Queen
On 29 July 1900, following his father's assassination, Victor Emmanuel ascended the Italian throne. Officially, Elena assumed her husband's whole titles: she became Queen of Italy, and after Mussolini's occupations of Albania and Ethiopia she assumed the titles of Queen of Albania and Empress of Ethiopia.
Elena was described as dignified but natural and simple, and kept the simple habits of her youth in Cetinje. She did not enjoy social life and entertainment or the life of public royal representational duties, but preferred to live a simple, quiet family life. She was described as a loving parent, devoted in giving her children a simple upbringing, designed to prevent them from feeling superior to other children because of their birth.
To her appearance, Queen Elena was described in 1911:
"No Queen in Europe to-day, save the Tsaritsa and Queen Victoria Eugenie, looks more a Queen than Elena. She is stately and tall, with a statuesque poise that anywhere singles her from the throng. Her hair is as black as midnight forest depths, her eyes as luminous as live coals. Her skin is like unto olives, and her hands firm and strong and large. Her shoulders are broad and she holds them squarely. The impression the woman gives is of unusual physical strength. Nor could this well be otherwise in view of her athletic training."
On 28 December 1908 Messina was hit by a disastrous earthquake. Queen Elena helped with the rescuers. She visited the scene, organized for the wounded to be taken to a Hospital ship and assisted personally to their care as nurse; she also organized a fundraiser for the victims in Rome. This helped to increase her popularity within the country.
Elena was the first Inspector of the Voluntary Nurses for the Italian Red Cross from 1911 until 1921. She studied medicine and obtained a laurea honoris causa. She financed charitable institutions for people with encephalitis and tuberculosis, former soldiers and poor mothers.
She was deeply involved in her fight against disease, and she promoted many efforts for the training of doctors, and for research against poliomyelitis, Parkinson's disease and cancer.
During World War I Elena worked as a nurse and, with the help of the Queen Mother, she turned the Quirinal Palace and Villa Margherita into hospitals, which functioned from July 1915 until 1919. To raise funds, she invented the "signed photograph", which was sold at the charity desks. At the end of the war, she proposed to sell the crown treasures to pay the war debts. In 1920, she founded the Elena di Savoia foundation for scholarships to the orphaned children of former railway workers or soldiers; she suggested that every woman in Italy donated some of her jewelry to the children whose fathers had been sacrificed for the nation, and she started by donating some of her own.
On 15 April 1937 Pope Pius XI gave her the Golden Rose, the most important honour given to a Catholic lady at the time. Pope Pius XII, in a condolence telegram sent to her son Umberto II upon the queen's death, defined her as a "Lady of charitable work".
In 1939, three months after the German invasion of Poland and the declaration of war by the United Kingdom and France, Elena wrote a letter to the six European Royals women - two monarchs (Queen Wilhelmina of the Netherlands and Grand Duchess Charlotte of Luxembourg) and four consorts (Queen Alexandrine of Denmark, Queen Elisabeth of Belgium, Maria, Queen Mother of Yugoslavia, and Elena's own daughter, Queen Ioanna of Bulgaria) - whose countries still remained neutral, seeking their support in an effort to prevent the great tragedy that World War II would become.
She influenced her husband to lobby Benito Mussolini, Prime Minister of Italy, for creation of the independent Kingdom of Montenegro in 1941. In 1943 she subsequently obtained the release from a German prison of her nephew, Prince Michael of Montenegro, and his wife, Geneviève. Prince Michael had been imprisoned after refusing to become King of Montenegro under the protection of Italy.
On 25 July 1943 Victor Emmanuel III had Benito Mussolini arrested. The king left Rome on 9 September to flee to Brindisi with the help of the Allies and Elena followed her husband in his escape. In contrast, on 23 September their daughter Mafalda was arrested by the Nazis and sent to Buchenwald concentration camp, where she died in 1944.