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Quarantine

By:
Abdullah Srour Aljoudi
Source:
Oxford Islamic Studies Online What is This? Online-only content developed by noted scholars is continuously added to the site, part of our ongoing efforts to expand our coverage of the Islamic world.

Quarantine

Introduction

The word “quarantine” is derived from the Latin word quadraginta through the French word quarantaine or Italian word quarantena and refers to a period of forty days (Merriam-Webster). Quarantine is defined as the “restriction of the activities of well persons or animals who have been exposed to a case of communicable disease during its period of communicability to prevent disease transmission during the incubation period if infection should occur.” Quarantine differs from isolation, in that isolation targets patients while quarantine targets persons at risk of developing the disease in addition to patients. Quarantine can be done voluntarily and involuntarily; at the same time, it can be implemented at the community level and at the group level (Chin, 2000).

This article offers an overview of quarantine from the Islamic perspective, highlighting important theological and jurisprudential questions. The article starts by giving a short definition, then a brief background followed by a concise discussion from the bioethical perspective.

Background

In Islamic history, quarantine is associated with the outbreak of plague. One of the earliest reports covers the plague that occurred in Emmaus in 638. Historians recorded other incidents throughout the Muslim world, with evidence of voluntary community quarantine in some of these reported incidents (Ibn Ḥajar, 1991, pp. 361-371). The first documented involuntary community quarantine was established by the Ottoman quarantine reform in 1838 (Bulmus, 2012). The involuntary hospital quarantine of special groups of patients such as lepers started earlier in Islamic history. In 707 the sixth Umayyad caliph built the first hospital in Damascus and issued an order to isolate lepers from other patients in the hospital (Baik, 1981, p. 203). The practice of involuntary quarantine of lepers in general hospitals continued until the year 1431 when the Ottomans built a leprosy hospital in Edirne, where only lepers were admitted and treated (Baik, 1981).

According to Western sources, quarantine was first practiced in 1377 when the people of Dubrovnik in Croatia, prevented the ships coming from areas of epidemic from docking until they completed an isolation period at the shore for thirty to forty days. In 1423 the Republic of Venice established the first plague hospital known as a lazaretto. In 1476 the authority of Marseille in France, established their French version of lazaretto. The first English quarantine was in 1663, and in 1668 quarantine appeared in North America. The practice continued until 1851, when the first international sanitary conference was held in Paris. In the eleventh international sanitary conference in 1903, restructuring of international quarantine regulations was approved. With the establishment of the World Health Organization and the United States Centers for Disease Control and Prevention, quarantine became more regulated. In the beginning of the twenty-first century with the SARS pandemic, quarantine was one of the powerful measures used to control the epidemic in many countries with different forms, ranging from voluntary quarantine in Canada to involuntary quarantine with aggressive punishment, including the death penalty, for violators in China (Tognotti, 2013).

Quarantine and Bioethics

Quarantine aims to prevent the progression of a contagious disease by restricting the movement of patients and their contacts, limiting their personal liberty and violating their autonomy. Three conditions, at least, are essential for a person to have autonomy: free will, capacity of intentional action, and knowledge enabling him or her to comprehend a situation sufficiently to make an informed decision (Beauchamp and Childress, 2001). Quarantine is sometime exercised in the absence of full knowledge about the agent causing the disease or its mode of transmission. In this situation of uncertainty, where the health-care provider lacks the necessary knowledge to take evidence-based actions, quarantine is still practiced as a precautionary measure to protect the community. In quarantine, the community rights will be in contradiction with the individual rights if we consider the harm that patients can cause to the community by spreading the diseases and the harm that can happen to patients by restricting their personal freedom. Protecting the community from possible harm is probably the most important ethical argument to justify the practice of quarantine in the modern period. Here, we need to differentiate between voluntary quarantine and involuntary quarantine. For each of them the same ethical principles, apply but the context is different. In the case of voluntary quarantine, individuals choose to restrict their activity to protect the community without being influenced by governmental (authority) forces. In such cases, their internal sense of moral obligations to prevent harm to others is probably as important as those external influences in the involuntary quarantine (Cetron and Landwirth, 2007). In Islam, this internal sense of moral obligation is enforced by linking the action to God’s reward as a powerful motive even in the absence of a governmental (authority) force (Draz, 2008).

Quarantine in Islam

The concept of quarantine in Islam can be traced back to the attitude of the second caliph ʿUmar ibn al-Khattāb (581–644) concerning the Plague of Emmaus (in Arabic, ʿAmwās, a village in Palestine). In the year 638 he departed for Shām (the Levant, comprising present-day Palestine, Jordan, Lebanon, and Syria) and when he reached Sargh (a village on the road from Medina to Palestine), the commander of the Muslim army, Abu ʿUbaydah ibn al-Jarrāḥ (583–638), informed him that an epidemic had broken out in Shām. ʿUmar called the Muslim leaders and consulted them on whether he, along with the accompanying army, should proceed. They differed in their opinions. Some of them said, “We have come out for a purpose and we do not think that it is proper to give it up,” whereas others said, “You have along with you the rest of people [including some of the Prophet’s Companions] so we do not advise you to take them to this epidemic.” Eventually ʿUmar made an announcement: “I will ride back to Medina in the morning, so you should do the same.” Abu ʿUbaydah said to ʿUmar: “Are you running away from what God had ordained?” ʿUmar replied, “Yes, we are running from what God had ordained to what God has ordained.” At that time ʿAbd al-Raḥmān ibn ʿAwf (580–653), who had been absent, came and said, “I have heard God’s Messenger saying: ‘If you hear about it (an outbreak of plague) in a land, do not go to it; but if plague breaks out in a country where you are staying, do not run away from it.’” ʿUmar thanked God and returned to Medina (Ṣaḥīḥ al-Bukhārī, chapter on what has been mentioned about the plague, Book of Medicine). Abu ʿUbaydah returned to his camp and later on died of plague (Ibn Ḥajar, 1991).

Theological and Jurisprudential Discussions

This Prophetic report inspired extensive theological and jurisprudential discussions among Muslim scholars about quarantine. The majority of Muslim scholars concluded that it is strictly prohibited to enter the area of plague for those who were out of it when it occurred and to leave the area of plague for those who were inside it. On the other hand, a minority of scholars held the opinion that running away from plague is not strictly prohibited (al-Mawsūʿah al-Fiqhiyah). The minority opinion was influenced by their understanding of the concept of contagion (ʿadwā) mentioned in a ḥadīth narrated by al-Bukhārī (810–870). The Prophet said, “(There is) no ʿadwā … and one should run away from the leper as one runs away from a lion” (Ṣaḥīḥ al-Bukhārī, chapter on leprosy, Book of Medicine). The minority argued that the ʿadwā of plague is from God and the person with the disease has no ability to infect others because the disease itself is not the reason for contagion, but God’s will is. Therefore whether a person runs away from a plague-striken area or not will have no effect on his developing the disease (al-Mawsūʿah al-Fiqhiyah). In addition to this argument, they supported their interpretation by a ḥadīth narrated by al-Tirmidhī (824–892) that: “The Prophet took the hand of a leper and put it in the plate of food and said: Eat in God's Name, trusting in God and relying upon Him’” (Jāmiʿ al-Tirmidhī, chapter on what has been mentioned about eating with a leper, Book of Food).

The scholars who supported the strict prohibition questioned the authenticity of the ḥadīth reported by al-Tirmidhī because he himself was not sure if the practice mentioned in the ḥadīth is to be attributed to the Prophet or to one of his companions and thus will not have the binding authority of the Sunnah. In addition, they challenged the understanding of contagion by interpreting the ḥadīth reported by al-Tirmidhī through linking its beginning with its end (no ʿadwā … and run away from the leper). The instruction at the end of the ḥadīth is to run away from the leper as one would run away from a lion, which means that the leper is a danger for a non-leper and that he can act as a source of the disease (ability to infect). Therefore denial of contagion at the beginning of the ḥadīth must have a meaning that would not contradict its concluding part (al-Mawsūʿah al-Fiqhiyah). They supported their argument with a narration by Muslim ibn al-Ḥajjāj (815–875) indicating that the Prophet sent this message to a leper who came with the delegation of Thaqīf (a tribe from Ṭāʾif) to Medina: “We have accepted your allegiance, so you may go” (Ṣaḥīḥ Muslim, chapter on avoiding lepers and similar people, Book of Greetings). According to Ibn al-Qayyim (1292–1350), coming in contact with a person with plague or leprosy is a necessary but not sufficient factor to cause the disease. It is like putting a seed in the soil, necessary but not sufficient for the seed to grow without the will of God (Ibn al-Qayyim, 1987, pp. 37-42). Following the majority view, one could conclude that it is strictly prohibited to enter the area of plague for those who were out of it when it occurred to avoid acquiring the disease and to leave the area of plague for those who were inside it when it occurred to avoid transmitting the disease.

Voluntary or Involuntary Quarantine

Based on the teaching of the Prophet, Muslims practiced quarantine as part of their religion, which deals with all aspects of their lives, including health and disease. The controversy that existed among Muslim jurists may explain why, most probably, the community quarantine in early Islam, such as the plague of Emmaus, was voluntary. Muslims were encouraged by many Prophetic reports indicating the rewards for staying at the land of plague. For example, in one ḥadīth, the Prophet is reported to have said: “None [among the believers] remains patient in a land in which plague has broken out and considers that nothing will befall him except what God has ordained for him, but that God will grant him a reward similar to that of a martyr.” Muslim scholars were acting as role models by staying in the land of plague and not leaving it. Ibn ʿAbd al-Barr (978–1071), stated that: “I never heard of any scholar [who was in a place when a plague happened] who ran away from the plague” (see Ibn Ḥajar, 1991, pp. 361-371).

We cannot find evidence that quarantine was imposed by the government (authority) on the community in the early period of Islam. However, there is evidence that some groups such as lepers were isolated and treated in a hospital after an order was issued by the authorities (Baik, 1981, p 203). It is clear that the isolation was involuntary. According to Ibn Taymiyyah (1263–1328), “the lepers have to stay away from people and live in separate places [isolated] and the ruler has to enforce isolation on them, and if the leper or the ruler refuses to do that then they will be considered sinful” (Ibn Taymiyyah, 2000). Ibn al-Qayyim added: “The authority [government] has the obligation to provide the leper with necessary needs (shelter, food, and cloths), if he doesn’t have enough resources for that” (Ibn al-Qayyim, 2008, pp. 731-739).

Quarantine in Modern Times

In the modern period, the discovery of the agents responsible for infectious diseases has relatively impacted the jurisprudential discussions among Muslim scholars regarding the necessary measures to be taken to control infectious diseases, including quarantine and isolation (Riḍā, 1898). The International Islamic Fiqh Academy affiliated with the Organization of the Islamic Cooperation, representing all Muslim countries, issued a fatwa (non-binding legal opinion) that in cases of contagious diseases, seeking treatment becomes obligatory on infected individuals. If they refuse to seek treatment, the government has the power to enforce necessary measures even against their will (without consent) in order to protect the community (International Islamic Fiqh Academy, 2013).

In addition to the textual evidence that is used and discussed in detail to produce a fatwa, modern Muslim scholars are now using, more frequently, the principles of Islamic jurisprudence (al-Qawāʿid al-Fiqhyah) to find answers to contemporary bioethical issues in accordance with the purposes of Islamic law (Maqāṣid al-Shariʿah) (Kasule, 2010). In the case of quarantine, for example, it is clear that the main purpose of Islamic law is to protect people’s lives, through preventing the spread of the disease, and this can be justified by applying the principle of preventing harm (injury). This principle is one of the five main universal maxims of Islamic jurisprudence whose authority is a matter of consensus among the scholars of all schools of thought (madhhabs). This principle reads: “harm shall be removed.” It supports forbidding any act that may cause harm by whatever means. Any act that is harmful must be removed or avoided, and if it is not possible to avoid, then the lesser of two harms should be chosen in order to avoid the one which causes greater harm to the community. Similarly, avoidance of harm takes priority over the attainment of benefit. The permissibility of enforcing quarantine is often justified on the basis of this principle (Bah and Aljoudi, 2015).

Since the Ottoman quarantine reform in 1838, Muslim countries have adopted the quarantine system to protect citizens and visitors from infectious diseases. For example, Saudi Arabia, where the two holy cities of Mecca and Medina are located, has to deal with a significant threat of infectious diseases during the annual Ḥajj season. The country has adopted the quarantine system since the early days of its establishment. The royal decree of health precautions for infectious diseases was issued in 1934, which includes the possibility of enforcing quarantine as a measure for preventing and controlling infectious diseases. In 1955 a special policy and procedure for quarantine was issued by the Ministry of Health. Islamic Shariʿah is the basis for all laws in Saudi Arabia, but it is not clear if these decrees that enable the quarantine actions were developed through a rigorous juristic discourse or not (Mishakhkhas, 2006).

Conclusion

Quarantine is a necessary measure to protect communities from the spread of communicable diseases. The autonomy-limiting strategies that characterize quarantine practice could be justified through the harm-prevention principle from secular as well as Islamic perspectives. The relevant type of quarantine in the early part of Islamic history is the voluntary quarantine, both at the community and the group levels. For these, there is evidence going back to the Prophet and his immediate successors. In Islamic history, there is evidence for involuntary quarantine at the group level, through the Bimaristans (hospitals). There is hardly any evidence of involuntary quarantine at the community level before 1831. Since then, quarantine has become a part of public health measures to control communicable diseases in Islamic countries. Modern Muslim scholars often resort to the principles of Islamic jurisprudence in resolving controversies and suggesting solutions for contemporary bioethical challenges. Early theological and jurisprudential controversies about the scope of restrictions under quarantine have little impact, if any, in the modern period.

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