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  You are in: Home > History > ¡SALUD!  

British Volunteers in the Republican Medical Service during the Spanish Civil War, 1936–1939

Linda Palfreeman

Linda Palfreeman is Lecturer in Journalism at the University of Cardenal Herrera, Elche, Spain. She has spent some years researching local aspects of the Spanish Civil War and of the International Brigades’ Medical Service. ¡Salud! is a response to the lack of accessible literature on what was surely one of the most important aspects of the conflict – health care and medical assistance during wartime.


¡Salud! reviews the enormously valuable contribution of the volunteers who left Britain to serve with the Republican Medical Services during the Spanish Civil War. Acknowledgement is also given to the immense effort and self-sacrifice made by men and women from all walks of life who, working ceaselessly at home, made it possible for the medical teams to function in Spain. In Britain, in spite of the government’s official policy of non-intervention, there was a campaign of fervent support for the legitimate Republican government.. Such was the case in Britain where, in spite of the government’s official policy of non-intervention, there was a campaign of fervent support for the legitimate Republican government.

The first British Medical Unit in Spain had immense political significance for the Spanish Republic. Barely a month into the start of the civil war and this small group was the first visible sign of international support. It would later become part of the Republican Medical Service and, within that, of the Medical Service of the International Brigades.

Not only did volunteers help to create and to maintain an emergency medical service, some of the individuals involved were also responsible for important developments that were of relevance to later military-medical practice and also to the history of medicine in general.

Medical personnel generally worked in dreadful conditions, for hours and even days without rest, and with a lack of equipment and provisions of all kinds. They were mostly young and inexperienced men and women who suddenly found themselves thrown together in desperate circumstances, with the task of salvaging something of life amidst the inhumanity and mayhem. That they rose to the challenge is, in itself, worthy of tribute.

Published in association with the Cañada Blanch Centre for Contemporary Spanish Studies

Political parties active in Barcelona in 1936.
Abbreviations used in references

1 Medicine and the Spanish Civil War
2 British Response to the Uprising in Spain
3 The Call for International Medical Assistance
4 Grañen, the First British Hospital
5 To Albacete and the International Brigade
6 The Creation and Development of the International Brigades’ Medical
7 The Integration of the British Unit into the International Brigades’
Medical Service
8 The Organization of Republican Medical Assistance
9 Medical Provision for the Battle of Jarama
10 Medical Provision for the Battle of Guadalajara
11 Restructuring of the International Brigades’ Medical Service
12 Medical Provision for the Battle of Brunete
13 Medical Provision for the Aragon Offensive: the Battles of Belchite,
Quinto and Teruel
14 Further Hospitals Established by British Personnel
15 Medical Provision for the Battle of the Ebro
16 Withdrawal of the International Brigades and the British
Medical Personnel
17 Select Biographies
18 The Spanish Civil War: Repercussions for World War II Medical Care

• Medical Officers on the General Staff of the International Brigades Front Line
Medical Service (25 June 1937)
• The National Joint Committee for Spanish Relief
Spanish Medical Aid Committee
• The first British SMAC Unit sent to Spain in August 1936
• The Scottish Ambulance Unit
• British medical personnel who died in Spain
• Volunteers who left Britain or Ireland to work as part of the Republican
Medical Service in Spain


“Dr Palfreeman provides a fascinating vision of the circumstances surrounding the creation and development of the Republican Medical Service itself. In doing so, she sheds light on the contribution made by the medical personnel of other nationalities, including the Spanish, alongside whom the British volunteers lived and worked.” Paul Preston, Series Editor, London School of Economics

“¡Salud!” explains how the medical volunteers left everything – their loved ones, their jobs and the safety of their homes – in order to administer aid to a distant people. There were surgeons, GPs, nurses, first-aiders and orderlies, ambulance drivers, stretcher-bearers, mechanics and administrators, individuals with a broad range of professional experience and from widely differing social backgrounds.

Some were communists, while others professed no particular political calling. A few were opportunists who went to Spain in search of adventure or as a means of gaining medical experience in conditions of war. But the very great majority were simply committed to using their specialist knowledge and expertise in easing the pain and suffering of those in need.
The book considers the social and political circumstances leading up to the formation of the first British medical teams and the departure of the first volunteers for Spain, together with the subsequent creation of the medical service of the International Brigades into which the British medical units were incorporated.

There is mention of the important medical achievements made during the war and, in particular, the part played in these by British medical personnel.
Reports in Britain poured praise on the marvellous running of hospitals in Spain. This is, perhaps, understandable given that the objective of such reports was to raise the consciousness of the British people about the plight of the sick and the wounded in Republican Spain and to raise funds towards their continued medical care.

The reality of life in the improvised hospital was often quite different. Medical personnel generally worked in dreadful conditions, for hours and even days without rest, and with a lack of equipment and provisions of all kinds. This inevitably created nervous tension and sometimes led to quarrels among the mostly young and inexperienced men and women of the medical unit who suddenly found themselves thrown together in desperate circumstances. All this is vividly described in Linda Palfreeman’s ground-breaking new book.

“The medical volunteers were charged with the task of salvaging something of life amidst inhumanity and mayhem,” she says. “That they rose to the challenge in itself merits tribute. I hope this new book does them justice.” International Brigade Memorial Trust

“Linda Palfreeman’s largely chronological chapters build in a clear and concise way on the research done many years ago by the American nurse who had served in Spain, Fredericka Martin, who died before she could publish her findings, and by Jim Fyrth for his classic 1986 publication, The Signal was Spain: The Aid Spain Movement in Britain 1936–39. To these sources Palfreeman has added more recently available archival material and a wealth of oral and written testimonies.

Palfreeman first explores the social and political background leading up to the formation of the first medical teams from Britain and recounts the experiences of the volunteers after their arrival in Spain. She grapples with the problems they faced, discussing the tensions between them as well as the many challenges they overcame to care for the wounded. The majority of the British personnel were soon incorporated into the medical services of the International Brigades as part of the Republican army. The organisation of the services and the work they carried out in key battles is followed in detail, but ¡Salud! Is not primarily a study of the practice of medicine in the civil war, already well-covered in Nicholas Coni’s book, Medicine and Warfare: Spain, 1936–1939. However, Palfreeman describes many related aspects, such as the system of triage in which surgical interventions and treatment were carried out as quickly as possible for urgent cases, forerunner of the later M.A.S.H. units. During the war in Spain, provisional hospitals were set up closer to the front lines than ever before, sometimes in haste during terrifying retreats, and in a wide variety of less than adequate locations including disused railway tunnels and caves. In one chapter, biographical portraits of four individuals (two doctors, a medical student and an ambulance driver/mechanic) give a more personal perspective on the work being done. Nurses feature in an appendix giving basic details of their lives, though information is often sadly limited by the lack of available information. Re-constructing the life stories of women who were not well-known in the public sphere, like the majority of these nurses, is a difficult and at times, impossible task, although it can be done in some cases (see Angela Jackson, ‘For us it was Heaven’: The Passion, Grief and Fortitude of Patience Darton from the Spanish Civil War to Mao’s China). Palfreeman gives due recognition to the part played by British volunteers in the development of new medical techniques and improvements in the blood transfusion services. As a result, many lives were saved despite the frequently horrific conditions, not only due to bombardments and extremes of weather, but also thanks to frequent shortages of everything imaginable, except perhaps, flies, lice and rats.

Palfreeman hoped to produce a book that would do justice to the work of the medical volunteers who were attempting to salvage something of life amongst the mayhem of war. She has succeeded in doing so, and has produced an account that is valuable not only for students of the history of medical services in wartime, but also as a record of man’s humanity to man under inhuman conditions.” Angela Jackson, Independent Scholar, Bulletin for Spanish and Portuguese Historical Studies

Reviewed in Italian, Spagna contemporanea (2014).


Publication Details

Hardback ISBN:
Paperback ISBN:
Page Extent / Format:
384 pp. / 229 x 152 mm
Release Date:
February 2012
  Illustrated:   Yes
Hardback Price:
£65.00 / $79.95
Paperback Price:
£24.95 / $34.95

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