Illness and Inhumanity is the latest in a growing number of studies on the Soviet Gulag. It focuses on the exploitation and suffering of inmates, primarily in terms of nutrition, labor, and illness, with evidence drawn from both memoirs and archival sources. The book is organized primarily by topic, with the nine body chapters centered on such themes as “food,” “health,” and “invalids.” Most chapters begin in the early 1930s and end in the early 1950s, thus providing a sense of chronology for each topic.

Much of Illness and Inhumanity will be familiar to those who have read a few memoirs or scholarly works on the Stalinist Gulag. Alexopoulos chronicles in painstaking detail how production concerns were paramount and how Gulag personnel dehumanized prisoners by referring to them as “labor power” rather than people. She demonstrates how rations were often insufficient and tied to labor productivity, and how inmates were sorted and sent to different camps or colonies based on their health and work capability. She also details gross deficiencies in the medical system, with Gulag medical staff in short supply, poorly trained, and compliant with the production concerns of their superiors. The result of these conditions was a massive number of sick and starving inmates, many of whom died in the camps or shortly after release.

In a few areas Alexopoulos significantly extends our understanding of how the Gulag worked. One discovery is the extent to which some territorial penal apparatuses, as opposed to the large and better-known corrective-labor camps, served as dumping grounds for sick and emaciated inmates. Another contribution is demonstrating precisely how Gulag officials manipulated illness statistics to conceal the true numbers of starving inmates. A third key insight is that hard-working inmates who received the highest levels of rations often still perished from malnutrition because the extra exertion was not compensated by the relatively small increase in caloric intake. Like all richly-researched books, a few mistakes have crept in. Alexopoulos seems unaware that the colony system existed under republican NKVD structures until 1934 (190). The term aktirovanie is defined variously—does it mean discharge or just being taken off the working rolls? (169, 216) Ivan Serov in 1956 was head of the KGB, not the MVD (237). These inaccuracies do not significantly detract from the wealth of information provided, however.

The most provocative part of Illness and Inhumanity is Alexopoulos's three framing arguments. First, she contends that Aleksandr Solzhenitsyn was correct: the Stalinist Gulag was “destructive by design” (7). Second, Alexopoulos argues that at least six million people died in the Stalinist Gulag, or shortly after their release, out of the roughly eighteen million who entered the system. This is much higher than the figure of around 1.6 million provided in archival documents (although researchers have long assumed the actual number to be somewhat greater). Finally, she concludes that the deadliest period of the Gulag was not World War II, as other scholars have concluded, but the final years of Stalin's life.

These assertions will certainly spark renewed debate among Gulag scholars, but in Illness and Inhumanity they are supported primarily by indirect or misinterpreted evidence. No newly-discovered documents prove that Stalin deliberately orchestrated mass death by starvation in the camps, leaving the claim of intentionalism a matter of interpretation. Alexopoulos does not provide a detailed breakdown of the claimed six million deaths, but much of this number is clearly tied to her argument about the late 1940s and early 1950s. Unfortunately, Alexopoulos's conclusions here seem to be based on a misreading of a key statistic. Examining an internal report of inmate data for the second quarter of 1948, she interprets the category “directed to other places of detention” as meaning release from the Gulag, and likely transfer to “special settlements.” She thus sees this as a massive “unloading” of hundreds of thousands of inmates on the verge of death, and notes that similar figures show up in reports from the early 1950s (150–51). The category in question, however, simply denoted the number of inmates transferred to other camps or colonies within the Gulag. It was not a release statistic and should not be read as an indication of health.

In the final analysis, it is certainly true that “the Stalinist leadership placed little value on the health of prisoners” (178). Whether or not one accepts Alexopoulos's estimate of deaths, her chronology of suffering, or her claim of high-level intentionalism, she is correct to assert that the Stalinist Gulag was “one of the twentieth century's worst crimes against humanity” (18).