettle thousands of Muslim refugees pushed out of the Balkans as the Ottoman Empire collapsed and new ‘Christian’ nations were born. Christianity became one of the major defining characteristics of the new nations such as Greece, Bulgaria, Macedonia, Serbia, Bosnia and others. Muslims were driven out. The Muslim refugees who had arrived with mostly what was on their backs, having lost many of their relatives to war and famine, were first received at these quarantine centers such as in Urla near Izmir. They were given food and tents to sleep in and from there transferred to towns and villages where they would settle. Ahmet and I make a mental note to visit the Urla quarantine station, which has been restored and kept more or less intact. Read about Urla Quarantine Island

It is now time to meet the Director himself. His office has high ceilings and a beautiful tall wood stove in one corner. The Director welcomes us warmly, holding a large, framed picture in his hand. He hands it to us says: “This is our present to you, a framed picture of your grandfather, commemorating his tenure as the first Director of our institution”.

Dr. Kilisli Rifat, the first Director of the Directorate of Health for Borders and Coastlines, 1924 – 1927. Courtesy of the Directorate.

I am surprised and happy to hear that Dr. Rifat is still remembered so fondly. The Director, Ali Ihsan Bey is sitting at what looks like an antique desk. When I ask him about it, he says that this desk has been here for a long time. But wait, I have a picture of my grandfather sitting at a desk in the family photographs, and the desk in that picture and this desk seem to be one and the same! The unique aspect of the desk is that it has drawers facing outside. We ask each other about our families, inquire about the health and well-being of our spouses and children, a must in Turkish culture before you start any other business. Ali Ihsan Bey tells Ahmet and I that we are now part of the same big ‘family’ and that we can always come to him if we need anything. When he finds out that I am married to an American, Ali Ihsan bey is not too pleased. He says: ‘What did you do? Why did you marry a foreigner?” So I tell him, yes, but I did name my son Timur and I wouldn’t mind if he marries  a Turkish girl! He relaxes and smiles: “Ömer Bey, why don’t you find out if we can find a nice Turkish girl for Nükhet hanim’s son? We are now a family. In fact, I am always concerned and involved with all my staff members’ lives around here.” Speaking about family, it is time to find out more about my grandfather’s immediate family.

(c) Nükhet Kardam 2015

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References and Credits

Sariyildiz, Gulden, Hicaz Karantina Teskilati (1865-1914), (The Hecaz Quarantine Organization 1865-1914) Ankara, Turk Tarih Kurumu Yayinlari, 1996.

Zacher, Mark,  Global Epidemiological Surveillance: International Cooperation to Monitor Infectious Diseases

History of Kamaran Island

Hejaz Railway

The map of Arabian Peninsula under Ottoman control

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