From Palestine to Fiji, untold flu stories 100 years on

"I had a little bird, its name was Enza. I opened the window and in-flu-enza."

Almost like the creepy theme tune to a horror film, the rhyme above became a common refrain for young girls as they played and jumped rope in 1918 - when the Spanish flu began its deadly global rampage.

The 1918 - 1919 Spanish flu - so called because the virus was first widely reported in the Spanish press - killed at least 20 to 40 million people worldwide, claiming more lives than the First World War.

One hundred years ago this year, the world was a weary and battered place: the First World War would not end until November 1918.

The H1N1 pandemic ran in three waves and was first recorded in Camp Funston, Kansas, in March 1918. It saw the young and fit perish at an astonishing rate due to their strong immune systems which, scientists say, went into overdrive and turned against them. Many died from pneumonia or septicaemia.

The contagion killed notable figures such as Mark Sykes - the British co-architect of the controversial 1916 Sykes-Picot Agreement, which carved up the Middle East into colonial spheres of influence.

The Spanish flu took around 250,000 lives in the UK and 500,000 to 675,000 lives in the US.

But what of other parts of the world and other peoples little mentioned in retrospective accounts of the deadliest pandemic in modern history?

Al Jazeera has spoken to four experts ...

The Navajo experience

Benjamin Brady of The University of Arizona co-authored The Influenza Epidemic of 1918 - 1920 among the Navajos: Marginality, Mortality, and the Implications of Some Neglected Eyewitness Accounts:

"[Our paper] emerged as an offshoot of [a colleague's] effort to edit and publish the history of four Franciscan monks who struggled for decades to establish a mission among the Navajo.

While living on the reservation and running a mission school, the missionaries corresponded with each other and unwittingly recorded in their letters previously unpublished details around the severity of the flu on the reservation.

The reservation death rate was about 12 percent, far exceeding the overall flu fatality in the US which remained less than one percent.

Benjamin Brady, researcher

With this additional evidence, we made the argument that Navajo mortality from the Spanish flu had been undercounted and actually appeared to be around twice what was officially tallied.

We made the case that the reservation death rate was about 12 percent, far exceeding the overall flu fatality in the US which remained less than one percent.

The Navajo were a 'perfect storm' of vulnerability. This is not to say they were a deficient people, but that like many other indigenous and marginal peoples, they did not yet possess institutional knowledge and lacked important resources to prevent infection or treat symptoms in the same way as other groups.

Doctors and their medicines were largely ineffective against this flu - modern technology or Western medicine does not explain differential rates of survival, but more basic resources like the ability to rest and receive nursing and assistance in meeting basic needs like warmth, food and water.

Lower socioeconomic status, living in small and spread-out groups, and not having prior exposure or cultural knowledge to identify flu symptoms, for example, led to increased risk among the Navajo … When Navajo died, it was not uncommon to find multiple deaths among families, who lived in remote areas or 'camps', having died together."

The South African experience

Howard Phillips, emeritus professor of the University of Cape Town, authored In a Time of Plague: Memories of the Spanish Flu Epidemic of 1918 in South Africa:

"South Africa, by and large, was not affected by the first wave, so when the second wave hit, there was very, very little immunity. So the mortality was sky high. It was probably the third or fourth worst hit country or territory in the world with about four or five percent mortality.

The reasons for that include the fact that South Africa has a better rail network than anywhere else in Africa, which means that people move around in great numbers.

The second thing is that South Africa has an unusually large number of young men on the move, such as soldiers and migrant labourers, but particularly labourers working in the mines. 

If you look at the 1911 census and project what the population ought to have been in 1921 - projecting forward at the same rate of population increase - there's a shortfall of about 350,000 people

Howard Phillips, professor

The moment the mines are hit [with the virus], particularly in Kimberley [in Northern Cape Province], the labourers are desperate to get out. And what they do is go back to their homes in rural areas - so they carry the flu into areas that otherwise would have been quite isolated.

The actual number of recorded deaths is only a fraction of the actual number of deaths. There was a census in 1911 and a census in 1921. If you look at the 1911 census and project what the population ought to have been in 1921 - projecting forward at the same rate of population increase - there's a shortfall of about 350,000 people."

The Australian Army and Egyptian Expeditionary Force - EEF experiences in Palestine

Dennis Shanks authored the academic paper, Simultaneous epidemics of influenza and malaria in the Australian Army in Palestine in 1918, at the Australian Defence Force:

"Military operations favour the spread of infectious diseases due to crowding, stress and movement through hostile environments. Palestine in 1918 was a conjunction of adverse events, [including] two simultaneous infectious disease epidemics that struck roughly at the same time.

No one could have planned for the epidemics but they struck just as the great Egyptian Expeditionary Force cavalry offensive started from mid-September 1918.

Malaria incapacitated the soldiers starting 10 days after the start of the offensive which is the incubation period for malaria. It is likely that influenza was already in the civilian population which then spread to or from the troops.

Both diseases together were synergistically lethal for unclear reasons.

There would be no way to distinguish between the two diseases symptomatically except that influenza would have also caused respiratory symptoms such as coughing and increased secretions. The [EEF] - which actually had more Indian soldiers than Australians or New Zealanders - ground to a halt at the same time they cut off and defeated the Turkish armies.

At one point it was stated that there were barely enough well men to water the horses in one cavalry division. All military operations stopped and all forces did their best to deal with a combined epidemic that had not been previously observed.

Death rates were particularly high in soldiers who were already incapacitated such as Turkish POWs. Even with post-mortem examinations it was very difficult to say which infection caused any particular death - it was a synergistic product of two lethal diseases."

The Fijian, Samoan and Tongan experience

Phyllis Herda, lecturer at the University of Auckland, authored an academic paper - Disease and the Colonial Narrative: The 1918 influenza pandemic in Western Polynesia.

"With the arrival of the virus on the steamship Talune [in November 1918] the flu spread quickly through each of the archipelagoes. Steamship day was a big event in all three places so people would come down to the wharf.

In Western Samoa [now Samoa] and Tonga, people would come from the villages to meet the ship. The virus was, thus, easily spread across each of the islands. In addition, in Fiji, several indigenous Fijians who worked on the Talune as stevedores, who were ill, were allowed to return to their villages.

In both Fiji and Western Samoa, the colonial administrations blamed the habits of the indigenous people for the high death rates and described the pandemic in a manner which re-inscribed the superiority of the food, medicine and lifestyles of the West thereby indirectly legitimising their rule in each archipelago.

Phyllis Herda, lecturer

As elsewhere, once among the population the virus spread very quickly with fatal results. Unfortunately, the colonial medical administration in [the Fijian capital] Suva believed it was the normal annual flu rather than the deadly Spanish flu, which they knew was abroad.

In the end, 8,145 deaths were recorded for Fiji - amounting to five percent of the population of the British colony. In Western Samoa, approximately 8,500 people died, nearly 22 percent of the population, as a result of contracting the flu.

By contrast, American Samoa suffered no deaths due to a complete maritime quarantine imposed by the governor there. In Tonga, almost 2,000 people died which amounted to approximately eight percent of the population.

In both Fiji and Western Samoa, the colonial administrations blamed the habits of the indigenous people for the high death rates and described the pandemic in a manner which re-inscribed the superiority of the food, medicine and lifestyles of the West thereby indirectly legitimising their rule in each archipelago."

Follow Alasdair Soussi on Twitter: @AlasdairSoussi