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Certainly the Gulag bosses in Moscow took the problems posed by the large numbers of invalid “work-incapable” prisoners very seriously. Although their existence was hardly new, the problem became acute after Stalin and Beria’s 1939 decision to eliminate the policy of “conditional early release” for invalids: suddenly, the ill could no longer be easily shucked off the work rolls. This, if nothing else, would have forced camp commanders to turn their attention to camp hospitals. One inspector did a precise calculation of the time and money lost to illness: “From October of 1940, to the first half of March 1941, there were 3,472 cases of frostbite, thanks to which 42,334 working days were lost. Two thousand four hundred prisoners became too weak to work.” Another inspector reported that in that same year, of 2,398 prisoners in the labor camps in the Crimea, 860 had only a limited ability to work, and 273 could not work at all. Some were in hospital beds, some, for lack of beds, were being kept in prison cells, producing a drag on the whole system.⁷⁹

Yet, like everything else in the Gulag, there was nothing straightforward about the need to heal the sick. In some camps, it seems the special invalid lagpunkts were created largely to prevent the invalids from dragging down the camp production statistics. This was the case in Siblag, which counted 9,000 invalids and 15,000 “half-invalids” among its 63,000 prisoners in 1940 and 1941—more than a third. When these weak prisoners were removed from the significant work sites and replaced with brigades of “fresh” new workers, the camp’s production figures magically rose much higher.⁸⁰

Pressure to meet the plan forced many camp commanders into a dilemma. On the one hand, they genuinely wanted to cure the sick—so that they could be put back to work. On the other hand, they did not want to encourage the “lazy.” In practice, this often meant that camp administrations set limits—sometimes very precise—on how many prisoners were allowed to be ill at any one time, and how many could be sent to recovery lagpunkts. ⁸¹ Whatever the actual number of suffering prisoners, in other words, they permitted doctors to grant rest days only to a small percentage. Aleksandrovich, the camp doctor, remembered that in his camp “about 10 percent of the lagpunkt,” thirty or forty people, showed up every evening at the doctor’s receiving hour. It was understood, however, that no more than 3 to 5 percent could be freed from work: “more than that, and an investigation would begin.”⁸²

If more were ill, they would have to wait. Typical was the story of one prisoner in Ustvymlag, who stated several times that he was ill and could not work. According to the official report filed afterward, “The medical workers paid no attention to his protest, and he was sent to work. Not being in a condition to work, he refused to work, for which he was shut up in the punishment cell. There he was kept for four days, after which he was taken in very poor condition to the hospital, where he died.” In another camp, a tubercular patient was sent out to work and, according to the inspectors’ report, “was in such poor condition that he could not return to the camp without assistance.”⁸³

The low numbers set on those “allowed” to be sick meant that doctors were under terrible, conflicting pressures. They could be censured, or even sentenced, if too many sick prisoners died, having been refused access to the camp hospital.⁸⁴ They could also be threatened by the more violent and aggressive members of the camp criminal elite, who wanted release from work. If the camp doctor wanted to give rest days to genuinely sick prisoners, he had to resist these criminals’ advances. Shalamov, again, described the fate of one Doctor Surovoy, sent to work in the largely criminal lagpunkt at the Spokoiny mine in Kolyma: