Spanish Flu and Оther Infections Wreaked Havoc in Macedonia at the End of World War I


The end of World War I on the territory of the Southern Balkans and on the territory of today’s Macedonian state, in addition to major military destructions and victims of military operations, was marked with the outbreak of the Spanish flu epidemic. The disease, caused by the H1N1 influenza virus with unusual intensity, quickly spread not only among soldiers and warring parties leading the final battles of World War I, but also among the inhabitants of the areas where the hostilities took place, and the virus was also quickly spread by soldiers returning from the fronts


Author: Jugoslava Dukovska


The epidemic, which broke out in the spring months (1918), until the appearance of the current pandemic of COVID – 19, was considered the most terrible episode of disease in modern history, as it managed, in just 18 months, from 1918 to 1920, to infect about 500 million people and kill about 50 million worldwide, or about 3 to 4 percent of the world’s population at the time. Given that the world was not yet fully recovered from the largest and deadliest war to date, with a huge number of severely ill and wounded, neither the final numbers of deaths from the Spanish flu nor the Spanish fever as it has been called, can be precisely set, so some estimates for the victims of this global pandemic rise to 100 million deaths.



Shortly before the outbreak of World War I, the territory of Macedonia was divided into three parts, and the Macedonian people were under the rule of Serbia, Bulgaria and Greece. Most of Vardar Macedonia, with the exception of Strumica, was part of the Kingdom of Serbia. After the outbreak of World War I, all three countries mobilized the population of Macedonia in their armies, mobilizing about 200,000 people – about 50,000 in the Serbian, 120,000 in the Bulgarian and about 20,000 in the Greek army.


27,143 Macedonian recruits in the Serbian army crossed the Albanian mountains, 8,000 people from Macedonia were mobilized in the reserve. 2,000 of them passed through Albania, and 6,000 people died on the Albanian mountains, writes the historian Aleksandar Stojčev.

There is historical data that the Spanish flu has passed through the territory of the today’s Republic of North Macedonia, but due to the historical circumstances and difficulties with which the records of the dead, infected and cured soldiers and civilians were kept on all three sides, it was difficult to find and synthesize the total numbers. Therefore, the available data are very modest, and the collected testimonies about the 1918 Spanish flu epidemic in Macedonia are very rare.

The difficulty of determining the actual numbers of people infected and dead from the Spanish flu in the Balkans is also pointed out in the scientific paper: “The geography and mortality of the 1918 influenza pandemic” by American authors David Patterson and Gerald Pyle, where it is stated that figures cannot be determined “due to military and administrative obstacles”. On the other hand, according to an article in the Bulgarian newspaper Duma, 80,000 Bulgarians have died from the Spanish flu.

At that time, even entire troops from the 122th French Division came to the Thessaloniki front with the flu. Because of this, it can be concluded that in the beginning, among our soldiers, the outbreak of the flu epidemic was without serious consequences. But over time, most likely due to the increase in the virulence of the virus itself, as well as due to the immunosuppression that causes pneumonic complications and probably other complications as well, it became more serious and harder. The result has been a high mortality rate, but mortality is hard to pin point due to a lack of clear literature data, according to a military-medical study by a group of Serbian virologists and military doctors.


From the available documents, which deal with the situation in Macedonia from the end of the First World War, the study entitled: EPIDEMICS IN VARDAR MACEDONIA AND FIGHT WITH THEM DURING THE WARS (1912-1918) authored by Verica Josimovska can be highlighted. It describes the general health and sanitation situation of Macedonia and its population after the departure of the Ottomans after the Balkan Wars:

From 1912 to 1918, the most tragic period for the Macedonian people occurred, when the two Balkan and World War I events and even four pandemics of severe and deadly infectious diseases took place. The whole world became acquainted with this tragedy of Macedonia and thanks to the help and solidarity sent by many world governments, the epidemics were stopped, and part of the population and the army were saved. Nevertheless, the history of medicine has shown that the victims of epidemics were far greater than the victims of wars.

The Macedonian population has suffered from the centuries-old presence of infectious diseases with various pathologies, which have taken many lives, and the situation has been significantly complicated by the protracted wars.

The study found that according to a 1918 Report by the American Society for the Protection of Military Orphans, less than 12% of the population in Macedonia used the services provided by the medical service, either because there was no doctor nearby or, if there were any doctors, they were too expensive. Usually the sick were left to their own devices or at the mercy of fortune-tellers and witch-doctors.

According to the same report, at the beginning of the 20th century in Macedonia, one doctor covered over 80 thousand inhabitants. Exhausted by the Balkan wars and impoverished, the local population was more prone to the spread of infectious diseases.

After the cholera, which decimated the population, especially in the eastern part of Macedonia, among Serbian soldiers, but also among local residents, the epidemic typhus appeared. And all the armies that fought on the Thessaloniki front, created in 1916 in the southern part of Macedonia, were extremely affected by malaria, which is considered an endemic disease that has reigned in this part of the Balkans for centuries. Eventually, both soldiers and civilians were killed by Spanish flu.

Even in the mentioned study, there is no specific data on the infected with the Spanish flu in Macedonia. However, the study refers to testimonies from locals, describing the situation at the end of World War I in Macedonia (where heavy military action has been taking place for years on the so-called Macedonian or Thessaloniki Front and that has been run over by infectious disease epidemics), as extremely difficult:

In Macedonia, the youth was dying, there were no bachelors and brides, no weddings, dances and festivities, no songs and smiling faces, no children’s games outside. Not a city, a village, a street, not a house remained standing. The soil was deserted, life was no more, and there was nothing else left.





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