A Little History #14 : Things Fall Apart - A Tragedy in Three Acts by Tom McDermott

End games are often messy, and the end game for UNICEF's Mission in China was no exception. Only months earlier, UNICEF's experiment in training community health workers in Communist-controlled North China had seemed remarkably successful. UNICEF and the Chinese health authorities were planning to expand the programme. Yet by the end of 1949 the agreement that had made the programme possible would be abrogated by the government.

What happened?

Act I — Beijing, Early 1949

The Shijiazhuang Agreement was working well, and the first training course at the monastery near Shijiazhuang had gone well. Twenty graduates, including 11 men and 9 women, were now in the field. Both Dr. Leo Eloesser and Dr. Su Chin Kwan, CLARA's senior health official, were pleased with the results.

Eloesser asked Su what changes he would recommend for the second course. This one was planned for 80 students and would be held at Tongzhou, just outside Beijing. Communist forces had taken Beijing without armed resistance.  As the Communist government established itself in Beijing, CLARA's health headquarters was also moving there.

Eloesser and Su had somewhat different ideas about the curriculum for the second and subsequent courses. Eloesser favored the approach used at Shijiazhuang: give trainees "a little bit of everything" the workers were likely to encounter in the field. Su wanted greater concentration on fewer subjects. Eloesser agreed to incorporate Su's recommendations. After all, these health workers would serve within the Chinese health system, and their training needed to reflect the priorities of the Chinese health authorities.

Graduates of a community health workers class

The second course was therefore lengthened to six months and reorganized to provide more focus on fewer key topics. Training would build on four areas:

• sanitation, primarily for men;
• midwifery, for women;
• communicable-disease control, with mixed enrollment;
• child care and nursery-school techniques.

Each senior instructor would be paired with a junior assistant chosen from among the best students of the first Shijiazhuang course. The idea was to ensure that they were not only training health workers; they were beginning to train the people who could train the next generation of health workers.

Field experience also produced an important lesson. Rural villagers were sometimes reluctant to accept health advice from outsiders. Midwifery, however, was something rural communities clearly wanted. It was therefore decided that all the female health workers should receive some midwifery training. Helping women through pregnancy and childbirth could open the door to teaching sanitation, infant care and other preventive health practices.

Midwives - Hemingway and Galt

Training midwives

For this part of the programme, Eloesser recruited two well-qualified nurse-midwives, Isabel Hemingway and Edith Galt. Both had been born and raised in North China and spoke local dialects fluently. Both had trained and qualified as nurse midwives in New York.

Isabel Hemingway in Turkey after China

Hemingway had grown up in Shanxi, where her missionary father had founded a hospital. She had returned to China with UNRRA in 1946. (Interesting factoid: Isabel Hemingway was the first cousin of the author Ernest Hemingway).

Galt had been born at Paoting in Hebei and had trained with Hemingway in nurse-midwifery in New York.

It was an unusual team. Eloesser, 67, was a world-renowned thoracic surgeon with a newfound commitment to basic health care. Hemingway and Galt, both in their early 40s, were US-trained nurse-midwives who had grown up in China. Hanson, 32, had also been born and raised in China and had worked as a field liaison officer and translator during the war. Three of the four had been born in China and spoke Chinese fluently; Eloesser had also acquired a working knowledge of the language during his months in the north.

The second course began at Tongzhou in 1949. Extending the training to six months gave the instructors more opportunity to observe trainees working in villages. That experience also demonstrated the value of much shorter practical courses for the existing network of traditional "granny" midwives. The instructors knew from the first course that simple instruction in clean delivery practices could produce rapid results, particularly in preventing neonatal tetanus.

UNICEF's Midwifery Manual authored Eloesser, Hemingway, and Galt

Eloesser, Hemingway and Galt jointly produced a Chinese-language midwifery manual, Pregnancy, Childbirth and the Newborn. It was designed for rural midwives working with limited resources. UNICEF later published the manual in English, and editions and translations appeared in Spanish, Portuguese and Korean. It became a global standard text and was printed and reprinted in many editions, with the final edition appearing in 1976. Remarkably, it also found a quite different audience years later, becoming popular among advocates of natural childbirth and home birth in the United States.

So, as the first half of 1949 unfolded, the training programme itself seemed to be going rather well.

And That Was Where the Trouble Began

Outside the classroom, however, trouble was beginning. Around the time Marcel Junod was concluding in New York that his health would not permit him to return to China, Eloesser learned that supplies ordered months earlier to support the training programme were finally reaching Hong Kong. Procurement had been slow, but about $105,000 worth of equipment and supplies for the community health-worker programme was now ready for onward shipment.

CLARA wanted the supplies to be stored at their central warehouse in Tientsin. Eloesser wanted them held close to the training site where UNICEF could maintain direct supervision over their use.

CLARA pointed to the August 1948 agreement: they would handle distribution. UNICEF pointed to another clause: UNICEF retained supervision and control. As Perry Hanson later said, it was an "end of ship's tackle" dispute—who was responsible once supplies arrived, and the sort of ambiguity that should have been settled in the original agreement.

To those of us who later worked in UNICEF country offices, the argument sounds painfully familiar. Once UNICEF hands supplies to a government, who is responsible for them? What does government ownership mean? And what does UNICEF "supervision and control" mean in practice?

The disagreement need not necessarily have become a crisis. But Eloesser raised the stakes by ordering that the supplies—and subsequent shipments—be held in Hong Kong until the issue was settled.

The dispute festered through the summer. Remarkably, the second training programme continued smoothly  Sadly, in the chaos that followed we do not know what happened with the second training course - how many graduated and what results they achieved.  

The PRC Is Proclaimed

Mao proclaims the PRC

On 1 October 1949, Mao Zedong proclaimed the People's Republic of China. The new government now controlled most of mainland China. In December Chiang Kai-shek and his government along with some two million refugees completed their evacuation to Taiwan. Over the next few months the few remaining nationalist forces on the mainland collapsed.

Despite their withdrawal to Taiwan, the Nationalists continued to occupy China's seat at the United Nations, including its permanent seat on the Security Council. The PRC claimed that it alone represented China. The struggle over which government should occupy China's UN seat would continue until 1971.

UNICEF in an Unrecognized Country

What had begun as an argument over the control of training supplies was now caught up in a vastly larger question: how could a United Nations agency maintain an official relationship with authorities whose government did not hold China's seat at the United Nations?

With the Nationalists still holding the seat at the UN, Eloesser found the programme and himself in an impossible situation. In September he left for New York with the supplies question still unresolved. This left Perry Hanson as the acting Representative, with a few other staff in limbo.  On the positive side, Hemingway and Galt were continuing to work with the midwifery training programme.

Slowly, however, for the PRC the dispute over the training supplies was becoming a matter of national sovereignty. On 30 December 1949, CLARA abrogated the Shijiazhuang Agreement.

Eloesser was a surgeon, not a diplomat. He had enormous experience of China and considerable sympathy for the people with whom he was working, but he did not have Marcel Junod's diplomatic experience or finesse.

Years later, Eloesser looked back on the episode with considerable regret—and with remarkably little attempt to excuse his own part in it:

"Gradually, reluctantly, perhaps indeed mistakenly, it seemed to me that further active participation was not in the cards and that UNICEF should withdraw. I regretted the conclusion at the time, and again in retrospect regret still more strongly. For had we remained with our foot in the door crack, UNICEF might finally have helped... to open the United Nations door for China."

"In retrospect I recognize my dullness in not perceiving immediately that UNICEF's situation in China was an incompatible anomaly. How could China officially recognize and work with UNICEF, a United Nations agency, when the United Nations itself refused to recognize, let alone, accept, China? The fly, buzzing above the pudding, can see it and steer his course accordingly; once he's in the sticky mess, he's blind…"

— Leo Eloesser

Where Was Headquarters?

But the question of Eloesser's diplomatic limits leads directly to a larger one: where was Headquarters in all this?

Junod had gone to Headquarters in January where his medical situation quickly deteriorated, making a return to China impossible and his resignation inevitable. Yet he was not replaced. As the disagreement with CLARA moved from a programme problem to a political one, the small team in China were left without experienced leadership and apparently without guidance from Headquarters.

Had UNICEF effectively given up on its China mission? Or did New York simply fail to appreciate how quickly a manageable field dispute was becoming something much larger? Soon Headquarters itself would be caught up in a bigger struggle -  the battle over seating the PRC.

Act II — New York

By January 1950, the Cold War was playing out at the United Nations, both in the Security Council and, increasingly, at  every meeting and board session, including UNICEF's Executive Board.

In January 1950, the PRC demanded that the Nationalist representatives be replaced by their delegation. The United States, which continued to recognize only the Nationalist Government, opposed any change. Other governments were moving in a different direction. Britain had recognized the People's Republic on 6 January, followd by a growing number of other western countries. The Soviet Union and the communist-led governments of Eastern Europe had already recognized the new government.  The US remianed firmly opposed to recognition.

On 10 January, the Soviet Union formally proposed that the Nationalist representative be excluded from the Security Council. When the proposal failed, the Soviet representative, Yakov Malik, walked out. On 13 January, after another unsuccessful vote, he announced that the Soviet Union would boycott the Security Council until the representative of the People's Republic was seated.

The boycott soon extended to other United Nations bodies, including UNICEF's Executive Board where the crisis came to a head in February and March 1950.

Rajchman's Impossible Position

For Ludwik Rajchman, UNICEF's Chairman since its creation, the situation was particularly painful. He had worked extensively with Chinese leaders during his period heading the League of Nations Health Organization. Moreover, he had spent much of his career trying to build international cooperation across political boundaries. UNICEF itself had been founded on the principle that children should receive help regardless of the politics of the governments controlling the places where they lived.

By the time the confrontation reached UNICEF, Soviet and Eastern European delegates had already walked out of fifteen other United Nations meetings over the China representation issue. Rajchman and Pate could hardly have been unaware of what was coming. They had worked hard to keep UNICEF out of the growing Cold War confrontation, and Rajchman now tried to postpone the Board meeting rather than force the issue. The United States opposed postponement and pressed for the meeting to go ahead.

"New York Times

LAKE SUCCESS, Feb. 23—The United States has successfully pushed its demands that a meeting of the United Nations International Children's Emergency Fund be summoned. Some officials and delegations had sought to keep the child welfare agency outside the Soviet-West dispute over Chinese recognition.

Dr. Ludwik Rajchman, chairman of the fund's executive board, tonight informed the twenty-six member states that in response to requests from the United States, backed by similar moves on the part of Brazil and Ecuador, the board would meet on March 6.

Originally, the board's regular quarterly meeting had been scheduled for this morning. On Tuesday Dr. Rajchman informed member governments that after consultation with a “number of members” he had decided to cancel the session.

Dr. Rajchman gave no reasons for this cancellation, but it is generally understood here that the move was made to avoid another expected walkout by the Soviet Union and five other states on the board. Since the Eastern European states have walked out of fifteen other United Nations meetings, it was felt by some officials that the fund, which was set up as a non-political welfare organization, should be kept outside the China conflict."

On 6 March 1950, the Soviet delegation proposed the seating of the PRC delegate. The motion failed.  The Soviet representative on the UNICEF Board, V. I. Kobushko, walked out. He was joined by the Czechoslovak delegate. As Poland's delegate, Rajchman was bound to follow his government's position and joined the walkout. 

Poland had established diplomatic relations with the PRC just three days after Mao's proclamation. There was no doubt about their position over seating the PRC delegation at the UN.

There were two more unsuccessful attempts during the first half of 1950 to replace the Nationalist Chinese representative with a representative of the People's Republic. Neither vote was particularly close.

General Wu Yun-fu PRC Proposed Delegate

UNICEF Executive Board

Then, in August, Zhou Enlai formally notified UN Secretary-General Trygve Lie that the PRC was appointing a representative to the UNICEF Executive Board. Rajchman replied that he would support the PRC's application.

The War in Korea

There was a bitter irony in the Soviet boycott of the Security Council.

On 25 June 1950, North Korean forces invaded South Korea. With the Soviet delegate absent and therefore unable to cast a veto, the Security Council adopted Resolution 82, calling on North Korea to cease hostilities and withdraw its forces to the 38th parallel.

Security Council Votes to Authorize forces in Korea

Two days later, on 27 June, the Council recommended that UN members provide South Korea with the assistance necessary to repel the attack. This was followed on 7 July by a further resolution recommending that the forces being sent to Korea be placed under a unified command led by the United States and authorizing the use of the United Nations flag.

The Soviet boycott had produced a result Moscow could hardly have intended: by absenting itself from the Security Council in protest over China's representation, it had removed its own veto at precisely the moment when the Council authorized United Nations involvement in Korea.

By October, UN Command forces had crossed the 38th parallel and advanced deep into North Korea. Chinese forces, officially designated the Chinese People's Volunteers, entered the fighting in large numbers. In late November they launched a massive offensive against UN forces.

Forces fighting under United Nations authority were in direct combat with forces from the People's Republic of China—the very government whose exclusion from the United Nations had prompted the Soviet boycott in the first place.

The Board Deadlocks Again

On 27 November 1950, Rajchman recommended that the credentials of the representative of the People's Republic of China be recognized and take China's seat on the Board. The vote was 12 in favor- 12 opposed, with one abstention. The motion failed.

The Board reconvened that afternoon. After hearing from the UN Legal Department that the Nationalist Chinese delegate could vote even though his credentials were being contested, the Board voted again.

12–12, with one abstention. Again.

Under the Board's rules, the tied vote meant that the motion had not carried and the PRC representative would not be seated.

By the end of 1950 Rajchman's position had become increasingly difficult from both directions. To the United States and some Western delegations, UNICEF's Chairman represented Communist Poland at a time when the Cold War was rapidly hardening. Yet Rajchman's own relationship with the Polish government was also deteriorating badly.

At the end of 1950 Poland replaced its Permanent Representative to the UN with someone more closely aligned with the new communist government.  Then in early 1951 Poland cancelled and confiscated Rajchman's diplomatic passport. He would not recover his Polish passport until 1956.

Due to the walkout, through much of 1950 Rajchman could not effectively head the Executive Board, relying instead on Vice-Chairpersons. Rajchman finally stepped down as Chairman at the end of 1950. Adelaide Sinclair of Canada succeeded him in January 1951.

Act III 

UNICEF, being the home of eternal optimists, somehow kept alive the hope that its relationship with the new China could still be rescued.

Finger Pointing

In January 1950, barely three weeks after CLARA had abrogated the Shijiazhuang Agreement, UNICEF reversed its earlier decision to hold the training supplies in Hong Kong. The supplies would now be released on an "unconditional basis."

The Chinese authorities agreed to receive and use them. UNICEF also released, unconditionally, funds previously allocated for a kala azar (black fever) project. China accepted the funds but declined to accept the presence of UNICEF technical advisers.

In practical terms, New York had now abandoned the position that UNICEF must maintain supervision and control. UNICEF gave up its insistence on the very principle that had placed Eloesser in a quandary in the first place.

Worse, Headquarters now attributed the entire supply dispute to "decisions taken locally by the China mission," which had supposedly misinterpreted both the terms of the Shijiazhuang Agreement and UNICEF's own requirements for oversight of supplies.

Talk about leaving your field staff hanging in the wind!

Hanson and others left in China

While governments argued in New York and armies fought in Korea, Perry Hanson was still representing UNICEF in China. He headed a small team of international and Chinese staff. The community-health-worker and midwifery training continued, but without UNICEF assistance.

The Shijiazhuang Agreement under which he had entered Communist China had been abrogated. His own government, the United States, did not recognize the PRC and opposed its seating at the UN. And now forces fighting under the United Nations flag were at war with Chinese troops in Korea.

With the drama underway in New York, it is not clear that Headquarters could give him much support or guidance.

Not permitted to travel or leave 

The new PRC government informed Hanson that he no longer had any official status in China and was simply a private foreign citizen.

At the same time, the authorities continued to hold him responsible for actions taken by UNICEF, whether those decisions had been made in China or in New York.

He could not represent UNICEF. But he was held accountable for what UNICEF did in New York or in China. The government blocked his requests to travel within China and refused permission for him to leave the country. 

Hanson's obituary later described the family as having endured “two years of house arrest” in Nanjing. Hanson, Kathleen and their son Perry III were finally permitted to leave China on 1 May 1951.  

Others from UNICEF's China Mission

Please help if you know more about these figures in our history or have photos.

John Painter — was a transport and supply officer and took charge of Beijing following Drummond’s departure. Like Perry Hanson he became one of the last two UNICEF international staff in China. Also like Hanson, he was effectively held under house arrest until the end of February 1951. I recall his name (and perhaps his face) so assume that he continued in UNICEF.

Simon Polak — was head of the Canton office. After the fall of Nanjing in April 1949, Canton became the last foothold of the Nationalist government on China’s mainland. Simon Polak was thus the last person in direct contact with the Nationalists. He left in September 1949 and then took charge of the Thai Area Office in Bangkok and became UNICEF’s first Representative to Thailand.

John Merryman — was the Admin officer in Shanghai and became the OIC when Junod left China in January 1949, planning to return immediately after briefing the Board. Instead, Junod fell desperately ill with ascheleriosis and had to resign. Merryman continued as OIC until the fall of Nanjing in April. Merryman left Shanghai shortly before Shanghai also fell to the communist forces.

Dr. J. Earle McPhail — paediatrician recruited from UNRRA. Served as health advisor in Nanjing and Beijing. Worked with Galt and Hemingway as a tutor on MCH for village health workers and midwives. He left China in January 1951 and took up the post of WHO Representative to Burma.

Alexander McIver — was with UNRRA in 1947 as Acting Chief of the Far East Bureau. He then joined UNICEF and served as the first Representative to Pakistan.

Helen Drummond — a former UNRRA dietician, stayed on in Beijing as head of office after the city changed hands in late January 1949. She managed the office until she left Beijing in September 1949.

Yu Yung — UNICEF Representative in Nanjing from October 1949 until June 1951. After Hanson’s departure, Yu Yung was UNICEF’s last remaining staff member. It would be good for our history to know what became of Yu.

One Last Try

Even then, UNICEF did not entirely abandon hope.

In August 1951, in the midst of the Korean War, Maurice Pate wrote directly to the Chinese Minister of Foreign Affairs, Zhou Enlai. Pate wrote that UNICEF was a non-political humanitarian organization committed to helping children everywhere. UNICEF remained willing to provide funds and supplies for child welfare in China regardless of political circumstances.

There was no reply.

Lessons Learned?

Years later, when Perry Hanson reflected on UNICEF's China experience, he identified three mistakes on UNICEF's side:

1. The lost year of 1947. UNICEF had failed to field an operational team or establish a Representative presence during a crucial early period when relationships and working arrangements might have been established before the political situation hardened.

2. The lack of clear guidelines on control over supplies. Neither the Shijiazhuang Agreement nor UNICEF's broader procedures adequately defined the respective responsibilities of UNICEF and government for the custody, distribution and supervision of UNICEF-provided supplies. An ambiguity that should have been manageable became an intractable dispute.

3. The lack of an adequate political strategy for dealing with authorities from different factions in a country divided by civil war. And ultimately, for dealing with the reality that one of those factions had become the government of almost all China.

Looking back, I would add a fourth:

4. The failure to replace Marcel Junod. Junod should have been replaced promptly when it became clear that he could not return to China. By February 1949 he was seriously ill. Yet UNICEF did not replace him.

Eloesser was a highly experienced surgeon and humanitarian. Hanson was an experienced field officer who knew China intimately. But neither had Junod's position, diplomatic experience or authority. An experienced head of mission—or even a timely visit by someone senior from Headquarters—might have resolved or sidestepped what began as a relatively petty dispute over the management of supplies.

How many times have we seen this mistake repeated?

A crisis develops. A Representative or other key figure leaves and is not replaced. Field staff are left dealing with issues well above their level of authority. An ambiguity that should have been settled by clear policy becomes a dispute. The dispute becomes political. By the time Headquarters recognizes how serious things have become, the opportunity to fix them has passed.

But there is a deeper question, and one we cannot answer.

Would any of this really have made a difference?

By 1950, the Cold War was well underway. The United Nations continued to recognize the Nationalist Government as representing China. The Soviet bloc was boycotting UN bodies over the issue. The Korean War had broken out. Within months Chinese troops and forces fighting under the United Nations flag were killing one another.

UNICEF itself was still a young organization whose future had only recently been uncertain and whose finances depended heavily on support from the United States.

Could Marcel Junod—or anyone else UNICEF might have sent—really have kept the China Mission alive through all of that?

Perhaps not.

But Eloesser himself was never entirely convinced. Years later he still regretted that UNICEF had not somehow managed to keep, as he put it, "our foot in the door crack."

What Remained

UNICEF's assistance ended, but the idea behind the rapid training programme did not. China continued developing systems for bringing basic health care to the countryside. Seventeen years later, during the Cultural Revolution, the “barefoot doctors” became famous internationally.

Eloesser had written that by using the most promising trainees as teachers, “the number of trainees will increase rapidly, geometrically rather than arithmetically.” Over the following decades China would train hundreds of thousands of rural health workers and bring basic health services to populations that previously had little access to modern health care.

Epilogue - Ties Resumed at Last

The standoff between the Nationalists and the People's Republic over which government should represent China at the United Nations continued for another 21 years.

Finally, on 25 October 1971, the General Assembly adopted Resolution 2758, recognizing the representatives of the People's Republic of China as the only legitimate representatives of China at the United Nations and expelling the representatives of Chiang Kai-shek.

Even with that milestone finally reached, the resumption of China's participation in UNICEF and the re-establishment of a UN presence in Beijing took time.

It was not until 1978 that UNICEF received an invitation for Newton Bowles to visit China. His visit to Beijing in October of that year helped reopen a relationship that had been broken for nearly thirty years.

1979 - Opening up

35 Yuan Piece Commemorates the Year of the Child

1979 was a major year for China. It was the first year of implementation of Deng Xiaoping's “Reform and Opening-Up” policy (Gaige Kaifang), shifting the country away from rigid state planning toward a more market-oriented economy. On 1 January, China and the United States finally established diplomatic relations.

But 1979 was also the International Year of the Child, and China issued a special coin to mark the occasion. It was also the first year since 1949 that UNICEF allocated new funds for mainland China, pledging $200,000 in general resources and arranging a study tour involving government counterparts from six Asian countries.

That same year the wider UN relationship with China was also taking shape. On 29 June 1979, UNDP and China signed a Standard Basic Assistance Agreement, and UNDP became the first UN agency to establish an office in China following the beginning of China's reform and opening-up period.

September 1979 Brad Morse Meets Vice Premier Deng Xiaoping

A Chinese delegation attended the UNICEF Executive Board session in May 1980. Jim Grant had become Executive Director only a few months earlier, in January, and so was there to welcome the Chinese delegation.

Jim Grant meets Cheng Fei Vice Minister for Economic Relations to sign the new agreement.

On 22 June 1981, China and UNICEF signed a new Basic Cooperation Agreement. Nearly thirty-three years had passed since Junod had signed UNICEF's programme agreement with the Nationalist Government in May 1948—and since Eloesser had negotiated the separate Shijiazhuang Agreement with the Communist authorities that August.

For Jim, this was in some ways a return home. He had been born in Beijing, the son of Dr. John Grant, one of the pioneers of public health in China. Jim left China in 1937 at the age of 15, shortly before Beijing fell to Japanese forces. He returned during World War II as a US Army officer serving in Burma and China. After the war, both Jim and his wife Ethel worked with UNRRA in China.

Also in 1981, UNICEF and WHO opened offices in Beijing, with Ralph Eckert serving as UNICEF's first Representative. Eckert, a Swiss national and the last UNICEF Representative in South Vietnam, was well accustomed to politically sensitive assignments.

The door Eloesser had regretted seeing close three decades earlier was finally open again.

This brings to an end the mini-series on UNICEF's opening days in China.