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Hospitals and Medical Institutions

Miri Shefer-Mossensohn
The Oxford Encyclopedia of Philosophy, Science, and Technology in Islam What is This? Includes complete coverage of Islamic philosophy, sciences, and technologies from the classical through contemporary periods.

Hospitals and Medical Institutions

Medical institutions are epitomes of the medical system within which they operate. Nonetheless, their physical organization and location, division of labor, and management and the types of medicine(s) practiced are all products of the society that created and constructed such institutions. Hospitals thus undergo constant adjustments to accommodate changes in society. Consequently, medicine and hospitals are universal and cosmopolitan entities, but with local characteristics.

Medical institutions in the Muslim world are no exception. Medical treatment was dispensed at various sites: at the house of a physician, at the store of a pharmacist, in the marketplace, in the house of the patient, in the open air, and also at the hospital.

History reveals that Islamic hospitals (referred to interchangeably as bīmāristān, bīmārḥāne, tīmāristān, tīmārḥāne, and dār al-shifāʾ) were unique in several important respects. They were founded as charitable institutions, whose purpose was to heal sick patients (rather than serve as hostels or hospices caring for the dying or chronically ill); administered and financed as endowed institutions (Ar. waqf); and distinguished by the traditional medical practice of Galenism (in its Arabic-Muslim interpretation).

A hospital in the Muslim world originated within a mix of ideas and practices of structured medical assistance available in the eighth- and ninth-century Middle East, but the institution soon became uniquely Islamic.

Origins and Beginnings.

The Islamic hospital was the outcome of several contexts, namely early Islamic-Arab, Hellenized Christian, Persian, and Indian medical cultures. Although how each tradition might have contributed to its construction is not clear, the early Islamic hospital is now commonly regarded as a new type of medical institution in its day.

In pre-Islamic and early Islamic Arabia, medical aid was not institutionalized and formal; rather, various patterns of medical assistance existed. For instance, we know of female ṣaḥābah, companions of the Prophet, who joined the early Muslim armies with their husbands, sons, fathers, and brothers, and provided care (and perhaps a cure) to wounded men.

With the rise of the first Islamic dynasties and states came medical institutions. In describing the events of 707, al-Ṭabarī mentions that the Umayyad caliph al-Walīd (r. 705–715) founded a leprosarium. According to al-Ṭabarī’s account, al-Walīd had ordered the construction of a hospital for lepers in the Hejaz in 707, while preparing for his annual pilgrimage to Mecca, the ḥajj. Evidence, however, suggests that whatever original arrangements al-Walīd may have made for lepers, these were short-lived at best: A year later, the caliph ordered them killed. It seems that the measures taken at al-Walīd’s behest may have been intended to keep the lepers away from the public sphere, rather than to offer them health care.

The first Islamic hospital in the sense of a lasting institution had to wait for ʿAbbāsid Baghdad. Whether the founder was Hārūn al-Rashīd (r. 786–809) or Yaḥyā al-Barmakī, Hārūn al-Rashīd’s vizier, is a point of disagreement among scholars. The question of who founded the first Islamic hospital is about more than that identity; it also concerns the cultural and scientific context within which the hospital was established. Hārūn al-Rashīd is said to have imitated the Sassanids as patrons of medicine and science in a Christian-Hellenized format. Thus, establishing a hospital was an attempt to prop up the ʿAbbāsids’ image and enhance their legitimacy as true heirs to the Persian dynasty.

According to this view, the creation of the Islamic hospital was part of the transformation of Greek heritage, including a translation of its written works, into Arabic culture during the ninth century. Syriac-speaking Christian Nestorian physicians played a prominent role in this process. The Bukhtīshūʿ family of physicians, originally from Gondeshapur, was especially instrumental in the transmission of Hellenized medical knowledge and practice to Arabo-Muslim lands in general and to the court and hospitals in particular. Islamic hospitals thus evolved out of Galenic medicine by way of Hellenized Christian physicians and translators.

In addition to favoring the medical protocols of the Christian-Hellenized hospital, the Islamic hospital shared a similar purpose—assisting travelers, pilgrimages, the poor, lepers, and other needy people, a tradition with roots in Byzantine church institutions.

Yaḥyā al-Barmakī’s hospital was different. He was from a family of high-ranking, well-connected bureaucrats from Persian-Buddhist central Asia, and he established an institution inclined toward Indian medicine. The Barmakids patronized the arts and sciences; one of their focal interests was medicine. Indeed, during this same period, several Indian physicians enjoyed the patronage of the ʿAbbāsid elite and engaged in the translation of medical texts.

Whether founded by Hārūn al-Rashīd or Yaḥyā al-Barmakī, the “first” Islamic hospital served, from its inception, as an institution designated to cure sick patients by a professional medical staff. Any Indian influences, if such ever existed, were soon discarded, with the hospital in the Muslim world practicing Galenic-humoral medicine.

By the tenth century, under the ʿAbbāsids and Buyids, the institution had developed its own unique features that set it apart from medical institutions in medieval Latin and Eastern Christendom:

  • • The Islamic medical system, broadly speaking, included different medical options in terms of theory and clinical care: In addition to Galenic-humoral medicine, which was the only type of medicine practiced in Islamic hospitals, the options of folk medicine and religious medicine (“Prophetic medicine”), of similar popularity and legitimacy, also existed. These three options may not have been so apparent in the tenth century, only becoming clear afterward, but medical pluralism did exist.
  • • Hospitals practiced curative medicine. This was the natural outcome of the needs of their patients, who were sick people requiring treatment of specific ailments, rather than healthy individuals simply trying to maintain their health. This feature made hospitals unique in that Islamicate medicine, in general, emphasized another aspect, namely preventive measures, at least as an ideal theory.
  • • Some hospitals also became a venue for medical education. Several leading physicians left behind evidence indicating that they had instructed medical students in their hospitals. Abū Bakr Muḥammad ibn Zakarīyā al-Rāzī (d. c. 925), a particularly influential and pioneering clinician and medical author, mentions hospital training in his clinical case notes; al-Kaskarī, another physician in Baghdad, who flourished in the 920s, wrote a guide for hospitals with comments on medical education.
  • • Islamic hospitals were established as waqf endowments. This was the economic model for hospitals, which also added a charitable aspect to their activities.
  • • Choices for medical staff were based on medical expertise rather than religious affiliation: Documentation shows that non-Muslim physicians regularly worked in early Islamic hospitals. To the extent we know of the patients in these hospitals, it seems that they were Muslims; perhaps the unique religious dietary rules of each faith distanced non-Muslims from Islamic medical institutions (in private medical practice, though, religion seems not to have been a barrier between physicians and patients).
  • • Hospitals were urban facilities. With few noted exceptions, they tended to be situated in urban settings, often major cities. One exception would have been the two medical delegations dispatched, in the form of a mobile hospital, by Shaghab, the mother of the early-tenth-century caliph al-Muqtadir.
  • • Hospitals were affiliated with elite patronage through the institutions’ beneficiaries and some of the hospitals’ physicians, who sometimes also served as court physicians.
  • • Despite the attractive career opportunities associated with elite patronage, the vast majority of practicing physicians did not try to secure positions in hospitals and pursued their medical career in the “private sector.”


ʿAbbāsid patronage started the Islamic hospital. The Islamic dynasties that followed in the late medieval period, namely the eleventh through fifteenth centuries, brought regulation and maturation to the institution. Two biographical dictionaries dedicated to physicians, one by Ibn al-Qiftī (d. 1248) and the other by Abī Uṣaybiʿa (d. 1270), attest to the regular presence of hospitals within the urban landscape, elite patronage, and medical practice in general.

This phase also witnessed the diffusion of the institution to other geographic regions. Now hospitals were founded throughout the Middle East in all major urban centers, such as Damascus, Aleppo, Cairo, Mecca and Medina, Jerusalem, and various towns in Anatolia and Ilkhanid Persia (with the absence of contemporary Islamic hospitals in India, al-Andalus, and North Africa being conspicuous). Concurrent with this geographical diffusion, hospital patronage also extended into new sectors. Originally, hospitals had been primarily caliphal institutions, but in the late medieval period, hospital patronage became more varied. With the demise of ʿAbbāsid central power, local princes (and their female family members) began to patronize medical institutions. In all cases, the foundation and management of these hospitals adhered to the principles outlined above. Simultaneously, variations in the physical appearance of hospitals, as well as their functions, evolved.

The Zangids and Ayyūbids were famous for their hospital construction. Although their main building efforts focused on military sites against the Crusades and foundations associated with strengthening Sunnī Islam, they sponsored several large and impressive hospitals in their domains. This pursuit perhaps reflects their wish on the one hand to emulate the ʿAbbāsids, thus legitimizing the power of the Zangids and Ayyūbids, or on the other hand to compete with them. Architecturally, this phase provided an important new model for future hospitals. Zangid and Ayyūbid constructions were usually four īwān buildings, entered via a single monumental portal; at the center, there was a pool. Rooms for patients and physicians were located in the vaulted halls around the inner pool.

In Syria and Egypt, the Mamlūks (fl. 1250–1517) built extensively in the thirteenth and fourteenth centuries (less so in the later period). Their projects included hospitals in Egypt, Syria, and the Hejaẓ Mamlūk hospitals were organized and functioned as medical charities, to the extent to which the waqfiyya, the endowment deed, corresponded with realities on the ground. Some were larger than earlier constructions and could house dozens of patients as well as a sizable professional medical staff and supporting administrative and menial workers.

Al-Malik al-Manṣūr Qalaʾūn (r. 1279–1290) built a lavish hospital in Cairo in 1284. It was a second medical project for the sultan, the first being a smaller hospital in Hebron. According to contemporary sources, the Cairo institution had two separate wings, one for male patients and the other for female ones. Each wing was divided into three additional wards according to medical expertise: internal medicine, ophthalmology, and surgery. Internal medicine was further divided into several rooms designated for specific ailments: fevers, madness, and diarrhea. The Qalaʾūnid hospital functioned continuously well into the Ottoman period, at least until the eighteenth century.

Anatolia and Iran during the same period experienced significant political turmoil. This was the outcome of the Turkish-Muslim settlement in Anatolia and the decline in Byzantine power after the battle of Manzikert in 1071, and then the Mongol invasion of Anatolia in the 1240s and the conquest of ʿAbbāsid Baghdad in 1258. Nonetheless, in this politically chaotic time, cultural and scientific activities flourished, including the establishment of several hospitals in various locations. It is possible that the reality of many local dynasties was a major factor in the construction of hospitals, which were a means to tap into high Islamic culture and the legitimacy of charitable activity and political patronage while operating in a local setting.

Some hospitals were established by the Seljuks of Rum, the Anatolian branch of the Grand Seljuks of Iraq and Syria. Kayseri (in 1206), Sivas (in 1217), and Konya (c. 1230), for example, were centers of Seljukid power, and they included hospitals. Several additional hospitals were founded by local lords. Divriği was the center of another Anatolian principality, the less known Mengüçek dynasty. Princess Turan Melik founded a hospital there in 1228.

A third group of Anatolian-Iranian hospitals were founded under Ilkhanid patronage. This Mongol-Muslim dynasty ruled Iran and Iraq between the mid-thirteenth through mid-fourteenth centuries, its authority having extended into Anatolia after the 1240s. In 1308 Ilkhanid Princess Yıldız Hatun founded a hospital in Amasya in northern Anatolia above the Black Sea coast.

More famous is the Ilkhanid Hospital in Tabrīz, the capital, constructed by the vizier and historian Rashīd al-Dīn Faḍlallāh (b. 1247–d. 1318). Rashīd al-Dīn entered Mongolian service as a cook/dietician and physician, and later on used his wealth and influence to further medicine and pharmacy. He constructed a quarter in Tabrīz that was named for him as Rabʿ-i Rashīdī. This quarter became a center for scholars and scholarship, including a hospital and medical training facility. Its endowment charter reveals an institution similar to the Qalaʾūnid hospital in Cairo, although on a smaller scale, and with a clear indication of carrying out teaching assignments as well. The charter also mentions physicians in three traditional specializations: internal medicine, surgery, and ophthalmology; in addition, the hospital included teachers of medicine, teaching assistants, and students; a pharmacist; a stock-keeper; and a few housekeeping personnel for supplying water, cleaning, cooking, and other domestic chores.

Fruition: The Ottoman Era.

The Ottomans inherited this institution from previous Muslim societies, developed it considerably, and finally Ottomanized the Islamic hospital model.

Hospitals were founded in the three imperial capitals during the early modern period: Bursa (commissioned by Sultan Bēyazīd I, 1400), Edirne (Sultan Bēyazīd II, 1493), and Istanbul (Sultan Mehmed II, around 1470; Hürrem Sultan, the concubine and later wife of Sultan Süleyman the Magnificent, 1551; Sultan Süleyman, 1555; Nurbanu Sultan on the Asian shore, 1580; Ahmed I, 1613).

Some hospitals were founded in important provincial towns as well. Provincial centers with Ottoman hospitals included, for instance, Manisa (whose hospital was commissioned by Sultan Süleyman in the name of his mother, Hafsa Sultan, 1539), Mecca (Grand Vizier Soḳollu Mehmed Pasha, 1573; Gülnüş Sultan, 1679), and Tunis (Ḥamūda al-Murādī, the Ottoman provincial governor, 1662).

Hospitals were also built in the imperial palaces, such as Topkapı Palace—which included one hospital for the pages in the first court and another for concubines in the third and internal court. Funded by the imperial budget, palace hospitals were an exception to the rule in that most hospitals in premodern Muslim society were established as endowed institutions.

Hospitals were founded by an exclusive group of Ottoman elite: the imperial family and select members of the court. Not all members of the imperial family engaged in medical charity. The non-participation of male members of the imperial family save the reigning sultan is, in fact, very conspicuous. One possible explanation is that the princes threatened the sultan and challenged his legitimacy, thus crafting their own images as a possible ruler, and this may have contributed to their exclusion from hospital foundations.

The pre-Ottoman Islamic hospitals in Anatolia and the Middle East continued to function under Ottoman rule and were incorporated into the Ottoman hospital system. Hospitals founded by conquered Christian dynasties continued to function as well, but were apparently kept within their local communities, not becoming part of the imperial Ottoman bureaucracy.

Most Ottomans did not receive medical treatment in hospitals (it is possible, though, that they had other connections with hospitals, for example, receiving medication in their out-patient clinics or finding employment there). Likewise, most Ottoman physicians practiced their profession outside hospitals and did not seem to consider it as mandatory experience in advancing their careers. Nonetheless, hospitals remained at the center of mainstream Ottoman identity.

In the Ottoman Empire, the hospital became a bureaucratic and hierarchic institution, similar to other Ottoman ruling institutions: The process of bureaucratization and co-optation mechanisms as manifested in the Ottoman hospital positioned this medical institution parallel to other Ottoman institutions, such as the central administration, palace harem, and ulema. The bureaucratization of the hospital came about in two intertwined processes. The first was medical professionalization; the second, evolution of a hierarchy by way of graduated wage levels between hospitals and between staff members.

The Ottoman medical system, like Ottoman culture as a whole, was the result of combining central Asian, Anatolian, Arab-Muslim, and Byzantine influences. Hospitals merged several medical traditions with a new interpretation.

For instance, the architecture of Ottoman hospitals was influenced by that of Seljukid madrasahs and hospital buildings. Similar to earlier hospitals of the Late Middle Ages, Ottoman hospitals had well-kept gardens. Gardens were considered to promote overall well-being and to provide very effective therapeutics, based on the Galenic-humoral theory that viewed the body and psyche as interconnected. The Ottomans shared this medical concept with previous Muslim medical systems. The idea that thoughts, feelings, and sensory experiences might promote recuperation was one which appeared in numerous medical treatises starting with Galen. However, the Ottoman perspective was unique in the extent to which it made intentional and institutional use of this belief and sought to include all the human senses in the healing process. Music, the presence of water, storytelling, prayer, pleasant smells, and an aesthetic environment were all routinely found in most hospitals.

Ottoman hospitals, like previous Islamic hospitals, were charitable institutions founded and funded by endowments. Hospitals were established, and operated, as part of a complex of charities for the community. These complexes were an amalgamation of different institutions, with mosques situated at the very center of the site, offering an urban Ottoman-Muslim community various material and spiritual services. This is what Halil İnalcik has termed the vakıf-imaret system, which was an exclusive feature of the Ottoman Empire.

Ottoman Muslim hospitals, in general, followed the same management and personnel practices as pre-Ottoman Islamic hospitals. Here too, however, there was a shift: Ottoman hospitals employed larger medical, administrative, and manual staff than had been common in earlier periods. Organization-wise, Ottoman hospitals were more detailed and formal than previous norms.

Modernization and Westernization since the 1800s.

The foundation hospitals of the Ottoman Empire came to a halt in the eighteenth century. The high costs involved in the founding of hospitals and their day-to-day upkeep may have driven benevolent founders to channel their charitable activity toward cheaper venues, for example, fountains, hostels, and libraries. However, the choice to donate to new hospitals (or to refrain from it) was not just a question of finance. Other institutions, such as soup kitchens, were even more costly to operate than hospitals, and Ottomans continued to found them during the financial difficulties of the eighteenth century. Hospitals, in contrast, were founded in limited number during periods of greater affluence. It is possible that hospitals were deemed useful but not crucial for the community.

With the advent of a new wave of reforms in the late eighteenth century, and with more enthusiasm during the nineteenth century, Ottomans returned to hospital building. However, Ottomans (like their contemporaries in Iran and Egypt) had switched from Ottoman-humoral to European medicine. Hospitals constructed from the end of the eighteenth century onward demonstrated the Ottoman elite’s decision to promote a new kind of medicine. In 1822, for instance, Mehmed ʿAlī Pasha, the Ottoman ruler of Egypt, invited Antoine-Barthelemy Clot, a French physician, to modernize Egyptian medical services. In 1827 Clot founded a hospital and medical school in Cairo where European medicine was taught.

The first new institutions in the Middle East were inaugurated for the military with the help of European experts. One example was the naval hospital built by Selim III (r. 1789–1807) with the help of Italian physicians. Mehmed ʿAlī Pasha in Egypt enlisted Clot with the same aim in mind. The military medical school in Istanbul (Mekteb-i Tıbbiye) built by the Ottoman sultan Maḥmūd II in the 1820s and 1830s adopted French as a teaching language and was managed by a Viennese physician.

After several decades, such new hospitals came to be founded for the civilian population as well. The ultimate aim was not necessarily to improve the well-being of citizens (citizenship was a new concept in the Middle East), but rather to improve state management. With health intentionally and successfully transforming into a mechanism of state control, medicine and disease in general and medical institutions in particular attracted much attention on the local and imperial levels during this period.

In 1845 Valide Sultan Bezm-i ʿĀlem (d. 1853), the mother of ʿAbd al-Madjīd I (Abdülmecid, r. 1839–1856), constructed a hospital and a mosque in the capital’s center, Istanbul. Bezm-i ʿĀlem’s enterprise was firmly anchored in the Ottoman patronage tradition: A number of outstanding women in the imperial family preceded her in building hospitals as charitable institutions. Under this traditional cloak, however, the guiding principle of Bezm-i ʿĀlem’s institution was new. It required that medical personnel be trained and certified by Western-style medical schools, rather than in the humoral medicine traditionally practiced in earlier hospitals.

Opened in 1876, the Zeynep Kamil Hospital on the Asian banks of the Bosphorus marked yet several other significant changes. Similarly to the Bezm-i ʿĀlem hospital, also in Istanbul, the Zeynep Kamil Hospital was founded as an endowed institution for the Muslim community. Once again, the framework was traditional Muslim-Ottoman charity. The benevolent benefactors of the Zeynep Kamil Hospital were a husband and wife: He was the former grand vizier, Yusuf Kāmil Pasha; she was Zeynep Hanım (Lady Zeynep), the younger daughter of Mehmed ʿAlī Pasha. In both hospitals, Islamic-Ottoman medical charity merged with European medicine. The Zeynep Kamil Hospital thus continued the tradition of an Ottoman elite patronizing learned medicine, which during the nineteenth century switched its focus to the knowledge and practices of European medicine. In both hospitals, some of the personnel received their training in Europe or in newly established Ottoman medical schools. As in the Ottoman tradition of benevolence, private initiative mixed with public policy: It became state policy during the nineteenth century to promote European medicine, and hospitals were a means to that end.

The Zeynep Kamil Hospital marked yet another significant change—in the architecture of Ottoman hospitals. The hospital was arranged structurally according to the pavilion system of contemporary European hospitals. Such spatial organization enabled relatively easy expansion, as opposed to building a large central structure housing all of the institute’s activities. Another important change was the identity of its founders. Now, the patronage of hospitals with a European flavor lay in the hands of the broader Ottoman elite and not just members of the imperial family.

Nation-States of the Twentieth and Twenty-First Centuries.

After political independence was won with the emergence of modern independent Islamic states in the first part of the twentieth century, nationalist governments continued to make medical services an important political platform, and medical schools, hospitals, and other related facilities and public health systems were founded throughout the Muslim world.

There are presently widespread deficiencies, however, due to grave financial inequities and organizational difficulties. The oil-rich nations can afford to spend growing amounts of dollars to offer ultramodern medical facilities to their citizens. In contrast, the poorer Islamic nations of Southeast Asia, the Middle East, and Africa have inadequate medical facilities. Because of differences in medical facilities (as well as Shariʿah-based legal schools and formal legislation across Muslim states), the phenomenon of medical tourism is gaining momentum, especially in the realms of cosmetic surgery and infertility treatments.

Another concern in the Muslim world surrounding current medical institutions is the limited access of women to health care. The gender segregation promoted by Islamic morality and the legal sphere has resulted in tensions concerning medical encounters and the correct code for healer-patient relations. The reality is that women’s health has never been only women’s business, but still many Muslim men and women uphold an ideal of exclusive gendered domains of medical practice. With not enough female physicians available, many Muslim women are denied easy access to a practitioner. The reasons for a shortage in female medical doctors are numerous: Among them, not enough girls are allowed to start the long training, and the mostly male public medical institutions do not necessarily integrate female students. The opening of the Al-Aẓhar Medical School for Girls during the 1960s in Cairo is just one example of steps taken to encourage more women to become part of institutionalized health care. It fits within the ideology of several modern conservative Islamic movements that identify medical care with female (motherly) skills. Community leaders hope that as a greater number of female Muslim doctors become available, more female patients will find it easier to seek timely medical treatment.


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