Throughout history, wars and epidemics have been interrelated, as are immigration and health problems. Israel is a relatively young state, established in 1948, which already has a long, unique and impressive record in absorbing mass waves of immigration, and overcoming a variety of imported and endemic epidemics. In fact, the essence of the Zionist movement was to fulfill the old dream of the ingathering of exiles and the return of the children of Israel to their homeland. [1]

At the end of the Second World War (1945), Jewish survivors of the Holocaust wandered across European countries hoping to find living relatives. Many of them (around 250,000) were concentrated in temporary displaced persons camps (DP camps) and other residential arrangements in the American and British Occupation Zones in Austria and Italy, and particularly in Germany. The camps were operated by the Allied forces and humanitarian organizations. [2] The survivors were in poor health, exhausted physically, emotionally, and morally after years of hunger, torture and forced labor in concentration camps, or ghettos, or from constantly hiding and fleeing from Nazi persecution.

In addition to the poor hygienic conditions, the survivors suffered from a variety of contagious diseases (TB, typhoid, scabies etc.), extreme malnutrition, and post-traumatic stress disorders. [3] They were not welcome in their previous neighborhoods, nor did they have homes to return to. Furthermore, they were not allowed to start a new life in a different country. They could not go to Israel, as Palestine/Eretz Israel [4] at that time was still under the British Mandate and operated a closed-border policy. The United States also operated an immigration restriction policy.

The survivors were imprisoned again in an impossible dead-end situation. They pleaded for help in despair: “We were saved, but have not become liberated as of yet.” [5] The pre-statehood Jewish community in Israel (the Yishuv) felt they had a duty to rescue, cure and rehabilitate their fellow surviving brothers and sisters, but actually had very little to offer apart from good will gestures, as they themselves were under British restrictions. Nevertheless, between 1945 and 1948, the Yishuv sent about 400 emissaries (Shelichim), men and women, to prepare the survivors for their future life in Israel while also providing humanitarian help. [6]

The purpose of this article is to shed light on the roles, experiences and contributions of the nurses who volunteered to leave their families for a period of about two years to care for their Jewish brothers and sisters wherever needed. We describe the nurses’ experiences in eradicating epidemics within the camps and helping the Holocaust survivors at three different sites on their long and draining voyage to Israel: first, right after the war in the DP camps in Germany; then, after being caught as illegal immigrants, back in the detained immigration camps in Cyprus, and finally – after Israel’s independence – shedding some light on the condition of immigrants’ health within the newcomers’ absorption camps in Israel. We will discuss the dilemmas and the long-term effects that the treatment of epidemics had on the immigrants, the care providers, and the nursing profession, and offer some insights and suggestions for dealing with the current interaction of global pandemics and mass migration of refugees.

Documenting the historiography of nursing practice in general presents methodological difficulties, especially when it is practiced in unstructured, dynamic circumstances, as in the topic under study. First and foremost, it is generally agreed that nurses are better doers than writers; secondly, because of the transient nature of the camps the documentation of the events is incomplete, not kept in one place, unorganized and difficult to access. Thirdly, little has been previously written about the role of the Eretz Israel nurses in helping the Holocaust survivors, so we focused our studies on exploring, documenting, and publishing their unique contribution to nursing and to the history of the country. Fourthly, most of the existing literature sources are in Hebrew and not accessible to an international audience. This paper is therefore the first exposure of the original testimony of nurses dealing with the extreme reality of immigrants, epidemics and distress, providing lessons which are also relevant to the present global situation.

In searching for relevant information, we relied on a variety of sources, including our own previous extensive historical research. [7] The additional relevant materials included official texts, letters, official reports, protocols, press cuttings, and journals. The study is also reliant on written memoirs and oral history interviews. The use of oral testimonies is vital in providing support for issues described in other sources and for shedding light on subjects not documented in writing. [8]

Ms. Rebecca Lyons, later better known as Prof. Beccy (Rebecca) Bergman, was nominated to be the Chief Nurse for the American JDC in the American Zone of Germany (1946–1948). The JDC, commonly called the Joint, was established in the United States in 1914 by a small group of wealthy Jewish philanthropists, and later became the largest and most effective Jewish relief organization, capable of managing several projects simultaneously around the globe. The JDC’s ideology is to respond to distress and the emerging needs of Jewish people wherever needed. Its motto – “rescue, relief, and reconstruction” – was expressed in various ways: establishing soup kitchens during WWI, distributing food packages and helping refugees escape from Nazi regimes during WWII. The Joint’s strategy has always been to cooperate with and help local communities, with the agreement of the relevant governments. The Joint financed infrastructure and the operation of services inside and outside the DP camps, and provided food, medication, transportation, professional services, and training as needed. [14]

Prof. Rebecca Bergman (1919–2015) was chosen for the position in Germany due to her previous experiences of caring for refugees in the British detainee camp in Atlit, where illegal immigrants who arrived by ship were held. In 1944, Prof. Bergman joined the Middle East Relief and Refugee Administration (MERRA), a British aid organization which set up temporary tent cities in the Sinai Desert in Egypt to care for 40,000 Yugoslavian and Greek war refugees, mainly children, women, and the elderly. The combination of the desert heat, a lack of sanitation, and overcrowding led to outbreaks of disease and epidemics. Prof. Bergman successfully stopped the spread of measles by transforming an abandoned aircraft hangar into a children’s hospital for isolation. Without speaking their languages, she demonstrated to the sick children’s relatives how to treat them effectively. [15]

Prof. Bergman demonstrated the same creativity, sensitivity, and flexible thinking in the Atlit detainee camp that she had exhibited in finding efficient and versatile solutions for endless deficiencies and complications in Germany when she was barely 27 years old. Within the chaotic atmosphere that prevailed in Germany after the war, she succeeded in creating “something out of nothing”. Prof. Bergman and her driver searched for and found essential valuable medical equipment in deserted warehouses, and converted empty buildings into equipped medical and dental clinics. She cooperated with local Jewish communities to trace and take in orphan children and the sick and infirm. She translated pamphlets and essential information into Yiddish and encouraged the survivors to take advantage of the new network of medical and relief services that had been opened for them. In order to overcome the manpower shortage and the survivors’ idleness and apathy, she organized a short training course for nurses’ assistants and recruited physicians and nurses from among the survivors. During the two years she spent in Germany, she set up and assembled a range of essential health services that treated thousands of survivors and prepared them for their arrival in Israel.

Prof. Bergman shared her experiences and published her letters concerning her work with the Holocaust survivors in Israeli journals. [16] In her memoirs she specifically mentioned accompanying a group of tuberculosis survivors on a trip from Munich to the sanatorium in Davos, Switzerland. Another memorable experience was the month she spent with the people of the Exodus after they were shipped back to Germany. She was impressed by their strength and determination and treasured the Exodus membership card of honor she was awarded by their leader. [17] She also documented tough memories, the emotional distress, the voices of joy and/or devastation when the survivors found out what had happened to their loved ones during the war. “There was so much tragedy that it almost became the norm.” [18]

In 1948, she left her post in Germany to take on another challenging assignment in Israel. When the War of Independence broke out, she was drafted and assigned to open and head a frontline military hospital in Jerusalem. Later on, she became the chief nurse of Malben-Joint, a philanthropic organization that cared for elderly, disabled and infirm newcomers across Israel. She initiated and led the academization of nursing education and chaired the first nursing department at Tel Aviv University. Prof. Bergman became an international leader and carried out official roles as the second Vice-President of the International Council of Nurses (ICN) and as a World Health Organization (WHO) consultant for developing countries. She was presented with many prestigious prizes and awards. Prof. Bergman is the first and only nurse to be awarded the nation’s highest honor, the Israel Prize, for her life-long contribution to society and the nation.

As mentioned above, the pre-state administration in Eretz Israel, the Jewish Agency, responded willingly to the survivors’ plea for help and organized the Welfare Platoon. Between 1945 and 1948, a total of about 400 emissaries, men and women, volunteered to serve for a minimum period of one year in the DP camps, most of them in the American Occupation Zone in Germany. The camps were under the authority of the Allied forces, while UNRRA provided the everyday necessities and the relief services for the survivors.

After seven months of bureaucratic barriers, it was finally agreed that the Welfare Platoon’s emissaries would function independently but within the framework of UNRRA and would wear UNRRA uniforms. The emissaries’ official role was to prepare the survivors for their future lives in Eretz Israel, while also providing humanitarian aid. In practice, each emissary carried out his/her assignment differently according to their understanding, abilities, and circumstances.

Of the 132 identified emissaries reported by Keynan (1996), about half were women, equally divided between mothers and those without children. A breakdown by profession showed that they were mostly educators and people with experience in childcare. Very few came from the health care system. These included four nurses, one psychologist, one physician and six social workers. [19] We were able to trace three out of the four nurses, all of whom came from kibbutzim (communal settlements in Israel, typically agricultural).

The first known nurse to be sent for the missions in Austria and Germany was Rebecca Linkovski. However, we chose to report the work of Zvia Lahar and Tzila Rosen, as their experiences were better documented, supported by memoirs, letters, oral interviews, and some personal acquaintances. Their narratives reflected the major concerns and challenges they faced in caring for Holocaust survivors and the emotional burden they experienced.

Tzila Rosen (1903–1972) was born in Bukovina, Romania, came to Israel as a young pioneer in 1926, and was one of the founders of Kibbutz Sarid. She was trained in childcare and development and later completed her professional education in nursing. She specialized in pediatric nursing. The kibbutz ideology was the influencing spirit in those days and children’s welfare and socialization was of the utmost importance.

According to the kibbutz doctrines of those days, the collective interest of the group and the nation took precedence over individual preferences. Therefore, to free up the parents for their communal chores, and to provide the children with the best possible care and socialization, the kibbutz children were raised together with their age group in communal children’s homes within the kibbutz. Every afternoon, after work, the children spent several hours of quality time with their parents, but most of their daily care was provided by a trained childcare worker (nanny). She cared for them, watched them when they were sick, and monitored their vaccinations.

Tzila headed the health and development activities of all the children's homes in her kibbutz, guided the childcare workers and cooperated with other health agencies on behalf of the children. Because of her expertise, she was called in to participate in relevant national assignments: She cared for the “Children of Tehran” – a special group of about 700 children, mostly orphans who escaped from Poland during the war and who were finally brought to Israel through Tehran in 1943 with the help of the British army. These children were cared for in the Atlit detainee camp and Tzila was called to head the nursery and children’s homes of this fragile group. [20]

In 1947, when she was 44 years old, and already a mother of three children, she joined the Welfare Platoon and was sent to Germany to open mother and child clinics in coordination with UNRRA in the DP camps. In her ongoing reports and letters, she reported special actions and events, together with her impressions from her mission. Her writings reflect the fragile complexity of the mission and the encounter between the two different world views. [21] She describes, with deep sympathy, the significance that children had for the lives of the survivors. Many of them had lost their babies during the war and were eager to rebuild new families and a new life for themselves. She pointed out the very high birth rate in the camps, as well as the difficulties that arose in raising these precious children within those circumstances. At the same time, she was critical of the behavior of the mothers. In her diary she wrote (May 2, 1947):

She also added: “Today we finally received a baby’s weighing scale. It is a huge progress.” [22]

Toward the end of her assignment, she proudly wrote to her friend in the kibbutz (March 14, 1948) from the city of Kassel:

Upon her return to Israel, Tzila Rosen continued to hold leadership positions and initiated new national projects. She founded the national Health Committee for the kibbutzim, whose goal was to formulate a unified health policy for the kibbutzim and serve as a platform for information exchange and mutual learning. In 1949, she founded the Nursing School of the Kibbutz Movement. [24]

Another emissary nurse who played a crucial role was Zvia Lahar-Hershkovits (1915–2011). Zvia was born in Bialystok (Russia/Poland) and emigrated to Eretz Israel with her family at the age of 8 (1923). She later joined the Jewish defense organization (Haganah) which was a paramilitary organization (1920–1948). Zvia had a long and impressive record of participating in various operations and was wounded in one of them. She joined the Kibbutz Giv'at Brenner and graduated from the Hadassah Nursing School. After the death of her husband, a soldier in the Jewish Brigade within the British forces, she volunteered to serve in the DP camps. In the light of her previous achievements, she was assigned to head a DP camp in Germany (1945–1948).

A collection of her letters was published in a book entitled “Buds of Hope” (2002). In her letters she described the complexity of the survivors’ lives. The longer they stayed in the camps, the more ambivalent they became towards the emissaries from Eretz Israel. On her arrival in the DP camps, it seems that both sides held high expectations: “They (the survivors) waited for us to bring the gospel of aliyah (emigrating to Eretz Israel),” [25] while she herself wrote that she was thrilled with the honor and the responsibility of serving the survivors as a manager of the camp. However, the reality she faced was gloomy and disappointing. On September 2, 1947 she wrote from Ulm, Germany:

Zvia was also especially concerned with the Romanian Jews' situation:

Zvia played an important role in the “escape operation” (Habricha), the organization of illegal emigration to Israel, mainly by sea. On her return to Israel, she continued to serve in meaningful leadership positions within the national Health Committee for the kibbutzim and the Israeli Nurses’ Union. [28]

Most of the Cyprus deportees were young and relatively healthy, as they had previously been medically screened for the voyage. Yet, right from the beginning, 15 cases of open tuberculosis were detected and a similar number of old tuberculosis. There were also cases of typhoid fever, and diarrhea was common, as were scabies and pediculosis. Most of the health problems stemmed from the poor conditions in the camps: no running water, few toilets, overcrowding, and poor nutrition. [31]

Following an official visit by the medical delegations of the JDC and the Yishuv, management of the medical service in the camps was transferred to the JDC. Gradually and systematically, the JDC financed and directed its effort towards improving the poor living conditions, expanding the health services, and enriching the psycho-social wellbeing of the deportees. The delegates from Eretz Israel played a significant part in these operations. They set up children's homes and youth camps, taught them Hebrew and music, provided vocational training, and exposed them to Judaism and the modern Israeli culture and spirit.

The very first medical delegation sent to the camps included two nurses from Hadassah Hospital: Ms. Ahuva Goldfarb and Ms. Gotha Gostinski. The initial idea was that they would not replace the British team, but rather focus on medical examinations and screening of the refugees, in a manner similar to that operating in the DP camps. But in the light of the devastating conditions, the neglect, and the high incidence of wounds and abscesses, they changed their original plan completely. [32] They adapted barracks into clinics, and tents into small hospitals (patients’ rooms). They rearranged the medical supplies and equipment, allocated suitable places for the nursery and the kitchen, as well as for the health staff’s housing. They trained nurses from among the deportees to work in the hospital. The need for proper nutritional food was identified as an urgent concern as it was insufficient and unappetizing. On the recommendation of the Hadassah hospital staff, the JDC began providing food supplements. [33]

The nurses played a comprehensive and pivotal role in the refugees’ lives in sickness and in health (2,200 babies were born on the island). They felt pride in their contribution to the assistance provided to the detainees, and sympathized with their hardships. In their letters, they described the unbearable conditions on the island.

Ms. Ahuva Goldfarb was a public health nurse. She had previous professional experience with refugees in the Atlit camp. She served two terms in Cyprus and later volunteered to work in the temporary refugee camp in Aden. She described the depressing visual and spiritual atmosphere that prevailed in Cyprus upon their arrival.

Another senior nurse sent to Cyprus was Ms. Ida Wissotzky. She received her diploma in nursing from Warsaw. Almost everyone in her family perished in the Holocaust. She saw the mission to Cyprus as a fulfillment of a dream, the first front line of Zionism. She was especially sensitive to the resilience of the orphaned children. [35] She summarized her thoughts and experiences from Cyprus in a newspaper article in January 1979:

In general, aside from several expert and influential nurses, most of the nurses who served in Cyprus were young and new to nursing or childcare. They went straight from the protective environment of the school in Eretz Israel to the demanding constraints of the camp. They faced young people the same age as themselves – but with long and tragic life experiences. They argued that even though they had been thoroughly prepared for their work, no one could foresee the reality that they would have to face in the camps. [37] Almost immediately upon their arrival, they had to act resourcefully, improvise, and find creative solutions. The set of difficulties which piled up in front of the nurses was almost discouraging in its severity. Yet they continued to pursue their mission even under these almost impossible conditions. Something of what they faced can be learned from nurses' memoirs published in a booklet of Hadassah graduates. One of the nurses wrote:

She added that they opened a “humble” nursery in an old building. Washing the diapers in the salty sea water caused severe irritations for “these feeble babies”. They asked for an extra amount of sugar water, which the nurses kept in special locked boilers. The food was limited and dull. The nurses supplemented the families with egg powder, soaps and combs. She concluded that even in such tough circumstances the refugees made special efforts to restore normalcy as much as possible. [38]

In conclusion, the major health problems presented by the deportees resulted from poor sanitation and hygiene. Wounds, skin rashes, widespread furunculosis, and burns were all treated by dressings and medication. Scabies and pediculosis resulted from the combination of poor living conditions and the difficulty of washing clothes and blankets. Spraying with DDT was an essential and common treatment in the camps. Tuberculosis patients were quarantined in the island’s hospital. Heart disease, diabetes, and digestive problems were related to nutritional deficiencies, and were also treated through various diets and vitamins. The young neophyte nurses implemented principles of public health nursing, preventive medicine, community and emergency nursing in their practice.

On their return to Israel, many of the nurses from Cyprus followed the newcomers and worked at the absorption camps in Israel. Others returned to their previous workplaces. The former chief nurses of the Cyprus camps, who had been carefully screened and chosen for their demanding position in the detention camps, grew to assume top leadership positions following their mission in the camps. Several refugees, who were care assistants on the island, continued their professional training in one of Israel’s schools of nursing. As for the refugees, with the final evacuation of the camps in February 1949, the detention chapter of their lives finally ended, but the next chapter saw them enduring the absorption camps in Israel.

Nursing has a social mandate and a proven historical record of eradicating epidemics and achieving remarkable outcomes by applying a preventive medicine philosophy and health promotion techniques. [45] Styles (1982) believes in the critical importance of the sense of social significance, both for the personal development of nurses and for the profession. [46]

In that spirit, the nurses from Eretz Israel demonstrated the utmost confidence in the nation’s task of ingathering its fellow brothers and sisters from exile and establishing a homeland in Israel. They volunteered to be sent on extremely demanding missions abroad and/or at home, while paying a high personal price. Often their health was affected, their personal safety endangered, and their own families’ needs were neglected. They were totally committed to accomplishing their assignments. Referring to nurses and physicians, [47] two major interrelated goals were identified in their “battle for the nation’s health”:

1. To participate in the national effort of helping the immigrants become Israelis. In accordance with the “melting pot” dogma and the public health principles, the care providers encouraged the immigrants to adopt Israeli patterns of behavior and thinking. The intent was not cultural extinction but a desire to build a nation and a healthy young new generation (the social mandate).

2. To save lives, prevent the spread of epidemics, lower infant mortality etc. (the curing mandate).

In retrospect, the nurses helped to successfully achieve both the social mandate and the health mandate. Indeed, toward the end of Israel’s first decade, most of the serious health problems that endangered the country were treated and resolved. Tuberculosis, malaria, polio, and syphilis almost completely disappeared. Polio vaccinations (Salk and Sabin) eradicated the polio virus. The incidence of ringworm, trachoma and gonorrhea dropped drastically with the development of new antifungal ointments and antibiotics. The rate of infant mortality decreased due to mother and child clinics, which were successful in assimilating health education techniques, increasing the hospital birth rate, and providing nutritional and health services in schools. [48]

There is a general lesson that can be learned from analyzing both the strengths and the weaknesses of the accumulated Israeli experiences of integrating immigrants and fighting epidemics. We will refer to the organization of care services, the perspectives of the recipients of care, and the development of the nursing profession.

Considering the harsh conditions, in which the health personnel had to react swiftly to complex situations, their ability to find creative solutions, improvise, and get organized quickly were critical for achieving their goals. However, although these intuitive successful techniques could be effective and appropriate in resolving sporadic and local problems, they were not sufficient as a general plan to rely on. In effect, successful solutions and insights which were formulated in one camp were not necessarily passed on to another camp, nor were the recommendations translated into a deliberate policy of action.

Another characteristic of the camps’ organization of services was the multiplicity of voluntary and philanthropic organizations that took part in the provision of a wide range of essential health and welfare services. The advantages of multiple organizations cooperating and complementing each other are obvious, yet this situation could also lead to deficiencies, duplications, and the absence of a leading plan of action. In fact, one could argue that an over-reliance on philanthropic organizations to provide full-scale services is undesirable as it could lead to reducing the state’s responsibility.

The very fact that an entire country is enthusiastic about absorbing and assimilating masses of immigrants in its territory is a rare phenomenon in itself. Nurses and other health providers devoted considerable effort and thought to finding the best possible means to cure the immigrants and help them become independent and productive citizens. Given the lack of infrastructure resources and the harsh living conditions within the different camps, the centralized model of providing care, which was common and somewhat similar to the one practiced in the kibbutzim, seemed to be the best model for medical and financial effectiveness. Babies were treated and cared for in nurseries, tuberculosis patients were sent to temporary sanitariums, and children with ringworm to designated care centers. Care was basically regimented and centralized.

During those stormy days, little attention was given to the care recipients’ traditions, feelings, or preferences. Mistakes were certainly made – but mainly from a lack of knowledge and with good intentions. It was only years later that some of the immigrants’ voices of frustration were heard and documented, describing what they perceived as paternalism and poor cultural considerations. [49]

Nurses, both as individuals and as a profession, made a significant and unique contribution to the achievement of overcoming epidemics and absorbing the newcomers. Undoubtedly, the days of great immigration increased the recognition and prestige of the nursing profession, especially in the light of the shortage of physicians. The number of nurses increased dramatically through the recruitment of immigrant nurses and by opening new programs and nursing schools to train licensed practical nurses and registered nurses.

The increase in the supply of nurses came at the expense of the profession’s composition. In 1949 the majority of nurses (71%) were Registered Nurses (RNs), but by 1963 only 41% were RNs, compared with 59% Licensed Practical Nurses (LPNs). [50] The nurses’ place in public health improved, but the academization of nursing weakened. [51] This goal of academizing nursing, which was raised as early as 1922, was finally achieved in 1968, when Prof. Rebecca Bergman opened the first department of nursing at Tel Aviv University. It took that long to be implemented “because there was always something more pressing on the agenda”. [52]

The links between epidemics and mass immigration are not only of historic interest, but have currently become a global burning issue. [53] In fact, since 2005, and especially in the last decade, the number of refugees and economic migrants in the world has jumped by 100% to reach 80 million people globally, according to UNHCR [54] or 40 million according to Eyal. [55] A great deal of the increase relates to refugees who have escaped war zones, yet the majority are undocumented migrant workers who arrive from developing countries to seek a better life in modern welfare states.

With globalization, transferable diseases can easily develop into epidemics and pandemics. Immigrants, especially asylum seekers, are often particularly vulnerable to contagious infections, both as spreaders and as victims, due to pre- and post-migration risk factors. [56] Pre-migration factors include torture and refugee trauma, which may result in mental and physical illness. The refugees often come from conflict areas, with inadequate access to health services. Post-migration factors include detention, length of asylum procedure, language barriers, and a lack of knowledge about the new health care system. Prevalent physical problems include tuberculosis, HIV/AIDS, hepatitis A and B, parasitic diseases, and non-specific body pains. Mental health problems include depression and post-traumatic stress disorder (PTSD). [57]

Migrants are especially at risk in the current COVID-19 pandemic. Many live in densely packed quarters and rely on low-income jobs where it is impossible to implement social distancing. They may have limited access to personal protective equipment and healthcare and have higher rates of conditions that contribute to COVID-19 complications. [58] In light of the pre-migration difficulties and the many barriers to vaccination rooted in their unique status, it is crucial to solve this problem globally. Teerawattananon and his group report on their experience in vaccinating undocumented migrants in Singapore and Thailand. They call for a collective effort for a global vaccination alliance, as well as for each country to be accountable for vaccinating those living within its borders, including undocumented migrants.

Shallish (2020) actually proposed a conceptual-practice model for coping with outbreaks of infectious diseases in waves of immigration like those that the world is currently facing. Her model is based on lessons learned from her historical research on the eradication of tuberculosis in Israel. [60] The model refers mainly to the immigrant as a potential spreader of infectious diseases. The “four arms model” (meaning helping hands) is an organizational outline which consists of four consecutive and complementary stages/directions that governments are advised to follow:

1. Preliminary actions to prevent the outbreak of the disease, which should be taken before entering the country (i.e. medical screening, isolation and treatment).

2. Taking essential preventive measures immediately on arrival and before immigrants are assimilated into the general population. This includes maintenance of strict hygiene conditions, social distancing, digital registration and data sets, medical treatment and vaccination, culturally sensitive health education and instruction, and centralized management of care.

3. Recruiting and training of suitable personnel, knowledgeable about and responsive to the immigrants’ specific needs and culture.

4. Actions to assimilate immigrants in the general population. This final stage translates into providing counseling and support services to avoid the segregation of migrants and facilitate their genuine integration into society.

The encounter between mass immigration and epidemics is not just a medical problem, but rather a complex combination of political, social, economic, cultural and health phenomena, with significant potential implications that can be either positive or harmful. Nurses are in a unique position to make a difference to the health of immigrants and the wellbeing of society. In fact, there is a growing need to develop refugee health nursing as a specialty. Desmyth and her friends, employed by various Australian agencies for refugee health programs and services, refer specifically in their editorial article to refugees, but their descriptions also fit other categories of immigrants. [61] The authors believe that the key roles of this specialty are providing primary care that is culturally responsive, promoting health literacy and empowerment, and advocacy for these patients within healthcare systems. They state that such a specialty demands a vast extent of specific knowledge, understanding and skills, including immunization, oral health, nutrition, infectious diseases and parasitology, family planning and mental health.

Looking back on the practice of the young and dedicated nurses who cared for the Jewish immigrants in the different types of camps – the obvious conclusion is that they did in fact perform the actions proposed by the model. [62] They intuitively fulfilled most of the desired key roles expected of an advanced nursing specialist. [63] Their heroic practice should be unveiled, their story should be told, and their contributions should be cherished in the history of nursing and the Israeli nation.