‘Factory of invalids’: Mortality, disability and early release on medical grounds in GULAG, 1930-1955
Keywords: GULAG
concentration camps
Stalinism
history of medicine
mortality statistics
history of disability and palliative care
history of statistics

This thesis forms the first detailed, scholarly account of the so-called ‘aktirovka’, or medical release practices in the GULAG in 1930-1955. It explores two interlinked lines of inquiry. The first concentrates on medical release as mendacity: an informal tool of the GULAG administration to reduce mortality rates. Terminally ill invalids, discharged early on medical grounds, died soon after release, but camp doctors deliberately excluded these fatalities from medical registries.
The second line of inquiry constitutes a more general history of medical release, with a specific focus on decision-making, institutional confrontations around aktirovka, the evolution of its regulations and, particularly, overall quantification. Up until now, the total number of official invalids discharged from the GULAG in 1930-1955 remained unascertained. Without this figure, any meaningful conversation regarding a more precise estimate of additional GULAG-related deaths was all but impossible.
As the first principal quantitative contribution to the scholarship, this thesis establishes this figure, determining it to be around one million. Furthermore, having estimated the general magnitude of medical releases, the present project considers the range of possible survival rates among medically released invalids. The thesis ‘follows’ medical released invalids on their almost unstudied return journeys from the camps, traces their mortality and identifies four subgroups in the general mass of the medically released in relation to their probable life outcomes (‘terminally ill’, ‘chronically ill’, ‘survivors’ and ‘bogus invalids’).
As the second principal quantitative contribution, the thesis generates a novel educated estimate of additional 800,000-850,000 deaths of released ‘certified invalids’ (‘aktirovannye’). This raises the death toll directly caused by the results of GULAG incarceration to 2.5 million (prisoners only). This original estimate is substantially different from the only two available figures found in the academic literature to date (1.7 and 6 million respectively).
In addition, the thesis develops three original arguments. First, central administrative intervention in mortality distortion was not meticulously coordinated, but was ad hoc, reactive and short-term. Second, medical release demonstrated not an exponential, but a ‘wave-like’ pattern. The rise of the ‘wave’ correlated with crisis periods in GULAG operations (war, national famines). Its fall coincided with more ‘normal’ periods and improved supply. Third, the scale of medical releases did not increase exponentially over time with an apex in the late 1940s – early 1950s. Their numbers dramatically plummeted in the post-war period, being in the order of thousands and tens of thousands, not hundreds of thousands or millions, as some scholars contend.
Methodologically, the present thesis explores for the first time the history of medical release through the prism of three responsible agencies: the GULAG, the camp Procuracy and the Ministry of Justice. It depicts an unknown turf-war among and within them. The dissertation argues that medical release policy was not scrupulously coordinated, but represented a complex knot of contradictions between irreconcilable agendas (‘mendacious’, ‘productionist’ and ‘legalist’). Importantly, this thesis discovered that the camp Procuracy, formally an oversight agency tasked with inspecting the GULAG, often colluded with the NKVD in the distortion of mortality rates – both in Moscow and on the ground.
As the basis of its explanatory mechanism, the project introduces a new three-tier model of mortality recalculation. The tiers were based on incidents of mortality among medically discharged ex-cons in three stages, as found in the documents. The first tier included deaths of the released in the camp or colony. The second encompassed mortality en route, after departure from the place of confinement. The third factored in mortality after arrival at a destination. This project ‘follows’ an average invalid, released on medical grounds from the GULAG, exploring each tier of the model. It develops a novel methodological algorithm to reappraise official mortality, which allows one to trace the data of ex-inmates’ deaths after release and revise official - and deficient - mortality records. For the first time in the historiography, this thesis recalculates death rates for several localities and periods. Henceforth, scholars can productively apply this model as a universal template for future recalculations of GULAG death statistics, as soon as more evidence from various camps and colonies becomes available.