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Worse were the barracks, or rather mortuaries, for terminally ill patients. In one such barrack, set up for prisoners with dysentery, “patients lay in bed for weeks. If they were lucky they recovered. More often they died. There was no treatment, no medicines . . . patients usually tried to conceal a death for three or four days in order to get the dead man’s rations for themselves.”⁹⁴

Conditions were worsened by Gulag bureaucracy. In 1940, a camp inspector complained that one camp simply did not have enough hospital beds for sick prisoners. Since a prisoner who was not actually lying down inside a hospital was not allowed to receive a hospital ration, this meant that ill prisoners outside the hospital were simply receiving the reduced “shirkers” ration.⁹⁵

Nor, although many camp doctors can be said to have saved the lives of many people, were they all necessarily inclined to be helpful. Some, from their privileged perspective, had come to sympathize more with the bosses than with the “enemies” whom they were required to treat. Elinor Lipper described one doctor, the head of a hospital for 500 patients: “She behaved like a pomeshchitsa, a great lady and landowner of Tsarist times, and considered the entire staff of the hospital her personal serfs. With her fleshy hand, she once took hold of a neglectful orderly and pulled his hair until he screamed.”⁹⁶ In another camp, the wife of the camp commander, a doctor in the hospital section, was actually censured by the camp inspectorate because she “allowed the seriously ill into the hospital far too late, didn’t free the sick from work, was rude, and threw sick prisoners out of the infirmary.”⁹⁷

In some cases, doctors knowingly mistreated prisoner patients. While working in a mining camp in the early 1950s, one of Leonid Trus’s legs was crushed. The camp doctor bound the wound, but more was needed. Trus had already lost a great deal of blood, and was beginning to feel very cold. Because the camp did not have its own facilities for blood transfusions, the camp authorities sent him, in the back of a truck, to a local hospital. Half-conscious, he heard the doctor ask a nurse to begin a blood transfusion. The friend accompanying him gave his personal details: name, age, sex, place of work—after which the doctor halted the blood transfusion. Such help was not given to a prisoner. Trus recalls being given some glucose to drink— thanks to the friend, who paid a bribe for it—and some morphine. The following day, his leg was amputated:

The surgeon was so convinced I wouldn’t live that he didn’t even do the operation himself, but gave it to his wife, a therapist who was trying to re-qualify as a surgeon. Later they told me that she did everything well, that she knew what she was doing, except that she left out a few details. She hadn’t forgotten them, but she didn’t think I would live, and therefore it was immaterial whether these medical details were completed. And look, I remained alive!⁹⁸

Not that camp doctors, whether kind or indifferent, were necessarily qualified either. Those who carried the title ranged from top Moscow specialists serving out their prison sentences, to charlatans who knew nothing whatsoever about medicine, but were willing to fake knowledge in order to get a high-status job. As early as 1932, the OGPU had complained of the dearth of qualified medical personnel.⁹⁹ This meant that prisoners with medical degrees were the exception to every rule governing trusty jobs: whatever counter-revolutionary terrorist act they were alleged to have committed, they were almost always allowed to practice medicine.¹⁰⁰

Shortages also meant that prisoners received training as nurses and feldshers—training which was often rudimentary. Evgeniya Ginzburg qualified as a nurse after spending “several days” in a camp hospital, learning the art of “cupping” and how to give an injection.¹⁰¹ Alexander Dolgun, having been taught in one camp the basics of the feldsher’s job, was tested on his knowledge after being transferred to another camp. Told to do an autopsy by an officer suspicious of his qualifications, he “put on the best show I could and acted as if I did this sort of thing all the time.”¹⁰² In order to get his job as feldsher, Janusz Bardach also lied: he claimed to be a third-year medical student when, in fact, he had not yet entered university. ¹⁰³