This year marks the 100-year anniversary of World War I (WWI).

Australia’s involvement began on 4 August 1914, seven days after the war commenced in Europe.

The first Australian casualties – six dead and four wounded occurred in German New Guinea shortly after 11 September. Just over half a year later and half a world away, many thousands more would lose their lives or be forever scarred by a war that many vainly predicted would be over by Christmas.

WWI dragged on for over four years until 11am, 11 November 1918.

This column reflects upon WWI both broadly, and specifically in relation to the approximate 3,000 Australian nurses involved. Many were decorated and all honoured at the Australian War Memorial in Canberra, along with the 25 who died during active service.

We wish to touch on the tragedy of war, the sacrifice of those who died and suffered, and the contributions of the many women at home and abroad who served to comfort and care for WWIs unimaginable casualties. From less than five million Australians, 416,809 men enlisted, of whom over 60,000 were killed and more than 156,000 wounded, gassed, or taken prisoner.

WWI was a critical point in history- when global powers first discovered that the destructive potential of technology far outstripped their expectations. This led to an enduring stalemate, where battles lasted months and the casualties of an afternoon of fighting could eclipse those of an entire military campaign with little to no gain for either side. At Gallipoli, between February 1915 and January 1916, allied casualties exceeded 214,000 and Turkish casualties were over 300,000.

As with nurses from all belligerent nations, Australian nurses worked in appalling conditions often without supplies, equipment, or even shelter. While advances from Florence Nightingale’s work during the Crimean War certainly had an impact on care, WWI was fought without penicillin and trained first-responders and the number of casualties and severity of their injuries more horrific.

The extent and nature of the suffering nurses coped with was almost unthinkable. The true grit they demonstrated was heroic. Near battlefields, on hospital ships, trains, and camps, nurses alongside doctors, worked tirelessly and unselfishly to provide what care they could; from rapidly treating gaping shrapnel wounds, missing limbs, and lungs burned by gas, to prying dying men stuck by their own pooled, drying blood from canvas stretchers. Nurses also provided fundamental care and support; from the simple provision of warm drinks and blankets in sodden, freezing trenches, to comforting men driven mad by the hail of explosives (WWI marked the first reports of “shell shock”). Through the war, nurses learned new techniques in wound irrigation and infection control management, minor surgeries, and blood transfusion. Disease compounded the wounded’s suffering and work for nurses; over half of the men had dysentery or typhoid, and locked jaw from tetanus. WWI is also commonly understood to have been pivotal to the spread of Spanish flu which killed well over 50 million people worldwide.

It seems incomprehensible to compare such conditions to healthcare in Australia today, but there were lessons learnt when we consider the importance of fundamentals of care and the essential dignity afforded to an individual during any stage of their illness.

The drain on early health workforces was so great that many untrained women took on nursing and midwifery roles at home. WWI also marked a turning point for the nursing profession; contributing significantly to moves to regulation as well as a broader understanding and appreciation of the work that nurses do both in combat and civilian contexts.

Sadly, WWI was not the ‘war to end all wars’ as it has been described. Indeed, many of the worst conflicts and genocides since, including the Second World War, many Eastern European conflicts, and the various hostilities in the Middle East and Asia arose from conditions WWI created. Still, the Great War stands as one of the deadliest in history, consuming the lives of close to ten million combatants and perhaps seven million civilians. This doesn’t count the number of non-fatal casualties (21 million), nor the number of families or communities destroyed over its four years and three months. Often, entire townships were devastated, as it was common in many countries for groups of friends or classes to enlist, fight, and all to be killed in a single explosion or firefight. WWI shattered many poetic illusions of war.

Using today’s military technology, a war on the scale of WWI would probably be the end of all wars, and everything else. As time passes and memories of WWI are relegated to museum and family collections, Remembrance Day is both a time to look back and reflect upon the sacrifices of the many that died or who were injured, and to consider how we might avoid similar tragedies.

Out where the line of battle cleaves
The horizon of woe
And sightless warriors clutch the leaves
The Red Cross nurses go.
In where the cots of agony

Mark death’s unmeasured tide–
Bear up the battle’s harvestry —
The Red Cross nurses glide.

(from the Red Cross Nurses, T.L. Masson)

Dr Micah D J Peters is the ANMF National Policy Research Adviser (Federal Office) based in the Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia

Professor Marion Eckert is the Director of the Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia