Volume 8, No.3 August 2021

ISSN 2634 8071

Islam and Public Health Omer H El-Hamdoon

The Divine Wisdom behind Disease – Medical and

Islamic Philosophy of Pain and Suffering

Professor M A R Al-Fallouji

Time Management for Muslim Health

Practitioners

Dr Hussein Nagi

Patient-Physician Relationships: Islamic views

Hassan Chamsi-Pasha, Majed Chamsi-Pasha, Mohammed Ali Albar

The challenges facing medical workers towards

Syrian Refugees in Lebanon

L Haitham, M Alhasan, and Fadi Alhalabi

The Beginning of Life and Abortion 1001 Cures: Introduction to the History of Islamic

Medicine - by Rabie E Abdel-Halim

Prof Glen M. Cooper

Hatem M Al-Haj

Concept of Healthcare: A Divine approach and a

Contemporary View Organ donation in Muslim communities: sharing

your opinion with the family

Aiman Alzetani

Muhammad Hanif Shiwani

Bioethical Basis for Prioritising Critical Medical

Care During the COVID-19 Pandemic

Mohamed Abdelaty

A Rare and Magnificent Manuscript on

Ophthalmology (Al-Kafi fi al Kuhl)

M. Zafer Wafai & Serene Wafai

A Cry for better medical care in Al-Aqsa Mosque

from a Palestinian doctor in Al-Quds (Jerusalem)

Sofian Hamodeh

Dr Husain Nagamia Obituary

Marium Husain

ISSN 2634 8071

The Divine Wisdom behind Disease – Medical

and Islamic Philosophy of Pain and Suffering

Professor M A R Al-Fallouji

Dr Sharif Kaf Al-Ghazal, Editor in Chief

Time Management for Muslim Health

Practitioners

Patient-Physician Relationships: Islamic views Dr Hussein Nagi

Hassan Chamsi-Pasha, Majed Chamsi-Pasha, Mohammed Ali Albar

The challenges facing medical workers towards

Syrian Refugees in Lebanon

L Haitham, M Alhasan, and Fadi Alhalabi

The Beginning of Life and Abortion

Hatem M Al-Haj

Concept of Healthcare: A Divine approach and a

Contemporary View

Muhammad Hanif Shiwani

1001 Cures: Introduction to the History of

Islamic Medicine - by Rabie E Abdel-Halim

Prof Glen M. Cooper Bimaristans: Services and Their Educational Role

in Islamic Medical History and Their Influence

on Modern Medicine and Hospitals

Usman Maravia & Sharif Kaf Al-Ghazal Organ donation in Muslim communities: sharing

your opinion with the family

Aiman Alzetani A Rare and Magnificent Manuscript on

Ophthalmology (Al-Kafi fi al Kuhl)

M. Zafer Wafai & Serene WafaiBioethical Basis for Prioritising Critical Medical

Care During the COVID-19 Pandemic

Mohamed Abdelaty Muslim Communities & COVID-19 : Challenges

& Reflections

Zara Mohammed A Cry for better medical care in Al-Aqsa Mosque

from a Palestinian doctor in Al-Quds (Jerusalem)

Sofian Hamodeh

Dr Husain Nagamia Obituary

Marium Husain Islam and Public Health Omer H El-Hamdoon

Dr Sharif Kaf Al-Ghazal, Editor in Chief

AssalamoAlaikom

The progress we have made in fighting the Covidpandemic this year has been extraordinary, and it is good to see the vaccine working effectively. We’re not out of the woods yet however as various strains emerge andCovid has not yet been eliminated. Having said that,need to take a step back and ask ourselves what the worldwe live in is like, and what prospects does it hold for thefuture. Beyond the difficulties of Covid, there is astaggering level of death and destruction around theworld for a variety of reasons, and as medicalprofessionals, it is our duty to help the sick and needy. And whilst we cannot help everyone everywhere, thereare ways for us to work together to assist those with noaccess to medical care.

Disasters in the Muslim world are ongoing. The latestnews we are hearing in Afghanistan means that there willbe an influx of Afghan refugees fleeing there soonerrather than later. But in the same way as other conflictridden states like Syria, Yemen, PalestineMyanmar, not all the people there can flee. Those thatcannot leave and therefore cannot access the healthcarein a more stable country have to be helped. Iencouraging to see that there are a number of NGOs who work closely with medical Islamic organisations tocoordinate relief efforts on the ground. In the short term, pop-up clinics are formed and surgeons operate inmakeshift field hospitals. These are generally in responseto disasters that are ongoing or have just struck (anearthquake or Tsunami for example).

But in the long term there are genuine opportunities formedical relief efforts to be improved, and healthcareprofessionals should be at the forefront ofDoctors and NGOs should be advocating for capacitybuilding and long term public health campaigns so even if disaster strikes, the mechanisms are in place for thepublic to be educated about issues such as vaccination forexample. Disaster planning has to be professionalised,and healthcare professionals need to ensure that their work with medical NGOs is better coordinated too.

Editor in Chief

The progress we have made in fighting the Covid-19 pandemic this year has been extraordinary, and it is good

We’re not out of the woods yet however as various strains emerge and

Having said that, we need to take a step back and ask ourselves what the world we live in is like, and what prospects does it hold for the

ond the difficulties of Covid, there is a staggering level of death and destruction around the world for a variety of reasons, and as medical professionals, it is our duty to help the sick and needy. And whilst we cannot help everyone everywhere, there

ways for us to work together to assist those with no

Disasters in the Muslim world are ongoing. The latest news we are hearing in Afghanistan means that there will be an influx of Afghan refugees fleeing there sooner

ater. But in the same way as other conflict ridden states like Syria, Yemen, Palestine, Somalia and Myanmar, not all the people there can flee. Those that cannot leave and therefore cannot access the healthcare in a more stable country have to be helped. It is encouraging to see that there are a number of NGOs who work closely with medical Islamic organisations to coordinate relief efforts on the ground. In the short term,

up clinics are formed and surgeons operate in e generally in response

to disasters that are ongoing or have just struck (an

But in the long term there are genuine opportunities for medical relief efforts to be improved, and healthcare

forefront of these efforts. Doctors and NGOs should be advocating for capacity building and long term public health campaigns so even if disaster strikes, the mechanisms are in place for the public to be educated about issues such as vaccination for

le. Disaster planning has to be professionalised, and healthcare professionals need to ensure that their work with medical NGOs is better coordinated too.

Doctors generally have good experience when workingwith others in their Multi-Disciplinary Teathis should be replicated when working in the context of medical relief.

There is a real need for healthcare professionals to beproactive and work with said NGOs to advocategovernments on the importance of stable healthcaresystems and public health awareness and ensure that thelatter is a staple in schools and universities too so that thenext generation of citizens understands the importance of so many issues that we in the West may take for granted.

The lack of structure and opportunitycontribute to relief efforts has at times resulted intragedy, with the example of the late Dr Abbas Khan in2012, may Allah rest his soul, being one. He wasdetained, tortured and ultimately killed by the Syrianregime, though he had travelled to Syria on humanitariangrounds. Dr David Nott had better luck, but escaped by the skin of his teeth on more than one occasion in Aleppowhich convinced him not to go back.

We at BIMA should be using our man power to helpother organisations providing relief efforts on the ground.And whilst technology will never be a valid substitute for meeting patients face to face, we may not even need to bephysically present in a disaster zone to be of benefit.Virtual consultations with refugees and online teafor local doctors are innovative ways for us to providehelp for those who need it. We should embrace thesecreative solutions whilst remembering that in manycases, it’s the luck of where we were born that hasresulted in us being in a privileged poa stable area of the world. We must be thankful to Allahfor that.

Wassalam

Dr Sharif Al-Ghazal, Editor-in-Chief

Editorial

Doctors generally have good experience when working Disciplinary Team meetings;

this should be replicated when working in the context of

There is a real need for healthcare professionals to be proactive and work with said NGOs to advocate governments on the importance of stable healthcare

c health awareness and ensure that the latter is a staple in schools and universities too so that the next generation of citizens understands the importance of so many issues that we in the West may take for granted.

The lack of structure and opportunity for doctors to contribute to relief efforts has at times resulted in tragedy, with the example of the late Dr Abbas Khan in 2012, may Allah rest his soul, being one. He was detained, tortured and ultimately killed by the Syrian

lled to Syria on humanitarian grounds. Dr David Nott had better luck, but escaped by the skin of his teeth on more than one occasion in Aleppo which convinced him not to go back.

We at BIMA should be using our man power to help ng relief efforts on the ground.

And whilst technology will never be a valid substitute for meeting patients face to face, we may not even need to be physically present in a disaster zone to be of benefit. Virtual consultations with refugees and online teaching for local doctors are innovative ways for us to provide help for those who need it. We should embrace these creative solutions whilst remembering that in many cases, it’s the luck of where we were born that has resulted in us being in a privileged position and living in a stable area of the world. We must be thankful to Allah

1

Hassan Chamsi-Pasha FRCP, FACC

Mohammed Ali Albar MD, FRCP (Lond)

1- Consultant Cardiologist, GNP Hospital, Jeddah, Saudi Arabia

2-Senior Registrar in Internal Medicine, GNP Hospital, Jeddah

3-Director of Medical Ethics Center, Department of Medical Ethics, International Medical Center, Jeddah,Saudi Arabia

Dr. Hassan Chamsi

With the rapid growth of the field of medicine to the modern era, commercialization and consumerism gave riseto an unhappy patient population. Some physicians see their patients asturning into a market place. A good patienttreatment adherence, which ultimately leads to better outcomes.

Obtaining informed consent is the first step tconfidentiality and breaking bad news are among the most challenging tasks facing physicians. When treating aMuslim female patient, recognizing and understanding her concerns about modestydoctor should be fluent with the Islamic teachings on practical daily issues faced in his/her practice. Building afruitful physician-patient relationship is a vital part of successful medical care, and one of the most complicateprofessional responsibilities of the physicians.

Over the years, the patient-physician relationship (PPR)has dramatically changed due to commercialization,quality of healthcare services offered in the governmentset-up, and privatization of the health sector. Doctorsmay, nowadays, ask for unnecessary investigations ormay give over-prescriptions, just to be safa remarkable decline in human touch or empathy; and asignificant rise in unhealthy competition among doctors.

The ideal PPR has six components, namely voluntarychoice, doctor’s competence, good communication,continuity, doctor’s empathy, and the absence of aconflict of interest. A poor PPR, on the other hand, hasbeen proved to be a major hurdle for both doctors andpatients. In the case of poor PPR, patients show poor

FRCP, FACC 1, Majed Chamsi-Pasha MBBS, SBIM

MD, FRCP (Lond)3

Hospital, Jeddah, Saudi Arabia

Senior Registrar in Internal Medicine, GNP Hospital, Jeddah

Director of Medical Ethics Center, Department of Medical Ethics, International Medical Center, Jeddah,

Dr. Hassan Chamsi-Pasha, drhcpasha@hotmail.com

With the rapid growth of the field of medicine to the modern era, commercialization and consumerism gave riseto an unhappy patient population. Some physicians see their patients as customers, and medicine is sometimes,turning into a market place. A good patient-physician relationship is linked to patients’ satisfaction andtreatment adherence, which ultimately leads to better outcomes.

Obtaining informed consent is the first step to proper communication respecting the patient’s values. Protectingconfidentiality and breaking bad news are among the most challenging tasks facing physicians. When treating aMuslim female patient, recognizing and understanding her concerns about modesty is invaluable. The Muslimdoctor should be fluent with the Islamic teachings on practical daily issues faced in his/her practice. Building a

patient relationship is a vital part of successful medical care, and one of the most complicateprofessional responsibilities of the physicians.

physician relationship (PPR) dramatically changed due to commercialization,

quality of healthcare services offered in the government up, and privatization of the health sector. Doctors

may, nowadays, ask for unnecessary investigations or prescriptions, just to be safe. There is also

a remarkable decline in human touch or empathy; and a significant rise in unhealthy competition among doctors.1

The ideal PPR has six components, namely voluntary choice, doctor’s competence, good communication,

hy, and the absence of a conflict of interest. A poor PPR, on the other hand, has been proved to be a major hurdle for both doctors and patients. In the case of poor PPR, patients show poor

compliance with doctor’s advice; they may practicedoctor-shopping by frequently changing their doctors;remain anxious; may choose quacks or other nonscientific forms of treatment; and result in a significantincrease in medical expenses.The first consultation with a patient is the beginning of adoctor-patient relationship. Hence it is of majorimportance to conduct this in a proper way. In thehospital ward, the PPR is far more complex, since manyother people are involved when somebody is sick. Theseinclude patient’s relatives and neighbors, nurses,technicians, social workers and administrators.

Despite worldwide emphasis on the responsibility ofphysicians, teaching the art of physicianrelationship has not yet been incorporated into thecurriculum of many medical schools.

Ethics

MBBS, SBIM 2,

Director of Medical Ethics Center, Department of Medical Ethics, International Medical Center, Jeddah,

With the rapid growth of the field of medicine to the modern era, commercialization and consumerism gave rise customers, and medicine is sometimes,

physician relationship is linked to patients’ satisfaction and

o proper communication respecting the patient’s values. Protecting confidentiality and breaking bad news are among the most challenging tasks facing physicians. When treating a

is invaluable. The Muslim doctor should be fluent with the Islamic teachings on practical daily issues faced in his/her practice. Building a

patient relationship is a vital part of successful medical care, and one of the most complicated

compliance with doctor’s advice; they may practice by frequently changing their doctors;

remain anxious; may choose quacks or other non-scientific forms of treatment; and result in a significant increase in medical expenses.2

The first consultation with a patient is the beginning of a ionship. Hence it is of major

importance to conduct this in a proper way. In the hospital ward, the PPR is far more complex, since many other people are involved when somebody is sick. These include patient’s relatives and neighbors, nurses,

ocial workers and administrators.3

Despite worldwide emphasis on the responsibility of physicians, teaching the art of physician-patient relationship has not yet been incorporated into the curriculum of many medical schools.4

2

Factors like poor communication skills of the doctors,doctors not listening to their patient’s complaints, and amismatch between the doctors’ objectives and patients’ expectations, have together created a wide gap in thePPR which caused a massive impact on the trust andbonding level between doctors and patients.medical science is technology-based and there isinvestment behind the technology. Many doctors do notthink of the low socioeconomic condition of their patients. The patients, therefore, think of the doctors asavaricious and hungry for money.6

Without a full understanding of the cultural backgroundof the patient, it is impossible to build an effectiverelationship with the patient. The doctor must feel thedistress of the patient and do his best to eradicate tdisease the patient suffers from and not only thesymptoms of the disease.

Over the years, the relationship between doctors andpatients has evolved from a largely paternalistic model toa more interactive relationship. The principles of autonomy, beneficence, informed consent, patient’saccess to medical information, and medicoconcerns all now influence the doctorrelationship.7 The UK General Medical Councilpublished “What to expect from your doctor: a guide forpatients”. The guide is a provisional step trying to helppatients getting the best outcome from the interactionwith their physicians.8

Medical practice is considered a sacred duty in Islam,and the physician is rewarded by God for his good work.Al Izz ibn Abdul Salam, a renowned Islamic jurist (d660H/1243 CE) in his book “Qawa’id al Ahkam (Basicsof Rulings)”, said: “The aim of medicine, like the aim of Shari’ah (Islamic law), is to procure the maslaha (utilityor benefit) of human beings, bringing safety and health tothem and warding off the harm of injuries and ailments,as much as possible”. He also said: “The aim of medicineis to preserve health; restore it when it is lost; removeailment or reduce its effects. To reach that goal it may beessential to accept the lesser harm, in order to ward off agreater one; or lose a certain benefit to procure a greaterone”.9 This is a very pragmatic attitude, which is widelyaccepted, in Islamic jurisprudence, and it is frequentlyapplied in daily practice in all fields including medicine.

The Quran and sayings of the Prophet Muhammad PeaceBe Upon Him (PBUH) established morality and mode of conduct of physicians and surgeons. The Prophet gave

on skills of the doctors, doctors not listening to their patient’s complaints, and a mismatch between the doctors’ objectives and patients’ expectations, have together created a wide gap in the PPR which caused a massive impact on the trust and

el between doctors and patients.5 Modern based and there is

investment behind the technology. Many doctors do not think of the low socioeconomic condition of their patients. The patients, therefore, think of the doctors as

Without a full understanding of the cultural background of the patient, it is impossible to build an effective relationship with the patient. The doctor must feel the distress of the patient and do his best to eradicate the disease the patient suffers from and not only the

Over the years, the relationship between doctors and patients has evolved from a largely paternalistic model to a more interactive relationship. The principles of

ficence, informed consent, patient’s access to medical information, and medico-legal concerns all now influence the doctor-patient

The UK General Medical Council published “What to expect from your doctor: a guide for

a provisional step trying to help patients getting the best outcome from the interaction

Medical practice is considered a sacred duty in Islam, and the physician is rewarded by God for his good work. Al Izz ibn Abdul Salam, a renowned Islamic jurist (d 660H/1243 CE) in his book “Qawa’id al Ahkam (Basics of Rulings)”, said: “The aim of medicine, like the aim of Shari’ah (Islamic law), is to procure the maslaha (utility

ing safety and health to them and warding off the harm of injuries and ailments, as much as possible”. He also said: “The aim of medicine is to preserve health; restore it when it is lost; remove ailment or reduce its effects. To reach that goal it may be essential to accept the lesser harm, in order to ward off a greater one; or lose a certain benefit to procure a greater

This is a very pragmatic attitude, which is widely accepted, in Islamic jurisprudence, and it is frequently

tice in all fields including medicine.

The Quran and sayings of the Prophet Muhammad Peace Be Upon Him (PBUH) established morality and mode of conduct of physicians and surgeons. The Prophet gave

many rules regarding seeking remedy, and theimportance of consent. The Islamic jurisprudentsrequired from the practitioner to be competent and obtainlicensed to practice. He also should get the consent of thepatient or his guardian if he is not competent, otherwisehe would be liable.

The Quran and Sunna teacimportance of possessing good (Manners) which incorporate mercy, patience, tolerance,kindness, and honesty, while avoiding pride, arrogance,and anger.10

One of the earliest and most thorough books on medicalethics is entitled “Adab al-Tabib” (Practical Ethics of thePhysician) by Ishaq al-Ruhawi. Alcontemporary to Abu Bakr Alsecond-half of the ninth century A.D.This book wastranslated to English by Martin Levey in 1967(Transactions of the American Philosophical Society).Al-Ruhawi stated that the true physician is the one who fears God; the word fear here encloses love and respect.His conscience is his censor, and he is aware that God's eye is ever watching.

Al-Razi has also written a book fully devoted to medicalethics called “Akhlaq al-Tabib” (Medical Ethics). Toestablish such opinions in a wellthousand years ago is quite significant. Besides, theseideas still maintain their validities nowadays and aredown in several ethical codes of medicine.

Patients and students of medicine frequently complainabout attending physicians who want to spend theminimal time with them and lack patience in answeringtheir worries or queries. The physician shouhonest, benefit his or her patients, and speak kind wordsto others. The Sunnah warns against pride and arrogance,two major transgressions that have marked modernmedicine. The Prophet (PBUH) said: “Allah will notlook, on the Day of Resurrechis izār (garment) [behind him] out of pride andarrogance.13

With the advancement of diagnostic medical technology, many modern physicians refer their patients for sophisticated investigations without even performing aphysical examination, thus failing to treat the patient as human and instead treating the patient as a number or adisease to be dealt with as rapidly as possible. Manymedical codes of ethics request that physicians waivetheir fees for poor patients. In realitygranted to rich and powerful patients who could provide

Ethics

many rules regarding seeking remedy, and the consent. The Islamic jurisprudents

required from the practitioner to be competent and obtain licensed to practice. He also should get the consent of the patient or his guardian if he is not competent, otherwise

The Quran and Sunna teach the Muslim physician the importance of possessing good "khuluq" (Manners) which incorporate mercy, patience, tolerance, kindness, and honesty, while avoiding pride, arrogance,

One of the earliest and most thorough books on medical Tabib” (Practical Ethics of the Ruhawi. Al-Ruhawi was a

contemporary to Abu Bakr Al-Razi and lived in the half of the ninth century A.D.This book was

translated to English by Martin Levey in 1967 ns of the American Philosophical Society).

Ruhawi stated that the true physician is the one who fears God; the word fear here encloses love and respect. His conscience is his censor, and he is aware that God's

tten a book fully devoted to medical Tabib” (Medical Ethics). To

establish such opinions in a well-organized book over a thousand years ago is quite significant. Besides, these ideas still maintain their validities nowadays and are laid down in several ethical codes of medicine.11,12

Patients and students of medicine frequently complain about attending physicians who want to spend the minimal time with them and lack patience in answering their worries or queries. The physician should always be honest, benefit his or her patients, and speak kind words to others. The Sunnah warns against pride and arrogance, two major transgressions that have marked modern medicine. The Prophet (PBUH) said: “Allah will not look, on the Day of Resurrection, at a person who drags his izār (garment) [behind him] out of pride and

With the advancement of diagnostic medical technology, many modern physicians refer their patients for sophisticated investigations without even performing a

l examination, thus failing to treat the patient as human and instead treating the patient as a number or a disease to be dealt with as rapidly as possible. Many medical codes of ethics request that physicians waive their fees for poor patients. In reality, waivers are often granted to rich and powerful patients who could provide

3

physicians with societal benefits.10 The Prophet (PBUH) said: “Feed the hungry, visit the sick and set free thecaptives”.14 The medical profession is unique in that theclient should not be denied the service even if he cannotafford the fee. Empathy is the ability to understand an individual's subjective experience. It plays a major role in establishing a good physician-patient relationship.Enhancing a physician’s empathy mayattending to health-related religion and spirituality needsof the patients.16

The doctor should always honor the high standards of hisprofession and hold it in the highest regard, never prescribing to activities of propaganda, or receivincommission or similar misdoings. It is imperative for aMuslim doctor to always remember the ProphetMuhammad saying: “The best among you are those who have the best manners and character”.17

The Holy Qur’an and Hadiths of the Prophet Muhammad are full of verses and sayings of the Prophet enjoiningdoing good and refraining from doing harm.Qur’an says: “So whosoever does good equal to theweight of an atom (or a small ant), shall see it. Andwhosoever does evil equal to the weight of an atom (orsmall ant), shall see it.” 19

If medical necessity or emergency puts a needy personunder his care, the Doctor should be considerate andkind, and avoid his fees if any being a further burdenatop of the ailment. For as you give the poor it is Godyou are giving and alms giving is not only due on material possessions but on knowledge and skills too.The sphere of a Doctor's charity, nicety, patience andtolerance should be large enough to encompass thepatient’s relatives, friends and those who care forworry about him but without of course compromising thedictates of "Professional Secrecy".20,21He should avoidwrongdoing, not abusing his/her stat for monetary gain,and not misleading his/her patient because God does notlove the liars and wrongdoers.22 The Prophet (PBUH) said: “Those who have a perfect faith are those who havethe best character”.23Islamic ethics instructs human beings not only to be virtuous, but also to contribute tothe moral health of society. The Qur’an says “You enjoinwhat is right and forbid what is wrong”.of the Muslim is exemplified in a verse of the HolyQur’an saying: (“Indeed, Allah orders justice and goodconduct” … and “forbids immorality and bad conductand oppression”).25 The characteristic features ovirtuous physician are firmly rooted in the Qur’an and theSunna.

The Prophet (PBUH) said: “Feed the hungry, visit the sick and set free the

The medical profession is unique in that the uld not be denied the service even if he cannot

Empathy is the ability to understand an individual's subjective experience. It plays a major role in

patient relationship.15

Enhancing a physician’s empathy may be the key to related religion and spirituality needs

The doctor should always honor the high standards of his profession and hold it in the highest regard, never prescribing to activities of propaganda, or receiving a commission or similar misdoings. It is imperative for a Muslim doctor to always remember the Prophet Muhammad saying: “The best among you are those who

The Holy Qur’an and Hadiths of the Prophet Muhammad l of verses and sayings of the Prophet enjoining

doing good and refraining from doing harm.18 The Qur’an says: “So whosoever does good equal to the weight of an atom (or a small ant), shall see it. And whosoever does evil equal to the weight of an atom (or a

If medical necessity or emergency puts a needy person under his care, the Doctor should be considerate and kind, and avoid his fees if any being a further burden atop of the ailment. For as you give the poor it is God

are giving and alms giving is not only due on material possessions but on knowledge and skills too. The sphere of a Doctor's charity, nicety, patience and tolerance should be large enough to encompass the patient’s relatives, friends and those who care for or worry about him but without of course compromising the

He should avoid wrongdoing, not abusing his/her stat for monetary gain, and not misleading his/her patient because God does not

The Prophet (PBUH) said: “Those who have a perfect faith are those who have

Islamic ethics instructs human beings not only to be virtuous, but also to contribute to the moral health of society. The Qur’an says “You enjoin

right and forbid what is wrong”.24 The character of the Muslim is exemplified in a verse of the Holy Qur’an saying: (“Indeed, Allah orders justice and good conduct” … and “forbids immorality and bad conduct

The characteristic features of a virtuous physician are firmly rooted in the Qur’an and the

One major factor that must be considered in the care of Muslim patients is the importance of the family. Visitingfamily and friends in the hospital is extremely impoin Islam. Muslims are required to visit those who are sickor injured and provide patients and their families withcomfort and support. The teachings of Islam dictate thatMuslims not only meet with those who are ill but alsoconverse with them, provide words of encouragement, and pray for their well-being and prompt recovery. Thisimportant obligation is vital to the care of Muslimpatients, and measures should be taken to accommodatethese visitations.26,27 However, it is important torecognize that these events may provide additional stressto the nursing staff or adjacent patients sharingsemiprivate rooms.21

Obtaining patient’s permission prior to deliveringmedical treatment is obligatory in Islam if the patient hasfull legal capacity, or their legal guardian if the patient is a minor. This is only if the treatment prescribed ispermissible. However, according to the InternationalFiqh Academy (1992), consent is not required if thetreatment and the medical procedures are needeemergency to save a life, or organs, when the patient isunconscious or a minor, and no guardian is available, orin cases of contagious diseases and preventiveimmunizations ordered by the health authorities.Similarly, consent is not required if a mguardian refuses to give permission and it is clearlydetrimental to the patient under his/ her guardianship.While this may be different to the conventional law inmedical practices, it is derived from the principles of fiqh(Islamic Law), “harm should not be inflicted norreciprocated” (laadhararawalaadhiraar), and “publicinterest should be prioritized over personal interest” (almaslahah al-‘am tuqaddam‘alaa alHence, refraining from treatment is an act of misconductif the treatment is obligated, and preventing misconductis an obligation upon all Muslims.

The Qur’an tells both men and women to ‘lower their gaze and guard their modesty’ and further addresseswomen to ‘not display their beauty and ornaments exceptwhat (must ordinarily) appear thereof.often choose to cover their hair with a scarf called ahijab, and it is essential that physicians respect this

Ethics

One major factor that must be considered in the care of Muslim patients is the importance of the family. Visiting family and friends in the hospital is extremely important in Islam. Muslims are required to visit those who are sick or injured and provide patients and their families with comfort and support. The teachings of Islam dictate that Muslims not only meet with those who are ill but also

ide words of encouragement, being and prompt recovery. This

important obligation is vital to the care of Muslim patients, and measures should be taken to accommodate

However, it is important to these events may provide additional stress

to the nursing staff or adjacent patients sharing

Obtaining patient’s permission prior to delivering medical treatment is obligatory in Islam if the patient has

capacity, or their legal guardian if the patient is a minor. This is only if the treatment prescribed is permissible. However, according to the International Fiqh Academy (1992), consent is not required if the treatment and the medical procedures are needed in emergency to save a life, or organs, when the patient is unconscious or a minor, and no guardian is available, or in cases of contagious diseases and preventive immunizations ordered by the health authorities. Similarly, consent is not required if a minor’s legal guardian refuses to give permission and it is clearly detrimental to the patient under his/ her guardianship. While this may be different to the conventional law in medical practices, it is derived from the principles of fiqh

arm should not be inflicted nor reciprocated” (laadhararawalaadhiraar), and “public interest should be prioritized over personal interest” (al-

‘am tuqaddam‘alaa al-maslahah al-khassah). Hence, refraining from treatment is an act of misconduct f the treatment is obligated, and preventing misconduct

is an obligation upon all Muslims.28,29

The Qur’an tells both men and women to ‘lower their gaze and guard their modesty’ and further addresses

display their beauty and ornaments except what (must ordinarily) appear thereof.30 Muslim women often choose to cover their hair with a scarf called a hijab, and it is essential that physicians respect this

4

decision and allow them to do so whenever possiblexample, even when going to the operating room forsurgery, it is preferable to allow a Muslim woman towear her hijab in addition to the hospital gown. If this is

Hospital staff could offer to keep the curtains drawn, orthe door closed. Another effective way is a ‘knock, wait,enter’ policy by which staff knock, wait for peand then enter patient rooms. It must be stressed that theclinician uncover only that part of the body that needs tobe examined, and cover those that are not part of theexam or have been examined already.31

Avoiding unnecessary exposure is an important priority. Muslim women are encouraged to wear loose fittingclothing that can be stretched to allow adequate exposurefor examination while maintaining as much coverage aspossible. Although a patient may be unconscious,covering the genital area in the operating room with asurgical towel during skin preparation is also encouraged and conveys an additional element of trust between thepatient and the surgeon.21,26

“Khalwah” is defined as the situation where awoman are both located in a closed place alone andwhere sexual intercourse between them can occur’. Thissituation is prohibited between non-mahram (a very closerelative or husband) adult members of opposite sexes inorder to prevent the accusation, and committal of, illicitrelations.

Most Islamic scholars believe that a patient seeking nonurgent treatment should choose a physician according tothe following order of decreasing preference: Muslim of the same gender, non-Muslim of the same geMuslim of the opposite gender, nonopposite gender. For a Muslim woman, it could be verystressful to expose her body in front of a male physician,or even to discuss with him sensitive issues related to her health. It is quite common for the husband to ask to staywith his wife during a physical examination. Having afemale nurse available for examinations may help aMuslim woman to feel more comfortable, and ismandatory in all countries in the world.21,29

Islamic law does allow for deviation from normalregulations in cases of need and emergency.All Muslim scholars state that necessity allows things that are ordinarily forbidden to be permissible. IbnQudama, a renowned Hanbali scholar, writes: ‘‘It is permissible for the male doctor to inspect whatever parts

decision and allow them to do so whenever possible. For example, even when going to the operating room for surgery, it is preferable to allow a Muslim woman to wear her hijab in addition to the hospital gown. If this is

not permitted, using a surgical head and neck coveringcan allow a woman to maintain dignity without compromising hospital and operatingroom policy.

Hospital staff could offer to keep the curtains drawn, or the door closed. Another effective way is a ‘knock, wait, enter’ policy by which staff knock, wait for permission and then enter patient rooms. It must be stressed that the clinician uncover only that part of the body that needs to be examined, and cover those that are not part of the

important priority. Muslim women are encouraged to wear loose fitting clothing that can be stretched to allow adequate exposure for examination while maintaining as much coverage as possible. Although a patient may be unconscious,

in the operating room with a surgical towel during skin preparation is also encouraged and conveys an additional element of trust between the

“Khalwah” is defined as the situation where a ‘man and a woman are both located in a closed place alone and where sexual intercourse between them can occur’. This

mahram (a very close relative or husband) adult members of opposite sexes in

ation, and committal of, illicit

Most Islamic scholars believe that a patient seeking non urgent treatment should choose a physician according to the following order of decreasing preference: Muslim of

Muslim of the same gender, Muslim of the opposite gender, non-Muslim of the opposite gender. For a Muslim woman, it could be very stressful to expose her body in front of a male physician, or even to discuss with him sensitive issues related to her

or the husband to ask to stay with his wife during a physical examination. Having a female nurse available for examinations may help a Muslim woman to feel more comfortable, and is

21,29

eviation from normal regulations in cases of need and emergency. All Muslim scholars state that necessity allows things that are ordinarily forbidden to be permissible. Ibn Qudama, a renowned Hanbali scholar, writes: ‘‘It is

to inspect whatever parts

of the woman’s body that the medical examinationwarrants.’’ Ibn Muflih, also of the Hanbali school state:‘‘if a woman is sick and no female doctor is available, amale doctor may treat her. In such a case, the doctor ispermitted to examine her, including her genitals.’’Scholars are also clear that female doctors may fullyexamine male patients in cases of necessity. In all cases,a third party of the same gender as the patient is requiredto be present for the examination.outside of the examination should always be approachedwith caution. Understanding a Muslim woman concerns about modesty is invaluable in developing appropriatephysician-patient relationship.

Breach of confidentiality justifiable in Islam. Examples include reporting, to theassigned authorities, probable criminal acts (such asdomestic violence or child abuse), serious communicablediseases or circumstances, which pose a threat to others’ lives (such as an epileptic patient working as a driver),notification of births and deaths, medical errors, and drugside effects. If the patient agrees to disclose thecomplexity of his medical condition to the family, thenthere is no breaking of confidenHIV infection, then the physician’s duty is to inform theother consort of the true diagnosis. The doctor shouldtake the permission from the infected person, or ask himto tell his consort, in his presence, the true diagnosis.a fatwa issued by the International Islamic Fiqh Academyin 1993, jurists affirmed that a breach of confidentialitycan be acceptable only if the harm of maintainingconfidentiality overrides its benefits. The fatwa describessome situations in which allowed, or mandatory.33 “Such cases are of 2 categories:a) Cases where confidentiality must be broken ongrounds of the rational of committing a lesser evil andobviating the greater one, and the rational of seeing to apublic interest, which favor enduring individual harm soas to prevent public harm if needed. These include 2 sets:Those which involve protecting society against someprejudice, and those which involve protecting anindividual against some prejudice. b) Casesconfidentiality may be broken: 1) To ensure a publicinterest. 2) To prevent a public damage. In all such casesthe objectives and priorities are set out by Shari’ah(Islamic law) regarding preserving the faith, human life,reason, descendants, and wealth”.

Ethics

not permitted, using a surgical head and neck covering can allow a woman to maintain her sense of comfort and dignity without compromising hospital and operating room policy.26

of the woman’s body that the medical examination warrants.’’ Ibn Muflih, also of the Hanbali school state: ‘‘if a woman is sick and no female doctor is available, a male doctor may treat her. In such a case, the doctor is

ted to examine her, including her genitals.’’ Scholars are also clear that female doctors may fully examine male patients in cases of necessity. In all cases, a third party of the same gender as the patient is required to be present for the examination.29,32 Physical contact outside of the examination should always be approached with caution. Understanding a Muslim woman concerns about modesty is invaluable in developing appropriate

patient relationship.

under certain conditions is justifiable in Islam. Examples include reporting, to the assigned authorities, probable criminal acts (such as domestic violence or child abuse), serious communicable diseases or circumstances, which pose a threat to others’

ves (such as an epileptic patient working as a driver), notification of births and deaths, medical errors, and drug side effects. If the patient agrees to disclose the complexity of his medical condition to the family, then there is no breaking of confidentiality. If a consort has an HIV infection, then the physician’s duty is to inform the other consort of the true diagnosis. The doctor should take the permission from the infected person, or ask him to tell his consort, in his presence, the true diagnosis.29 In a fatwa issued by the International Islamic Fiqh Academy in 1993, jurists affirmed that a breach of confidentiality can be acceptable only if the harm of maintaining confidentiality overrides its benefits. The fatwa describes

breaching confidentiality is “Such cases are of 2 categories:

a) Cases where confidentiality must be broken ongrounds of the rational of committing a lesser evil and obviating the greater one, and the rational of seeing to a

ic interest, which favor enduring individual harm so as to prevent public harm if needed. These include 2 sets: Those which involve protecting society against some prejudice, and those which involve protecting an individual against some prejudice. b) Cases where confidentiality may be broken: 1) To ensure a public interest. 2) To prevent a public damage. In all such cases the objectives and priorities are set out by Shari’ah (Islamic law) regarding preserving the faith, human life,

wealth”.34,35

5

Healthcare workers in Muslim communities are required to modify the Western-based recommendations to matchthe culture of their patients and their families.problems arise when physicians break bad news; some of which are specific to Muslim countries. Breaking badnews would ideally require lengthy preparation andadequate time. However, due to patient overload, time isa luxury many physicians in Muslim countries do notpossess. Besides, physicians in Muslim countculture-specific training to break bad news and this is notcurrently incorporated in the medical curriculum in themajority of developing countries.37Junior doctors usuallyspend more time with their patients than their senior colleagues. Because of their limited clinical experience,junior doctors may have an unjustifiable level of conviction about a patient’s imminent death. They havenot seen yet the patients recovering from a situationwhere death seemed to be inevitable.38

Physicians working in Muslim communities are requiredto balance between the patient's rights to be informed (autonomy) and the relative's request to avoid emotionaldistress to the patient, and thus define the magnitude of bad news that the patient desires to know andaccordingly.37

During the meeting he should pay special attention to thebody language of the patient and his/her family. Is thepatient afraid, stressed, or at ease? Does the patient havea religious background? In patients who have strongreligious views, physicians should stress the positive andoptimistic religious statements such as, “Everything is inthe hands of God”.

Sometimes the patient may say to his doctor: “What isyour advice in my condition? What would you do if yourparent was in my situation? The physician may feelembarrassed, but he/she should be honest and give thesincere advice. The matter may be more complicatedwhen the patient relegates the decisiondoctor saying: “Look I have trust in you, andyou decide I will accept.” The physician should be tactfuland try to explain the situation and give information tothe patient and/or his family, and reach with them thecourse to be taken. As far as he can make it, thephysician should explain that the decision should be inthe hands of the patient and his family. He might help bygiving all the required data, and give his personaladvice.21

Healthcare workers in Muslim communities are required based recommendations to match

the culture of their patients and their families.36 Several problems arise when physicians break bad news; some of

hich are specific to Muslim countries. Breaking bad news would ideally require lengthy preparation and adequate time. However, due to patient overload, time is a luxury many physicians in Muslim countries do not possess. Besides, physicians in Muslim countries require

specific training to break bad news and this is not currently incorporated in the medical curriculum in the

Junior doctors usually spend more time with their patients than their senior

ause of their limited clinical experience, junior doctors may have an unjustifiable level of conviction about a patient’s imminent death. They have not seen yet the patients recovering from a situation

king in Muslim communities are required to balance between the patient's rights to be informed (autonomy) and the relative's request to avoid emotional distress to the patient, and thus define the magnitude of bad news that the patient desires to know and act

During the meeting he should pay special attention to the body language of the patient and his/her family. Is the patient afraid, stressed, or at ease? Does the patient have a religious background? In patients who have strong

views, physicians should stress the positive and optimistic religious statements such as, “Everything is in

Sometimes the patient may say to his doctor: “What is your advice in my condition? What would you do if your parent was in my situation? The physician may feel embarrassed, but he/she should be honest and give the sincere advice. The matter may be more complicated when the patient relegates the decision-making to the doctor saying: “Look I have trust in you, and whatever you decide I will accept.” The physician should be tactful and try to explain the situation and give information to the patient and/or his family, and reach with them the course to be taken. As far as he can make it, the

that the decision should be in the hands of the patient and his family. He might help by giving all the required data, and give his personal

In cases where the patient does not want to know thediagnosis, the physician should discuss the conditifully with the family, and let them try to persuade thepatient, at least to take part in the decisionpatients who prefer a nonphysicians are encouraged to stress a paternalisticapproach such as; “Don't worry, I will dpossible to improve your health” or “You're in goodhands.”.36

The question of confidentiality will crop up here, if thefamily gets to know the details of the ailment and its management. If the patient agrees to divulge theintricacies of his medical condition to the family or proxy, then there is no breaking of confidentiality, as it isdone after getting the consent of the patient himself

Medical practice is considered a sacred duty in Islam and the physician is rewarded byDespite the efforts of many medical universities toreform their medical curriculums and implementcommunication skills, it seems that many doctors do notappear to build effective relationships with their patients.Some doctors are reluctant to improve communication,which is one of the crucial elements of treatment. Theonly and sole interest the doctor should consider, is thebest interest of his/her patient. The importance of theintimate personal relationship between the physithe patient cannot be over emphasized.

1. Shrivastava SR, Shrivastava PS, Ramasamy J.Exploring the dimensions of doctorrelationship in clinical practice in hospital settings.Int J Health Policy Manag. 2014 Apr 25;2(4):15960.

2. Terpstra OT. On doctorfeedback interventions. Perspect Med Educ. 2012Nov;1(4):159-61

3. Meza JP, Fahoome GF. The development of aninstrument for measuring healing. Ann Fam Med.2008 Jul-Aug;6(4):355-60

4. Ghaffarifar S, GhofranipourKhoshbaten M. Barriers to effective doctorrelationship based on precedeHealth Sci 2015; 7: 43280

Ethics

In cases where the patient does not want to know the diagnosis, the physician should discuss the condition fully with the family, and let them try to persuade the patient, at least to take part in the decision-making .In patients who prefer a non-disclosure approach, physicians are encouraged to stress a paternalistic approach such as; “Don't worry, I will do everything possible to improve your health” or “You're in good

The question of confidentiality will crop up here, if the family gets to know the details of the ailment and its management. If the patient agrees to divulge the

his medical condition to the family or proxy, then there is no breaking of confidentiality, as it is done after getting the consent of the patient himself.29

Medical practice is considered a sacred duty in Islam and the physician is rewarded by God for his proper work. Despite the efforts of many medical universities to reform their medical curriculums and implement communication skills, it seems that many doctors do not appear to build effective relationships with their patients.

re reluctant to improve communication, which is one of the crucial elements of treatment. The only and sole interest the doctor should consider, is the best interest of his/her patient. The importance of the intimate personal relationship between the physician and the patient cannot be over emphasized.

Shrivastava SR, Shrivastava PS, Ramasamy J.Exploring the dimensions of doctor-patientrelationship in clinical practice in hospital settings.Int J Health Policy Manag. 2014 Apr 25;2(4):159-

Terpstra OT. On doctor-patient relationship andfeedback interventions. Perspect Med Educ. 2012

Meza JP, Fahoome GF. The development of aninstrument for measuring healing. Ann Fam Med.

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Ghaffarifar S, Ghofranipour F, Ahmadi F, Khoshbaten M. Barriers to effective doctor-patient relationship based on precede-proceed model. Glob J Health Sci 2015; 7: 43280

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5. Banerjee A, Sanyal D. Dynamics of doctorrelationship: A cross-sectional study on concordance,trust, and patient enablement. J Family CommunityMed. 2012 Jan;19(1):12-9.

6. Islam MS, Jhora S T. Physician-Patient Relationship:The Present Situation and Our Responsibilities.Bangladesh Medical Journal.2012, 41,1:55

7. Fontanella D, Grant-Kels JM, Patel T, Norman REthical issues in geriatric dermatology. Clin Dermatol 2012; 30: 511-515.

8. The doctor-patient relationship: capturing the ideal.Lancet 2013; 381: 1432.

9. Al Izz ibn AbdulSalam. Qaweed al Ahkamcommented by Nazih Hammad and Othman Dhamariyah. Dar al Qalam DSyria. 2000;1:8

10. ArawiT.The Ethics of the Muslim Physician and theLegacy of Muhammad (pbuh). JIMA 2011; 43, 35

11. Kaf Al-Ghazal S. Medical history in Islamicmedicine at a glance. JISHIM, 2004,3:12

12. Chamsi-Pasha H, Albar MA. Islamic medical ethicthousand years ago. Saudi Med J.2013;34 (7):673

13. Sahih al-Bukhari. Hadith: 5783

14. Sahih al-Bukhari. Hadith: 3046

15. Al-Habbal K, Arawi T. Physicians' empathy levels ina primary care setting: perceptions of patients andtheir physicians, a qualitative study. Fam Pract. 2020Nov 28;37(6):834-838.

16. Hamouda MA, Emanuel LL, Padela AI. Empathy and Attending to Patient Religion/Spirituality:Findings from a National Survey of MuslimPhysicians. J Health Care Chaplain. 2021 AprJun;27(2):84-104

17. Sahih al-Bukhari.Hadith: 3559

18. Chamsi-Pasha H, Albar MA. Western and Islamicbioethics: How close is the gap? Avicenna J Med.2013 Jan;3(1):8-14.

19. The Holy Quran 99: 7, 8

Banerjee A, Sanyal D. Dynamics of doctor-patient sectional study on concordance,

patient enablement. J Family Community

Patient Relationship:The Present Situation and Our Responsibilities.Bangladesh Medical Journal.2012, 41,1:55-58

Kels JM, Patel T, Norman R.Ethical issues in geriatric dermatology. Clin

patient relationship: capturing the ideal.

Al Izz ibn AbdulSalam. Qaweed al Ahkamcommented by Nazih Hammad and Othman

Dar al Qalam Damascus

ArawiT.The Ethics of the Muslim Physician and theLegacy of Muhammad (pbuh). JIMA 2011; 43, 35-38

Ghazal S. Medical history in Islamicmedicine at a glance. JISHIM, 2004,3:12-13

Pasha H, Albar MA. Islamic medical ethics a thousand years ago. Saudi Med J.2013;34 (7):673-5.

Habbal K, Arawi T. Physicians' empathy levels ina primary care setting: perceptions of patients and

dy. Fam Pract. 2020

Hamouda MA, Emanuel LL, Padela AI. Empathyand Attending to Patient Religion/Spirituality:Findings from a National Survey of MuslimPhysicians. J Health Care Chaplain. 2021 Apr-

Pasha H, Albar MA. Western and Islamicbioethics: How close is the gap? Avicenna J Med.

20. Islamic Code of Medical Ethics.1981. FirstInternational Conference on Islamic Medicine held inKuwait at the onset of the Fifteenth Hijri Century (610 Rabie Awal 1401: 12

21. Albar MA. Chamsi-Pasha H. PhysicianRelationship in Islamic Context. In IslamicBioethics: Current issues and challenges. BagheriAand Al-Ali K (ed.). WorldNov 2017.

22. Arawi TA. The Muslim physician and the ethics of medicine. JIMA. 2010 Nov;42(3):111

23. Al-Albani MN. Sahih Al Jamae. DarAlmaktabAlislami. Damascus, Syria. 2002 HadithNo: 3260

24. The Holy Qur’an. 3: 110.

25. The Holy Qur’an.16: 90.

26. Hussain W, Hussain H, Hussain M, Hussain S, Attar S. Approaching the Muslim orthopedic patient. JBone Joint Surg Am.2010;7;92(7):e2.

27. Ott BB, Al-Khadhuri J, Alethical dilemmas: understanding Islamic health carepractices. Pediatr Nurs.2003;29:227

28. Sharifudin MA, Wan Husin WR, Taib MN. ReligiousPerspective of Doctor-Patient Relationship Models inComplementing Uprising Social PhenomenalDemands.2014; Proceedings Book of ICETSR,Malaysia Handbook on the Emerging Trends inScientific Research.

29. Al-Bar MA, Chamsibioethics: Islamic perspective. Springer (Openaccess) 2015.http://link.springer.com/book/10.1007/97818428-9.

30. The Holy Qur’an 24:30-31.

31. Padela AI, Rodriguez del PozoP.Muslim patients andcross-gender interactions in medicine: an Islamicbioethical perspective. J Med Ethics.2011;37 (1):404.

32. Aldeen AZ. The Muslim ethical tradition andemergent medical care: an uneasy fit. AcadEmergMed.2007; 14(3):277-8.

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Islamic Code of Medical Ethics.1981. FirstInternational Conference on Islamic Medicine held in

the onset of the Fifteenth Hijri Century (6-10 Rabie Awal 1401: 12-16 January 1981).

Pasha H. Physician-PatientRelationship in Islamic Context. In IslamicBioethics: Current issues and challenges. Bagheri

Ali K (ed.). World Scientific Publishing.

Arawi TA. The Muslim physician and the ethics ofmedicine. JIMA. 2010 Nov;42(3):111-6.

Albani MN. Sahih Al Jamae. Dar AlmaktabAlislami. Damascus, Syria. 2002 Hadith

The Holy Qur’an. 3: 110.

0.

Hussain W, Hussain H, Hussain M, Hussain S, AttarS. Approaching the Muslim orthopedic patient. JBone Joint Surg Am.2010;7;92(7):e2.

Khadhuri J, Al-JunaibiS.Preventingethical dilemmas: understanding Islamic health care

rs.2003;29:227-30.

Sharifudin MA, Wan Husin WR, Taib MN. ReligiousPatient Relationship Models in

Complementing Uprising Social PhenomenalDemands.2014; Proceedings Book of ICETSR,Malaysia Handbook on the Emerging Trends in

Bar MA, Chamsi-Pasha H. Contemporary bioethics: Islamic perspective. Springer (Open access) 2015. http://link.springer.com/book/10.1007/978-3-319-

31.

Padela AI, Rodriguez del PozoP.Muslim patients andnder interactions in medicine: an Islamic

bioethical perspective. J Med Ethics.2011;37 (1):40-

Aldeen AZ. The Muslim ethical tradition andemergent medical care: an uneasy fit. AcadEmerg

7

33. Alahmad G, Dierickx K. What do Islamicinstitutional fatwas say about medical and researchconfidentiality and breach of confidentiality? DevWorld Bioeth2012; 12: 104-112.

34. Resolutions and Recommendations of the Council of the Islamic Fiqh Academy. International Islamic FiqhAcademy. 1993. Decision No. 79 (10/8). Availablefrom URL: http://www.fiqhacademy.org.sa/

35. Chamsi-Pasha H, Albar MA. Doctorrelationship. Islamic perspective. Saudi Med J. 2016Feb;37(2):121-6.

Alahmad G, Dierickx K. What do Islamictutional fatwas say about medical and research

confidentiality and breach of confidentiality? Dev

Resolutions and Recommendations of the Council ofthe Islamic Fiqh Academy. International Islamic Fiqh

No. 79 (10/8). Availablehttp://www.fiqhacademy.org.sa/

Pasha H, Albar MA. Doctor-patient relationship. Islamic perspective. Saudi Med J. 2016

36. Salem A, Salem AF. Breaking bad neprospective and practical guideline for Muslimcountries. J Cancer Educ 2013; 28: 790

37. Tavakol M, Murphy R, Torabi S. Educating doctorsabout breaking bad news: an Iranian perspective. J Cancer Educ. 2008;23(4):260

38. Chamsi-Pasha H, ChamsiPragmatic message to junior doctors. Postgrad MedJ. 2016 Jul;92(1089):418

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Salem A, Salem AF. Breaking bad news: currentprospective and practical guideline for Muslimcountries. J Cancer Educ 2013; 28: 790-794.

Tavakol M, Murphy R, Torabi S. Educating doctorsabout breaking bad news: an Iranian perspective. JCancer Educ. 2008;23(4):260-3.

Pasha H, Chamsi-Pasha M, Albar MA.Pragmatic message to junior doctors. Postgrad MedJ. 2016 Jul;92(1089):418-20.

8

Hatem M Al-Haj, MD, PhD, FAAP

Paediatric Hospital, Shore Medical Centre, Dean, College of Islamic Studies, Mishkah University, USA

Hatem.alhaj@gmail.com

All praise be to Allah, and may His blessings and peacebe upon His messenger.

There are many interfaces between jurisprudence) and medicine. After all, the subjectof medicine is the human body, which is tasked withreligious duties. The rulings of those duties are thesubject matter of fiqh.Fiqh also regulates all human activities of moral value, including the practice ofmedicine.

Change in the medical field happened quitethe early part of the 20th century, when the pace of advancement began to accelerate until medicine reachedits current state of development. Our early scholars of fiqh – may Allah have mercy upon themaccess to the medical knowledge that we now have. Many fiqhirulings rely on the propercertain ontological facts, about many of which thephysicians of their times differed. These include, for instance, determining the shortest and longest duration ofmenstruation and pregnancy, the status of intersexpersons (hermaphrodites), and the varioentry into the “hollow interior” or cavity of the body(jawf), are all legally consequential matters that arelargely reliant on medical expertise decisive scriptural proofs.

Thankfully, much of today’s current medical knowledand practice is based on experiment and certainty, not ondoubt and conjecture. Thus, it is vital to revise anytraditional fiqhi positions that had been influenced outdated medical knowledge. Indeed, such critical butrespectful revision is crucial to exonerate the Sharia(Islamic law) without impugning the traditionMuslims do not ignore mental axioms (universallyaccepted propositions) and neither do they ignore theempirical evidence perceptible by the senses.scholars of all orientations, including textualists andrationalists, reinterpret the apparent implications of the

, PhD, FAAP

Paediatric Hospital, Shore Medical Centre, NJ, USA Dean, College of Islamic Studies, Mishkah University, USA

Hatem.alhaj@gmail.com

blessings and peace

There are many interfaces between fiqh (Islamic jurisprudence) and medicine. After all, the subject-matter of medicine is the human body, which is tasked with religious duties. The rulings of those duties are the

also regulates all human activities of moral value, including the practice of

Change in the medical field happened quite slowly until the early part of the 20th century, when the pace of

te until medicine reached its current state of development. Our early scholars of

may Allah have mercy upon them – did not have access to the medical knowledge that we now have.

rulings rely on the proper knowledge of certain ontological facts, about many of which the physicians of their times differed. These include, for instance, determining the shortest and longest duration of menstruation and pregnancy, the status of intersex persons (hermaphrodites), and the various portals of entry into the “hollow interior” or cavity of the body

), are all legally consequential matters that are rather than on

medical knowledge and practice is based on experiment and certainty, not on doubt and conjecture. Thus, it is vital to revise any

positions that had been influenced by medical knowledge. Indeed, such critical but

to exonerate the Sharia (Islamic law) without impugning the tradition1. Sunni Muslims do not ignore mental axioms (universally accepted propositions) and neither do they ignore the empirical evidence perceptible by the senses.1 In fact,

entations, including textualists and rationalists, reinterpret the apparent implications of the

text when such realities contradict the apparent or primary interpretation; theyempirical evidence in judging the authenticity oftransmitted reports.2 Additionally, the fatwa (edict by ascholar) – but not the ḥukmchange from time to time and from place to placeaccording to certain guidelines known to those who arewell grounded in such knowledgemere change of time and place, but rather because theyare vehicles for the circumstantial variables that wouldresult in the change of a fatwa. For instance, theestablishment of paternity through DNA testing shouldnow take precedence over qiyâfah

One of the issues being revisited is the ruling of abortionbased on our better understanding of embryogenesis. Itmust be remembered, however, thatjuris or legal basis) of the emphatic prohibition of abortion in late term pregnancy is dependent not only on embryogenesis, but on the transcendent or metaphysicalevent of “ensoulment.” Here is a brief discussion of thisissue in light of up-to-date with the rulings on abortion found in the tradition,according to each of the four major Sunni schools of Islamic thought (madhâhib, sg.

The authorized position among the majority of traditionalHanafi authorities is arguably the permissibility of abortion before 120 days from conception.Humâm (rA: raḥimahu Allâhhim) opined,

Is it mubâh (permissible) to abort after impregnation? Itis permissible so long as no [externaldeveloped in [the fetus]. And in multiple places, theysaid: That does not take place until after the 120and this means that by “developing features,” they meantensoulment (the moment when a human being gains a

Ethics

text when such realities contradict the apparent or interpretation; they use axioms as well as

empirical evidence in judging the authenticity of Additionally, the fatwa (edict by a

ukm (Allah’s ruling) – may change from time to time and from place to place according to certain guidelines known to those who are well grounded in such knowledge.2 That is, not by the mere change of time and place, but rather because they are vehicles for the circumstantial variables that would result in the change of a fatwa. For instance, the establishment of paternity through DNA testing should

qiyâfah (physiognomy).

One of the issues being revisited is the ruling of abortion based on our better understanding of embryogenesis. It must be remembered, however, that the’illah (ratio legis/

or legal basis) of the emphatic prohibition of abortion in late term pregnancy is dependent not only on embryogenesis, but on the transcendent or metaphysical event of “ensoulment.” Here is a brief discussion of this

medical knowledge. I begin with the rulings on abortion found in the tradition, according to each of the four major Sunni schools of

, sg. madh-hab).

The authorized position among the majority of traditional horities is arguably the permissibility of

abortion before 120 days from conception.4 Ibn al-Allâh – may Allah have mercy on

(permissible) to abort after impregnation? It is permissible so long as no [external] features have developed in [the fetus]. And in multiple places, they said: That does not take place until after the 120th day, and this means that by “developing features,” they meant ensoulment (the moment when a human being gains a

9

soul). Otherwise, this would be incorrect because thedevelopment of physical features is observable beforethat period.5

To those who took this position, the husband’s consentwas not even required, as Ibn ‘Âbideen confirmed in hisstatement, “And they viewed that it was child before four months, even without the husband’sconsent.”6 However, the Ḥanafisare not all in agreementon the permissibility of abortion. Ibn ‘Âbideen (rA) citesthe author of al-Khâniyah (rA) as saying, “I do not holdthat it is lawful, since someone in iḥrâmdedication) – if he breaks an egg of a gamebird for it because it is the origin of a game animal. So, if heis obliged to expiate in that scenario, then it should besinful if she [the mother] aborts without an excuse.”

Perhaps this disagreement within the madhhabdrove some to reconcile between the positions by sayingthat the view of permissibility referred to special cases.For instance, Ibn Wahbân (rA), whom Ibn ‘Âbideen citedas saying, “The permissibility of abortion is understoodto be in reference to cases involving excuse (justification of need) or that it does not incur the sin of murder [but alesser sin].”8 This seems more plausible, because leavingthe permissibility unrestricted to include aborting a fetusafter its 100th day, which by then has a beating heart, acerebellum, a face with a recognizably human profile,two feet, two hands, and a trunk, without anyjustification, is something the spirit of the revelation would not accept. However, projecting our sensibilitiesonto the foremost scholars in order to reinterpret their unqualified statements is not without risks. Additionally, when we limit the “need” to extreme cases, we would bein defiance of their intent when they lefpermissibility and the “need/excuse” unqualified.

The Mâlikis hold that the fetus cannot be aborted in anyof its phases, and they are the strictest madhhab in this regard. Al-Dardeer (rA) stated, “And it is impermissibleto expel the semen that is gathered in the womb, even before forty days. And once the soul is blown into it, itbecomes unlawful by unanimous agreement.”

In fact, the Mâlikis went even further than this. Theyprohibited taking medicines that reduce one’s pfor progeny. Regarding this, al-Hattâb (rA) cites alJuzooli’s statement, “It is impermissible for a person todrink medicine that lessens his progeny.”disagreed with this view. One such was al

is would be incorrect because the development of physical features is observable before

To those who took this position, the husband’s consent was not even required, as Ibn ‘Âbideen confirmed in his statement, “And they viewed that it was mubâh to abort a child before four months, even without the husband’s

anafisare not all in agreement on the permissibility of abortion. Ibn ‘Âbideen (rA) cites

(rA) as saying, “I do not hold râm (state of sacred

if he breaks an egg of a gamebird – is liablefor it because it is the origin of a game animal. So, if he is obliged to expiate in that scenario, then it should be

without an excuse.”7

madhhab is what drove some to reconcile between the positions by saying that the view of permissibility referred to special cases. For instance, Ibn Wahbân (rA), whom Ibn ‘Âbideen cited

“The permissibility of abortion is understood to be in reference to cases involving excuse (justification of need) or that it does not incur the sin of murder [but a

This seems more plausible, because leaving to include aborting a fetus

day, which by then has a beating heart, a cerebellum, a face with a recognizably human profile, two feet, two hands, and a trunk, without any justification, is something the spirit of the revelation

cept. However, projecting our sensibilities onto the foremost scholars in order to reinterpret their unqualified statements is not without risks. Additionally, when we limit the “need” to extreme cases, we would be in defiance of their intent when they left both the permissibility and the “need/excuse” unqualified.

The Mâlikis hold that the fetus cannot be aborted in any of its phases, and they are the strictest madhhab in this

Dardeer (rA) stated, “And it is impermissible expel the semen that is gathered in the womb, even

before forty days. And once the soul is blown into it, it becomes unlawful by unanimous agreement.”9

In fact, the Mâlikis went even further than this. They prohibited taking medicines that reduce one’s potential

Hattâb (rA) cites al-Juzooli’s statement, “It is impermissible for a person to drink medicine that lessens his progeny.”10 Few Mâlikis disagreed with this view. One such was al-Lakhmi (rA),

who supported the permissibility of aborting during thenuṭfah (drop of fluid) phase, but not thereafter.

Al-Ramli (rA) said about abortion, “And the strongerposition is it being unlawful in all cases followingensoulment, and its permissibility before that.disagreement was reported by alal-Ṭâlibeen as follows:

Al-Bujayrami precisely said, “They disagreed over thepermissibility of causing the expulsion of theit has settled in the womb.” Abu Ishâq al“It is permissible to expel thethat [view] has been reported about Abu in al-Ihyâ’, under the discussion on interruptus), is what indicates[opinion] is stronger because once it [theits outcome will be the genesis which prepares it for ensoulment, unlike ‘azl… And the authorized position isthat it [abortion] is not forbidden until after ensoulment.

The official position in the permissibility, as was established by alhis Hâshiyah, where he wrote, “Yes, it is permissible toexpel it, even by way of medicine, before ensoulment,contrary to [the view of] al-Gh

Al-Mardâwi (rA) presented theabortion, beginning with the authorized position of themadhhab, which is to them the permissibility of abortingthe nuṭfah during the first 40 days. Then he mentionedthe two other positions: the one that prohibits abortionaltogether and the one that permits it before ensoulment.He explained, “It is permissible to drink medicine toabort the nuṭfah. This was stated in that in al-Furoo ‘. Ibn al-Jawzi said in ‘It is unlawful.’ In al-Furoo ‘words of Ibn ‘Aqeel in al-Funoonto abort it before ensoulment.’ He said, ‘This is a variant[i.e., not the dominant] view.’ Taqi alTaymiyyah] said, ‘It is safer that the woman does not usemedicine which prevents the semen from entering thecervix’.”14

Some scholars believed that Ibn Qudâmah (rA) leanedtoward the position of impermissibility,If the pregnant woman drinks medicine, and expels afetus using it, then the ghurrahand she does not inherit anything from it. She must also

Ethics

ibility of aborting during the (drop of fluid) phase, but not thereafter.

Ramli (rA) said about abortion, “And the stronger position is it being unlawful in all cases following ensoulment, and its permissibility before that.”3 The disagreement was reported by al-Dimyâṭi (rA) in I ‘ânat

Bujayrami precisely said, “They disagreed over the permissibility of causing the expulsion of the nuṭfah after it has settled in the womb.” Abu Ishâq al-Marwazi said, “It is permissible to expel the nuṭfah and ‘alaqah,” and that [view] has been reported about Abu Ḥaneefah. And

, under the discussion on ‘azl (coitus interruptus), is what indicates its unlawfulness. This [opinion] is stronger because once it [the nuṭfah] settles, its outcome will be the genesis which prepares it for

… And the authorized position is that it [abortion] is not forbidden until after ensoulment.12

The official position in the madhhab is arguably that of permissibility, as was established by al-Qalyubi (rA) in

, where he wrote, “Yes, it is permissible to expel it, even by way of medicine, before ensoulment,

Ghazâli.”13

Mardâwi (rA) presented the Ḥanbali views on abortion, beginning with the authorized position of the madhhab, which is to them the permissibility of aborting

during the first 40 days. Then he mentioned the two other positions: the one that prohibits abortion altogether and the one that permits it before ensoulment. He explained, “It is permissible to drink medicine to

. This was stated in al-Wajeezand before Jawzi said in Ahkâm an-Nisâ’,

Furoo ‘, he said, ‘The apparent Funoonare that it is permissible

to abort it before ensoulment.’ He said, ‘This is a variant t the dominant] view.’ Taqi al-Deen [Ibn

Taymiyyah] said, ‘It is safer that the woman does not use medicine which prevents the semen from entering the

Some scholars believed that Ibn Qudâmah (rA) leaned toward the position of impermissibility, since he stated, If the pregnant woman drinks medicine, and expels a

ghurrah is incumbent upon her and she does not inherit anything from it. She must also

10

free a slave, and there is no disagreement which we knowof between the scholars on this statement, except theposition of those who do not believe it is mandatory to free a slave.15

Perhaps what those scholars posited regarding Ibn Qudâmah’s view is inaccurate, because we find himstating, “There is no disagreement which we knbetween the scholars.” This proves that he wasexplaining the position on the abortion that is unlawfulaccording to all scholars (i.e., post-ensoulment).

In summary, the scholars unanimously agree on theprohibition of abortion after ensoulment,poses risk to the mother’s life, in which case it ispermissible according to the stronger view. They also agree that ensoulment takes place after 120 days. Asidefrom that, their differences fall into three main views:

1. It is unlawful to abort in all phases, and this is theauthorized position of the Mâlikis and Dhâhiris. It is also the position of some Ḥanafis, Ḥanbalis.

2. It is unlawful to abort after the first 40 days, and it ispermissible during them. This is the authorizedposition of the Ḥanbalis and the position of someMâlikis.

3. It is unlawful to abort after ensoulment, and it ispermissible before that. This is arguauthorized position of the Ḥanafis and also the position of some Ḥanbalis.

Modern-day scholars and fiqh bodies do tend to concurwith the authorized Ḥanbali position, albeit withemphasis on the requirement of some sound motive for abortion in the first 40 days. They largely do not considerthe fear from poverty to be a sound justification. Theyalso all agree on the impermissibility of abortion after120 days, when it becomes an act of murder unless themother’s life or health are in real danger. As for theperiod between those two terms, they differ on whether itmay be permitted to abort for a very significant cause.For instance, the Fiqh Assembly of the Muslim WorldLeague has permitted abortion during this intermediateterm when there is a major fetal deformity incompatiblewith dignified life.17 This category certainly does notinclude the mere absence of some of the limbs or senses.According to some scholars, instances of rape ma

free a slave, and there is no disagreement which we know holars on this statement, except the

position of those who do not believe it is mandatory to

Perhaps what those scholars posited regarding Ibn Qudâmah’s view is inaccurate, because we find him stating, “There is no disagreement which we know of between the scholars.” This proves that he was explaining the position on the abortion that is unlawful

ensoulment).

In summary, the scholars unanimously agree on the prohibition of abortion after ensoulment,16 except if it poses risk to the mother’s life, in which case it is permissible according to the stronger view. They also agree that ensoulment takes place after 120 days. Aside from that, their differences fall into three main views:

t in all phases, and this is theauthorized position of the Mâlikis and Dhâhiris. It is

anafis, Shâfi ‘is, and

It is unlawful to abort after the first 40 days, and it ispermissible during them. This is the authorized

anbalis and the position of some

It is unlawful to abort after ensoulment, and it ispermissible before that. This is arguably the

anafis and Shâfi ‘is. It is

bodies do tend to concur anbali position, albeit with

sis on the requirement of some sound motive for abortion in the first 40 days. They largely do not consider the fear from poverty to be a sound justification. They also all agree on the impermissibility of abortion after

murder unless the mother’s life or health are in real danger. As for the period between those two terms, they differ on whether it may be permitted to abort for a very significant cause. For instance, the Fiqh Assembly of the Muslim World

tted abortion during this intermediate term when there is a major fetal deformity incompatible

This category certainly does not include the mere absence of some of the limbs or senses. According to some scholars, instances of rape may be

considered a justification during this period of 41 to 120days.

Has our new understanding of embryogenesis affectedour choices with respect to rulings on abortion? It ispossible. We have observed that modern scholars tend tobe more conservative in this respect. However, the issueis not that simple. We should not rush to think that ourtraditional scholars did not observe the obvious featuresof a human embryo aborted before 120 days fromconception. As we have shown from the statement of Ibnal-Humâm (rA), at least some of them did observe that. Itis also obvious that, regardless of their positions on theruling of abortion, they all agreed that ensoulment takes place at 120 days post-conception. Those scholars also allagreed that abortion after ensoulment would be graver,equating it in some regards to murder. Much, then,depends on ensoulment, and that in turn depends on their understanding of a particular hadith. So, let us brieflydiscuss the issue of ensoulment and the controversyaround this hadith.

Ensoulment (nafkh al-rooḥ), which is sometimes referredto as personhood, is an event that takes place in thewomb at a particular moment, according to the confirmed consensus of all Muslim scholars implications of the prophetic traditions. According toanother consensus, reported by aland Ibn Ḥajar, the soul is breathed into the body after 120days post-conception.18

However, the latter consensus is not as credible as theformer, and some of the contemporary scholars claim it isnot verifiable. The basis of this consensus is thefollowing hadith of Ibn Mas’ood (rAa:‘anhu – may Allah be pleased with him) reported in various wordings. In alhadith goes as follows:

ه أربعين يوما وأربعين ليلة، ثم في بطن أم خلق أحدكم يجمع إنمضغة مثله، ثم يبعث إلي علقة مثله، ثم يكون ه الملك، فيؤذن يكون

وأجله وعمله وشقي أم سعيد، ثم ينفخ فيه رزقه فيكتب كلمات، بأربع

Each of you is gathered in his mother’s womb for fortydays, then becomes a clot of blood (period; then it becomes a clump of flesh (the same period. Then the angel will be sent tobe commanded regarding four matters: he will record itslivelihood, its span of life, and its felicity or damnation

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considered a justification during this period of 41 to 120

Has our new understanding of embryogenesis affected our choices with respect to rulings on abortion? It is possible. We have observed that modern scholars tend to

n this respect. However, the issue is not that simple. We should not rush to think that our traditional scholars did not observe the obvious features of a human embryo aborted before 120 days from conception. As we have shown from the statement of Ibn

umâm (rA), at least some of them did observe that. It is also obvious that, regardless of their positions on the ruling of abortion, they all agreed that ensoulment takes

conception. Those scholars also all ensoulment would be graver,

equating it in some regards to murder. Much, then, depends on ensoulment, and that in turn depends on their understanding of a particular hadith. So, let us briefly discuss the issue of ensoulment and the controversy

), which is sometimes referred to as personhood, is an event that takes place in the womb at a particular moment, according to the confirmed consensus of all Muslim scholars and the definitive implications of the prophetic traditions. According to another consensus, reported by al-Qurṭubi, al-Nawawi,

ajar, the soul is breathed into the body after 120

However, the latter consensus is not as credible as the former, and some of the contemporary scholars claim it is not verifiable. The basis of this consensus is the following hadith of Ibn Mas’ood (rAa: raḍiyaAllâhu

may Allah be pleased with him) that was reported in various wordings. In al-Bukhari’s version, the

ه أربعين يوما وأربعين ليلة، ثم« إن خلق أحدكم يجمع في بطن أميكون علقة مثله، ثم يكون مضغة مثله، ثم يبعث إلي

فيه وشقي أم سعيد، ثم ينفخ بأربع كلمات، فيكتب رزقه وأجله وعملهوح .»...الر

Each of you is gathered in his mother’s womb for forty days, then becomes a clot of blood (alaqah) for the same period; then it becomes a clump of flesh (muḍghah) for the same period. Then the angel will be sent to it and will be commanded regarding four matters: he will record its livelihood, its span of life, and its felicity or damnation

11

[in the afterlife]. Then he will breathe the spirit/soul intoit…

The vast majority of scholars understood this to meanthat the nuṭfah (drop) phase will last for 40 days,followed by ‘alaqah (clot of blood) for 40 days, thenmuḍghah (clump of flesh) for 40 days, then the blof the soul (nafkh al-rooḥ) takes place at 120 days.

In Muslim’s report of this hadith, however, it says, “thenbecomes a clot in this for an equal period.” The deicticphrase “in this” should refer here to the fortyitself, because “40 days” was the last semantic elementmentioned before the deictic. This leads to theunderstanding that all of the three stages of the drop offluid (nuṭfah), clot of blood (alaqah), and clump of flesh(muḍghah) occur in that very period of the first fortydays. These three stages together may also not take theentire span of the 40 days.

Advances in medical sciences supported an earlier understanding by some scholars, such as Ibn alZamlakâni (rA) from the 7th – 8th century AH, that thethree phases of embryogenesis mentioned in theprophetic traditions are completed by the fortieth or forty-second day after conception. After all, since the 20century we have known that the first heartbeat happens about 21 – 24 days post-conception.19

The minority position of Ibn al-Zamlakâni is alsosupported by the following hadith reported by Muslimfrom Ḥudhyfah (rAa):

رها مر بالنطفة اثنتان وأربعون ليلة بعث هللا إليها ملكا فصو إذاوبصرها وجلدها ولحمها وعظامها ثم قال يا رب أذكر معهاربك ما شاء ويكتب الملك ثم يقول يا رب أجله فيقول فيقضي أم أنثى

ويكتب الملك ثم يقول يا رب رزقه فيقضي رب ك ما شاء ربك ما شاءحيفة في يده فال يزيد على ما أمر ويكتب الملك ثم يخرج الملك بالص

When the nuṭfah has attained forty-two nights, Allahsends the angel and gives it shape. Then He creates itssense of hearing, sense of sight, skin, flesh, and bones.Then [the angel] asks, “My Lord, would it be male orfemale?” And your Lord decides as He desires and theangel then records that also and then asks, “My Lord,what about its lifespan?” And your Lord decides as Hewishes, and the angel records it. Then [the angel] asks, “My Lord, what about its livelihood?”decides as He likes, and the angel writes it down; thenthe angel leaves [the womb] with the scroll of destiny in

Then he will breathe the spirit/soul into

The vast majority of scholars understood this to mean (drop) phase will last for 40 days,

(clot of blood) for 40 days, then (clump of flesh) for 40 days, then the blowing

) takes place at 120 days.

In Muslim’s report of this hadith, however, it says, “then for an equal period.” The deictic

phrase “in this” should refer here to the forty-day period days” was the last semantic element

mentioned before the deictic. This leads to the understanding that all of the three stages of the drop of

), and clump of flesh ) occur in that very period of the first forty

days. These three stages together may also not take the

Advances in medical sciences supported an earlier understanding by some scholars, such as Ibn al-

century AH, that the three phases of embryogenesis mentioned in the prophetic traditions are completed by the fortieth or

second day after conception. After all, since the 20th century we have known that the first heartbeat happens

Zamlakâni is also supported by the following hadith reported by Muslim

رها « فصو ملكا هللا إليها بعث وأربعون ليلة إذا مر بالنطفة اثنتانرب أذكروخلق س قال يا وعظامها ثم ولحمها وجلدها معها وبصرها

فيقول رب أجله ويكتب الملك ثم يقول يا أم أنثى فيقضي ربك ما شاءرب فيقضي رزقه رب ربك ما شاء ويكتب الملك ثم يقول يا

على ما أمر فال يزيد في يده حيفة ويكتب الملك ثم يخرج الملك بالص »وال ينقص

two nights, Allah sends the angel and gives it shape. Then He creates its

of sight, skin, flesh, and bones. Then [the angel] asks, “My Lord, would it be male or female?” And your Lord decides as He desires and the angel then records that also and then asks, “My Lord, what about its lifespan?” And your Lord decides as He

and the angel records it. Then [the angel] asks, “My Lord, what about its livelihood?” So, your Lord decides as He likes, and the angel writes it down; then the angel leaves [the womb] with the scroll of destiny in

his hand and nothing is added to it, andsubtracted from it.

This position is also supported by Allah’s statement,

فخلقنا العلقة مضغة فخلقنا المضغة عظاما علقة خلقنا النطفة ثمخلقا آخر أحسن الخالقين فكسونا العظام لحما ثم أنشأناه .فتبارك

[Then We made the sperm-drop into a clinging clot, andWe made the clot into a lump [of flesh], and We made[from] the lump, bones, and We covered the bones withflesh; then We developed it into another creatioblessed is Allah, the best of creators.Mu'minūn, 23:12-14.]

The development “into another creation” mentioned inthis verse is reported by ‘Ali (rAthe ensoulment – an interpretation that is widelyaccepted. In the verse the clump of flesh (the ensoulment are separated by two other developments:the formation of bones and their envelopment by flesh.This is contrary to what the majority understood from thehadith of Ibn Mas’ood stating that ensoulment hright after the end of the muḍ

It is thus clear that much of the process of embryogenesis(takhalluq) takes place within the first forty days fromconception. This knowledge has caused manycontemporary scholars to question not only theunderstanding of embryogenesis based on the hadith ofIbn Mas’ood, but also the consequent position thatensoulment takes place at 120 days. While I agree withtheir first conclusion, I am not compelled to agree withthe second.

The consensus on the blowing of the soul, while it issukooti (tacit) and therefore notbe at least treated as a speculative proof that should notbe dismissed unless it is outweighed by a stronger one.This is one of many positioconsensus, but it is the position closest to the middle of the spectrum on this issue. We must also remember that adefinitive positive consensus after the era of theCompanions is implausible. We also know thatconsensus is an independent source of Sharia, thustextual substantiation is not needed to cite it as a proof.Nevertheless, according to the majority positionconsensus would not happen without some textual proof.This proof, however, may be known to some scholars butnot to others,20 and it may even be known to somegenerations but not to others.

Ethics

his hand and nothing is added to it, and nothing is

This position is also supported by Allah’s statement,

عظاما فخلقنا المضغة مضغة ثم خلقنا النطفة علقة فخلقنا العلقةفكسونا العظام لحما ثم أنشأناه خلقا آخر

drop into a clinging clot, and We made the clot into a lump [of flesh], and We made [from] the lump, bones, and We covered the bones with flesh; then We developed it into another creation. So blessed is Allah, the best of creators. [Sūrat al-

The development “into another creation” mentioned in this verse is reported by ‘Ali (rAa) to be a reference to

an interpretation that is widely verse the clump of flesh (muḍghah) and

the ensoulment are separated by two other developments: the formation of bones and their envelopment by flesh. This is contrary to what the majority understood from the

ood stating that ensoulment happens ḍghah phase.

It is thus clear that much of the process of embryogenesis ) takes place within the first forty days from

conception. This knowledge has caused many contemporary scholars to question not only the traditional understanding of embryogenesis based on the hadith of

ood, but also the consequent position that ensoulment takes place at 120 days. While I agree with their first conclusion, I am not compelled to agree with

The consensus on the blowing of the soul, while it is (tacit) and therefore not qaṭ’i(definitive), should

be at least treated as a speculative proof that should not be dismissed unless it is outweighed by a stronger one. This is one of many positions concerning this type of consensus, but it is the position closest to the middle of the spectrum on this issue. We must also remember that a definitive positive consensus after the era of the Companions is implausible. We also know that

ndependent source of Sharia, thus textual substantiation is not needed to cite it as a proof. Nevertheless, according to the majority position consensus would not happen without some textual proof. This proof, however, may be known to some scholars but

and it may even be known to some generations but not to others.21

12

Here are additional reasons why this consensus and the120-day mark should still be respected:

The lag between takhalluq and nafkh alestablished in the scriptures. The Arabic article(then), used in the hadiths above to separate between thestages of development and ensoulment, means that theevents occur in succession, with some delay in timebetween them. Moreover, in the verse cited above fromSūrat al-Mu'minūn, thumma is used to separate betweenthe different stages of embryogenesis, and betweenembryogenesis and ensoulment. In addition, theformation of bones and their envelopment by flesh ismentioned between the first three stages of developmentand the reference to ensoulment. We showed earlierobservant scholar like Ibn al-Humâm pointed out the lagbetween embryogenesis and ensoulment.

Moreover, while ensoulment is a ghaybimetaphysical) event, there may be medical signs corroborating the reported consensus of the scholars thatit takes place at 120 days post-conception. The legaldebate over abortion and personhood has caused manydisputants to invoke certain events in fetal developmentto support their various positions. Some hopersonhood starts from fertilization, which is when thepaternal and maternal genetic codes combine to form aunique cell. Others posit that it starts upon implantation,which happens about 1-2 weeks from fertilization,about the time the cell cannot divide anymore to producetwins.23 Others argue that it should begin with the firstheartbeat, which happens about 21-conception.24

Still others contend that it should start with the firstvoluntary movements, which take place around 120post-conception.25Shortly thereafter, around the end ofthe twentieth week, the thalamus develops, and that is theregion of complex thought.26 This is also the lowest agefor independent fetal viability outside the uterus.soul departs from the body when that body is no longerable to host it, should it not also be true that the soulwould not be blown into the body until that body is ableto host it?

From this discussion, one may argue that the blowing ofthe soul into the fetus indeed occurs well after thecompletion of embryogenesis. The 120conceptional age is still the threshold of is most rational and that engenders the most widespreadagreement amongst the scholars.

Allah knows best.

Here are additional reasons why this consensus and the

nafkh al-rooḥ is The Arabic article thumma

(then), used in the hadiths above to separate between the stages of development and ensoulment, means that the events occur in succession, with some delay in time between them. Moreover, in the verse cited above from

is used to separate between the different stages of embryogenesis, and between embryogenesis and ensoulment. In addition, the formation of bones and their envelopment by flesh is mentioned between the first three stages of development

reference to ensoulment. We showed earlier that Humâm pointed out the lag

between embryogenesis and ensoulment.

ghaybi (transcendent or metaphysical) event, there may be medical signs

ating the reported consensus of the scholars that conception. The legal

debate over abortion and personhood has caused many disputants to invoke certain events in fetal development to support their various positions. Some hold that personhood starts from fertilization, which is when the paternal and maternal genetic codes combine to form a unique cell. Others posit that it starts upon implantation,

2 weeks from fertilization,22

nnot divide anymore to produce Others argue that it should begin with the first

-24 days post-

Still others contend that it should start with the first voluntary movements, which take place around 120 days

Shortly thereafter, around the end of the twentieth week, the thalamus develops, and that is the

This is also the lowest age for independent fetal viability outside the uterus.27If the

the body when that body is no longer able to host it, should it not also be true that the soul would not be blown into the body until that body is able

From this discussion, one may argue that the blowing of urs well after the

completion of embryogenesis. The 120thday of post-conceptional age is still the threshold of ensoulment that

the most widespread

1. The tradition with respect to Islamic jurisprudencerecognizes four main sources of Sharia: the Quran,the Sunnah (authentic hadith), ijmâ’ (juridicalconsensus), and qiyâs (analogical reasoning).

2. Taqi al-Deen Ahmad ibn ‘Abd alTaymiyyah. Dar’ Ta’âruEdited by Muhammad RashâdSâlim (Riyadh:Mohammad Ibn Saud Islamic University, 1411),7:332.

3. Muhammad ibn Abi Bakr ibn alal-Muneef (Ḥalab: Maktabat alIslâmiyyah, 1403 AH), 1:51.

4. For more on the scope and guidelines of this concept,see: Hatem al-Haj, “Shari‘ah in Today's World:Renewing Islamic Discourse” (Yaqeen Institute forIslamic Research, https://yaqeeninstitute.org/hatemal-haj/shariah-in-todays-discourse), accessed July 16

5. Physicians calculate the age of pregnancy from thefirst day of the last menstrual period, which is twoweeks prior to conception. This is called thegestational age. 134 days of gestational agecorresponds to 120 days of post(also called fertilization age), which is used by thefuqahâ’ (fiqh scholars).

6. Kamâl ad-DeenMuḥammad ibn alSharḥFatḥ al-Qadeer, 2nd ed. (Beirut: Dâr aln.d.), 3:401-402.

7. Muhammad ibn Ameen ibn ‘Âbideen. Hâshiyat Ibn ‘Âbideen (Beirut: Dâr al

8. Ibid.

9. Ibid.

10. Ahmad ibn Ahmad al-Dardeer, al(Beirut: Dâr al-Fikr, n.d.), 2:266.

11. Muḥammad ibn ‘Abdul-al-Jaleel (Beirut: Dâr al-Fikr, 1398 AH), 3:477.

12. 1Muhammad ibn Abi alal-MuhtâjIlâSharḥ al-Minhâj (Beirut: Dâr al1404 AH), 8:443.

Ethics

ion with respect to Islamic jurisprudence recognizes four main sources of Sharia: the Quran, the Sunnah (authentic hadith), ijmâ’ (juridical consensus), and qiyâs (analogical reasoning).

Deen Ahmad ibn ‘Abd al-Ḥaleem ibn âruḍ al-’Aqlwa al-Naql, 2nd ed.

Edited by Muhammad RashâdSâlim (Riyadh: Mohammad Ibn Saud Islamic University, 1411),

Muhammad ibn Abi Bakr ibn al-Qayyim, Al-Manâr alab: Maktabat al-Maṭboo’ât al-

Islâmiyyah, 1403 AH), 1:51.

nd guidelines of this concept, Haj, “Shari‘ah in Today's World:

Renewing Islamic Discourse” (Yaqeen Institute for Islamic Research, https://yaqeeninstitute.org/hatem-

-world-renewing-islamic-discourse), accessed July 16, 2021.

Physicians calculate the age of pregnancy from thefirst day of the last menstrual period, which is twoweeks prior to conception. This is called thegestational age. 134 days of gestational agecorresponds to 120 days of post-conceptional age

o called fertilization age), which is used by the

ammad ibn al-Humâm, Qadeer, 2nd ed. (Beirut: Dâr al-Fikr,

Muhammad ibn Ameen ibn ‘Âbideen. Hâshiyat Ibn‘Âbideen (Beirut: Dâr al-Fikr, 1421 AH), 3:176.

Dardeer, al-Sharḥ al-Kabeer Fikr, n.d.), 2:266.

-Raḥman al-Ḥațțâb, MawâhibFikr, 1398 AH), 3:477.

Muhammad ibn Abi al-‘Abbâs al-Ramli, Nihâyat Minhâj (Beirut: Dâr al-Fikr,

13

13. Abu Bakr al-Dimyâṭi, I‘ânat al-Ṭâlibeen(Beirut: Dâr al-Fikr, n.d.), 3:256.

14. Ahmad al-Qalyubi and Ahmad HâshiyatâQalyubiwa ‘Umayrah (Cairo: DârIKutub al-’Arabiyyah, n.d.), 4:160.

15. ‘Ali ibn Sulaymân al-Mardâwi, AlDârIḥyâ’ at-Turâth al-‘Arabi, 1988), 1:386.

16. ‘Abdullâh ibn Aḥmad Ibn Qudâmah, Al(Beirut: Dâr al-Fikr, 1405 AH), 8:328.

17. Ahmad ibn Ahmad al-Dardeer, al-(Beirut: Dâr al-Fikr, n.d.), 2:266.

18. See: Islamic Fiqh Assembly of the Muslim WorldLeague (4/12) , Makkah, 1410 AH/1990 CE.access to pre-Internet archives, contact the IFA viathe MWL website:https://themwl.org/en/node/34237

19. See: Abu ‘Abd Allâh Muhammad ibn Ahmad alQurṭubi, Tafseer al-Qurṭubi, 2nd ed.Kutub al-Miṣriyyah, 1384/1964), 12:8; YaSharaf an-Nawawi, Șaḥeeḥ Muslim biNawawi (Beirut: DârIhyâ’ at-Turâth al1392/1972), 16:191; Ahmad ibn ‘Ali ibn Ḥajar al‘Asqalâni, Fatḥ al-Bâri fi SharBukhâri(Beirut: Dâr al-Ma’rifah, 1959), 11:481.

20. Robert Resnik et al., Creasy and Resnik’s Maternaland Fetal Medicine: Principles and (Philadelphia: W. B. Saunders, 1989).

âlibeen(Beirut: Dâr

Qalyubi and Ahmad ’Umayrah, HâshiyatâQalyubiwa ‘Umayrah (Cairo: DârIḥyâ’ al-

Mardâwi, Al-Inșâf (Beirut: ‘Arabi, 1988), 1:386.

mad Ibn Qudâmah, Al-Mughni Fikr, 1405 AH), 8:328.

-Sharḥ al-Kabeer

See: Islamic Fiqh Assembly of the Muslim World, Makkah, 1410 AH/1990 CE. For Internet archives, contact the IFA via

the MWL website:https://themwl.org/en/node/34237

See: Abu ‘Abd Allâh Muhammad ibn Ahmad al-2nd ed. (Cairo: Dâr al-

riyyah, 1384/1964), 12:8; Yaḥyâ ibn Muslim bi-Sharḥ an-

Turâth al- ‘Arabi, Ahmad ibn ‘Ali ibn Ḥajar al-

fi SharḥṢaḥeeḥ al-Ma’rifah, 1959), 11:481.

Robert Resnik et al., Creasy and Resnik’s Maternaland Fetal Medicine: Principles and Practice, 2nd ed.(Philadelphia: W. B. Saunders, 1989).

21. Aḥmad ibn ‘Abdul-Majmoo‘al-Fatâwa, ed. ‘Abd alal-Najdi, 2nd ed. (Cairo: Maktabat Ibn Taymiyyah, n.d.), 24:269.

22. Abd al-Raḥmân ibn Ahmad ibn RajabSharḥṢaḥeeḥ al-Bukhâri, (Cairo: MaktabTaal-Ḥaramayn, 1417/1996), 9:22.

23. American College of OGynecologists, ‘Terms used in reference to the fetus,’ACOG Terminology Bulletin, no. 1, September1965.

24. Michael J.F. Barresi and Scott F. Gilbert,Developmental Biology, 12th ed. (Oxford: OxfordUniversity Press, 2019).

25. Creasy and Resnik, Maternal and Fetal Medicine:Principles and Practice.

26. Christopher Vaughan, How Life Begins: The Scienceof Life in the Womb (New York: TimesBooks/Random House, 1996

27. Barresi and Gilbert, Developmental Biology, 2019.

28. Louis Halamek, ‘Prenatal consultation at the limits ofviability,’ NeoReviews, Vol. 4, No. 6 (2003)

Ethics

-Ḥaleem ibn Taymiyyah,Fatâwa, ed. ‘Abd al-Raḥmân ibn Qâsim

Najdi, 2nd ed. (Cairo: Maktabat Ibn Taymiyyah,

mân ibn Ahmad ibn Rajab, Fatḥ al-Bâri fi Bukhâri, (Cairo: MaktabTaḥqeeqDâr

aramayn, 1417/1996), 9:22.

American College of Obstetricians andGynecologists, ‘Terms used in reference to the fetus,’ACOG Terminology Bulletin, no. 1, September

J.F. Barresi and Scott F. Gilbert,Developmental Biology, 12th ed. (Oxford: Oxford

Maternal and Fetal Medicine:

Christopher Vaughan, How Life Begins: The Scienceof Life in the Womb (New York: TimesBooks/Random House, 1996), p. 134.

Barresi and Gilbert, Developmental Biology, 2019.

Louis Halamek, ‘Prenatal consultation at the limits ofviability,’ NeoReviews, Vol. 4, No. 6 (2003)

14

Muhammad Hanif Shiwani, MBBSFRCS Glasg, FCPS, FEBS, Consultant General and Laparoscopic Surgery, Barnsley General HospitalTrust, Honorary Senior Clinical Lecturer, University of Sheffield

mhshiwani@gmail.com

Health has been defined in many ways and in recent years,various healthcare models have been proposed. Muslims believe that the Qur’an is an immutable divine bookfourteen hundred years ago. The Qur’an claims that there is cure in it for the believersandoftenreaders to reflect upon and ponder cure,wellbeingand health in the Qur’an is “use of these words has been subject to numerous linguistic and metaphorical interpretations, which have varied depending upon the background and knowlived. This narrative study reflects upon the concepts of health and diseases outlined in verses of the Qur’an and examines their relationship to contemporary medical knowledge.research about its applicability according to the contemporary knowledge of healthcare delivery system.

In 1946, the World Health Organisation (WHO) definedhealth as a state of complete physical, mental, and socialwell-being and not merely the absence of diseaseThat was a ground-breaking formulation for the time.The 1986 Ottawa Charter adapted this definition todescribe health as: “a resource for everyday life, not thobject of living”. The definition emphasizes social andpersonal resources as well as physical capacities”. In2005, theWHO defined the term “health promotion” as“the process of enabling people to increase control over their health and its determinants, and thereby improvetheir health”(2)

In effect, health is described as a resource that supportsan individual’s function in society. Physical and mentalhealth are the most discussed components of overallhealth, however, spiritual health, emotional hefinancial health also play an important role, and have

MBBS, MSc Clin Edu (Edin), FRCS (Eng), FRCSI ( Gen

Consultant General and Laparoscopic Surgery, Barnsley General HospitalSenior Clinical Lecturer, University of Sheffield, UK

mhshiwani@gmail.com

Health has been defined in many ways and in recent years,various healthcare models have been proposed. Muslims believe that the Qur’an is an immutable divine book revealed to the Prophet Muhammad more than fourteen hundred years ago. The Qur’an claims that there is cure in it for the believersandoften

and ponder its verses to understand the true meaning. The Arabic word used for wellbeingand health in the Qur’an is “shifa”, and the word used for sickness and disease is “

use of these words has been subject to numerous linguistic and metaphorical interpretations, which have varied depending upon the background and knowledge of the readers, as well as the time and place in which they lived. This narrative study reflects upon the concepts of health and diseases outlined in verses of the Qur’an and examines their relationship to contemporary medical knowledge. This divine healthcare model requires further research about its applicability according to the contemporary knowledge of healthcare delivery system.

In 1946, the World Health Organisation (WHO) defined omplete physical, mental, and social

being and not merely the absence of disease(1946). breaking formulation for the time.

The 1986 Ottawa Charter adapted this definition to describe health as: “a resource for everyday life, not the object of living”. The definition emphasizes social and personal resources as well as physical capacities”. In 2005, theWHO defined the term “health promotion” as “the process of enabling people to increase control over

and thereby improve

In effect, health is described as a resource that supports an individual’s function in society. Physical and mental health are the most discussed components of overall health, however, spiritual health, emotional health, and financial health also play an important role, and have

been linked to mental and physical wellhave been criticisms on the definitions of health providedby the World Health Organisation and questions remainsas how one shall define health. Among various popular models of health care like WHO model, medical model,wellness model and environmental model, questionremains as which one toadopt.

Muslims believe that the Qur’an is an immutable divinebook that was revealed to the Pin 610 AD over a period of 23 years, when the Prophetwas 40 years old. The Qur’an provides explicit guidanceto Muslims with regards to how to live their life andprovides guidance about health. The original Qur’an wasin the Arabic language as stated in the book in verses41:44 and 20:112, however, there are now numeroustranslations of the Qur’an in most of the major languages of the world, and much of the original meaning may notbe available to those who read the Qur’an in transl

Ethics

, MSc Clin Edu (Edin), FRCS (Eng), FRCSI ( Gen-Surg),

Consultant General and Laparoscopic Surgery, Barnsley General Hospital NHS Foundation

Health has been defined in many ways and in recent years,various healthcare models have been proposed. revealed to the Prophet Muhammad more than

fourteen hundred years ago. The Qur’an claims that there is cure in it for the believersandoftenencourages its verses to understand the true meaning. The Arabic word used for

”, and the word used for sickness and disease is “marad”. The use of these words has been subject to numerous linguistic and metaphorical interpretations, which have varied

ledge of the readers, as well as the time and place in which they lived. This narrative study reflects upon the concepts of health and diseases outlined in verses of the Qur’an and

healthcare model requires further research about its applicability according to the contemporary knowledge of healthcare delivery system.

been linked to mental and physical well-being. There have been criticisms on the definitions of health provided by the World Health Organisation and questions remains

health. Among various popular models of health care like WHO model, medical model, wellness model and environmental model, question remains as which one toadopt.(3–6)

Muslims believe that the Qur’an is an immutable divine book that was revealed to the Prophet Muhammad (PUH) in 610 AD over a period of 23 years, when the Prophet was 40 years old. The Qur’an provides explicit guidance to Muslims with regards to how to live their life and provides guidance about health. The original Qur’an was

language as stated in the book in verses 41:44 and 20:112, however, there are now numerous translations of the Qur’an in most of the major languages of the world, and much of the original meaning may not be available to those who read the Qur’an in translation.

15

When translated, it ceases to be “God’s very own words”and simply becomes an interpretation of the Arabicoriginal. This includes the word “shifaQur’an for health and well-being and the word “used for illness and disease. This narrative study therefore aims to identify verses inthe Qur’an relating to health and wellinterpretations of these verses, and evaluate the guidancegiven in the Qur’an against current medical literature.

All instances of theroot words “shifa”and “retrieved through a search of the Quranic ArabicCorpus(7) . The contents of all relevant verses wereconfirmed using 2copies of the Qur’an, a physical copythe Noble Quran,(8)and an online copy available onQuran.com (7). Both versions utilised an Englishtranslation of the Qur’an produced by the same scholar.The key contents of the verses providing guidance onmatters of health were extracted, tabulated, and analysed.

In total, the Qur’an has 6,236 verses in(surahs). Thetriliteral root shīnfāyā (شفي) occurs six times in the Quran, in two derived forms: twice as theverb yashfi ( يشف) in verse 9:14 and 26:80 and four times as the noun shifā (شفآء) in 16:69, 17:82, 10:57 and 41:44.(table 1). These verses have been described below:

The verse 9:14, is in relation to story of atribe,BaniKhuzaah, at the time of the “opening of theMakkah”. This verse states that believers among theProphet’s companions would have their hearts healed by God following their anger and disappointment after awar.

The verse 10:57, describes that God sent the Qur’an as aremedy for ignorance and for spiritual ailments such as vile faiths, doubt, superstitions, wickedness, and anxiety. The effect of healing is in the form of calmness.

The verse 16:69, discusses the honeybee which produceshoney, and indicates that honey contains a cure for mankind. It proposes a cure for physical diseases.

The verse 17:82, refers totheQur’anas a remedy for allailments to believers, but describes that it provides nobenefit for non-believers because it contains rules of life,prohibition, reminders, past, present and future storiesand God promises about life hereafter.

When translated, it ceases to be “God’s very own words” and simply becomes an interpretation of the Arabic

shifa” used in the being and the word “marad”

narrative study therefore aims to identify verses in the Qur’an relating to health and well-being, outline interpretations of these verses, and evaluate the guidance given in the Qur’an against current medical literature.

”and “marad” were retrieved through a search of the Quranic Arabic

. The contents of all relevant verses were confirmed using 2copies of the Qur’an, a physical copy

and an online copy available on . Both versions utilised an English

translation of the Qur’an produced by the same scholar. The key contents of the verses providing guidance on matters of health were extracted, tabulated, and analysed.

In total, the Qur’an has 6,236 verses in 114 chapters ) occurs six times

in the Quran, in two derived forms: twice as the ) in verse 9:14 and 26:80 and four times

) in 16:69, 17:82, 10:57 and 41:44. hese verses have been described below:

, is in relation to story of a tribe,BaniKhuzaah, at the time of the “opening of the Makkah”. This verse states that believers among the Prophet’s companions would have their hearts healed by

ing their anger and disappointment after a

describes that God sent the Qur’an as a remedy for ignorance and for spiritual ailments such as vile faiths, doubt, superstitions, wickedness, and anxiety.

orm of calmness.

discusses the honeybee which produces honey, and indicates that honey contains a cure for mankind. It proposes a cure for physical diseases.

refers totheQur’anas a remedy for all ailments to believers, but describes that it provides no

believers because it contains rules of life, prohibition, reminders, past, present and future stories

The verse 41:44, describes the Qur’an as a form ofguidance and cure for the believers who understand it’smeaning, and that it provides remedies for spiritualailments. It states that for those who do not believe, thereis deafness in their ears, and for thmessage. Belief in this this book as the divine words ofGod is the key element.

The verse 26:80, describes the story of the ProphetIbrahim when he fell sick; he prayed to God and had fullbelief that God has the absolute powerverse places more emphasis on the word “mard”.

The triliteral root word “mīmrātimes in the Quran, in three derived forms: once as theverb mariḍ ( مرض), 13 times as the nounand 10 times as the noun“mard” is sometimes used in the Qur’an to convey theliteral meaning of physical illness, while at other times, itis used in a metaphorical sense. It has been translated as“sickness”, “ill”, and “disease”. (table 2).

Thelinguistic meaning of the Arabic word “shifa” is“cure and well- being. “Theinterpretation of this word isbased on the background, knowledge, and skill of theauthor as well as the time and place in which they lived.The Qur’an refers to itself of the hearts( verse 10:57, 9:125).There is a lot of emphasis in the Qur’an on moral and spiritual illnessrather than physical illness. However, the verse 26:80 uses the word “mard”, and explicitly refers to physicalailment and soundness; the prophet Ibrahim prayed toGod with the full belief that God has the absolute power of healing.

The active participle “marīḍ”times (2:184, 185, 196; 24:61form “marḍā”(4:43, 102; 5:usually refers to the “sick person”describing the performance of some religious duties. Inthat context, the sickness is described as a valid excusenot to perform those rituals and duties and carry out thalternatives which have been prescribed as well. Theseinclude exemptions from the obligatory day time fastingin the month of Ramadan: verse 2:184shaving their scalp hairs after the Haj: verse 2:196,abstinence to go for the “Jihad“ (fightingIslam) :verse 8:17, and avoiding water to use for thebathing and ablution (wudhu)for cleansing and purification: verse 4:43 and 5:6.

Ethics

describes the Qur’an as a form of guidance and cure for the believers who understand it’s meaning, and that it provides remedies for spiritual ailments. It states that for those who do not believe, there is deafness in their ears, and for them it is blindness toits message. Belief in this this book as the divine words of

, describes the story of the Prophet Ibrahim when he fell sick; he prayed to God and had full belief that God has the absolute power of healing. The verse places more emphasis on the word “mard”.

mīmrāḍād” (م ر ض) occurs 24 times in the Quran, in three derived forms: once as the

), 13 times as the noun maraḍ (مرض), noun marīḍ (ريض The word .(م

“mard” is sometimes used in the Qur’an to convey the literal meaning of physical illness, while at other times, it is used in a metaphorical sense. It has been translated as “sickness”, “ill”, and “disease”. (table 2).

Thelinguistic meaning of the Arabic word “shifa” is being. “Theinterpretation of this word is

based on the background, knowledge, and skill of the author as well as the time and place in which they lived.

an refers to itself as a cure (shifāʾ) for diseases of the hearts( verse 10:57, 9:125).There is a lot of emphasis in the Qur’an on moral and spiritual illness rather than physical illness. However, the verse 26:80 uses the word “mard”, and explicitly refers to physical

nt and soundness; the prophet Ibrahim prayed to God with the full belief that God has the absolute power

The active participle “marīḍ” (sick person) occurs five 61; 48:17), as does its plural :6; 9:91; 73:20). The Qur’an

usually refers to the “sick person” (marīd,) when describing the performance of some religious duties. In that context, the sickness is described as a valid excuse not to perform those rituals and duties and carry out the alternatives which have been prescribed as well. These include exemptions from the obligatory day time fasting in the month of Ramadan: verse 2:184– 185, men shaving their scalp hairs after the Haj: verse 2:196, abstinence to go for the “Jihad“ (fighting in the path of Islam) :verse 8:17, and avoiding water to use for the bathing and ablution (wudhu)for cleansing and purification: verse 4:43 and 5:6.

16

The Qur’an does not describe the exact methods of treatment of disease in detail butprovidesguidance anprinciplesas how to remain well. There are numerousverses which are relevant to the concept of health or provide guidance with regards to living a healthylifestyle. Theoverall emphasis is more on thepreventative aspects of the diseases at individual asociety level.

Food and nutrition are important part of health andhealthy lifestyle. In many verses, the Qur’an describesvarious types of food that people should consume toenjoy life and good health (verses2:168, 23:51, 5:88,2:57, 7:160, 6:118,5:87,16:114,7:157). There are manyverses where the Qur’an describes the permissibility ofvarious food including meat, fish, milk (verses5:96,16:14, 16:5, 35:12, 16:66,80:32, 6:142, 5:4,22:28,22:30, 22:36, 23:21), grains and fruits (verses:6:141,6:99, 36:33,16:11,16:67,19:25,80:27,80:28,80;29,16:69,13:4,23:19, 23:20).

Current medical literature corroborates many of thehealth benefits of specific food items that are described inthe Qur’an. These include, grains, fruits like dates13)grapes (14–18)olives(19), pomegranatehoney(22–24), milk, fish(25) and meat.

The Qur’an also addresses the nutrition of infants. In theverse 2:233, the Qur’an encourages mothers to suckletheir children for two years, or up to the age of thirtymonths as described in verse 46:15. Despite theavailability of alternatives, modern scientific evidencestill advocates the benefits of breast feeding for bothinfants and mothers(26–29).

In many verses, the Qur’an provides explicit instructionsto avoid certain food and drinks, like swine flesh, carrionandintoxicants (verse: 6:119, 5:3, 2:173, 16:115, 6:145,5:90, 5:91, 2:219).

The Qur’an forbids the consumption of alcohol, andmodern research has provided evidence that the harms of alcohol outweigh the benefits (30) .

Equally, the Qur’an provides instructions to avoidexcessive consumption of food (verses 7:31, 20:81,6:141). Although it is not always the case, it is nowwidely understood in nutritional science that anabundance of a particular foodtype in one’s diet can beharmful. For example, excess intake of carbohydratespredisposes to diabetes mellitus whilst excess intake of

The Qur’an does not describe the exact methods of treatment of disease in detail butprovidesguidance and principlesas how to remain well. There are numerous verses which are relevant to the concept of health or provide guidance with regards to living a healthy lifestyle. Theoverall emphasis is more on the preventative aspects of the diseases at individual and at a

Food and nutrition are important part of health and healthy lifestyle. In many verses, the Qur’an describes various types of food that people should consume to enjoy life and good health (verses2:168, 23:51, 5:88,

8,5:87,16:114,7:157). There are many verses where the Qur’an describes the permissibility of various food including meat, fish, milk (verses 5:96,16:14, 16:5, 35:12, 16:66,80:32, 6:142, 5:4,22:28, 22:30, 22:36, 23:21), grains and fruits (verses:

36:33,16:11,16:67,19:25,80:27,80:28,80;29,16:69,13:4,2

Current medical literature corroborates many of the health benefits of specific food items that are described in the Qur’an. These include, grains, fruits like dates (9–

, pomegranate(20,21),

The Qur’an also addresses the nutrition of infants. In the verse 2:233, the Qur’an encourages mothers to suckle their children for two years, or up to the age of thirty months as described in verse 46:15. Despite the availability of alternatives, modern scientific evidence still advocates the benefits of breast feeding for both

In many verses, the Qur’an provides explicit instructions id certain food and drinks, like swine flesh, carrion

andintoxicants (verse: 6:119, 5:3, 2:173, 16:115,

The Qur’an forbids the consumption of alcohol, and modern research has provided evidence that the harms of

Equally, the Qur’an provides instructions to avoid excessive consumption of food (verses 7:31, 20:81, 6:141). Although it is not always the case, it is now widely understood in nutritional science that an

odtype in one’s diet can be harmful. For example, excess intake of carbohydrates predisposes to diabetes mellitus whilst excess intake of

fat and cholesterol predisposes to atherosclerosis and cardiovascular diseases. Overpredisposes to obesity and its associated coThese chronic diseases are contributing to a hugeproportion of the world’s healthcare burden.

While encouraging to eat and drink what God hasprovided and made permissible, the Quran providesinstructions for certainacts and rituals which are mademandatory such as daytimefasting for eligible adultsduring the month of Ramadhan (verse2:183,2:184,2:187).The current scientific literaturefavours the health benefits of Intermittent Fasting(31,32).

Part of physical well-being includes sexual wellSexuality and intimacy are both topics that the Qur’anhas mentioned in many verses and in various contexts.The Qur’an provides basic guidance on healthy sexualbehaviour including maintaining chastity, loweone’s own gaze, protecting private parts and avoidingadultery and fornication (30:21,2:222, 17:32, 24:2,26:165,23:5,24:30, 24:31, 33:59, 4:34, 17:32, 24:2), anddescribes the philosophy behind the recommendation to improve the health at individu(verses: 4:1, 30:21, 7:189).

The current scientific literature suggests that there areover twenty infectiousdiseases that can be transmittedthrough various types of sexual practices. According to aWHO report more than one million Sexually TransmittedInfections (STIs) are acquired everyday worldwideEach year, there are an estimated 376 million new infections(34). WHO recommends counselling andbehavioural intervention to prevent STIs.Comprehensive sex education,populations such as sex workers and counselling tailoredto the needs of adolescents is needed. Having multiplesex partners increases the risk of infection with HIV andHPV. WHO has been using multiple resources to encourage safe sex practice all around the world andfocusing some developing and underdeveloped countriesto reduce the incidence of HIV and STI.

There are many verses of the Quran advising on thepractice of personal hygiene (2:222, 74:5).For example,performing five daily prayers is obligatory for an adultand sane Muslim. This is not allowed without being in astate of physical purification by the way of performing an“ablution” ,whichmeans cleaning and washing the face,hands, arms, and feet.(4:43.5:6).The current medicalliterature about the infectious diseases confirms thatsimply washing hands can minimises the risk of

Ethics

fat and cholesterol predisposes to atherosclerosis and cardiovascular diseases. Over-eating in general

obesity and its associated co-morbidities. These chronic diseases are contributing to a huge proportion of the world’s healthcare burden.

While encouraging to eat and drink what God has provided and made permissible, the Quran provides

ertainacts and rituals which are made mandatory such as daytimefasting for eligible adults during the month of Ramadhan (verse 2:183,2:184,2:187).The current scientific literature favours the health benefits of Intermittent Fasting

being includes sexual well-being. Sexuality and intimacy are both topics that the Qur’an has mentioned in many verses and in various contexts. The Qur’an provides basic guidance on healthy sexual behaviour including maintaining chastity, lowering the one’s own gaze, protecting private parts and avoiding adultery and fornication (30:21,2:222, 17:32, 24:2, 26:165,23:5,24:30, 24:31, 33:59, 4:34, 17:32, 24:2), and describes the philosophy behind the recommendation to improve the health at individual and at a society level.

The current scientific literature suggests that there are over twenty infectiousdiseases that can be transmitted through various types of sexual practices. According to a

million Sexually Transmitted Infections (STIs) are acquired everyday worldwide(33). Each year, there are an estimated 376 million new

. WHO recommends counselling and behavioural intervention to prevent STIs. Comprehensive sex education, targeting to key populations such as sex workers and counselling tailored to the needs of adolescents is needed. Having multiple sex partners increases the risk of infection with HIV and HPV. WHO has been using multiple resources to

ctice all around the world and focusing some developing and underdeveloped countries to reduce the incidence of HIV and STI.

There are many verses of the Quran advising on the practice of personal hygiene (2:222, 74:5).For example,

rayers is obligatory for an adult and sane Muslim. This is not allowed without being in a state of physical purification by the way of performing an “ablution” ,whichmeans cleaning and washing the face, hands, arms, and feet.(4:43.5:6).The current medical literature about the infectious diseases confirms that simply washing hands can minimises the risk of

17

transmission of many diseases, especially certainparasitic infestations specially those which aretransmitted through faeco-oral route and certain viralinfections like Covid 19.

The Qur’an claims that “hearts find peace only inremembrance of Allah” (verse 13:28). When sufferingfrom physical, mental, or spiritual ailments, Muslimsfollow the practice of the Prophet Muhammad and oftenrecite verses of the Qur’an. To date, a significant number of research studies haveprovided evidence that the recitation of the Qur’an(RHQ) can improve the health of patientsrecitation of Qur’an has been shown to benefit themanagement of patients with anxiety, patients receivinghaemodialysis, Muslim patients suffering from mentalillness, reducing the anxiety level of the women goingthrough labour and patients undergoing surgery(36or endoscopic procedures. Further studies have suggestedthat the recitation of Qur’an improves stress responses,hemodynamic stability and conscious levels of patientswho require intensive care support. The primarymechanism by which the recitation of Qur’an benefitsphysical, mental, and spiritual health appears to bethrough the reduction of anxiety. However, it isimportant to recognise that these mental and spiritualfactors are key components of the holistic concept ofhealth, as defined by organisations such as the WHO.

TheQur’an further advises readers to adopt a healpsychological lifestyle with regards to adopting anattitude of kindness and forgiveness, controlling anger(verse 42.37, 3:134,9:15)and controlling feelings of delusions and jealousy. There are many verses whereinstructions have been given to adopt hvalues of being honest and trustworthy, which in turnimprove psychological and spiritual health.

The Qur’an provides advice about spiritual and emotionalhealth. Multiple verses in the Qur’an advise about stayingaway from the lust of the world and advise believers toadopt an appropriate and a balanced lifestyle to achievereward in the hereafter.

While the Qur’an emphasises a preventative approach tohealthcare, the Qur’an also provides instructions tomankind to protect life. In verse 5:32, the Qur’anemphasizes that saving one life is like saving the life of all mankind.

Since its inception, the WHO has been spendingextensive resources in conjunction with the internationalhealth care authorities to improve the healthcare

transmission of many diseases, especially certain parasitic infestations specially those which are

oral route and certain viral

The Qur’an claims that “hearts find peace only in remembrance of Allah” (verse 13:28). When suffering from physical, mental, or spiritual ailments, Muslims follow the practice of the Prophet Muhammad and often

To date, a significant number of research studies have provided evidence that the recitation of the Qur’an (RHQ) can improve the health of patients(35). The recitation of Qur’an has been shown to benefit the

, patients receiving haemodialysis, Muslim patients suffering from mental illness, reducing the anxiety level of the women going through labour and patients undergoing surgery(36–41) or endoscopic procedures. Further studies have suggested

ion of Qur’an improves stress responses, hemodynamic stability and conscious levels of patients who require intensive care support. The primary mechanism by which the recitation of Qur’an benefits physical, mental, and spiritual health appears to be

h the reduction of anxiety. However, it is important to recognise that these mental and spiritual factors are key components of the holistic concept of health, as defined by organisations such as the WHO.

TheQur’an further advises readers to adopt a healthy psychological lifestyle with regards to adopting an attitude of kindness and forgiveness, controlling anger (verse 42.37, 3:134,9:15)and controlling feelings of delusions and jealousy. There are many verses where instructions have been given to adopt healthy moral values of being honest and trustworthy, which in turn improve psychological and spiritual health.

The Qur’an provides advice about spiritual and emotional health. Multiple verses in the Qur’an advise about staying

orld and advise believers to adopt an appropriate and a balanced lifestyle to achieve

While the Qur’an emphasises a preventative approach to healthcare, the Qur’an also provides instructions to

:32, the Qur’an emphasizes that saving one life is like saving the life of

Since its inception, the WHO has been spending extensive resources in conjunction with the international health care authorities to improve the healthcare

worldwide. This includes personaland communityhygiene, nutrition-related diseases likemalnutrition in underdeveloped countries and obesity in the developedworld, promoting and encouraging the practice of breastfeeding, measures to minimise maternal and infantmortality rate, prevention of infectious diseases including healthy sexual practice, and cancer prevention includingdiscouraging use of smoking and alcohol.

In the last few decades,the traditional Grecomedicine has been superseded by the modern meinmost of the world. However, “Islamic medicine” ispracticed as an adjunct or as an alternative to the westernmedicine. The guidance from the Quranis valued assacred by Muslimsand practices recommended in theQuran directly and through the practiMuhammad are valued to be beneficial as a religiouspractice.

The Qur’an claims to be a divine book of guidance andthe unmuted words of God. It is not a book of science.However, it provides guidance for readers on matters of lifestyle in order that believers may enjoy good healthand avoid illness. Current medicalscience supportstheprinciples of preventative medicine. Promoting theguidance about the healthcare that isprovided in theQuran will achieve many of the health carewhich WHO has been trying to achieve since itsinception. This divine health care model requires furtherresearch about its applicability according to thecontemporary knowledge of healthcare delivery system.

1. Constitution of the WorAmerican journal of public health and the nation’shealth. 1946 Nov 1;36(11):1315

2. Health Organization W. Milestones in HealthPromotion: Statements from Global Conferences.

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Ethics

. This includes personaland community related diseases likemalnutrition in

underdeveloped countries and obesity in the developed world, promoting and encouraging the practice of breast feeding, measures to minimise maternal and infant

rtality rate, prevention of infectious diseases including healthy sexual practice, and cancer prevention including discouraging use of smoking and alcohol.

In the last few decades,the traditional Greco-Islamic medicine has been superseded by the modern medicine inmost of the world. However, “Islamic medicine” is practiced as an adjunct or as an alternative to the western medicine. The guidance from the Quranis valued as sacred by Muslimsand practices recommended in the Quran directly and through the practices of Prophet Muhammad are valued to be beneficial as a religious

The Qur’an claims to be a divine book of guidance and the unmuted words of God. It is not a book of science. However, it provides guidance for readers on matters of ifestyle in order that believers may enjoy good health

and avoid illness. Current medicalscience supports theprinciples of preventative medicine. Promoting the guidance about the healthcare that isprovided in the Quran will achieve many of the health care objectives which WHO has been trying to achieve since its inception. This divine health care model requires further research about its applicability according to the contemporary knowledge of healthcare delivery system.

Constitution of the World Health Organization.American journal of public health and the nation’shealth. 1946 Nov 1;36(11):1315–23..

Health Organization W. Milestones in HealthPromotion: Statements from Global Conferences.

Huber M, André Knottnerus J, Green L, van derHorst H, Jadad AR, Kromhout D, et al. How shouldwe define health? BMJ (Online).

The Lancet. What is health? The ability to adapt.The Lancet . 2009;373(9666):781.

Jadad AR, O’Grady L. How should health bedefined? . Vol. 337, BMJ. British Medical Journal

18

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to Holy Quran Recitation on Weaning Patients ceiving Mechanical Ventilation in the Intensive

Care Unit: A Pilot Study. Journal of religion and health . 2019 Feb 15 [cited 2020 Mar 27];58(1):64–

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20

Table 1: The word Cure” شفاء" in Quran

Surah name Verse no. Verse

Al-Taubah 9:14 - ؤمنين بأيديكم ويخزهم وينصركم عليهم ويشف صدور قوم م بهم قاتلوهم يعذ

“Fight them, so that Allah should punish them at your hands and disgracethem, and help you win against them and bring relief tobelieving people,”

Yunus 10:57 – منين

“O men, there has come to you an advice from your Lord, and a cure for the ailments of your hearts, and guidance and mercy for the believers.”

Al-Nahl 16:69 فيه شفاءلقوم يتفكرون - آلية

“Then, eat from all the fruits, and go along the pathways of your Lord made easy for you.” From their bellies comes out a drink of various colorsin which there is cure for people. Surely, in that there is a sign for apeople who ponder.”

Al-Isra 17:82 - خسارا المين إال الظ لمؤمنين وال يزيد ل ورحمة ما هو شفاء من القرآن ل وننز

“We reveal the Qur’ān, which is cure and mercy for the believers; and itadds nothing to the unjus

Ash-Shuara 26:80 فهو يشفين وإذا مرضت

"And when I am ill, it is He Who

Fussilat 41:44 ين آمنوا هدى وشفاءكان بعيد ن م

“Had We made it a nonits verses not clearly explained? Is it a non(messenger)?” Say, “For those who believe, it is guidance and cure. As for those who do notit is blindness. Such people are being called from a distant place.”

" in Quran

erse

ؤمنين بأيديكم ويخزهم وينصركم عليهم ويشف صدور قوم م بهم قاتلوهم يعذ

“Fight them, so that Allah should punish them at your hands and disgracethem, and help you win against them and bring relief tobelieving people,”

لمؤ منين دور وهدى ورحمة ل بكم وشفاء لما في الص ن ر وعظة م جاءتكم م قد يا أيها الناس

“O men, there has come to you an advice from your Lord, and a cure for he ailments of your hearts, and guidance and mercy for the believers.”

ختلف ألوانه فيه شفاء فاسلكي سبل ربك ذلال يخرج من بطونها شراب م كلي من كل الثمرات ثملك آلية لقوم يتفكرون للناس إن في ذ

“Then, eat from all the fruits, and go along the pathways of your Lord made easy for you.” From their bellies comes out a drink of various colorsin which there is cure for people. Surely, in that there is a sign for apeople who ponder.”

المين إال خسارا لمؤمنين وال يزيد الظ من القرآن ما هو شفاء ورحمة ل ل وننز

“We reveal the Qur’ān, which is cure and mercy for the believers; and itadds nothing to the unjust but loss.”

وإذا مرضت فهو يشفين

"And when I am ill, it is He Who cures me;

لت آياته أأعجمي وعربي قل هو للذ ين آمنوا هدى وشفاء ولو جعلناه قرآنا أعجميا لقالوا لوال فصكان بعيد ئك ينادون م ن م ال يؤمنون في آذانهم وقر وهو عليهم عمى أول والذين

Had We made it a non-Arabic Qur’ān, they would have said, “Why areits verses not clearly explained? Is it a non-Arabic (book) and an Arab (messenger)?” Say, “For those who believe, it is guidance and cure. As for those who do not believe, there is deafness in their ears, and for themit is blindness. Such people are being called from a distant place.”

Ethics

ؤمنين بأيديكم ويخزهم وينصركم عليهم ويشف صدور قوم م بهم قاتلوهم يعذ

“Fight them, so that Allah should punish them at your hands and disgrace them, and help you win against them and bring relief to bosoms of the

لمؤ ل وهدى ورحمة دور لما في الص وشفاء بكم ن ر م وعظة يا أيها الناس قد جاءتكم م

“O men, there has come to you an advice from your Lord, and a cure for he ailments of your hearts, and guidance and mercy for the believers.”

ختلف ألوانه م من بطونها شراب ربك ذلال يخرج ثم كلي من كل الثمرات فاسلكي سبل

“Then, eat from all the fruits, and go along the pathways of your Lord made easy for you.” From their bellies comes out a drink of various colors in which there is cure for people. Surely, in that there is a sign for a

خسارا المين إال الظ لمؤمنين وال يزيد ل ورحمة ما هو شفاء ل من القرآن وننز

“We reveal the Qur’ān, which is cure and mercy for the believers; and it

لت آياته أأعجمي وعربي قل هو للذ ولو جعلناه قرآنا أعجميا لقالوا لوال فصم ئك ينادون عمى أول عليهم وهو وقر في آذانهم والذين ال يؤمنون

Arabic Qur’ān, they would have said, “Why are Arabic (book) and an Arab

(messenger)?” Say, “For those who believe, it is guidance and cure. As believe, there is deafness in their ears, and for them

it is blindness. Such people are being called from a distant place.”

21

Table 2: The word “ill” “mard” in the Quran

Surah Verse number

Verb(form)-to be ill

Ash-

Shu’ara(Thepoets)

26:80

Noun

Al Baqarah

(TheCow)

2:10

Al-

Ma’idah(Thetable

spread)

5:52

Al-Anfal(The spoils

of war)

8:49

At-Tawbah

(The Repentance)

9:125

Al-Haj (The

Pilgrimage) 22:53

Table 2: The word “ill” “mard” in the Quran

Verse number Verse

وإذا مرضت فهو يشفين - 26:80

“and when I become sick, He heals me,”

مرضا ولهم عذاب أليم بما كانوا يكذبون - 2:10 رض فزادهم في قلوبهم م

“In their hearts there is a malady, so Allah has made them growin their malady; and for them there is a grievous punishment,because they have been lying.”

رض يسارعون فيهم يقولون نخشى أن تصيبنا دائرة فعسى في قلوبهم م فترى الذينوا في أنفسهم نادمين - ن عنده فيصبحوا على ما أسر أن يأتي بالفتح أو أمر م 5:52: “Now, you see those who have disease in their hearts racetowards them saying, “We apprehend thatovertake us.”So, it is likely that Allah may bring victory or something else from His own side, whereupon they will becomeregretful over what they concealed in their hearts.

ؤالء دينهم ومن يتوكل :8:49 رض غر ه والذين في قلوبهم م افقون عزيز حكيم فإن على

“When the hypocrites and those who have a malady in their hearts said, “The belief of these people has deluded them.whoever places his trust in Allah (becomes victorious, because)Allah is Mighty, Wise.”

فزادتهم رجسا إلى رجسهم وماتوا وهم كافرون - 9:125 رض قلوبهم م في ا الذين وأم

“As for those who have malady in their hearts, it adds further impurity to their (initial) impurity, and they die infidels.”

المين رض والقاسية قلوب هم وإن الظ لذين في قلوبهم م فتنة ل ما يلقي الشيطان ليجعل لفي شقاق بعيد - 22:53

“(All this is allowed to be done) so that He may make what Satan casts a trial for those in whose hearts there is a disease, and whose hearts are hard;-and surely the wrongdoers are in the

Ethics

مرضا ولهم عذاب أليم بما كانوا يكذبون رض فزادهم في قلوبهم م

malady, so Allah has made them grow in their malady; and for them there is a grievous punishment,

فيهم يقولون نخشى أن رض يسارعون فترى الذين في قلوبهم موا في أنفسهم نادمين ن عنده فيصبحوا على ما أسر أن يأتي بالفتح أو أمر م

Now, you see those who have disease in their hearts race towards them saying, “We apprehend that some misfortune may overtake us.”So, it is likely that Allah may bring victory or something else from His own side, whereupon they will become regretful over what they concealed in their hearts.”

دينهم ومن يتوكل ؤالء غر ه رض إذ يقول المنافقون والذين في قلوبهم م

“When the hypocrites and those who have a malady in their hearts said, “The belief of these people has deluded them.” And whoever places his trust in Allah (becomes victorious, because)

كافرون وماتوا وهم رجسهم رجسا إلى رض فزادتهم ا الذين في قلوبهم م وأم

those who have malady in their hearts, it adds further impurity to their (initial) impurity, and they die infidels.”

قلوب والقاسية رض قلوبهم م في لذين ليجعل ما يلقي الشيطان فتنة ل

“(All this is allowed to be done) so that He may make what Satan casts a trial for those in whose hearts there is a disease, and

and surely the wrongdoers are in the

22

An-Nur(The Light) 24:50

Al-Ahzab(The

combined Forces)

33:12

Al-Ahzab(The

combined Forces)

33:32

Al-Ahzab(The

combined Forces)

33:60

Muhammad

(Muhammad)

47:20

Muhammad 47:29

utmost antagonism-“

ئك هم عليهم ورسوله بل أول رض أم ارتابوا أم يخافون أن يحيف أفي قلوبهم م الظالمون - 24:50

“Is there a malady in their hearts or do they have doubt or do they fear that Allah and His messenger will do injustice to them? Rather they themselves are the unjust.”

ورسوله إال غرورا - ا وعدنا رض م وإذ يقول المنافقون والذين في قلوبهم م33:12

“(Remember) when the hypocrites and those having malady in their hearts were saying, “Allah and His messenger did notpromise us but deceitfully;”

ن النساء إن اتقيتن فال تخضعن بالقول فيطمع الذي في قلبه م كأحد النبي لستن يا نساءعروفا - 33:32 مرض وقلن قوال م

“O wives of the prophet, you are not like any other women, if you observe taqwā (righteousness). So, do not be too soft in your speech, lest someone having disease in his heart should develop fancies (about you); and do speak with appropriate words.”

رض والمرجفون في المدينة لنغرينك بهم ثم في قلوبهم م والذين لئن لم ينته المنافقون ال يجاورونك فيها إال قليال - 33:60

“If the hypocrites and those having malady in their hearts and the ones who spread rumours in Madīnah do not stop (their evildeeds), We will certainly stir you up against thno longer live in it as your neighbours, but for a little while,”

حكمة وذكر فيها القتال ر أيت لت سورة فإذا أنزلت سورة م ويقول الذين آمنوا لوال نزرض ينظرون إليك نظر المغشي عليه من الموت فأولى لهم - في قلوبهم م47:20

And the believers say, “Why has a (new) Sūrah not been revealed?” Then, once an operative Sūrah is sent down, and fighting (in Allah’s way) is mentioned in it, you notice those who have disease in their hearts, looking to you like one who is faintbecause of death. So, destruction is very close to them.

أضغانهم - 47:29 رض أن لن يخرج حسب الذين في قلوبهم م أم

Ethics

ئك هم عليهم ورسوله بل أول رض أم ارتابوا أم يخافون أن يحيف أفي قلوبهم م

“Is there a malady in their hearts or do they have doubt or do that Allah and His messenger will do injustice to them?

ورسوله إال غرورا ا وعدنا رض م وإذ يقول المنافقون والذين في قلوبهم م

“(Remember) when the hypocrites and those having malady in their hearts were saying, “Allah and His messenger did not

ن النساء إن يا نساء النبي لستن كأحد م

“O wives of the prophet, you are not like any other women, if you observe taqwā (righteousness). So, do not be too soft in your

est someone having disease in his heart should develop fancies (about you); and do speak with appropriate words.”

في المدين والمرجفون رض لئن لم ينته المنافقون والذين في قلوبهم م

“If the hypocrites and those having malady in their hearts and the ones who spread rumours in Madīnah do not stop (their evil deeds), We will certainly stir you up against them, then they shall no longer live in it as your neighbours, but for a little while,”

فيها القتال ر وذكر حكمة م فإذا أنزلت سورة لت سورة ويقول الذين آمنوا لوال نزفأولى لهم من الموت عليه إليك نظر المغشي رض ينظرون الذين في قلوبهم م

And the believers say, “Why has a (new) Sūrah not been revealed?” Then, once an operative Sūrah is sent down, and

s mentioned in it, you notice those who have disease in their hearts, looking to you like one who is faint because of death. So, destruction is very close to them.

رض أن لن يخرج قلوبهم م أم حسب الذين في

23

(Muhammad)

Al- Muddaththir(The

Cloaked one)

74:31

Al Baqarah (The

Cow)

2:184

Al Baqarah (The

Cow)

2:185

Do those having malady in their hearts think that Allah willnever expose their grudges (against Islam)?

لذين كفروا ليستيقن وما جعلنا أصحاب النار إال مالئكة وما جعلنا عدته م إال فتنة لويزداد الذين آمنوا إيمانا وال يرتاب الذين أوتوا الكتاب الذين أوتوا الكتابلك ذا مثال كذ به رض والكافرون ماذ ا أراد في قلوبهم م والمؤمنون وليقول الذين من يشاء ويهدي من يشاء وما يعلم جنود ربك إال هو وما هي إال ذكرى يضل للبشر - 74:31

And We did not make wardens of the Fire but (from) angels, and did not fix their number but as a test for those who disbelieve, so that those who are given the Book may come to believe, and those who believe may improve in belief, and so that those who are given the Book and those who believe may not doubt (its correctness), and so that those having malady in their hearts and the disbelievers say, “What has Allah meant by this strangestatement?” Thus Allah lets go astray whomever He wills, and leads to the right path whomever He wills. And no one knows thehosts of your Lord but He. And this is nothing else but areminder for mankind.

ن أيام أخر وعلى الذين ريضا أو على سفر فعدة م منكم م فمن كان عدودات أياما مع خيرا فهو خير له وأن تصوموا خير لكم إن فمن تطو ين كنتم تعلمون - 2:184

for days few in number. However, should any one of you be sick or on a journey, then (he should fast) a number of other days (equal to the missed ones); and those who have the strength, (still, they do not opt for fasting,) on them there is a fidyah (compensation), that is, the feeding of a poor person.Thenwhoever does good voluntarily, that is better for him. However, that you fast is better for you, if you only knew.

ن الهدى والفرقان فمن شهد فيه القرآن هدى للناس وبينات م رمضان الذي أنزل شهر بكم ن أيام أخر يريد فليصمه ومن كان مريضا أو على سفر فعدة م الشهر منكم على ما هداكم ولعلكم تشكرون - اليسر وال يريد بكم العسر ولتكملوا العدة ولتكبروا 2:185

The month of Ramadan is the one in which the Qrevealed as guidance for mankind, and as clear signs that show the right way and distinguish between right and wrong. So thoseof you who witness the month must fast in it. But the one who is sick, or is on a journey (should fast) as much from othe missed). Allah intends (to provide) ease for you and does notintend (to create) hardship for you. All this is so that you maycomplete the number (of fasts as prescribed) and proclaim theTakbīr of Allah for having guided you, and (so) tha

Ethics

Do those having malady in their hearts think that Allah will never expose their grudges (against Islam)?

وما جعلنا أصحاب النار إال مالئكة وما جعلنا عدتهالذين أوتوا الكتاب آمنوا إيمانا وال يرتاب الذين أوتوا الكتاب ويزداد الذين

ماذ والكافرون رض والمؤمنون وليقول الذين في قلوبهم م من يشاء ويهدي من يشاء وما يعلم جنود ربك إال هو وما هي إال ذكرى يضل

And We did not make wardens of the Fire but (from) angels, and not fix their number but as a test for those who disbelieve, so

that those who are given the Book may come to believe, and those who believe may improve in belief, and so that those who are given the Book and those who believe may not doubt (its

ss), and so that those having malady in their hearts and the disbelievers say, “What has Allah meant by this strange statement?” Thus Allah lets go astray whomever He wills, and leads to the right path whomever He wills. And no one knows the

Lord but He. And this is nothing else but a

أخر وعلى الذين ن أيام م فعدة على سفر ريضا أو عدودات فمن كان منكم م أياما مخير له وأن تصوموا خير لكم إن خيرا فهو ع يطيقونه فدية طعام مسك ين فمن تطو

for days few in number. However, should any one of you be sick or on a journey, then (he should fast) a number of other days

missed ones); and those who have the strength, (still, they do not opt for fasting,) on them there is a fidyah (compensation), that is, the feeding of a poor person.Then whoever does good voluntarily, that is better for him. However,

er for you, if you only knew.

والفرقان فمن شهد ن الهدى م وبينات شهر رمضان الذي أنزل فيه القرآن هدى للناسعلى مريضا أو منكم الشهر فليصمه ومن كان

على ما هداكم ولعلكم اليسر وال يريد بكم العسر ولتكملوا العدة ولتكبروا

The month of Ramadan is the one in which the Qur’ān was revealed as guidance for mankind, and as clear signs that show the right way and distinguish between right and wrong. So those of you who witness the month must fast in it. But the one who is sick, or is on a journey (should fast) as much from other days (as he missed). Allah intends (to provide) ease for you and does not intend (to create) hardship for you. All this is so that you may complete the number (of fasts as prescribed) and proclaim the Takbīr of Allah for having guided you, and (so) that you may be

24

Al Baqarah)The

Cow)

2:196

Al-Nisa( The

Women)

4:43

Al-Nisa( The

Women)

4:102

grateful.

فإن أحصرتم فما استيسر من الهدي وال تحلقوا رءوسك م وا الحج والعمرة وأتمن صيام أو أسه ففدية م ن ر ريضا أو به أذى م محله فمن كان منكم م حتى يبلغ الهديفمن تمتع بالعمرة إلى الحج فما استيسر من الهدي فم ن لم صدقة أو نسك فإذا أمنتملك لمن لم يكن في الحج وسبعة إذا رجع تم تلك عشرة كاملة ذ فصيام ثالثة أيام يجد شديد العقاب - 2:196 واعلموا أن أهله حاضري المسجد الحرام واتقوا

Accomplish the Hajj and the ‘Umrah for Allah, but if you arerestricted, then (sacrifice) whatever animal of offering is available, and do not shave your heads until the offering reaches its place. But if anyone of you is ill, or has some trouble with hisscalp, then there is a ransom through fasting or alms giving.And when you are safe, then, whoever avails the advantage of the‘Umrah along with the Hajj shall make an offering of whatever animal is available. However, any one who finds none shall fastfor three days during Hajj, and for seven days when you return;thus they are ten in all. This is for him whose family folk are notresidents of Al-Masjid-ul-Harām. Fear Allah and be aware thatAllah is severe in punishment.

الة وأنتم سكارىحتى تعلموا ما تقولون وال جنبا إال تقربوا الص يا أيها الذين آمنوا الن الغائط نكم م رضى أو على سفر أو جاء أحد م حتى تغتسلوا وإن كنتم م عابري سبيل موا صعيدا طيبا ف امسحوا بوجوهكم وأيديكم إن فتيم فلم تجدوا ماء المستم النساء أو كان عفوا غفورا - 4:43

O you who believe! Do not go near Salāh when you areintoxicated, until you know what you say, nor in a state of ‘major impurity’.,-save when you are traversing a waybath. If you are sick, or in travel, or if one of you has come after relieving himself, or you have had contact with women, and you find no water, go for some clean dust and wipe your faces and hands (with it). Surely, Allah is Most-Pardoning,Forgiving.

عك وليأخذوا أسلحتهم فإذ ا سجدوا نهم م الة فلتقم طائفة م الص فأقمت لهم فيهم وإذا كنتولتأت طائفة أخرى لم يصلوا فليصلوا معك وليأخذوا حذرهم فليكونوا من ورائكمي لة كفروا لو تغفلون عن أسلحتكم وأمتعتكم فيميلون عليكم م الذين وأسلحتهم ودرضى أن تضعوا أسلحتكم طر أو كنتم م ن م بكم أذى م عليكم إن كان جناح واحدة والهينا - 4:102 أعد للكافرين عذابا م وخذوا حذركم إن

When you (O prophet) are in their midst, and arrange for themthe Salāh, then, a party from them should stand with you, and should take their arms along. Then, once they performed Sajdah, they should move away from you, and the other party, that has not yet performed Salāh, should come and perform Salāh with

Ethics

فإن أحصرتم فما استيسر من الهدي وال تحلقوا رءوسك وا الحج والعمرة وأتمريضا أو به منكم م حتى يبلغ الهدي محله فمن كان

من الهدي فم فما استيسر صدقة أو نسك فإذا أمنتم فمن تمتع بالعمرة إلى الحجيجد فصيام ثالثة أيام في الحج وسبعة إذا رجع

شديد العقاب واعلموا أن أهله حاضري المسجد الحرام واتقوا

Accomplish the Hajj and the ‘Umrah for Allah, but if you are (sacrifice) whatever animal of offering is

available, and do not shave your heads until the offering reaches its place. But if anyone of you is ill, or has some trouble with his scalp, then there is a ransom through fasting or alms giving.And

safe, then, whoever avails the advantage of the ‘Umrah along with the Hajj shall make an offering of whatever animal is available. However, any one who finds none shall fast for three days during Hajj, and for seven days when you return;

in all. This is for him whose family folk are not Harām. Fear Allah and be aware that

وأنتم سكارىحتى الة يا أيها الذين آمنوا ال تقربوا الصن الغائط نكم م م جاء أحد على سفر أو رضى أو عابري سبيل حتى تغتسلوا وإن كنتم م

موا صعيدا طيبا ف أو المستم النساء فلم تجدوا ماء فتيم

O you who believe! Do not go near Salāh when you are intoxicated, until you know what you say, nor in a state of ‘major

save when you are traversing a way-until you take a bath. If you are sick, or in travel, or if one of you has come after relieving himself, or you have had contact with women, and you find no water, go for some clean dust and wipe your faces and

Pardoning, Most-

فإذ وليأخذوا أسلحتهم عك م نهم م طائفة فلتقم الة وإذا كنت فيهم فأقمت لهم الصفليكونوا من ورائكم ولتأت طائفة أخرى لم يصلوا

ي عليكم م فيميلون وأمتعتكم عن أسلحتكم وأسلحتهم ود الذين كفروا لو تغفلونطر أو ن م واحدة وال جناح عليكم إن كان بكم أذى م

هينا أعد للكافرين عذابا م وخذوا حذركم إن

When you (O prophet) are in their midst, and arrange for them the Salāh, then, a party from them should stand with you, and should take their arms along. Then, once they performed Sajdah, they should move away from you, and the other party, that has

t performed Salāh, should come and perform Salāh with

25

Al-Ma’idah( The

Table Spread)

5:6

At-Tawbah

( The Repentance)

9:91

Al-Nur( The Light) 24:61

you, and should take their precautionary measures and their arms. Those who disbelieve would want you to become heedless to your arms and your belongings, so that they come down upon you in a single move. There is no sin on you, if you have someinconvenience due to rain, or you are sick, in putting your arms aside, but take your precautionary measures. Surely, Allah hasprepared for the disbelievers a humiliating punishment.

الة فاغسلوا وجوهكم وأيديكم إلى المرافق وام سحوا قمتم إلى الص يا أيها الذين آمنوا إذارضى أو على روا وإن كنتم م وأرجلكم إلى الكعبين وإن كنتم جنبا فاطه برءوسكمموا صعيدا ط يبا ن الغائط أو المستم النساء فلم تجدوا ماء فتيم نكم م م جاء أحد سفر أوكن يريد ن حرج ول ليجعل عليكم م نه ما يريد فامسحوا بوجوهكم وأيديكم مركم وليتم نعمته عليكم لعلكم تشكرون - 5:6 ليطه

O you who believe, when you rise for Salāh, (prayer) wash your faces and your hands up to the elbows, and make MasH (wipingby hands) of your heads and (wash) your feetyou are in a state of major impurity, cleanse yourselves well (bytaking bath). If you are sick, or on a journey, or if one of you has come after relieving himself, or you have had sexual contact with women, and you find no water, then, go for some clean dust and wipe your faces and hands with it. Allah does not like to imposea problem on you; He, rather likes to cleanse you and to complete His favour upon you, so that you may be grateful.

على المرضى وال على الذين ال يجدون ما ينفقون حرج إذا وال عفاء لى الضحيم - 9:91 غفور ر ورسوله ما على المحسنين من سبيل و نصحوا

There is no blame on the weak, or on the sick, have nothing to spend, if they are sincere to Allah and His Messenger. There is no way against those who are good in deeds. Allah is most Forgiving, Very Merciful.

وال على األ عرج حرج وال على المريض حرج وال على حرج على األعمى ليسهاتكم أو بيوت إخوانكم أو أنفسكم أن تأكلوا من بيوتكم أو بيوت آبائكم أو بيوت أماتك م أو بيوت أخوالكم أو بيوت خاالتكم بيوت أخواتكم أو بيوت أعمامكم أو بيوت عمصديقكم ليس عليكم جناح أن تأكلوا جميعا أو أشتاتا فإذ ا دخلتم فاتحه أو ما ملكتم م أو لكم اآليات لك يبين مباركة طيبة كذ ن عند بيوتا فسلموا على أنفسكم تحية م لعلكم تعقلون - 24:61

There is no blame on a blind person, nor is there any blame on any lame one, nor is there any blame on a sick person, nor on yourselves in that you eat (something) from your own homes or from the homes of your fathers or the homes of your mothers or the homes of your brothers or the homes of your sisters or thehomes of your paternal uncles, or the homes of your paternal

Ethics

you, and should take their precautionary measures and their arms. Those who disbelieve would want you to become heedless to your arms and your belongings, so that they come down upon

e. There is no sin on you, if you have some inconvenience due to rain, or you are sick, in putting your arms aside, but take your precautionary measures. Surely, Allah has prepared for the disbelievers a humiliating punishment.

وام وأيديكم إلى المرافق فاغسلوا وجوهكم الة يا أيها الذين آمنوا إذا قمتم إلى الصرضى روا وإن كنتم م فاطه جنبا وإن كنتم برءوسكم وأرجلكم إلى الكعبين

موا صعيدا ط فتيم فلم تجدوا ماء المستم النساء ن الغائط أو نكم م سفر أو جاء أحد مكن ن حرج ول ليجعل عليكم م نه ما يريد فامسحوا بوجوهكم وأيديكم م

O you who believe, when you rise for Salāh, (prayer) wash your faces and your hands up to the elbows, and make MasH (wiping by hands) of your heads and (wash) your feet up to the ankles. If you are in a state of major impurity, cleanse yourselves well (by taking bath). If you are sick, or on a journey, or if one of you has come after relieving himself, or you have had sexual contact with

n, go for some clean dust and wipe your faces and hands with it. Allah does not like to impose a problem on you; He, rather likes to cleanse you and to complete His favour upon you, so that you may be grateful.

حرج إذا ما ينفقون ال يجدون على الذين وال عفاء وال على المرضى ليس ع لى الضحيم غفور ر ورسوله ما على المحسنين من سبيل و نصحوا

There is no blame on the weak, or on the sick, or on those who have nothing to spend, if they are sincere to Allah and His Messenger. There is no way against those who are good in deeds.

ليس على األعمى حرج وال على األهاتكم أو بيوت إخوانكم أو آبائكم أو بيوت أم بيوت أنفسكم أن تأكلوا من بيوتكم أو

اتك عم أو بيوت بيوت أخواتكم أو بيوت أعمامكمجناح أن تأكلوا جميعا أو أشتاتا فإذ عليكم فاتحه أو صديقكم ليس أو ما ملكتم م

عند ن م بيوتا فسلموا على أنفسكم تحية

There is no blame on a blind person, nor is there any blame on any lame one, nor is there any blame on a sick person, nor on

eat (something) from your own homes or from the homes of your fathers or the homes of your mothers or the homes of your brothers or the homes of your sisters or the homes of your paternal uncles, or the homes of your paternal

26

Al-Fath( The

Victory)

48:17

Al- Muzzammil(

The Enshrouded

one)

73:20

aunts or the homes of your maternal uncles or the homes of your maternal aunts or from the places the keys of which you haveunder your control,16 or from (the home of) your friend.There is no sin on you if you eat together or separately. So when you enter homes, greet one another with Salām , a greeting prescribedby Allah, which is blessed, pleasant. This is how Allah explains the verses to you, so that you may understand.

على األعرج حرج وال على المريض حرج ومن يطع وال حرج على األعمى ليسبه عذابا أليما - ورسوله يدخله جنات تجري من تحتها األنهار ومن يتول يعذ 48:17

There is no blame on the blind, nor is there any blame on thelame, nor is there any blame on the sick. Whoever obeys Allah and His Messenger, He will admit him to the gardens beneath which rivers flow. But whoever turns away, He will punish himwith a painful punishme

ن الذين معك و وم أدنى من ثلثي الليل ونصفه وثلثه وطائفة مر من القرآن علم أن لن تحصوه فتاب عليكم فاقرءوا ما تيس علم والنهار ر الليل يقد رضى وآخرون يضربون في األرض يبتغون من فضل م م

كاة الة وآتوا الز فاقرءوا ما تيسر منه وأقيموا الص وآخرون يقاتلون في سبيل هو خيرا ن خير تجدوه عند موا ألنفسكم م قرضا حسنا وما تق د وأقرضوا حيم - 73:20 غفور ر إن وأعظم أجرا واستغفروا

Your Lord knows that you stand (in prayer) for nearly two thirds of the night, and (at times) for half of it, and (at times) for onethird of it, and (so do) a group of those who are with you. And Allah measures the night and the day. He knows that you (O Muslims,) cannot do it in regular way; therefore He turned to you in mercy.Now, recite as much of the Qur’ān as is easy (for you). He knows that some of you may be sick, and others traveling in the land, seeking the grace of Allah, and yet others fighting in Allah’s way. Therefore, recite as much of it as is easy. And establish Salāh, and pay Zakāh, and advance to Allah a goodlyloan. And whatever good you will send ahead for your ownselves, you will find it with Allah much better in condition, and much greater in reward. And seek forgiveness from Allah. Indeed, Allah is Most-Forgiving, Very-Merciful.

Ethics

ternal uncles or the homes of your maternal aunts or from the places the keys of which you have under your control,16 or from (the home of) your friend.There is no sin on you if you eat together or separately. So when you

h Salām , a greeting prescribed by Allah, which is blessed, pleasant. This is how Allah explains the verses to you, so that you may understand.

على وال حرج ليس على األعمى حرج وال على األعرجبه عذابا أليما ورسوله يدخله جنات تجري من تحتها األنهار ومن يتول يعذ

There is no blame on the blind, nor is there any blame on the n the sick. Whoever obeys Allah

and His Messenger, He will admit him to the gardens beneath which rivers flow. But whoever turns away, He will punish him

ن الذين معك و إن ربك يعلم أنك تق وم أدنى من ثلثي الليل ونصفه وثلثه وطائفة م من القرآن ر عليكم فاقرءوا ما تيس فتاب ر الليل والنهار علم أن لن تحصوه يقد

رضى وآخرون يضربون في األرض يبتغون من فضل أن سيكون منك م مكاة الة وآتوا الز فاقرءوا ما تيسر منه وأقيموا الص وآخرون يقاتلون في سبيل

قرضا حسنا وما تق وأقرضوا حيم غفور ر إن وأعظم أجرا واستغفروا

Your Lord knows that you stand (in prayer) for nearly two thirds half of it, and (at times) for one

third of it, and (so do) a group of those who are with you. And Allah measures the night and the day. He knows that you (O Muslims,) cannot do it in regular way; therefore He turned to you

the Qur’ān as is easy (for you). He knows that some of you may be sick, and others traveling in the land, seeking the grace of Allah, and yet others fighting in Allah’s way. Therefore, recite as much of it as is easy. And

d advance to Allah a goodly loan. And whatever good you will send ahead for your own-selves, you will find it with Allah much better in condition, and much greater in reward. And seek forgiveness from Allah.

Merciful.

27

Usman Maravia1 and Sharif Kaf Al1ESRC Centre for Corpus Approaches to Social Science (CASS), Bailrigg House, Lancaster University,National Director of BIMA ethics team2Consultant Plastic Surgeon, Bradford Teaching Hospital, Bradford Council & Founding member of the International Society for History oPresident of the British Islamic Medical Association (BIMA)

u.maravia@lancaster.ac.uk

bimaristans, education, ethics

The NHS is struggling to retain health careconsequence of Brexit. One solution to retainingIslamic medical ethics. British Muslims form a significant portion of the NHS. A look into the legacy of Muslims and health care may help to reduce Islamophobia and appreciate what inspires and motivates Muslimhealth care providers to contribute to the NHS. This legacy can be explored by visiting the way bimaristans, which were hospitals largely funded by Muslim philanthropists, operated in the Middle Ages. By understanding the way bimaristans helped to develop ancient medicine and the way theyhelp to shed light on Islamic medical ethics. Importantly, Islam promotes an attitude of welland teaches health care providers to remain modest and resilient throughout their careers whilst alwaysendeavouring to improve the provision of health care.

The NHS has certainly become a worldadmired health service. Among the NHS’ greatestachievements include arguably its provision of care based on need and free health care for all as a basic human right. Free care by the NHS is a commendable aspect ofhealth care. Free care removes the fear for patients ofhow they would pay for their treatment. Furthermore,free care allows health care providers to focus on their patients’ health rather than engage in financialdiscussions about the treatment. The strength of the NHS

Sharif Kaf Al-Ghazal 2

Corpus Approaches to Social Science (CASS), Bailrigg House, Lancaster University,National Director of BIMA ethics team

Consultant Plastic Surgeon, Bradford Teaching Hospital, Bradford Council & Founding member of the International Society for History of Islamic Medicine(ISHIM),President of the British Islamic Medical Association (BIMA)

u.maravia@lancaster.ac.uk

ethics, hospitals , Islamic history, middle ages, Muslim, waqf

health care providers, a notion that could be described as Drexit, as aconsequence of Brexit. One solution to retaining health care providers is to welcome diversity bIslamic medical ethics. British Muslims form a significant portion of the NHS. A look into the legacy of

may help to reduce Islamophobia and appreciate what inspires and motivates Muslimte to the NHS. This legacy can be explored by visiting the way bimaristans,

which were hospitals largely funded by Muslim philanthropists, operated in the Middle Ages. By understanding the way bimaristans helped to develop ancient medicine and the way they influenced European hospitals canhelp to shed light on Islamic medical ethics. Importantly, Islam promotes an attitude of well

providers to remain modest and resilient throughout their careers whilst alwaysavouring to improve the provision of health care.

The NHS has certainly become a world-renowned and admired health service. Among the NHS’ greatest achievements include arguably its provision of care based

for all as a basic human right. Free care by the NHS is a commendable aspect of

. Free care removes the fear for patients of how they would pay for their treatment. Furthermore,

providers to focus on their health rather than engage in financial

discussions about the treatment. The strength of the NHS

lies in its withstanding the numerous restructures andadaptations to innovation to meet the demands of anever-growing and ageing population. Additionally, thNHS continues to meet the needs of the diverse culturalneeds of patients [1].

Nevertheless, health care providers continue to face twomain challenges a) for doctors to maintain a strongtrusting relationship with patients and b) for the NHS toretain health care providers. In this article, we examine,from the Middle Ages, the organisation and setup of Muslim hospitals, better known as

History

Corpus Approaches to Social Science (CASS), Bailrigg House, Lancaster University,

f Islamic Medicine(ISHIM),

middle ages, Muslim, waqf

providers, a notion that could be described as Drexit, as a providers is to welcome diversity by exploring

Islamic medical ethics. British Muslims form a significant portion of the NHS. A look into the legacy of may help to reduce Islamophobia and appreciate what inspires and motivates Muslim

te to the NHS. This legacy can be explored by visiting the way bimaristans, which were hospitals largely funded by Muslim philanthropists, operated in the Middle Ages. By understanding

influenced European hospitals can help to shed light on Islamic medical ethics. Importantly, Islam promotes an attitude of well-being for patients

providers to remain modest and resilient throughout their careers whilst always

lies in its withstanding the numerous restructures and adaptations to innovation to meet the demands of an

growing and ageing population. Additionally, the NHS continues to meet the needs of the diverse cultural

providers continue to face two main challenges a) for doctors to maintain a strong trusting relationship with patients and b) for the NHS to

providers. In this article, we examine, from the Middle Ages, the organisation and setup of Muslim hospitals, better known as bimaristans, to

28

explore a range of traditional approaches based onIslamic medical ethics. The bimaristans were knownwelcome staff diversity including multimulti-faith perspectives to address everyday problems.Such diversity attracted health care providers andpatients. Additionally, this ecumenical approach alsoattracted philanthropists to fund the acquire the latest medical equipment, instruments, andservices. We also explore, in this article, the way Islamicmedical ethics influenced and inspired medical practicein Europe.

As the NHS is a patient-centred service, by revisiting thway bimaristans operated, insight could be gained intothe traditions, norms, values, and needs of Muslimpatients and health care providers. Stakeholders couldthen apply this knowledge to accommodate better theneeds of a diverse range of health carepatients.

Bimaristans inspired Muslim health caretake up the career by appealing to the spiritual reward ofsaving lives being equal to saving humanity, as describedin the Holy Qur’an. Muslim physicians also viewedillnesses as a test of patience rather than a curse andbelieved that the body and soul were both possible tosave. Moreover, based on Prophet Muhammad’s (Peacebe upon him) vision, Muslim philanthropists supportedbimaristans through generous donations to serve aspeacemakers.

2.1 Qur’anic perspective on medicine as a career

In Islam, humans are believed to have the important roleof exercising God’s will on Earth through justice andkindness. Each individual plays a different role incontributing to the many complex systems that lead tocreating a harmonious civilisation. Prophet Muhammadtaught that everyone should commit to their workbecause the inspiration to work comes from God a person to their destiny [2][3]. The idea of meaning ability, is likewise, an important concept for Muslims. A sufi understanding is that the sense of responsibility one feels to serve a noble call ismeaning inspiration and blessing from God. Likewise,the notion of khidmameaning ‘service’ and workingsabil Allah meaning ‘for the sake of Allah’, all promote astrong Islamic work ethic.

explore a range of traditional approaches based on Islamic medical ethics. The bimaristans were known to welcome staff diversity including multi-ethnicity and

faith perspectives to address everyday problems. Such diversity attracted health care providers and patients. Additionally, this ecumenical approach also attracted philanthropists to fund the bimaristans to acquire the latest medical equipment, instruments, and services. We also explore, in this article, the way Islamic medical ethics influenced and inspired medical practice

centred service, by revisiting the way bimaristans operated, insight could be gained into the traditions, norms, values, and needs of Muslim patients and health care providers. Stakeholders could then apply this knowledge to accommodate better the

health care providers and

health care providers to take up the career by appealing to the spiritual reward of saving lives being equal to saving humanity, as described

ly Qur’an. Muslim physicians also viewed illnesses as a test of patience rather than a curse and believed that the body and soul were both possible to save. Moreover, based on Prophet Muhammad’s (Peace be upon him) vision, Muslim philanthropists supported bimaristans through generous donations to serve as

2.1 Qur’anic perspective on medicine as a career

In Islam, humans are believed to have the important role of exercising God’s will on Earth through justice and kindness. Each individual plays a different role in contributing to the many complex systems that lead to

phet Muhammad taught that everyone should commit to their work because the inspiration to work comes from God - to lead a person to their destiny [2][3]. The idea of tawfeeq, meaning ability, is likewise, an important concept for

ing is that the sense of responsibility one feels to serve a noble call is ilham meaning inspiration and blessing from God. Likewise,

meaning ‘service’ and working fi meaning ‘for the sake of Allah’, all promote a

The Qur’an states that ‘If anyone saves a life, it is as if hesaves the lives of all mankind’ [4]. As such, Muslimpatients might not only feel the natural need to take careof their health but Islam places a sense of duty on humanity and especially on physicians to take care of theill. In this way, the physicians may feel a sense of achievement by treating their patients, whereas thepatients may feel a sense of wanting to regainso that they may continue to serve their calling. Furthermore, the higher objectives of Islamic law, known as the maqasid al-shari’ahQur’an, include preservation of faith, life, mind,offspring, and wealth [5].

Based on these objectives, the bimaristans ensured thatquality health care was provided. At the centre of care in Islam is the notion of being mindful of one’spurpose and goal in life. With regard to such a calling, Prophet Muhammad reminded people tobefore they are lost: youth, good health, financialstability, leisurely time, and indeed life itself [6]. Basedon the Qur’an and the teachings of Prophet Muhammad,the ethos of a bimaristan could be understood as being aplace where physicians felt a strong sense of religiousduty toward their patients [7]. The expectation ofcare providers appears to have been to seek spiritualsatisfaction more so than to gain only material rewards.The prophetic teachings on taking care of thenot only on the physically sick but focus also on thosefacing mental health issues. Likewise, the focus is notonly on city dwellers, but also on being mindful of thesick among the Bedouins, travellers, prisoners, and other categories of people who are likely to be overlooked andwho may have lower life expectancy.

2.2 Attending to the body and faith

A popular belief in Europe during the middlethat certain illnesses were a curse from God. By contrast,Muslim theologians viewed sickof atonement. Treating physical symptoms, on the other hand, was viewed as a noble effort because it restoredpatients’ well-being. Scholars from ProphetMuhammad’s progeny also engaged in changing themindset of the people toward(d.813), who is regarded as the father of Arab chemistryand one of the founders of modern pharmacy[8], creditsJa’far al-Sadiq (d.765) as the source of his knowledge of chemistry [9].Ja’far’s son Musa alecho the Prophet’s words:

History

The Qur’an states that ‘If anyone saves a life, it is as if he saves the lives of all mankind’ [4]. As such, Muslim patients might not only feel the natural need to take care

ir health but Islam places a sense of duty on humanity and especially on physicians to take care of the ill. In this way, the physicians may feel a sense of achievement by treating their patients, whereas the patients may feel a sense of wanting to regain their health so that they may continue to serve their calling. Furthermore, the higher objectives of Islamic law, known

shari’ah, which are based on the Qur’an, include preservation of faith, life, mind,

on these objectives, the bimaristans ensured that quality health care was provided. At the centre of health

in Islam is the notion of being mindful of one’s purpose and goal in life. With regard to such a calling, Prophet Muhammad reminded people to value five things before they are lost: youth, good health, financial stability, leisurely time, and indeed life itself [6]. Based on the Qur’an and the teachings of Prophet Muhammad, the ethos of a bimaristan could be understood as being a

sicians felt a strong sense of religious duty toward their patients [7]. The expectation of health

providers appears to have been to seek spiritual satisfaction more so than to gain only material rewards. The prophetic teachings on taking care of the sick focus not only on the physically sick but focus also on those facing mental health issues. Likewise, the focus is not only on city dwellers, but also on being mindful of the sick among the Bedouins, travellers, prisoners, and other

e who are likely to be overlooked and who may have lower life expectancy.

2.2 Attending to the body and faith

A popular belief in Europe during the middle-ages was that certain illnesses were a curse from God. By contrast, Muslim theologians viewed sickness itself to be a means of atonement. Treating physical symptoms, on the other hand, was viewed as a noble effort because it restored

being. Scholars from Prophet Muhammad’s progeny also engaged in changing the mindset of the people towards diseases. Jabir bin Hayyan (d.813), who is regarded as the father of Arab chemistry and one of the founders of modern pharmacy[8], credits

Sadiq (d.765) as the source of his knowledge of chemistry [9].Ja’far’s son Musa al-Kazim (d. 799) would

29

When a believer falls ill, Allah instructs the scribeto the patient’s left side: “Do not record a single sinagainst my servant as long as he is in my custody, and in my hold.” And He instructs the scribe to theright: “Write for my servant on his page of gooddeeds that which you would have recorded for himwhen he was well.”[10]

Al-Kazim’s son, Ali Al-Rada (d. 818) is credited as having authored the text Al-Risala almedical treatise which the Abbasid caliph Al(d.775) ordered to have written in gold ink [11].

The teachings of the Prophet Muhammad and hisprogeny continued to inspire Muslim physicians duringthe Abbasid golden era. One notable hadith states that‘God has appointed a treatment for every dtreat yourselves medically’ [12]. This shift towardattending to the spiritual and physical needs of patientsalso meant that to practise medicine, practitioners neededto be qualified in medicine and not that they relied solelyon theological knowledge. Prophet Muhammad warnedsociety that ‘should anyone practise medicine withoutbeing qualified to do so must be held accountable’ [13].As such, bimaristans employed only licensed physicianswho were held in high esteem and even received high wages. This approach kept the patients safe from quacks and charlatans, as well as from dangerous surgery, whichat the time was practised by street barbers.

In this way, physicians at the bimaristans were able totend to the spiritual well-being of patientssimilar to the Church. Bimaristans, however, differed by treating the physical symptoms which were explored byapplying and developing Galenic medicine. For instance,leprosy was known to be infectious as detailed by theGreeks but an illness that was despised in Europe to thepoint of viewing patients with leprosy as cursed [14].

The bimaristans took a different approach by segregatingpatients with leprosy humanely. Physicians specialisingin treating leprosaria were assigned to treat leproFurthermore, bimaristans had different wards for patients suffering from fevers, ophthalmic diseases, dysentery,and psychiatric illnesses. The psychiatric bimaristan inBaghdad in the 9th century is perhaps the first of its kind[15].

Other renowned psychiatric bimaristans were founded byIbn Tulun (d. 884) in Egypt in 872 and by the Mamlukgovernor Arghun Al-Kamili (image 1 below) in Aleppoin 1354 [16].

When a believer falls ill, Allah instructs the scribe to the patient’s left side: “Do not record a single sin against my servant as long as he is in my custody, and in my hold.” And He instructs the scribe to the

for my servant on his page of good deeds that which you would have recorded for him

Rada (d. 818) is credited as Risala al-Dhahabiyya, a

medical treatise which the Abbasid caliph Al-Mansur (d.775) ordered to have written in gold ink [11].

The teachings of the Prophet Muhammad and his progeny continued to inspire Muslim physicians during the Abbasid golden era. One notable hadith states that ‘God has appointed a treatment for every disease. So treat yourselves medically’ [12]. This shift toward attending to the spiritual and physical needs of patients also meant that to practise medicine, practitioners needed to be qualified in medicine and not that they relied solely

nowledge. Prophet Muhammad warned society that ‘should anyone practise medicine without being qualified to do so must be held accountable’ [13]. As such, bimaristans employed only licensed physicians who were held in high esteem and even received high

s. This approach kept the patients safe from quacks and charlatans, as well as from dangerous surgery, which at the time was practised by street barbers.

In this way, physicians at the bimaristans were able to being of patients in a manner

similar to the Church. Bimaristans, however, differed by treating the physical symptoms which were explored by applying and developing Galenic medicine. For instance, leprosy was known to be infectious as detailed by the

that was despised in Europe to the point of viewing patients with leprosy as cursed [14].

The bimaristans took a different approach by segregating patients with leprosy humanely. Physicians specialising in treating leprosaria were assigned to treat leprosy. Furthermore, bimaristans had different wards for patients suffering from fevers, ophthalmic diseases, dysentery, and psychiatric illnesses. The psychiatric bimaristan in

century is perhaps the first of its kind

psychiatric bimaristans were founded by Ibn Tulun (d. 884) in Egypt in 872 and by the Mamluk

Kamili (image 1 below) in Aleppo

Figure 1. BimaristanArghun Al(Aleppo, Syria)[17]

2.3 The Awqaf financing system

During the second medical revolution in Europe towardsthe end of the 4th century, Christians in the ByzantiEmpire had established civilian hospitals in cathedrals[18]. Prophet Muhammad envisioned the next step; asystem whereby free health carepeople irrespective of religion. This vision was actualisedwhen Muqawqis, who administered Egypt on behalf of the Christian Byzantine Empire, sent a physician toMuhammad in Medina. Muhammad instructed the doctorto treat patients gratuitously [19]. Muslims who soughtspiritual reward appear to have found the motivation to be altruistic rather than focus primarily on receivingmaterial gain for their medical services.

Moreover, Muslim philanthropists funded thebimaristans. The emphasis in the Qur’an to save lives combined with Prophet Muhammad’s charitableapproach to health care led to what later developed intobimaristans, a new type of medicalinstitution, where sick people of all backgrounds could betreated for free [20]. The first mobile dispensary that wasset up by Muhammad took the form of a tent at the battleof Khandaq (circa 627), wherein RufaidabintSa’ad, thefirst female Muslim nurse, treated the wounded [21].

Interestingly, the bimaristans differedhospitals in that the bimaristans were not run by religious establishments nor was supernatural healing practised.Bimaristans were run either by government officials or by philanthropists [22]. A diverse team of physicians of different religions and ethnicities came together to healthe sick. The gratuity led to bimaristans being largeelaborate institutions with advanced urban structures,some of which are UNESCO protected sites today (see

History

1. BimaristanArghun Al-Kamili (Aleppo, Syria)[17]

financing system

During the second medical revolution in Europe towards century, Christians in the Byzantine

Empire had established civilian hospitals in cathedrals [18]. Prophet Muhammad envisioned the next step; a

health care would be provided to all people irrespective of religion. This vision was actualised when Muqawqis, who administered Egypt on behalf of the Christian Byzantine Empire, sent a physician to Muhammad in Medina. Muhammad instructed the doctor

itously [19]. Muslims who sought spiritual reward appear to have found the motivation to be altruistic rather than focus primarily on receiving material gain for their medical services.

Moreover, Muslim philanthropists funded the emphasis in the Qur’an to save lives

combined with Prophet Muhammad’s charitable approach to health care led to what later developed into bimaristans, a new type of medical-cum-charitable institution, where sick people of all backgrounds could be

or free [20]. The first mobile dispensary that was set up by Muhammad took the form of a tent at the battle of Khandaq (circa 627), wherein RufaidabintSa’ad, the first female Muslim nurse, treated the wounded [21].

Interestingly, the bimaristans differed from Byzantine hospitals in that the bimaristans were not run by religious establishments nor was supernatural healing practised. Bimaristans were run either by government officials or by philanthropists [22]. A diverse team of physicians of

igions and ethnicities came together to heal the sick. The gratuity led to bimaristans being large elaborate institutions with advanced urban structures, some of which are UNESCO protected sites today (see

30

figures 2 and 3 below). Bimaristans were open to pof all gender and age groups, belief systems, and tomilitary personnel as well as civilian patients [23].

Figure 2. Bimaristan Al-Muayyidi(Cairo, Egypt)[24]

Figure 3.Divriği Ulu Cami veDarüşşifası (Divriği GreatMosque and Hospital, Turkey) [25]

Figuire 4. Bimaristan Al-Mansuri (Cairo, Egypt)[26]

Some bimaristans were extremely large and served asregional primary medical centres. For instance, theBimaristan Al-Mansuri (see image 4 above) established in1248 had 8,000 beds primarily for the people of Cairothroughout the 15th century [27]. To put into perspectivethe sheer size of the Bimaristan Al-Mansuri, NorthernIreland has 41 hospitals with a total of 3,879 beds for a

2 and 3 below). Bimaristans were open to patients of all gender and age groups, belief systems, and to military personnel as well as civilian patients [23].

Muayyidi(Cairo, Egypt)[24]

3.Divriği Ulu Cami veDarüşşifası (Divriği Great Mosque and Hospital, Turkey) [25]

Mansuri (Cairo, Egypt)[26]

Some bimaristans were extremely large and served as regional primary medical centres. For instance, the

(see image 4 above) established in or the people of Cairo

century [27]. To put into perspective Mansuri, Northern

Ireland has 41 hospitals with a total of 3,879 beds for a

population of 1.89 million [28]. TheMansuripolicy statement read:

The hospital shall keep all patients, men andwomen, until they are completely recovered. Allcosts are to be borne by the hospital whether thepeople come from afar or near, whether they areresidents or foreigners, strong or weak, lowrich or poor, employed or unemployed, blind or sighted, physically or mentally ill, learned or illiterate. There are no conditions of considerationand payment; none is objected to or even indirectlyhinted at for non-payment. The entire servicethrough the magnificence of Allah, The GenerousOne [29].

In 1948, the NHS furthered the idea of freewhen it made health care available to meet the needs ofeveryone for free at the point of delivery based onclinical need and not on the ability to pay.

According to research conducted by Baker et al. (2019)on the language of patient feedback, they found thatamong the concerns that were raised as ‘urgent’ includednot having access to services such as being referred to specialists; problems with bookingappointments; lack of parking facilities especiallydisabled parking spaces; and parking being too expensivein general [30]. Such concerns raise issues related to theway hospitals are financed and the way the budget ismanaged. Whereas the NHS, itaxation and National Insurance contributions (NICs),bimaristans were mainly financed bywhich is a property that is dedicated to a beneficial causein the hope to seek spiritual reward. The proceeds weretypically used to finance educational institutions,graveyards, mosques, shelters, and retirement homes [31][32].

Waqf, however, was largely used to fund hospitals andmedicines. The 50 hospitals in Cordoba were all financedby waqf. In Istanbul, the waqf fund wasa hospital for children [33]. Moreover, the waqf fundswere used not only to establish whole institutions butwere also used to make improvements or provide specificservices. The waqf fund was used also to maintain and pay for the running costs of the bimaristans. For instance,funds would be used to offer clothing to patients as wellas to provide plenty of healthy food. The patients’ eatinghabits were considered for prognosis. Surviving recipesfrom early Islamic cookbooks and bimarisreveal that meats, vegetables, and fruits were morecommon than common staples such as bread.

History

population of 1.89 million [28]. The Bimaristan Al-y statement read:

The hospital shall keep all patients, men and women, until they are completely recovered. All costs are to be borne by the hospital whether the people come from afar or near, whether they are residents or foreigners, strong or weak, low or high, rich or poor, employed or unemployed, blind or

ed, physically or mentally ill, learned or illiterate. There are no conditions of consideration and payment; none is objected to or even indirectly

payment. The entire service is through the magnificence of Allah, The Generous

In 1948, the NHS furthered the idea of free health care available to meet the needs of

everyone for free at the point of delivery based on ability to pay.

According to research conducted by Baker et al. (2019) on the language of patient feedback, they found that among the concerns that were raised as ‘urgent’ included not having access to services such as being referred to specialists; problems with booking medical appointments; lack of parking facilities especially disabled parking spaces; and parking being too expensive in general [30]. Such concerns raise issues related to the way hospitals are financed and the way the budget is managed. Whereas the NHS, is funded mainly from taxation and National Insurance contributions (NICs), bimaristans were mainly financed by Waqf (pl. Awqaf), which is a property that is dedicated to a beneficial cause in the hope to seek spiritual reward. The proceeds were

used to finance educational institutions, graveyards, mosques, shelters, and retirement homes

Waqf, however, was largely used to fund hospitals and medicines. The 50 hospitals in Cordoba were all financed by waqf. In Istanbul, the waqf fund was used to establish a hospital for children [33]. Moreover, the waqf funds were used not only to establish whole institutions but were also used to make improvements or provide specific services. The waqf fund was used also to maintain and

ng costs of the bimaristans. For instance, funds would be used to offer clothing to patients as well as to provide plenty of healthy food. The patients’ eating habits were considered for prognosis. Surviving recipes from early Islamic cookbooks and bimaristan records reveal that meats, vegetables, and fruits were more common than common staples such as bread.

31

Interestingly, the discharge of patients seems to been based on their their ability to consume a wholechicken; viewed as a sign of well-being an equivalent of a three-course meal [34].

A recent example of a waqf-based clinic in a noncountry is the MyintMyatPhu Zin clinic founded in 2009, located in the middle of Mandalay, the cultural andreligious centre of Buddhism in Burma. The land wasdonated by two founders and additional contributorssupported the building of the clinic. The clinic wasestablished to show how Islamic teachings could play asignificant role in the well-being of the people ofMyanmar irrespective of their beliefs [35].

Bimaristans influenced the mindset of physicians in theMiddle Ages. This section explores how the medicinepreviously practised in Christian Europe was developed;the way Europe embraced the medical achievembimaristans; and importantly, how the bimaristans servedas models of a patient-centred health care

3.1 Change of medical mindset

A major shift in the way medicine was approached wasthat the physicians focused more on health rather thandisease. Avicenna (from the Arabic IbnSinathe Canon of Medicine, writes,

To medicine pertains the (study of the) human body— how its health is maintained; how it loses health.To know fully about each of these we must ascertainthe causes of both health and sickness. Now ashealth and sickness and their causes are sometimes evident to the senses and sometimes only perceivedby means of the evidence afforded by the varioussymptoms, we must in medicine gain knowledge of the symptoms of health and sickness [36].

Diseases were not viewed by Muslim physicians as adivine punishment but as a result of the interaction of thehuman body with its surroundings. Moreover, this led tofinding the elementary cause of diseases and finding thetreatment. An idea which Prophet Muhammad himselfemphasised, ‘Allah did not create an illness except healso created for it a treatment. Those with knowledge areaware; whilst those who are ignorant, remain ignorant’ [37]. This statement is likely the cause of Musscientists wanting to witness the truthfulness of Muhammad’s statement and choosing to no longer remain ignorant of such life-changing knowledge. In this

Interestingly, the discharge of patients seems to have their ability to consume a whole

being to be able to eat [34].

based clinic in a non-Muslim country is the MyintMyatPhu Zin clinic founded in 2009, located in the middle of Mandalay, the cultural and

Burma. The land was donated by two founders and additional contributors supported the building of the clinic. The clinic was established to show how Islamic teachings could play a

being of the people of their beliefs [35].

Bimaristans influenced the mindset of physicians in the Middle Ages. This section explores how the medicine previously practised in Christian Europe was developed; the way Europe embraced the medical achievements of bimaristans; and importantly, how the bimaristans served

health care system.

A major shift in the way medicine was approached was that the physicians focused more on health rather than

IbnSina, d. 1037), in

To medicine pertains the (study of the) human body how its health is maintained; how it loses health.

To know fully about each of these we must ascertain of both health and sickness. Now as

health and sickness and their causes are sometimes evident to the senses and sometimes only perceived by means of the evidence afforded by the various symptoms, we must in medicine gain knowledge of

h and sickness [36].

Diseases were not viewed by Muslim physicians as a divine punishment but as a result of the interaction of the human body with its surroundings. Moreover, this led to finding the elementary cause of diseases and finding the

. An idea which Prophet Muhammad himself emphasised, ‘Allah did not create an illness except he also created for it a treatment. Those with knowledge are aware; whilst those who are ignorant, remain ignorant’ [37]. This statement is likely the cause of Muslim scientists wanting to witness the truthfulness of Muhammad’s statement and choosing to no longer

changing knowledge. In this

way, the bimaristans were not just places where patientswere treated but where the spirituality opatients was strengthened as they witnessed diseases that were once thought impossible to curebefore their eyes [38].

3.2 Development of the medicinal practice of theChurch

The focus on saving the body as well as the ssense, unique to bimaristans. During medieval times, theChurch made efforts to curb the spread of diseases and to tend to the care of the sick. The aim of the Churchappears to have been the salvation of the soul sinceeffective treatments had not developed [39].Nevertheless, followers of the Abrahamic faiths werespiritually motivated to attend to the ‘physical needs’[40] of the sick often by female nurses, who kept patientswarm and well fed, hence, the word ‘nurse’, whichcomes from the Latin nutriciusnourishing [41].

The Church helped in establishing hospitals annexed tomonasteries to tend to the care of the ill. The medicine ofthe time was based on Hippocrates’ theory of the four humors. Humorism is the idea thatthe human body (phlegm, blood, yellow bile, and blackbile) were out of balance then one would become sick. Galen developed humorism through the theory ofopposites, by this he believed that bodily liquids couldregain balance for instance by having a hot bath duringcold weather to control excessive phlegm. This theoryalso gave rise to purging, bloodletting, and amputation oflimbs [42]. However incorrect Galen’s theory, heconcluded that the design of such a marvellous bodymeant that there must be a God who designed it. Galen’smonotheistic views attracted the Church which adoptedhis work. However, without the Church challenging Galen’s theories, it faced a great medical challengeduring the great plague.

With the fall of the Roman Empire, the blueprintsexplaining the methods to repair aqueducts, toilets, andpublic baths too were lost. Access to clean drinking waterdeclined and biological waste in public places increased.The foul smell and bad air gave rise to miasma theorywhich held that plagues were caused by rotting organicmatter [43]. The Church also held the belief that plagues,as described in the Bible, were divine punishments for sins. Between 1000 and 1500 CE, over 700 hospitals nextto monasteries were set up in En[44]. Another belief during the time, which was rootedneither in Christianity nor Islam, was that the plague was

History

way, the bimaristans were not just places where patients were treated but where the spirituality of physicians and patients was strengthened as they witnessed diseases - that were once thought impossible to cure - being cured

3.2 Development of the medicinal practice of the

The focus on saving the body as well as the soul was in a sense, unique to bimaristans. During medieval times, the Church made efforts to curb the spread of diseases and to tend to the care of the sick. The aim of the Church appears to have been the salvation of the soul since

d not developed [39]. Nevertheless, followers of the Abrahamic faiths were spiritually motivated to attend to the ‘physical needs’[40] of the sick often by female nurses, who kept patients warm and well fed, hence, the word ‘nurse’, which

nutricius or nutritius meaning

The Church helped in establishing hospitals annexed to monasteries to tend to the care of the ill. The medicine of the time was based on Hippocrates’ theory of the four humors. Humorism is the idea that if the four liquids in the human body (phlegm, blood, yellow bile, and black bile) were out of balance then one would become sick. Galen developed humorism through the theory of opposites, by this he believed that bodily liquids could

stance by having a hot bath during cold weather to control excessive phlegm. This theory also gave rise to purging, bloodletting, and amputation of limbs [42]. However incorrect Galen’s theory, he concluded that the design of such a marvellous body

hat there must be a God who designed it. Galen’s monotheistic views attracted the Church which adopted his work. However, without the Church challenging Galen’s theories, it faced a great medical challenge

man Empire, the blueprints explaining the methods to repair aqueducts, toilets, and public baths too were lost. Access to clean drinking water declined and biological waste in public places increased. The foul smell and bad air gave rise to miasma theory

hich held that plagues were caused by rotting organic matter [43]. The Church also held the belief that plagues, as described in the Bible, were divine punishments for sins. Between 1000 and 1500 CE, over 700 hospitals next to monasteries were set up in England by the Church [44]. Another belief during the time, which was rooted neither in Christianity nor Islam, was that the plague was

32

due to the position of the planets. The Churchencouraged regular prayer to God and to burn incense.Additionally, some Christians viewed making pilgrimageto holy sites as a way of atonement. Bearing in mind thetheological and supernatural explanations, the plague isknown to have travelled through the European traderoutes through rats and fleas. Despite the many wellintended efforts of the Church, the physical cause of theplague appears to have remained unknown. On the otherhand, the Muslim lands were also unable to curb thespread of the plague and casualties were high even inCairo despite the QalawunBimaristan. Howevphysicians in bimaristansendeavoured to understand thecause of the plague based on empirical evidence.

3.3 Influence of bimaristans throughout Europe

The influence of bimaristans is still acknowledged inplaces across Europe today. In the scholars pavilion atthe UN office in Vienna are situated statues of Muslimphysicians Rhazes (from the Arabic Zakariyya al-Razi, d. 925) and Avicenna. Ch1400), who is considered to be the founder of Englishpoetic tradition as well as the greatest English poet of theMiddle Ages, also included Rhazes and Avicenna among the greatest physicians ever known alongside Aesclepius(c.1250 BC) and Hippocrates [45].

Among the reasons why Europeans in the Middle Ages cherished the Muslim legacy was perhaps because muchof European history would have been lost forever had thebimaristans not preserved European medicine. In 814 CE, after the death of Charlemagne, Latin European culturebegan to fade. However, this culture survived in Toledo,Spain [46]. Archbishop Raymond de Sauvetât (d. 1152)of Toledo established a translation institute where Arabicmanuscripts, which were received from various locations,were translated into Latin. These Latin translations werethen shared throughout Europe especially in France andGermany in the 17th century. Seeking medical knowledgefrom books, however, was still secondary. Bimaristanswere the primary locations where medical knowledgewas acquired first-hand.

Bimaristans offered an opportunity for physicians, and medical students, men and women, to pool their resources together becoming a place of medical training. Cordoba alone consisted of 50 major hospitals thattreated physical and mental illnesses [47]. This new phenomenon gave rise to medical institutions emergingin Western Europe such as in Salerno, Padua, andBologna in Italy, and Montpellier and Paris in France[46]. The harmonious relations between the Islam

due to the position of the planets. The Church encouraged regular prayer to God and to burn incense.

ristians viewed making pilgrimage to holy sites as a way of atonement. Bearing in mind the theological and supernatural explanations, the plague is known to have travelled through the European trade routes through rats and fleas. Despite the many well-

nded efforts of the Church, the physical cause of the plague appears to have remained unknown. On the other hand, the Muslim lands were also unable to curb the spread of the plague and casualties were high even in Cairo despite the QalawunBimaristan. However, physicians in bimaristansendeavoured to understand the cause of the plague based on empirical evidence.

3.3 Influence of bimaristans throughout Europe

The influence of bimaristans is still acknowledged in places across Europe today. In the scholars pavilion at the UN office in Vienna are situated statues of Muslim physicians Rhazes (from the Arabic Muhammad ibn

, d. 925) and Avicenna. Chaucer (d. 1400), who is considered to be the founder of English poetic tradition as well as the greatest English poet of the Middle Ages, also included Rhazes and Avicenna among the greatest physicians ever known alongside Aesclepius

Among the reasons why Europeans in the Middle Ages cherished the Muslim legacy was perhaps because much of European history would have been lost forever had the bimaristans not preserved European medicine. In 814 CE,

magne, Latin European culture began to fade. However, this culture survived in Toledo, Spain [46]. Archbishop Raymond de Sauvetât (d. 1152) of Toledo established a translation institute where Arabic manuscripts, which were received from various locations, were translated into Latin. These Latin translations were then shared throughout Europe especially in France and

century. Seeking medical knowledge from books, however, was still secondary. Bimaristans

edical knowledge

Bimaristans offered an opportunity for physicians, and medical students, men and women, to pool their resources together becoming a place of medical training. Cordoba alone consisted of 50 major hospitals that

eated physical and mental illnesses [47]. This new phenomenon gave rise to medical institutions emerging in Western Europe such as in Salerno, Padua, and Bologna in Italy, and Montpellier and Paris in France [46]. The harmonious relations between the Islamic East,

Andalusia, and the Latin West in the 12century gave rise to European medical institutions thatwere comparable to bimaristans, such as the Hospital of Our Lady Mary of the Innocents in Valencia [48].

3.4 Patient-centred health car

Bimaristans considered the needs of the patients and their families. In broad terms, these needs included spiritual,mental, physical, and social needs [49]. As the patientswere most likely to have a religious affiliation,bimaristans included separate prayer rooms for thepatients. For instance, the Bimaristan Alcontained prayer areas for Muslims and other followersof the Abrahamic faiths [50]. Areas of worship wereincluded not only in hospitals but medical treatment was also made available to travellers on their way to Makkah.Understanding the importance of the annual Hajj forMuslims, road bimaristans were also set up byphilanthropists [51].

The bimaristans also considered the social needs of thepatients. Muslim communitspecific services. Furthermore, bimaristans were neededin villages and rural areas as much as they were neededin cities. The Qur’an also encourages showing kindnessto prisoners and so free medical care was also madeavailable to prisoners [52].

The wards in bimaristans were separated by diseases aswell as gender [53]. The Bimaristan Alspecialised wards. The hospital itself had two sections:one for men and the other for women. This aspect isimportant in Islamic culture as Muslim women tend toavoid exposing their bodies unnecessarily, especially tomen outside of their families. However, since medicalexaminations may require exposing the abdomen or genitalia, men and women were provided with separatewards and where possible, women were treated bywomen. Catering for such needs inspired women to takeup a career in medicine.

Considering the wider communities; those in the villages and peripheries, Isa ibn Ali Althe Abbasid Caliph Al-Muqtadirbillah

I thought of people who live in the peripheries andthat among them are patients who do not receiveany medical care because there are no doctors there.So, assign - May God prolong your lifephysicians to visit the periphericontaining drugs and syrups. They have to travel allthrough the peripheries and stay in each region

History

Andalusia, and the Latin West in the 12th to the 14th century gave rise to European medical institutions that were comparable to bimaristans, such as the Hospital of Our Lady Mary of the Innocents in Valencia [48].

health care system

Bimaristans considered the needs of the patients and their families. In broad terms, these needs included spiritual, mental, physical, and social needs [49]. As the patients were most likely to have a religious affiliation,

eparate prayer rooms for the Bimaristan Al-Mansuriin Cairo

contained prayer areas for Muslims and other followers of the Abrahamic faiths [50]. Areas of worship were included not only in hospitals but medical treatment was

made available to travellers on their way to Makkah. Understanding the importance of the annual Hajj for Muslims, road bimaristans were also set up by

The bimaristans also considered the social needs of the patients. Muslim communities tend to value gender-specific services. Furthermore, bimaristans were needed in villages and rural areas as much as they were needed in cities. The Qur’an also encourages showing kindness to prisoners and so free medical care was also made

The wards in bimaristans were separated by diseases as Bimaristan Al-Mansurihad many

specialised wards. The hospital itself had two sections: one for men and the other for women. This aspect is

ic culture as Muslim women tend to avoid exposing their bodies unnecessarily, especially to men outside of their families. However, since medical examinations may require exposing the abdomen or genitalia, men and women were provided with separate

d where possible, women were treated by women. Catering for such needs inspired women to take

Considering the wider communities; those in the villages and peripheries, Isa ibn Ali Al-Jarrah (d. 946) wrote to

Muqtadirbillah [54]:

I thought of people who live in the peripheries and that among them are patients who do not receive any medical care because there are no doctors there.

May God prolong your life - some physicians to visit the peripheries; also a pharmacy containing drugs and syrups. They have to travel all through the peripheries and stay in each region

33

enough time to perform treatment of patients, thenthey move to another one.

Likewise, Isa wrote regarding prisons:

I thought - May God prolong your lifeimprisoned and they are exposed, due to their bignumber and their hard situation, to diseases; they areincapable to deal with their excretions or to meetdoctors to seek their advice about diseases. Youhave - May God grant you honor physicians to visit them daily and they should carrywith them drugs and syrups and all they need totreat the patients and cure illnesses with God's will.

This call was answered by Al-Muqtadir and a bimaristanfor prisoners was built in circa 919, which was financedwith 200 dinars monthly [54].

The bimaristans also made efforts to minimise patients’anxiety and worries. Bimaristans were constructed onsites with fresh air and which were aesthetically pleasing. For instance, when Rhazes searched for a place inBaghdad to establish a bimaristan, he chose a placewhere pieces of meat would take the longest to rot [55].Bimaristans also appear to have promoted the restorationof health where patients felt that they were not left to Instead, bimaristans were built within the cities wherethey could be visited by families and friends and hope to rejoin society upon recovery. Bimaristan Albuilt by the River Tigris. The water from the river wouldflow into the courtyard of the bimaristan and through thehalls before it reconnected to the Tigris [56][57].

Perhaps, the greatest worry for patients is notunderstanding the information they are given. ProphetMuhammad taught to speak to people in a manner thatwas comprehensible for the audience and to avoidesoteric language. He was known to be succinct andrepetitive in his main points and the hadith literaturecontains a plethora of similes, examples, analogies, aswell as questioning the audience to assess their understanding. Low health literacy is likely among theelderly and ethnic and racial minorities [Salman, the renowned elderly Persian immigrantcompanion of Muhammad, fell ill on one occasion,Muhammad checked on his well-being in Farsi [59]. An interesting parallel to note is how Muhammad himself welcoming foreign words led to hospitals in to be known as bimaristans; derived fromperson, and -stan - place, meaning ‘a place wherepatients reside’ [60]. The very use of this Persian word inArab lands reveals a process of international social

enough time to perform treatment of patients, then

God prolong your life - of the imprisoned and they are exposed, due to their big number and their hard situation, to diseases; they are incapable to deal with their excretions or to meet doctors to seek their advice about diseases. You

t you honor - to assign physicians to visit them daily and they should carry with them drugs and syrups and all they need to treat the patients and cure illnesses with God's will.

Muqtadir and a bimaristan uilt in circa 919, which was financed

The bimaristans also made efforts to minimise patients’ anxiety and worries. Bimaristans were constructed on sites with fresh air and which were aesthetically pleasing.

n Rhazes searched for a place in Baghdad to establish a bimaristan, he chose a place where pieces of meat would take the longest to rot [55]. Bimaristans also appear to have promoted the restoration of health where patients felt that they were not left to die. Instead, bimaristans were built within the cities where they could be visited by families and friends and hope to rejoin society upon recovery. Bimaristan Al-Adudiwas built by the River Tigris. The water from the river would

the bimaristan and through the halls before it reconnected to the Tigris [56][57].

Perhaps, the greatest worry for patients is not understanding the information they are given. Prophet Muhammad taught to speak to people in a manner that was comprehensible for the audience and to avoid esoteric language. He was known to be succinct and

petitive in his main points and the hadith literature contains a plethora of similes, examples, analogies, as well as questioning the audience to assess their understanding. Low health literacy is likely among the elderly and ethnic and racial minorities [58]. When Salman, the renowned elderly Persian immigrant companion of Muhammad, fell ill on one occasion,

being in Farsi [59]. An interesting parallel to note is how Muhammad himself welcoming foreign words led to hospitals in Arab lands to be known as bimaristans; derived from bimar – a sick

place, meaning ‘a place where patients reside’ [60]. The very use of this Persian word in Arab lands reveals a process of international social

healing and leaving behindpractice, the physicians in the bimaristans would beexpected to speak to patients in a way that was accessibleto the patients to increase adherence.

Furthermore, as soon as patients were admitted to thebimaristans, their clothes and possessions would be keptsafely in a place of trust by the security team [61].Patients were also separated into different wardsaccording to an initial diagnosis. Three separate hallswould be found which were allocated to patients with a) internal diseases, b) patients with trauma and fractures,and c) communicable diseases. Because contagiousdiseases are highly likely to create fear and panic amongpatients, they would not be kept in the same halls.Likewise, patients with severe mental illnessesaggression were also isolated safely and securely [62].

Along with bimaristans being known as places for thesick to seek medical treatment, they were also appealingfor trainees to learn medical knowledge and specialise indifferent fields of medicine and surgery. The medicaleducation system was based on an Islamic ethos of valuing everyone involved in the bimaristans, fromrespecting the senior staff to helping develop the junior staff and creating an overall supportive workenvironment. The participation of children in bimaristansis also noteworthy. Children would volunteer to help withadministrative tasks [63].

Such practises reveal clear cultural differences between now and the Middle Ages regarding child labour.Nevertheless, inspiring future generations to valuecare can be promoted in creative ways. During theCOVID-19 pandemic, a group of enthusiastic childrenfrom different ethnicities created videos in Bengali,Gujarati, Punjabi, and Urdu among other South Asianlanguages to encourage the elderly in their communitiesto take the vaccine [64].

The educational aspect of the bimaristans focused on theimportance of a positive rapport in the doctorrelationship. Faith and spiriplayed a major role in motivatingbuild resilience to their career challenges and avoidburnout.

4.1 Mentor-trainee relationship

The education system involved senior staff being rolemodels for trainees and junior staff. From the onset,

History

healing and leaving behind old enmity. In medical practice, the physicians in the bimaristans would be expected to speak to patients in a way that was accessible to the patients to increase adherence.

Furthermore, as soon as patients were admitted to the s and possessions would be kept

safely in a place of trust by the security team [61]. Patients were also separated into different wards according to an initial diagnosis. Three separate halls would be found which were allocated to patients with a)

diseases, b) patients with trauma and fractures, and c) communicable diseases. Because contagious diseases are highly likely to create fear and panic among patients, they would not be kept in the same halls. Likewise, patients with severe mental illnesses exhibiting aggression were also isolated safely and securely [62].

Along with bimaristans being known as places for the sick to seek medical treatment, they were also appealing for trainees to learn medical knowledge and specialise in

f medicine and surgery. The medical education system was based on an Islamic ethos of valuing everyone involved in the bimaristans, from respecting the senior staff to helping develop the junior staff and creating an overall supportive work

e participation of children in bimaristans is also noteworthy. Children would volunteer to help with

Such practises reveal clear cultural differences between now and the Middle Ages regarding child labour.

ng future generations to value health can be promoted in creative ways. During the

19 pandemic, a group of enthusiastic children from different ethnicities created videos in Bengali, Gujarati, Punjabi, and Urdu among other South Asian

to encourage the elderly in their communities

The educational aspect of the bimaristans focused on the importance of a positive rapport in the doctor-patient relationship. Faith and spirituality also appear to have played a major role in motivating health care providers to build resilience to their career challenges and avoid

trainee relationship

The education system involved senior staff being role es and junior staff. From the onset,

34

despite the hierarchy of the staff and managementstructure, the Qur’an states, that ‘above anyone who possesses knowledge, there is one with greater knowledge’ [65]. This verse helps to reduce hubris andinstil a realisation within the workforce that everyindividual has something unique to offer. ProphetMuhammad himself once said to a physician, ‘Allah isthe one who cures, you are the one who is gentle’ [66].This hadith promotes a patient-centred attitude wherebythe role of the physician is to be gentle with the patientwho is experiencing a difficult time, whether that bethrough for instance CPR or heart surgery. The hadithalso promotes the idea that the medical staff are a meansthrough which healing occurs. This idea is internalisedand expressed by Muslims in the expression‘Qaddarallah’ meaning ‘As Allah expected’; a phrasethat would have also resonated with Christian physiciansthrough Christ’s parable of the Master and servant [67].

To be a part of the healing process in bimaristans,however, required training and showing competence.Notably, bimaristans promoted the assurance thatphysicians needed to be accredited and licensed by senior physicians to practise medicine [68]. Arguably, in 1207,the Qarawiyyin University in Fez honoured Dr Abdellah Ben Saleh El-Koutami as the first physician to have beenawarded Doctor of Medicine. The document, whichsurvives until today, highlights that physicians wereexpected to be spiritual as well as have excellentrelational skills [69]. This approach is what likely gaverise to an unprecedented high quality of medical practice.Physicians also specialised in different diseases. Thespecialities gave rise to the separation of patients indifferent wards depending on the nature of the diseases.

Clear expectations were made known to trainees. WhenAdud Al-Dawlah (d. 983) established the bimaristan inwestern Baghdad, he made known that out of a hundredphysicians, only 24 would be selected for work [54.] Physicians were also reminded that they would be heldaccountable in the case of any death. Physicians were,therefore, expected to keep a record of all the medicationthey prescribed until the patient was either cured or died[70]. If a patient died, then the chief physireview the prescriptions to evaluate the treatment andconclude whether the death was natural or due tonegligence. In the case of negligence, the physician washeld accountable and was liable to pay blood money tothe family of the deceased. The records themselves would be archived for future research. Training the staffto perform their duties competently was, therefore, ofgreat importance at the bimaristans [71].

despite the hierarchy of the staff and management structure, the Qur’an states, that ‘above anyone who possesses knowledge, there is one with greater knowledge’ [65]. This verse helps to reduce hubris and

sation within the workforce that every individual has something unique to offer. Prophet Muhammad himself once said to a physician, ‘Allah is the one who cures, you are the one who is gentle’ [66].

centred attitude whereby e role of the physician is to be gentle with the patient

who is experiencing a difficult time, whether that be through for instance CPR or heart surgery. The hadith also promotes the idea that the medical staff are a means

s idea is internalised and expressed by Muslims in the expression

meaning ‘As Allah expected’; a phrase that would have also resonated with Christian physicians through Christ’s parable of the Master and servant [67].

ling process in bimaristans, however, required training and showing competence. Notably, bimaristans promoted the assurance that physicians needed to be accredited and licensed by senior physicians to practise medicine [68]. Arguably, in 1207,

in University in Fez honoured Dr Abdellah Koutami as the first physician to have been

awarded Doctor of Medicine. The document, which survives until today, highlights that physicians were expected to be spiritual as well as have excellent

tional skills [69]. This approach is what likely gave rise to an unprecedented high quality of medical practice. Physicians also specialised in different diseases. The specialities gave rise to the separation of patients in

nature of the diseases.

Clear expectations were made known to trainees. When Dawlah (d. 983) established the bimaristan in

western Baghdad, he made known that out of a hundred physicians, only 24 would be selected for work [54.]

also reminded that they would be held accountable in the case of any death. Physicians were, therefore, expected to keep a record of all the medication they prescribed until the patient was either cured or died [70]. If a patient died, then the chief physician would review the prescriptions to evaluate the treatment and conclude whether the death was natural or due to negligence. In the case of negligence, the physician was held accountable and was liable to pay blood money to

e records themselves would be archived for future research. Training the staff to perform their duties competently was, therefore, of

‘Make matters easy, do not make them difficult’,instructed Prophet Muhammad [efforts to make easier the lives of staff and patients. Staff members were provided with all the medical instrumentsand apparatuses that were necessary for the time.Pharmacies, known as Khizanat alwere annexed to bimaristans so that medication, syrups,and drugs were readily available [73]. The etymology ofthe English noun ‘syrup’ is of Arabic origin from theword sharab meaning beverages [74]. The word wasadopted as a result of the widespread medicinal syrupsthat were made available throughout Europeandispensaries based on recipes prepared by chemists forthe bimaristans [46].

Prophet Muhammad was a strong advocate of documentation as is evident from the Qur’an, whichencourages documenting financial transMuhammad allowed prisoners of war to free themselvesby teaching literacy skills [76]. Muhammad himself would often use his staff to draw diagrams in the sand tovisually explain abstract concepts. This combination ofwriting and illustrations was also encouraged amongMuslim physicians which led to grand medical libraries.For instance, Egypt’s Ibn TulunBimaristan is known tohave had a collection of over 100,000 books on medicine[77].

Leading physicians supported fellow physicians in themedical field by authoring instruction manuals. For instance, Albucasis (from the ArabicZahrawi, d. 1013) wrote his 30encyclopediaKitab al-Tasrif liTa'lif(meaning ‘The arrangement of medical knowledgefor one who is unable to compile a manual for himself’)[78], in which he wrote sections on medicine,orthopaedics, ophthalmology, pharmacology, andnutrition[79] and discussed over 300 diseases and their treatments [80]. The last volume also describes surgicalprocedures and instructions on how to use more than 200surgical instruments. Albucasis described ways to treatcongenital hand deformities such as polydactyly andsyndactyly as well as ways to treat hypospadias and genital reconstruction. Other procedurecovered include oculoplastics, eyelid surgerygynecomastia, and breast surgery [81]. The work wasfirst translated into Latin in 1519 under the titletheoricaenecnonpracticaeAlsaharaviireference guide in Europe untimost eminent surgeon of the European Middle Ages Guyde Chauliac in his work ‘Great Surgery’, completed in 1363), quoted

History

‘Make matters easy, do not make them difficult’, instructed Prophet Muhammad [72]. Bimaristans made efforts to make easier the lives of staff and patients. Staff members were provided with all the medical instruments and apparatuses that were necessary for the time.

Khizanat al-sharab or Saydaliyah to bimaristans so that medication, syrups,

and drugs were readily available [73]. The etymology of the English noun ‘syrup’ is of Arabic origin from the

meaning beverages [74]. The word was adopted as a result of the widespread medicinal syrups that were made available throughout European dispensaries based on recipes prepared by chemists for

Prophet Muhammad was a strong advocate of documentation as is evident from the Qur’an, which encourages documenting financial transactions [75]. Muhammad allowed prisoners of war to free themselves by teaching literacy skills [76]. Muhammad himself would often use his staff to draw diagrams in the sand to visually explain abstract concepts. This combination of

s was also encouraged among Muslim physicians which led to grand medical libraries. For instance, Egypt’s Ibn TulunBimaristan is known to have had a collection of over 100,000 books on medicine

Leading physicians supported fellow physicians in the medical field by authoring instruction manuals. For instance, Albucasis (from the Arabic Abul Qasim Al-

, d. 1013) wrote his 30-volume medical Tasrif li-man 'Ajizja 'an al-

(meaning ‘The arrangement of medical knowledge one who is unable to compile a manual for

himself’)[78], in which he wrote sections on medicine, orthopaedics, ophthalmology, pharmacology, and nutrition[79] and discussed over 300 diseases and their treatments [80]. The last volume also describes surgical procedures and instructions on how to use more than 200 surgical instruments. Albucasis described ways to treat congenital hand deformities such as polydactyly and syndactyly as well as ways to treat hypospadias and genital reconstruction. Other procedures which Albucasis covered include oculoplastics, eyelid surgery, gynecomastia, and breast surgery [81]. The work was first translated into Latin in 1519 under the title Liber theoricaenecnonpracticaeAlsaharaviiand served as a reference guide in Europe until the 18th century.The most eminent surgeon of the European Middle Ages Guy de Chauliac in his work Chirugia magna (meaning ‘Great Surgery’, completed in 1363), quoted al-Tasrif

35

over 200 times [82]. An instruction to ‘Seek knowledgeeven unto China’[83] is also attributed to ProphetMuhammad. Such instruction may have alluded tolearning Chinese medicine. Excelling in response to thisinstruction, Muslim physicians reached a reputation to the point that the Chinese came to learn medicine fromRhazes [84].

4.2 Appreciating the diversity of staff

The practice of medicine is a joint global contribution of many civilisations and is inextricably intertwined and onewhich requires diverse representation [85]. The seniormedical team in bimaristans would consist of diversemembers. Prophet Muhammad valued and promoteddiversity and appreciated the invaluable experience of those around him irrespective of gender, religion, and race. Muhammad’s caller to prayer was Bilal, anEthiopian who was once a slave in Makkah; Muhammad acted on the advice of Salman when the latter adviseddigging a trench around the city; a Persian military tactic.At the treaty of Hudebiya, Muhammad was the first toterminate his pilgrimage after being advised by his wifeUmm Salama. At a time when the status quo was for freeArab men to make important decisions, Muhammad demonstrated the value of allowing a voice to all people.Such opportunities inspired women to lead in medicine[86]. Bint Shihab al-Deen, in 1627 became themasheekhat al-tibb, meaning the chief physician at theBimaristan Al-Mansuri. Such an ecumenical approachinspired bimaristans to also create opportunities tocollaborate for leading physicians irrespective of religion,gender, and race [87]. Bimaristans became the discussionplace for physicians who were interested in challengingGalenic medicine; they were welcomed by Muslimphysicians who were interested in looking at medicinethrough the lens of Islamic medical ethics.

With Muhammad’s descendants marrying into othercultures, this would have made working witMuslims easier for people of other faiths, as well as nonArabs. Al-Mansur established the Bait almeaning the house of wisdom. This institute became alibrary of academic work. Great scholars of Syrian,Hebrew, and Persian heritage belonginggroups including Islam, Christianity, Judaism, andZoroastrianism, gathered to translate Greek, Latin, andeven Sanskrit works into Arabic.

The collaborative environment of bimaristans alsopromoted the idea that even senior physicians to learn from other scholars. This attitude would then beinstilled within the trainees, who would also realise that

An instruction to ‘Seek knowledge is also attributed to Prophet

Muhammad. Such instruction may have alluded to learning Chinese medicine. Excelling in response to this instruction, Muslim physicians reached a reputation to the point that the Chinese came to learn medicine from

The practice of medicine is a joint global contribution of many civilisations and is inextricably intertwined and one which requires diverse representation [85]. The senior medical team in bimaristans would consist of diverse

ed and promoted diversity and appreciated the invaluable experience of those around him irrespective of gender, religion, and race. Muhammad’s caller to prayer was Bilal, an Ethiopian who was once a slave in Makkah; Muhammad

hen the latter advised digging a trench around the city; a Persian military tactic. At the treaty of Hudebiya, Muhammad was the first to terminate his pilgrimage after being advised by his wife Umm Salama. At a time when the status quo was for free

n to make important decisions, Muhammad demonstrated the value of allowing a voice to all people. Such opportunities inspired women to lead in medicine

Deen, in 1627 became the , meaning the chief physician at the

. Such an ecumenical approach inspired bimaristans to also create opportunities to collaborate for leading physicians irrespective of religion, gender, and race [87]. Bimaristans became the discussion

ted in challenging Galenic medicine; they were welcomed by Muslim physicians who were interested in looking at medicine through the lens of Islamic medical ethics.

With Muhammad’s descendants marrying into other cultures, this would have made working with Arab Muslims easier for people of other faiths, as well as non-

Mansur established the Bait al-Hikma, meaning the house of wisdom. This institute became a library of academic work. Great scholars of Syrian, Hebrew, and Persian heritage belonging to several faith groups including Islam, Christianity, Judaism, and Zoroastrianism, gathered to translate Greek, Latin, and

The collaborative environment of bimaristans also promoted the idea that even senior physicians had much to learn from other scholars. This attitude would then be instilled within the trainees, who would also realise that

mistakes are inevitable, however, the more effective thecollaboration, the better the outcome would be movingforward. The physicians worked in shifts to ensure thatsenior physicians were available to support the traineestaff morning and night [88]. Trainees would gather around the senior physicians to learn how to examinepatients as well as learn the way to appropriately interacwith patients. Aside from teaching trainees practically,medical theory was also taught through lectures.Theoretical medical knowledge was taught through lecture rooms and libraries as was found in thebimaristans at Baghdad, Damascus, and Cairo in thecentury [89].

The trainees in these bimaristans would knowing that medicine would be a challenging career yetone that would be spiritually fulfilling. The senior staff would foster the resilience that trainees needed through positive and active behaviours; that is by demonstratinghard work, constant reflection, and discussions on waysto improve by challenging and pushing the boundaries ofmedicine.

The spiritual and religious aspects of bimaristans arelikely to have played a larmotivating trainees to build the resilience required for acareer in medicine. Leading physicians also heldprominent religious status; Averroes (from the ArabicRushd, d. 1198) was a leading jurist of the Maliki schoolof Islamic jurisprudence and also held the position of chief judge in Cordoba. Ibn alphysician in the history of Islamic medicine who worked at Bimaristan Nur al-Din (see images 5 and 6 below) inDamascus also worked later in Cairo as jurist [90]. Part of the Muslim culture of the bimaristanswas the prohibition of drinking alcohol, gambling, andany other addictive behaviour for entertainment orcelebratory purposes, or to relieve stress. Excessivealcohol intake, drug misuse, and relationship breakdown are all associated with burnout, which could adverselyaffect patient care [91]. The Islamic alternatives would beto enjoy non-alcoholic feasts, gifting, and establishing aculture of praise and gratitude. Trainees woulsuccess as a blessing and view failure as understandingthat they were still on a journey.

4.3 Cultivating a trusting doctor

Islamic medical ethics also focuses on trust between thedoctor and patient. Ishaq ibn Ali Ruhawiextensively on the doctor-patient relationship in his mostcelebrated work Adab al-Tabib

History

mistakes are inevitable, however, the more effective the collaboration, the better the outcome would be moving

ians worked in shifts to ensure that senior physicians were available to support the trainee staff morning and night [88]. Trainees would gather around the senior physicians to learn how to examine patients as well as learn the way to appropriately interact with patients. Aside from teaching trainees practically, medical theory was also taught through lectures. Theoretical medical knowledge was taught through lecture rooms and libraries as was found in the bimaristans at Baghdad, Damascus, and Cairo in the 10th

The trainees in these bimaristans would enter the field knowing that medicine would be a challenging career yet one that would be spiritually fulfilling. The senior staff would foster the resilience that trainees needed through

e and active behaviours; that is by demonstrating hard work, constant reflection, and discussions on ways to improve by challenging and pushing the boundaries of

The spiritual and religious aspects of bimaristans are likely to have played a large role in inspiring and motivating trainees to build the resilience required for a career in medicine. Leading physicians also held prominent religious status; Averroes (from the Arabic Ibn

, d. 1198) was a leading jurist of the Maliki school mic jurisprudence and also held the position of

chief judge in Cordoba. Ibn al-Nafis (d. 1288), a pioneer physician in the history of Islamic medicine who worked

Din (see images 5 and 6 below) in Damascus also worked later in Cairo as a leading Shaf’i

Part of the Muslim culture of the bimaristans was the prohibition of drinking alcohol, gambling, and any other addictive behaviour for entertainment or celebratory purposes, or to relieve stress. Excessive

misuse, and relationship breakdown are all associated with burnout, which could adversely affect patient care [91]. The Islamic alternatives would be

alcoholic feasts, gifting, and establishing a culture of praise and gratitude. Trainees would view success as a blessing and view failure as understanding that they were still on a journey.

4.3 Cultivating a trusting doctor-patient relationship

Islamic medical ethics also focuses on trust between the Ishaq ibn Ali Ruhawi (d.931) wrote

patient relationship in his most Tabib (Practical Ethics of the

36

Physician)[94]. Trust could be built on a physician’sexperience or knowledge about a specialised area of

Figure 5. Bimaristan Nur al-Din from the inside(Damascus, Syria)[92]

Figure 6. Bimaristan Nur al-Din from outside(Damascus, Syria)[93]

medicine. However, there are additional factors thatbe at play, which may affect the doctorrelationship. Many fatwas related to medicine often focuson the doctors themselves as the subject of the fatwas[95]. Considering the socio-cultural interests of Muslimpatients, a patient’s level of anxiety and distress may becaused as a result of a negative experience [96]. For many Muslim patients, the doctor’s gender, the languageof communication, personality, and moral conduct allplay a role in the decision-making process when seekingmedical treatment. A negative experience or anexperience that does not meet the expectations of thepatient may affect a patient’s decision to take any

Physician)[94]. Trust could be built on a physician’s experience or knowledge about a specialised area of

Din from the inside

Din from outside

medicine. However, there are additional factors thatcould be at play, which may affect the doctor-patient relationship. Many fatwas related to medicine often focus on the doctors themselves as the subject of the fatwas

cultural interests of Muslim nxiety and distress may be

caused as a result of a negative experience [96]. For many Muslim patients, the doctor’s gender, the language of communication, personality, and moral conduct all

making process when seeking eatment. A negative experience or an

experience that does not meet the expectations of the patient may affect a patient’s decision to take any

prescribed medication and may also result in the patientnot returning for a second visit [97].

From an Islamic perspective then, the first encounter between a patient and the doctor requires meeting certainexpectations that include a range of aspects including thecharacteristics of the doctor as well as meeting sociocultural requirements. Importantly, this aspeethics should be valued especially because the firstinteraction has intrinsic value as well as it could have animpact on relevant clinical outcomes [98].

A greater focus on diversity and welcoming diffeperspectives in the NHS could help pool together a widerange of experiences. Bimaristans were places thatattracted patients and physicians from different placesdue to their ecumenical approach to inviting a diverseteam to advance in the field of mthe workforce in bimaristans influenced Europeanmedicine whereby comparable institutes began to emergeacross Europe. Physicians and trainees in bimaristanswere supported in an environment that focussed on thepatients’ well-being whilst highlighting that physicians play a vital part in the medical process. The motivation tobe a resilient member of this process was nurturedthrough the spiritual ethos of the bimaristans.

Although religion at the workplace remains a privatematter, perhaps religion and spirituality are reaching astage where its mention creates unease or even discrimination. A physician’s faith and belief are likely toplay a role in building a strong work ethic [99].Moreover, referring to such a great period ofthe ‘dark ages’ is ironic if health carein the dark about the great medical, surgical, andpharmaceutical advancements that were taking place[100][101]. Positive and constructive discussions onfaith and medical history maunderstand better what motivatesOn the other hand, institutional racism and a legacy of mistreatment of patients have led to a lack of trust in theNHS as has been shown in the reluctance of ethnicminority groups to register as organ donors as well as intheir low uptake of vaccines [102]. In medical textbooks, a representation of influential male and female physiciansfrom the Middle Ages from various cultures and placescould prove to be more inviting to m

Bimaristans appear to have provided the workforce withthe essential equipment and tools needed to completejobs effectively - either through government funding or

History

prescribed medication and may also result in the patient not returning for a second visit [97].

perspective then, the first encounter between a patient and the doctor requires meeting certain expectations that include a range of aspects including the characteristics of the doctor as well as meeting socio-cultural requirements. Importantly, this aspect of medical ethics should be valued especially because the first interaction has intrinsic value as well as it could have an impact on relevant clinical outcomes [98].

A greater focus on diversity and welcoming different perspectives in the NHS could help pool together a wide range of experiences. Bimaristans were places that attracted patients and physicians from different places due to their ecumenical approach to inviting a diverse team to advance in the field of medicine. The attitude of the workforce in bimaristans influenced European medicine whereby comparable institutes began to emerge across Europe. Physicians and trainees in bimaristans were supported in an environment that focussed on the

g whilst highlighting that physicians play a vital part in the medical process. The motivation to be a resilient member of this process was nurtured through the spiritual ethos of the bimaristans.

Although religion at the workplace remains a private er, perhaps religion and spirituality are reaching a

stage where its mention creates unease or even discrimination. A physician’s faith and belief are likely to play a role in building a strong work ethic [99]. Moreover, referring to such a great period of history as

health care providers are kept in the dark about the great medical, surgical, and pharmaceutical advancements that were taking place

Positive and constructive discussions on faith and medical history may prove to be healthy to understand better what motivates health care providers. On the other hand, institutional racism and a legacy of mistreatment of patients have led to a lack of trust in the NHS as has been shown in the reluctance of ethnic

groups to register as organ donors as well as in their low uptake of vaccines [102]. In medical textbooks, a representation of influential male and female physicians from the Middle Ages from various cultures and places could prove to be more inviting to medical students.

Bimaristans appear to have provided the workforce with the essential equipment and tools needed to complete

either through government funding or

37

through the awqaf system. Such funding sources could beused in our time to set up courses on buildinginterpersonal and soft skills. Additionally, staff could be taught cultural competence to bettersupport patients. Translation services could also bedeveloped with such funds. Moreover, the idea of funding evening clinics may help address the concerns ofMuslim patients in Ramadan when they are likely toavoid medication and appointments during daylight hoursdue to devoting time to religious matters whilst fasting [103].

Importantly, the workforce at bimaristansforce behind medical advancements. The workforce wasa product of the modest and resilient culture that waspromoted within the bimaristans. Hospitals today providecutting-edge treatments using advanced technologicaltools that were unimaginable in the Middle Ages. However, we need to remind ourselves that patientsexpect to build rapport with trustworthy humanphysicians before agreeing to the use of any sophisticatedtechnology.

The NHS in many ways mirrors the oncebimaristans. The NHS continues to attract physiciansfrom around the world. In 1971, 31% of all doctors inEngland were born and qualified abroad. By 2016, over 9,200 of the 29,200 Muslim staff held specialisedpositions. Of the 61,900 doctors who were asked abouttheir religion, 15% disclosed that they were Muslims. Interestingly, 15% is an over-representation since theMuslims make up only 5% of the national populace[104]. Muslim health care providers in the UK today donot work separately in bimaristans but rather mvery fabric of the NHS. British Muslim organisations likethe British Islamic Medical Association (Muslim Doctors Association (MDA), AlBalagh Academy, and Muslim Doctors Cymru (MDC) continueto promote Islamic medical ethics, offer aphysicians to engage in academic research, and helpjunior doctors develop personally and professionally. Furthermore, during the COVID-19 pandemic, a numberof British Muslim communities offered their localmosques as vaccination centres [103].

Further collaboration between the NHS, Public Health,and current Islamic medical organisations could help to refine medical ethics, raise standards of deliver a better patient-centred health carecreate an inclusive educational culture wherein senior staff and trainees of all backgrounds can take pride intheir careers. Moreover, greater inclusion efforts arelikely to attract philanthropists. In closing, for

system. Such funding sources could be to set up courses on building

interpersonal and soft skills. Additionally, health care staff could be taught cultural competence to better support patients. Translation services could also be developed with such funds. Moreover, the idea of

clinics may help address the concerns of Muslim patients in Ramadan when they are likely to avoid medication and appointments during daylight hours due to devoting time to religious matters whilst fasting

Importantly, the workforce at bimaristans was the driving force behind medical advancements. The workforce was a product of the modest and resilient culture that was promoted within the bimaristans. Hospitals today provide

edge treatments using advanced technological ginable in the Middle Ages.

However, we need to remind ourselves that patients expect to build rapport with trustworthy human physicians before agreeing to the use of any sophisticated

The NHS in many ways mirrors the once-great The NHS continues to attract physicians

from around the world. In 1971, 31% of all doctors in England were born and qualified abroad. By 2016, over 9,200 of the 29,200 Muslim staff held specialised positions. Of the 61,900 doctors who were asked about

r religion, 15% disclosed that they were Muslims. representation since the

Muslims make up only 5% of the national populace providers in the UK today do

not work separately in bimaristans but rather make up the very fabric of the NHS. British Muslim organisations like the British Islamic Medical Association (BIMA), the Muslim Doctors Association (MDA), AlBalagh Academy, and Muslim Doctors Cymru (MDC) continue to promote Islamic medical ethics, offer a platform for physicians to engage in academic research, and help junior doctors develop personally and professionally.

19 pandemic, a number of British Muslim communities offered their local

Further collaboration between the NHS, Public Health, and current Islamic medical organisations could help to refine medical ethics, raise standards of health care,

health care system, and al culture wherein senior

staff and trainees of all backgrounds can take pride in their careers. Moreover, greater inclusion efforts are likely to attract philanthropists. In closing, for health care

providers to attain cultural proficiencypluralism, respect, and openness to diverse ways of viewing health care are strongly advised.

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contributions-to-the-nhs/

42

M. Zafer Wafai MD, FACS,FICS, FRCOphth

The book will be discussed in this articleKuhl, The Sufficient in Ophthalmologywritten by Khalifah Ibn Abi Al-Mahasin Al656AH=1256 CE).

The first medical historian to mention this book and bringit to the attention of the medical historians’ communitywas the famous French medical historian Lucien LeClerc, who in 1876 wrote briefly about the then onlyknown copy of the book in the BibiliothequeParis (Number: 1043 B Arabe) (1). Since then, manyother historians came to mention the book and discuss itscontents scientifically and artistically.

Carl Brockelmann (1868-1956), the famous Germanorientalist historian and biographer, mentioned the bookand CITED a second manuscript in Istanbul, Turkeythe Sulaymaniea library (YeniJame 924) in his bookentitled Geschecte Der Arabischen Literaturein Berlin in 1902 (2).

In 1905, the famous orientalist, ophthalmologistfounder of the field of the history of ophthalmology, Julius Hirschberg, (3) along with another twoJ. Lippert, and E. Mittwoch, wrote a book entitledArabischen Augenarzte, or Ophthalmologists, in which they studied thgreat detail and translated select sectionslanguage based on the two known manuscripts. The bookwas translated into English and publisheKSA (4).

It is very surprising to notice that the outstanding books written by famous Arabian historians and biographershave neglected to mention this book, especially Ibn AbiUsaybia who wrote the most accurate and reliablemedical biography entitled Uyon Al-Anbaa fi Tabaqat AlAtebba, especially since they were colleagues and stu

,FICS, FRCOphth and Serene Wafai M.S.Ed

zaferwafai@gmail.com

discussed in this article is Al-Kafi fi al The Sufficient in Ophthalmology, which was

Mahasin Al-Halabi (D

The first medical historian to mention this book and bring it to the attention of the medical historians’ community was the famous French medical historian Lucien

wrote briefly about the then only heque Nationale in Since then, many

came to mention the book and discuss its

the famous German mentioned the book

a second manuscript in Istanbul, Turkey in library (YeniJame 924) in his book

Arabischen Literature published

phthalmologist, and the field of the history of ophthalmology,

along with another two orientalists, wrote a book entitled Dei

, or The Arabian which they studied the book in

nd translated select sections into the German known manuscripts. The book

was translated into English and published in Riyadh,

It is very surprising to notice that the outstanding books famous Arabian historians and biographers

have neglected to mention this book, especially Ibn Abi Usaybia who wrote the most accurate and reliable

Anbaa fi Tabaqat Al-they were colleagues and studied

medicine in Al-Bimaristan Alunder the same mentor the famous what is more surprising is that most of thebiographers, such as Al-Zirkly, Kahhale, Diab, etcignored the book and its authorof the book was by the late Prof. Kamal Al

As mentioned above, there aremanuscripts of this book:

1- The Paris manuscript in the Bibliotheque Nthe recent number (Arabe

2- The Istanbul manuscript in thethe index number (YeniJame 924)

In this article, we will focusbecause it is complete, well organized, neatly written inNaskh calligraphy (1560CE)Library manuscript (written in 1274CE), and very wellillustrated.

The manuscript consists of 230 folterms of chapters and subbecause it was written towards the end of the peak of theArabic/Islamic civilization era, books written in the field of ophthalmology, namely:

1- Al-Muhadhab Fi Al-Kuhl AlIbn Al-Nafis(1210-1280 CE

2- The Light of the Eyes and the Cwritten by Salah Al-(D1296CE) (7)

3- Uncovering the Disorders of the Eye, written by IbnAl-Akfani (D1348CE) (8)

4- The Ophthalmologic SupportSadaqah Al-Shadhili, (D1360

The significance of this book lies in the following facts:

History

Ed

zaferwafai@gmail.com

Bimaristan Al-Nooriin Damascus, Syria, der the same mentor the famous (Al-Dukhwar). And

what is more surprising is that most of the modern-day Zirkly, Kahhale, Diab, etc. have

ignored the book and its author. The only brief mention of the book was by the late Prof. Kamal Al-Samarrai(5).

As mentioned above, there are currently two known

anuscript in the Bibliotheque Nationale, Arabe2999)

manuscript in the Sulaymanieh Library, index number (YeniJame 924)

, we will focus on the Istanbul manuscript because it is complete, well organized, neatly written in

calligraphy (1560CE), more recent than the Paris (written in 1274CE), and very well

e manuscript consists of 230 folios, well organized in ms of chapters and sub-chapters; it is important

because it was written towards the end of the peak of the Arabic/Islamic civilization era, followed by only four books written in the field of ophthalmology, namely:

Kuhl Al-Mujarrab, written by 1280 CE) (6)

Light of the Eyes and the Collector of the Arts, -din Al-Kahhal Al-Hamwi

isorders of the Eye, written by Ibn(8)

The Ophthalmologic Support of the Eye, written by D1360). (9)

ook lies in the following facts:

43

1- It summarizes most, if not all, that was wrfield prior to its time.

2- The author quoted 72 authors and 41 books andpharmacopeias starting with Hippocrates up untiltime and gives credit to each author and

3- It is the first book to elegantly illustrate the anatomy of the eye globe, the optic nerves, the optic chiasm, the optic pathway, the occipital lobe, the four cerebral ventricles, and the Dura mater and the Piamater (Fig. 1). This illustrates the cross section of theeye globes with great details to the llens behind the iris, the pupil in the middle of the iris,the three coats of the eye, the sclera, the cthe retina, the optic nerve, the chiasmpathway, the four ventricles of the brain, asmall circle behind the chiasm which we believe tobe the pituitary gland, but he didn’t dare to name it.One can see the occipital lobe where vision takesplace as well as the periostium labelled

4- This illustration was used as the emblemAmerican Academy of Ophthalmologymeeting in Dallas, Texas in 1987,reference to the original drawing (Fig. 2)

5- It is the first book to place the ophthalmic surgicalinstruments in very elegant tables, with the drawingof the instrument, its name at the topuse it below (Fig.3).

6- It is the first book to classify the eyelids and diseases in well-organized tables (Fig. 4

7- It is the first book to describe the measurements(weights and volumes) necessary fomedication ratios. Those measurements were moreprecise than what was mentioned in Ibn Sina’Qanon.

8- It is the first book to dedicate a whole separatechapter to meticulously describe the technique of venesection (bloodletting), which seems mcompared to what Ibn Sina wrote in Al

9- 8-For the first time in history, it describesthe magnet to extract a broken piece of a couchingneedle from the eye.

It is worth mentioning that this book was edited byZafer Wafai,MD and the late Prof. M. Rawwas Kalaaji,Ph.D., and was published by the Islamic Educational,Scientific and Cultural Organization (ISESCO), Rabat,Kingdom of Morocco, 1990 (Fig.5).

hat was written in this

quoted 72 authors and 41 books andstarting with Hippocrates up until his

each author and book.illustrate the anatomy

of the eye globe, the optic nerves, the optic chiasm,the optic pathway, the occipital lobe, the four

he Dura mater and the PiaThis illustrates the cross section of the

t details to the location of the ris, the pupil in the middle of the iris,

, the choroid and the chiasm, the optic

he four ventricles of the brain, and the ich we believe to

didn’t dare to name it. ccipital lobe where vision takes

labelled in Arabic. This illustration was used as the emblem to the American Academy of Ophthalmology’s annual

, without giving (Fig. 2).

It is the first book to place the ophthalmic surgicalinstruments in very elegant tables, with the drawing

instrument, its name at the top, and the way to

t book to classify the eyelids and the eye tables (Fig. 4).

It is the first book to describe the measurementsnecessary for accurate easurements were more

what was mentioned in Ibn Sina’s Al-

It is the first book to dedicate a whole separatethe technique of

hich seems more precise compared to what Ibn Sina wrote in Al-Qanon.

, it describes the use of the magnet to extract a broken piece of a couching

It is worth mentioning that this book was edited by M. and the late Prof. M. Rawwas Kalaaji,

Ph.D., and was published by the Islamic Educational, Scientific and Cultural Organization (ISESCO), Rabat,

Fig.1 An illustration of the anatomy of the eye.

Fig. 2 The program cover for the Academy’s 1987 convention in Dallas, TX.

History

An illustration of the anatomy of the eye.

cover for the Academy’s 1987 convention in Dallas, TX.

44

Fig. 3 The ophthalmic surgical instruments, organizedinto tables for the first time.

Fig. 3 The ophthalmic surgical instruments, organized into tables for the first time.

Fig. 4. Classification of eyelid and eye diseases in organized tables.

Fig. 5 The cover of the newly edited and published copyof Al-Kafi Fi Al

History

Fig. 4. Classification of eyelid and eye diseases in organized tables.

Fig. 5 The cover of the newly edited and published copy Kafi Fi Al-Kuhl, 1990.

45

1. Lucien Le Clerc: Histoir De La MedicineII PP145-147

2. Publisher; Ernest Lecroue, Paris 1876

3. Carl Brockelmann: Geschecte Der ArabischenLetirature. Published 1892-1905

4. (The history of Arabic Letirature)

5. Julius Hirschberg: Geschecte DerAugenheilkunde(1899-1917) 9 Volumes

6. (The History of Ophthalmology).

7. Julius Hirschberg, J. Lippert, E. Mittwoch

8. Die ArabischenAugenarzte,

9. Leipzig, Verlag Von Veit& Comp. 1905

10. Translated into English by:

11. Prof. Frederick C. Blodi, Wlfried J. Rademaker, Gisla Rademaker and Kenneth F. Wildman

12. Edited by: M. ZaferWafai, MD.

13. Published by: King Abdul-Aziz City for Science andtechnology, Riyadh, KSA. 1993

Clerc: Histoir De La Medicine Arabe, Vol.

Publisher; Ernest Lecroue, Paris 1876

Carl Brockelmann: Geschecte Der Arabischen

Julius Hirschberg: Geschecte DerAugenheilkunde

Julius Hirschberg, J. Lippert, E. Mittwoch

Comp. 1905

Prof. Frederick C. Blodi, Wlfried J. Rademaker,Rademaker and Kenneth F. Wildman

Aziz City for Science and

14. Abstract of the History of Arabian Medicine. 2Volumes

15. Kamal Al-Samarrai, MD

16. Published by: Dar Al-Nidal, Baghdad, Iraq 1985

17. Edited by M. Zafer Wafai, MD.Rawwas KalaajiPh.D.

18. Published by: The Islamic Educational, Scientificand Cultural Organization (ISESCO)

19. Rabat, Kingdom of Morocco, 1988

20. Edited by M. ZaferWafai, MD.Rawwas Kalaaji Ph.D.

21. Published by: King Faisal center for research andIslamic Studies. Riyadh, KSA. 1987

22. Edited by M. ZaferWafai, MD.RawwasKalaaji, Ph.D.

23. Published by: King Faisal Center for Research andIslamic Studies. Riyadh, KSA. 1993

24. Edited by M. Zafer Wafai, MDKhashan, Ph.D. Pharmacy

25. Published by: Dar Al-Nafaes, Beirut, Lebanon, 202

History

tory of Arabian Medicine. 2

Samarrai, MD

Nidal, Baghdad, Iraq 1985

Wafai, MD. And Prof. M.

Published by: The Islamic Educational, Scientificand Cultural Organization (ISESCO)

at, Kingdom of Morocco, 1988

ZaferWafai, MD. And Prof. M.

Published by: King Faisal center for research andIslamic Studies. Riyadh, KSA. 1987

ZaferWafai, MD. And Prof. M.

King Faisal Center for Research andIslamic Studies. Riyadh, KSA. 1993

Wafai, MD and Abdul Kader Khashan, Ph.D. Pharmacy

Nafaes, Beirut, Lebanon, 202

46

Zara Mohammed

Secretary General, Muslim Council of Britain (MCB)

zara.mohammed@mcb.org.uk

When I think of what has been achieved and just how much has changed, I am astounded. The sense ofthat was borne out of adversity, the unrelenting serviceprovided by those on the frontline and of course thecompassion and care every one of us shared towards eachother – all a reminder of our common humanity. I takethis time to share the Muslim Council of Britain’sexperiences; critical challenges, opportunities,recommendations for what could have been done better. I also express my thanks to the British Islamic MedicalAssociation (BIMA) and the wider healthcarecommunity; this was a public health emergency,could not have been prouder of the leadership you haveshown, the sacrifice made and legacy that has been left.

The onset of the pandemic was a time of much confusionand uncertainty for British Muslims. On theMarch the MCB issued a statement strongly recommending mosque leaders to suspend congregationalactivities, realising the critical nature of the situThis was a week before the governmentwas essential for the protection of life

The MCB facilitated a national platform for affiliates andnon-affiliates to come together to provide a national planof action and response. The MCB also set up severalCOVID Response Groups, ranging from Mosques,Charities, Mental Health, to Economic and Burial, theseserved as platforms for coordinated action

Given this was a public health emergency, the MCBaffiliate, the British Islamic Medical Association (BIMA)helped lead in formulating timely guidance forcommunities about the virus.

Secretary General, Muslim Council of Britain (MCB)

zara.mohammed@mcb.org.uk

When I think of what has been achieved and just how am astounded. The sense of unity

was borne out of adversity, the unrelenting service provided by those on the frontline and of course the compassion and care every one of us shared towards each

all a reminder of our common humanity. I take is time to share the Muslim Council of Britain’s

opportunities, and recommendations for what could have been done better. I also express my thanks to the British Islamic Medical Association (BIMA) and the wider healthcare

emergency, and we could not have been prouder of the leadership you have shown, the sacrifice made and legacy that has been left.

The onset of the pandemic was a time of much confusion and uncertainty for British Muslims. On the 16th of March the MCB issued a statement strongly recommending mosque leaders to suspend congregational activities, realising the critical nature of the situation. This was a week before the government-mandated and

tial for the protection of life (1).

The MCB facilitated a national platform for affiliates and affiliates to come together to provide a national plan

also set up several COVID Response Groups, ranging from Mosques, Charities, Mental Health, to Economic and Burial, these

latforms for coordinated action (2).

Given this was a public health emergency, the MCB cal Association (BIMA)

helped lead in formulating timely guidance for

One of the first major concerns from Muslimcommunities was a proposed measure by the governmentto potentially cremate all COVIDcollaborated with the National Burial Council to provideclarity on the latest guidance and ensure those who passed away would get the utmost respect at end of life.Mosques worked relentlessly to find ways to supportfamilies, ensuring compliance with regulations whilstdelivering religious rites in the most sensitive waypossible. (3)

I also pay tribute to the first deaths of COVIDwere Muslim doctors and nurses on the frontline, theygave the ultimate sacrifice for our safety. Myfor their families and that they may be granted thehighest abode in heaven. (4)

Another key challenge for our communities was thefrequency in which the guidance was changing, causingconfusion both at national and locreach of the MCB and its trusted reputation acrossMuslim communities, the MCB with the support ofBIMA was able share timely and critical supplementaryguidance across all social media platforms includingWhatsApp. This guidance incluinfo graphic posters and multiaccessible and thus enabling immediate implementationby all. (5)

The MCB hosted over 50 webinars with partners acrosssectors, with hundreds of attendees (in one case over athousand). These sessions covered issues from improvinghealth and safety standards in mosques, combating vaccination fake news, hajj and umrah updates, to advicefor parents in lockdown. (6)

Advocacy

One of the first major concerns from Muslim communities was a proposed measure by the government to potentially cremate all COVID-19 deceased. The MCB collaborated with the National Burial Council to provide clarity on the latest guidance and ensure those who passed away would get the utmost respect at end of life. Mosques worked relentlessly to find ways to support

liance with regulations whilst delivering religious rites in the most sensitive way

I also pay tribute to the first deaths of COVID-19 which were Muslim doctors and nurses on the frontline, they gave the ultimate sacrifice for our safety. My prayers are for their families and that they may be granted the

Another key challenge for our communities was the frequency in which the guidance was changing, causing confusion both at national and local levels. Given the reach of the MCB and its trusted reputation across Muslim communities, the MCB with the support of BIMA was able share timely and critical supplementary guidance across all social media platforms including WhatsApp. This guidance included easy to understand info graphic posters and multi-language formats, easily accessible and thus enabling immediate implementation

The MCB hosted over 50 webinars with partners across sectors, with hundreds of attendees (in one case over a

ousand). These sessions covered issues from improving health and safety standards in mosques, combating vaccination fake news, hajj and umrah updates, to advice

47

A particularly difficult time for Muslims, myself included, was during Ramadan 2020 - the first Ramadan in history where we could not go to the mosque, meet ourfamilies, and break the fast with neighbours and friends.This of course also meant the Eid ul Fitr festival was alsoimpacted with last-minute changes to goverguidance resulting in local lock downs in some areas justhours before celebrations were to begin. (

Despite these challenges, British Muslim communitiescontinued to show great resilience. Although Mosqueswere physically closed to their congregations, theycontinued to serve their communities in even more ways than before. Muslim communities still found ways to share in charity - thousands of hot meals distributed, foodhubs set up to support the poor and vulnerable, mealprovided for key workers on the front line, whilstproviding essential counselling and spiritual guidance.

There are many stories of forgotten communities, fromthe refugees living in hotels like prisoners to hundreds of international students without recourse to jobs or food. Itwas down to foodbanks in local mosques and otherplaces of worship to be a lifeline when it mattered most.

Imams and scholars also helped to promote the campaignfor vaccine uptake and NHS plasma donation videos in different languages and utilising intergenerational homes to convey key messages to encouragethe elderly to get vaccinated.

Innovation with the use of technology has also played agreat role in widening access and helping mosquesprovide essential pastoral care and support. TalentedImams and madrassah teachers switched to onlineservices (e.g., up skilling and training to useZoom/Teams/YouTube etc).

The prevalence of large-scale and institutional racism andinequality have been further highlighted during thepandemic. The death of George Floyd sent ripples across the globe and awoke a new conversation about thesociety we wanted versus the one we had. Now young people are demanding a more equitable future, one inwhich diversity is embraced.

It was also quite apparent, how COVIDprevailing health inequalities with the disproportionatedeaths of ethnic minorities from the virus. These are also

A particularly difficult time for Muslims, myself the first Ramadan

in history where we could not go to the mosque, meet our families, and break the fast with neighbours and friends.

Fitr festival was also minute changes to government

guidance resulting in local lock downs in some areas just begin. (7)

Despite these challenges, British Muslim communities continued to show great resilience. Although Mosques

closed to their congregations, they continued to serve their communities in even more ways than before. Muslim communities still found ways to

thousands of hot meals distributed, food hubs set up to support the poor and vulnerable, meals provided for key workers on the front line, whilst providing essential counselling and spiritual guidance.

There are many stories of forgotten communities, from the refugees living in hotels like prisoners to hundreds of

course to jobs or food. It was down to foodbanks in local mosques and other

when it mattered most.

Imams and scholars also helped to promote the campaign for vaccine uptake and NHS plasma donation - producing

different languages and utilising inter-generational homes to convey key messages to encourage

Innovation with the use of technology has also played a great role in widening access and helping mosques

pastoral care and support. Talented Imams and madrassah teachers switched to online

up skilling and training to use

scale and institutional racism and her highlighted during the

pandemic. The death of George Floyd sent ripples across awoke a new conversation about the

society we wanted versus the one we had. Now young people are demanding a more equitable future, one in

It was also quite apparent, how COVID-19 highlighted prevailing health inequalities with the disproportionate deaths of ethnic minorities from the virus. These are also

related to social and economic barriers; Muslimcommunities are in some of tlowest income jobs with large families often living incramped accommodation. It is one of the MCB’s keypriorities, as we come out of this pandemic, to helpaddress these legacy inequalities by working inpartnership with decision makers to effect the change weneed. (8)

The role played by Mosque, imams and communities hasbeen truly remarkable. Without these efforts andsacrifice, we could not have achieved as much progressas we have done in both the vaccination effort but in alstaking care of the most vulnerable in our society. Thispartnership will be essential with the surge of mentalhealth and the ongoing healing from bereavement andloss. (9)

Finally, our government and decision makers have muchto heed. They must work wunderstand how to effect change and not continue tocherry-pick “community representatives” who do nothave local credibility. They must appreciate theimportance of tackling structural barriers and inequalitiesand create policies where the most marginalised are notleft behind. Further they must acknowledge the role thatMuslim communities have played not just in relation tothe pandemic but for the future of the country. We needinclusive politics and leadership that speaks for diversity of communities they represent.

1. MCB calls for the suspension of congregationalactivities at UK mosques and Islamic centres Muslim Council of Britain (MCB)

2. https://mcb.org.uk/resources/coronavirus/

3. https://mcb.org.uk/press-burial-measures-in-covid

4. https://muslimnews.co.uk/newsstories/british-muslim-doctorsprofession-die-coronavirus/

5. https://mcb.org.uk/resources/coronavirus/

6. MCB National Webinar: Preparing for SafeReopening of Mosques across the UK [07/06/2020]

Advocacy

related to social and economic barriers; Muslim communities are in some of the most deprived areas, lowest income jobs with large families often living in cramped accommodation. It is one of the MCB’s key priorities, as we come out of this pandemic, to help address these legacy inequalities by working in

makers to effect the change we need. (8)

The role played by Mosque, imams and communities has been truly remarkable. Without these efforts and sacrifice, we could not have achieved as much progress as we have done in both the vaccination effort but in also taking care of the most vulnerable in our society. This partnership will be essential with the surge of mental health and the ongoing healing from bereavement and

Finally, our government and decision makers have much to heed. They must work with local communities who understand how to effect change and not continue to

pick “community representatives” who do not have local credibility. They must appreciate the importance of tackling structural barriers and inequalities

s where the most marginalised are not left behind. Further they must acknowledge the role that Muslim communities have played not just in relation to the pandemic but for the future of the country. We need inclusive politics and leadership that speaks for the diversity of communities they represent.

MCB calls for the suspension of congregationalactivities at UK mosques and Islamic centres -Muslim Council of Britain (MCB)

https://mcb.org.uk/resources/coronavirus/

-releases/mcb-statement-on-covid-19-emergency-legislation/

https://muslimnews.co.uk/newspaper/top-doctors-nurses-first-

coronavirus/

https://mcb.org.uk/resources/coronavirus/

MCB National Webinar: Preparing for SafeReopening of Mosques across the UK [07/06/2020]

48

7. https://news.sky.com/story/like-cancellinghancock-criticised-for-lockdown-announcementbefore-eid-12039686

8. https://www.health.org.uk/news-and-comment/blogs/emerging-evidence-oninequalities-and-covid-19-march-2021

9. MCB COVID Report: https://mcb.org.uk/report/covid-and

cancelling-christmas-announcement-

-on-health-

2021

and-muslims/

Advocacy

49

Omer H El-Hamdoon, BDS, MMedSci, MA (Islamic Studies)General Dental Practitioner, Guildford, UK

omerelhamdoon@hotmail.com

The NHS (England) defines public health as abouthelping people to stay healthy and protecting themthreats to their health. Sometimes public health activitiesinvolve helping individuals, at other times they involvedealing with wider factors that have an impact on thehealth of many people (for example an ageethnic group, a locality, or a country).

Acheson defines public health as “the science and art of preventing disease, prolonging life and promotinghealth through organized efforts of society

Islam claims to be a system of life that covers all aspectsof human life. In Arabic, it is named as atranslated as a way-of-life. And any system whichaddresses human needs will have to encompass thehuman necessities for mind, body, and soconcept of the body is fundamental, as it is viewed as avehicle, through which a person will carry the mind andsoul.

The Prophet said, “The animal that doesn’t stop for restwill not cover any ground, nor will it remain long.”Giving the similitude of the body as the human vehicle.Islam addresses the care one should undertake for thebody, by providing general and specific notions whichenable the individual to maintain optimal health or atleast attempt to.

In the primary Islamic texts, we find multiple indicationswhich point towards healing and cure, and drivingimportant notions in public health, although not definedas such due to it preceding the terminology. In moderntimes, as we understand public health, and this field hasbecome vital in developing communities, we can reflecton the Islamic messages and associate them with thisdiscipline.

The emergence of Islam dates back in the seventhcentury when medicine was very much in its primitivestate; and much relied on from traditional practices andherbalist remedies. Having said that, it does not mean

BDS, MMedSci, MA (Islamic Studies) General Dental Practitioner, Guildford, UK

omerelhamdoon@hotmail.com

The NHS (England) defines public health as about helping people to stay healthy and protecting them from threats to their health. Sometimes public health activities involve helping individuals, at other times they involve dealing with wider factors that have an impact on the health of many people (for example an age-group, an

“the science and art of preventing disease, prolonging life and promoting health through organized efforts of society”.1

Islam claims to be a system of life that covers all aspects of human life. In Arabic, it is named as a dīn, which is

life. And any system which addresses human needs will have to encompass the

and soul. Indeed, the concept of the body is fundamental, as it is viewed as a vehicle, through which a person will carry the mind and

The Prophet said, “The animal that doesn’t stop for rest will not cover any ground, nor will it remain long.”2

e similitude of the body as the human vehicle. Islam addresses the care one should undertake for the body, by providing general and specific notions which enable the individual to maintain optimal health or at

s, we find multiple indications which point towards healing and cure, and driving important notions in public health, although not defined

the terminology. In modern times, as we understand public health, and this field has

me vital in developing communities, we can reflect on the Islamic messages and associate them with this

The emergence of Islam dates back in the seventh century when medicine was very much in its primitive

ional practices and herbalist remedies. Having said that, it does not mean

that these are of a lesser quality. Herbalist remedies tendto work on generalised approaches and aim at a holisticapproach. And this is why we note from the Islamicmedicinal principles, there is reference to remedies whichdeal with wider concepts, aimed at prevention, reducinginflammation and strengthening the immune system.

Islam as a practice which claims divinity in its sources, isunique in being preserved with great accurapossible that much of Islamic practice are indeed foundin the early traditions of other Prophets, who may nothave had their tradition accurately or fully recorded. In contrast, the Prophet Muhammad’s words and sayings are highly preserved and greatly scrutinised for their authenticity. Being a religion, much of the practices arelinked to an individuals’ rituals and worship, and thisallows for better compliance. We know that those whohave a belief system or engage in spirituality are moradherent to medicinal regimes, as they have betteroutlooks.3

Great emphasis is placed on prevention within theIslamic Public Health messages. The prevention elementsare included in the whole discourse of good decisidaily living, from eating to cleanliness and takingappropriate precautions.

Importance is put on cleanliness of the body as well as the spirit. The Prophet’s saying, “Cleanliness is halffaith”4 puts great emphasis on the importance ofmaintaining cleanliness in all avenues. A further saying, “God is clean and loves cleanliness”conscious individual to strive towards that which is loved by God. Another quotation from twith all that you can, for Allah has built Islam on cleanliness, and the only ones admitted to Paradise arethose who are clean.”6

Islam & Health

that these are of a lesser quality. Herbalist remedies tend to work on generalised approaches and aim at a holistic approach. And this is why we note from the Islamic

ciples, there is reference to remedies which deal with wider concepts, aimed at prevention, reducing inflammation and strengthening the immune system.

Islam as a practice which claims divinity in its sources, is unique in being preserved with great accuracy. It is very possible that much of Islamic practice are indeed found in the early traditions of other Prophets, who may not have had their tradition accurately or fully recorded. In contrast, the Prophet Muhammad’s words and sayings

and greatly scrutinised for their Being a religion, much of the practices are

linked to an individuals’ rituals and worship, and this allows for better compliance. We know that those who have a belief system or engage in spirituality are more adherent to medicinal regimes, as they have better

Great emphasis is placed on prevention within the Islamic Public Health messages. The prevention elements are included in the whole discourse of good decisions in daily living, from eating to cleanliness and taking

Importance is put on cleanliness of the body as well as the spirit. The Prophet’s saying, “Cleanliness is half of

great emphasis on the importance of maintaining cleanliness in all avenues. A further saying, “God is clean and loves cleanliness”5 encourages a god-conscious individual to strive towards that which is loved by God. Another quotation from the Prophet: “Cleanse with all that you can, for Allah has built Islam on cleanliness, and the only ones admitted to Paradise are

50

Despite emerging in a desert environment with limited water resources, Islamic teaching gave precedence tousing water for regular washing as part of acts of worship. Muslims are required to carry out(ablutions) prior to engaging in the five daily prayers.Wuḍūʾ involves the washing of those limbs that areapparent and used the most in daily life and interactions,namely the face, arms, and feet.8 Additionally, a fullwash to encompass the whole body is encouraged on aweekly basis, when attending public gatherings. It ismade mandatory following acts of intimacy betspouses and following the end of a woman’s monthlycycle or post-natal bleeding.9 Linking the obligation tothese acts further promotes regular full washing.

We know that regular washing is of great benefit for theindividual, as it is a mode for cleansing and removingdirt, dead skin and reducing pathogens. Whilst it mightbe common knowledge today, past societies consideredwashing to be a privilege, with anecdotal evidencedescribing how people washed once a year on average.

The Prophet said, “Of the blessing of food is to makeablution before it and after it.”10 Some commentators saythat the ablution referred here is a reference to thewashing of hands as opposed to the full ablution. Thispractice has important consequences in the reduction oforal-faecal diseases such as typhoid and choleraas overall reduction in infection.12

Islam identified certain items are filth, which require to be cleaned of the body, clothes, purification from these items further promotes health, asthese items are potential carriers of pathogens. Theseinclude urine, stools, blood, pus, vomit, dead carcasses,etc. When a man got up and urinated in the mosque, theProphet instructed to get buckets of water to pour overthe urine to wash away the filth 13. We know that bodilyfluids do carry pathogens and can be media for growth.During the 7th Century, there was no understandingMicroorganisms, which came much later in tCentury.14 Meanwhile, in the ancient Western World,

Despite emerging in a desert environment with limited Islamic teaching gave precedence to

using water for regular washing as part of acts of worship. Muslims are required to carry out wuḍūʾ (ablutions) prior to engaging in the five daily prayers.

involves the washing of those limbs that are d used the most in daily life and interactions,

Additionally, a full wash to encompass the whole body is encouraged on a weekly basis, when attending public gatherings. It is made mandatory following acts of intimacy between

following the end of a woman’s monthly Linking the obligation to

these acts further promotes regular full washing.

We know that regular washing is of great benefit for the ansing and removing

dirt, dead skin and reducing pathogens. Whilst it might be common knowledge today, past societies considered washing to be a privilege, with anecdotal evidence describing how people washed once a year on average.

The Prophet said, “Of the blessing of food is to make Some commentators say

that the ablution referred here is a reference to the washing of hands as opposed to the full ablution. This

tant consequences in the reduction of faecal diseases such as typhoid and cholera11 as well

Islam identified certain items are filth, which require to and floor. The

purification from these items further promotes health, as these items are potential carriers of pathogens. These include urine, stools, blood, pus, vomit, dead carcasses,

When a man got up and urinated in the mosque, the instructed to get buckets of water to pour over

. We know that bodily can be media for growth.

Century, there was no understanding of icroorganisms, which came much later in the 19th

Meanwhile, in the ancient Western World,

Romans and other Europeans were washing their clothesin urine used as a stain-remover to dissolve grease,loosen dirt, and bleach yellowing fabrics.dead carcasses as filth also diras it meant avoiding these items from one’s diet.

Great emphasis is placed on oral health, as openly demonstrated by the ProphetThere are substantial texts in which he encourages toothbrushing on different occasions, more than the twiceday regime advocated by modern dentists.

In addition to this, he has been reported to brush histongue as part of the routine. Whilst the benefits of tongue brushing for general oral health isn’t establish16, it has definitely been demonstrated to help withhalitosis.

The encouragement of regular tooth brushing is animportant preventative tool in preventing dental cariesand gingivitis and periodontitis, coupled with thefavourable outcome of freshe

One of the steps in the Muslim ablution is the nasalirrigation. It is described as sniffing up water through thenose, and then to expel the water thereafter. Someaccounts encourage to be extreme in his one is not fasting.

A clinical review and literature review by Lancedemonstrated the benefits of nasal irrigation in dealing with nasal symptoms.17

Islam introduced a system to its followers whichencourages a demarcation betw‘Aishah reported that her husband the Prophet preferredthe right hand for his eating/ drinking, and his left handfor his cleansing.

By following this system, there is clear demonstration of potential reduction in spreading contaminants that maycome from one’s nose or indeed from back passage.

Islam & Health

Romans and other Europeans were washing their clothes remover to dissolve grease,

loosen dirt, and bleach yellowing fabrics. Classifying dead carcasses as filth also directly impacted on health, as it meant avoiding these items from one’s diet.

Great emphasis is placed on oral health, as openly demonstrated by the Prophet Muhammad, and preached. There are substantial texts in which he encourages tooth

ing on different occasions, more than the twice-a-day regime advocated by modern dentists.

In addition to this, he has been reported to brush his tongue as part of the routine. Whilst the benefits of tongue brushing for general oral health isn’t established15,

, it has definitely been demonstrated to help with

The encouragement of regular tooth brushing is an important preventative tool in preventing dental caries and gingivitis and periodontitis, coupled with the favourable outcome of fresher breath.

One of the steps in the Muslim ablution is the nasal irrigation. It is described as sniffing up water through the nose, and then to expel the water thereafter. Some accounts encourage to be extreme in his process when

A clinical review and literature review by Lance et. al demonstrated the benefits of nasal irrigation in dealing

Islam introduced a system to its followers which encourages a demarcation between how hands are used. ‘Aishah reported that her husband the Prophet preferred the right hand for his eating/ drinking, and his left hand

By following this system, there is clear demonstration of reduction in spreading contaminants that may

come from one’s nose or indeed from back passage.

51

There is a great need for better gut health. Modernmedicine has placed great weighting on having a healthygut.

Modern western society is suffering from a crisis whichis obesity18. Delormieret al doesn’t shy away fromterming it a crisis, and they have described how it islinked to obesogenic environments and societal trendsthat encourage overeating and little physical activity.They add that preventing obesity, however, haspredominantly focused on the behaviour of individuals.Islam dealt with the issue of eating through public healthmessages, although they were general statements, and notprimarily aimed at obesity. Deeply rooted in of Islam is the importance of addressing eatingbehaviour.

In many of his traditions, the Prophet discouraged overeating. He said, “The human has not filled a vesselworse than the stomach. It is enough for the human tohave a few morsels of food to enable him to straightenhis back. If he must eat, then a third for his food, a thirdfor his drink and a third for his breath.”19

Other messages include the importance of healthy eating. It is no doubt that traditional society didn’t have thedangers of modern society of refined food, and fast food. Nonetheless, the focus was on eating welland reducing consumption.

One important perspective is to deny oneself what itdesires, and not to eat any food which one is tempted to.This was a clear message from a religious perspectivewhich sought that the human overcome his desires andtemptations.

The topic of halal meat is in need for deeper discussion. Islam prohibited the consumption of certain gave great weighting on the preparation of an animalmeat for consumption. Strict injunctions meant that for aland animal to be consumed, it must be its blood spilled. If an animal were to die in another way without allowing the blood to spill, then it would bedeemed as unlawful.

Blood is a nutrient filled media for bacteria which acts as spoilers of food. By commanding this practice, through the health messages, it greatly reduced the contamination

There is a great need for better gut health. Modern medicine has placed great weighting on having a healthy

is suffering from a crisis which doesn’t shy away from

terming it a crisis, and they have described how it is linked to obesogenic environments and societal trends that encourage overeating and little physical activity.

d that preventing obesity, however, has predominantly focused on the behaviour of individuals. Islam dealt with the issue of eating through public health messages, although they were general statements, and not

Deeply rooted in the message of Islam is the importance of addressing eating

In many of his traditions, the Prophet discouraged overeating. He said, “The human has not filled a vessel worse than the stomach. It is enough for the human to

ood to enable him to straighten his back. If he must eat, then a third for his food, a third

19

Other messages include the importance of healthy eating. It is no doubt that traditional society didn’t have the

ers of modern society of refined food, preservatives, and fast food. Nonetheless, the focus was on eating well

One important perspective is to deny oneself what it desires, and not to eat any food which one is tempted to.

s a clear message from a religious perspective which sought that the human overcome his desires and

The topic of halal meat is in need for deeper discussion. Islam prohibited the consumption of certain meats and gave great weighting on the preparation of an animal meat for consumption. Strict injunctions meant that for a land animal to be consumed, it must be slaughtered, and its blood spilled. If an animal were to die in another way

spill, then it would be

Blood is a nutrient filled media for bacteria which acts as spoilers of food. By commanding this practice, through the health messages, it greatly reduced the contamination

of the meat, and thence reduced diseabacterial growth. The method of halal slaughtering isn’tthe topic for this article, but it warrants further explanation to demonstrate that this mode is truly animportant public health message.

Islam also encouraged seeking cures and medicine. Onechallenge to public health is to get patients to seekmedical treatment. In developed society, this may not bea wide issue, but in traditional developing societies itremains a big step for them to go forth.

The Prophet was clear in advocating for healthypractices, and to seek medicine and cure when ill. Hesaid, “Seek remedies, O people. For God has not placedany disease without making for it a cure, except oneillness: old age.”20

This served as an important guidance for humans Muslims in particular – to seek for remedies, under thegeneral notion that every illness has a cure or remedy.the other hand, Islam discourages the use of superstitious behaviour. Research by Anwar et al (2012)in Pakistan – as an exampleusing myths and superstitions relating to healthbehaviour.

The prevalence of STDs in western society is welldocumented with specific diseases identified to be spreadthrough sexual intercourse. The increase of sexualpromiscuity plays a role in spreading STDs

Islam, along with most other religions, was strictlyopposed to sex outside marriage. This clear injunctionhad direct effect on reducing the incidence of STDswithin the community. As societies abandoned religionand thence the abstinence of extraSTDs became more prevalent, with new disease beingidentified in the 20th Century.

Embedded in the Islamic teachings is an array of adviwhich amount to important public health advice. Coupledwith the religious element, it has gained much tractionamong adherents of the religion. We know that a belief ina divine system gives more probability for better uptakein the community. This article is aimed as an introduction

Islam & Health

of the meat, and thence reduced disease associated with bacterial growth. The method of halal slaughtering isn’t the topic for this article, but it warrants further explanation to demonstrate that this mode is truly an important public health message.

lso encouraged seeking cures and medicine. One challenge to public health is to get patients to seek medical treatment. In developed society, this may not be a wide issue, but in traditional developing societies it remains a big step for them to go forth.

The Prophet was clear in advocating for healthy practices, and to seek medicine and cure when ill. He said, “Seek remedies, O people. For God has not placed any disease without making for it a cure, except one

tant guidance for humans – andto seek for remedies, under the

general notion that every illness has a cure or remedy. On the other hand, Islam discourages the use of superstitious behaviour. Research by Anwar et al (2012)21 showed that

as an example – there were still trends ofusing myths and superstitions relating to health-seeking

The prevalence of STDs in western society is well documented with specific diseases identified to be spread

ough sexual intercourse. The increase of sexual promiscuity plays a role in spreading STDs22.

Islam, along with most other religions, was strictly opposed to sex outside marriage. This clear injunction had direct effect on reducing the incidence of STDs within the community. As societies abandoned religion and thence the abstinence of extra-marital relations, STDs became more prevalent, with new disease being

Century.

Embedded in the Islamic teachings is an array of advice which amount to important public health advice. Coupled with the religious element, it has gained much traction among adherents of the religion. We know that a belief in a divine system gives more probability for better uptake

icle is aimed as an introduction

52

to the topic of Islam and public health, and each categorywarrants further elaboration.

1. Acheson, D. Independent Inquiry into Inequalities inHealth Report. 1998. The Stationery Office,

2. Al-Suyuṫī J. Al-Jāmiʿ al-Kabīr, Dar al‘Alamiyah. Beirut

3. Taylor EJ. Health Outcomes of Religious andSpiritual Belief, Behavior, and Belonging:Implications for Healthcare Professionals. In Spirituality in Healthcare: Perspectives for Innovative Practice 2019 (pp. 67Cham.

4. Al-Nīsābūrī, Muslim. Ṣaḥīḥ Muslim. Riyadh. Darussalam. 1999

5. Al-Suyuṫī J. Al-Jāmiʿ al-Kabīr, Dar al‘Alamiyah. Beirut

6. Al-Suyuṫī J. Al-Jāmiʿ al-Kabīr, Dar al‘Alamiyah. Beirut

7. Khalifa, M. and Bidaisee, S., 2018. The importanceof clean water. Sch J ApplSci Res, 1(7), pp.17

8. Al-Hadrami, A. I. A. R. The Hadramī Introduction.London. Kingston Oak Tree Institute. 2021

9. Al-Hadrami, A. I. A. R. The Hadramī Introduction.London. Kingston Oak Tree Institute. 2021

10. Al-Sajstānī, Abi Dāwūd. SunanAbīDāwūd. Riyadh.Darussalam. 1999

11. Idowu OA, Rowland SA. Oral fecal parasites andpersonal hygiene of food handlers in Abeokuta,Nigeria. African health sciences. 2006 Nov21;6(3):160-4.

12. Larson E. A causal link between handwashirisk of infection? Examination of the evidence.

to the topic of Islam and public health, and each category

Acheson, D. Independent Inquiry into Inequalities in1998. The Stationery Office, London.

Kabīr, Dar al-Kutub al-

Taylor EJ. Health Outcomes of Religious andSpiritual Belief, Behavior, and Belonging: Implications for Healthcare Professionals. In Spirituality in Healthcare: Perspectives for

(pp. 67-82). Springer,

Muslim. Riyadh.

Kabīr, Dar al-Kutub al-

Kabīr, Dar al-Kutub al-

018. The importance(7), pp.17-20.

Hadrami, A. I. A. R. The Hadramī Introduction.London. Kingston Oak Tree Institute. 2021

Hadrami, A. I. A. R. The Hadramī Introduction.London. Kingston Oak Tree Institute. 2021

Sajstānī, Abi Dāwūd. SunanAbīDāwūd. Riyadh.

Idowu OA, Rowland SA. Oral fecal parasites andpersonal hygiene of food handlers in Abeokuta,Nigeria. African health sciences. 2006 Nov

Larson E. A causal link between handwashing and risk of infection? Examination of the evidence.

Infection Control & Hospital Epidemiology. 1988Jan;9(1):28-36.

13. Al-Nīsābūrī, Muslim.Darussalam. 1999

14. Barnett JA. Beginnings of microbiology and biochemistry: the contribution of Microbiology. 2003 Mar 1;149(3):557

15. Danser MM, Gómez SM, Van der Weijden GA.Tongue coating and tongue brushing: a literaturereview. International journal of dental hygiene. 2003Aug;1(3):151-8.

16. Yaegaki K, Coil JM, Kamemizu T, MiyazakiTongue brushing and mouth rinsing as basictreatment measures for halitosis. International dentaljournal. 2002 Jun 1;52(5):192

17. Tomooka LT, Murphy C, Davidson TM. Clinicalstudy and literature review of nasal irrigation. TheLaryngoscope. 2000;110(7

18. Delormier, T., Frohlich, K.L. and Potvin, L., 2009.Food and eating as social practiceeating patterns as social phenomena and implications for public health. Sociology of health &illness, 31(2), pp.215-228.

19. Al-Qazwīnī, Muhammad Mājah. Riyadh. Darussalam. 1999

20. Al-Sajstānī, Abi Dāwūd. SunanAbīDāwūd. Riyadh.Darussalam. 1999

21. Anwar, M., Green, J. and Norris, P., 2012. Healthseeking behaviour in Pakistan: A narrative review ofthe existing literature. Public517.

22. Kreiss J, Carael M, Meheus A. Role of sexuallytransmitted diseases in transmitting humanimmunodeficiency virus. Genitourinary medicine.1988 Feb;64(1):1

Islam & Health

Infection Control & Hospital Epidemiology. 1988

Nīsābūrī, Muslim. Ṣaḥīḥ Muslim. Riyadh.

Barnett JA. Beginnings of microbiology andbiochemistry: the contribution of yeast research.Microbiology. 2003 Mar 1;149(3):557-67.

Danser MM, Gómez SM, Van der Weijden GA.Tongue coating and tongue brushing: a literaturereview. International journal of dental hygiene. 2003

Yaegaki K, Coil JM, Kamemizu T, Miyazaki H.Tongue brushing and mouth rinsing as basictreatment measures for halitosis. International dentaljournal. 2002 Jun 1;52(5):192-6.

Tomooka LT, Murphy C, Davidson TM. Clinicalstudy and literature review of nasal irrigation. TheLaryngoscope. 2000;110(7):1189-93.

Delormier, T., Frohlich, K.L. and Potvin, L., 2009.Food and eating as social practice–understandingeating patterns as social phenomena and implications

Sociology of health &228.

Qazwīnī, Muhammad ibn Mājah. Sunan Ibn Mājah. Riyadh. Darussalam. 1999

Sajstānī, Abi Dāwūd. SunanAbīDāwūd. Riyadh.

Anwar, M., Green, J. and Norris, P., 2012. Health-seeking behaviour in Pakistan: A narrative review of

Public health, 126(6), pp.507-

Kreiss J, Carael M, Meheus A. Role of sexuallytransmitted diseases in transmitting humanimmunodeficiency virus. Genitourinary medicine.1988 Feb;64(1):1

53

Professor M A R Al-Fallouji, PhD (London), FRCSI, FRCS (Glas.), FRCS (Edin.)

Consultant Surgeon, Director of Institute of History of Arab

alfallouji@hotmail.com

No doctor or a pharmacist, nor any person (whoever theymay be) is immune from disease, suffering, andcalamities. Everyone has a share of it; no one is sparedfrom the disease. Many doctors suffer from allergicdiseases, many leaders suffer from cancer, mpeople suffer from back pain, and many children aredeformed, disabled, or handicapped. Furthermore, thedoctor may even die from a disease that he used to treathimself, and the sick person may live contrary to allmedical indications for his impending death!

No plant, nor an animal, not even inanimate matter isexcluded from disease (!); many baren lands andwastelands are infested with plague, many pools of waterspread cholera, and many houses are contaminated withdeadly bacteria, and many stones are home to fungi.

So, why did God create disease? A question that is notanswered by most (if not all) medical colleges in theworld; they do not even teach, despite the fact that thequestion is at the heart of the medical profession, and it isa question that has serious consequences in human thought and in peoples’ culture.

Many atheists rejected the existence of God because theycould not reconcile God the Almighty, the Allthe Merciful, with the creation of disease, evil, and suffering in life. Not answering this question promptedsceptics such as the famous Cambridge cosmologist andblack hole professor Stephen Hawking, author of ‘ShortHistory of Time’, and the Four Philosophers of Atheism:Sam Harris, Richard Dawkins, Christopher Hitchens, andDaniel Dennett for declaring that there is no God (God).Indeed, Stephen Hawking (before his death inMarch 2018 at age of 76) became daring in criticizing thebelief of Isaac Newton and Einstein in God, for exa“So Einstein was wrong when he said: “God does not

, PhD (London), FRCSI, FRCS (Glas.), FRCS (Edin.)

Director of Institute of History of Arab-Islamic Medicine and Science

ouji@hotmail.com

No doctor or a pharmacist, nor any person (whoever they may be) is immune from disease, suffering, and calamities. Everyone has a share of it; no one is spared from the disease. Many doctors suffer from allergic diseases, many leaders suffer from cancer, many great people suffer from back pain, and many children are

or handicapped. Furthermore, the doctor may even die from a disease that he used to treat himself, and the sick person may live contrary to all

pending death!

No plant, nor an animal, not even inanimate matter is excluded from disease (!); many baren lands and wastelands are infested with plague, many pools of water spread cholera, and many houses are contaminated with

stones are home to fungi.

So, why did God create disease? A question that is not answered by most (if not all) medical colleges in the world; they do not even teach, despite the fact that the

medical profession, and it is a question that has serious consequences in human

Many atheists rejected the existence of God because they could not reconcile God the Almighty, the All-Knowing,

ion of disease, evil, and suffering in life. Not answering this question prompted

such as the famous Cambridge cosmologist and black hole professor Stephen Hawking, author of ‘Short History of Time’, and the Four Philosophers of Atheism:

s, Richard Dawkins, Christopher Hitchens, and Daniel Dennett for declaring that there is no God

Indeed, Stephen Hawking (before his death in March 2018 at age of 76) became daring in criticizing the belief of Isaac Newton and Einstein in God, for example: “So Einstein was wrong when he said: “God does not

play dice.” Looking at black holes suggests, not only thatGod plays dice, but sometimes He confuses us byscattering black holes where we can't look for them.”(See: Does God Play Dice?such atheists persisted in their belief despite their imperfect knowledge. The burden of the disease casted aheavy shadow on Hawking, who was diagnosed withMotor Neuron Disease, at age of 21 years old, whendoctors have announced that he wtwo years, yet he struggled with the disease withdetermination and composure until he exceeded the ageof 76, which is longer than what the doctors expected.Hawking should have thanked God for giving him a longlife, giving him the opportunity in theoretical physicsinstead of his atheism and denial of God's existence (!).After a while, the disease made him paralyzed, but hewas nevertheless able to match and even surpass hispeers in physicists, although their bodies were healthyand they could write complex equations and do their longcalculations on paper, while Hawking was doing thecalculations in his mind. Proud to have had the same titleand professorial chair as Sir Isaac Newton, Hawkingbecame an icon in the will to challendisease that lasted nearly 55 years. With the progressionof his illness, and because of his tracheostomy due tobronchitis, Hawking became unable to speak or move his arm or foot, that is, he became completely unable tomove, so the American company Intel Corporation forprocessors and digital systems in Santa Clara, California(in the Silicon Valley), has developed a special computer system connected to his chair, through which Hawkingcan control the movement of his chair, communicateusing an electronic generator voice, and issue commandsthrough the movement of his eyes and head, as he outputsdata previously stored in the device representing wordsand commands.

Although the church was never a part of Hawking's life,and although his first Catholic wife left him because of

Islam & Health

, PhD (London), FRCSI, FRCS (Glas.), FRCS (Edin.)

Islamic Medicine and Science

play dice.” Looking at black holes suggests, not only that God plays dice, but sometimes He confuses us by scattering black holes where we can't look for them.” (See: Does God Play Dice? 1996). It is a wonder that such atheists persisted in their belief despite their imperfect knowledge. The burden of the disease casted a heavy shadow on Hawking, who was diagnosed with Motor Neuron Disease, at age of 21 years old, when doctors have announced that he will not live more than two years, yet he struggled with the disease with determination and composure until he exceeded the age of 76, which is longer than what the doctors expected. Hawking should have thanked God for giving him a long

opportunity in theoretical physics instead of his atheism and denial of God's existence (!). After a while, the disease made him paralyzed, but he was nevertheless able to match and even surpass his peers in physicists, although their bodies were healthy and they could write complex equations and do their long calculations on paper, while Hawking was doing the calculations in his mind. Proud to have had the same title and professorial chair as Sir Isaac Newton, Hawking became an icon in the will to challenge disability and disease that lasted nearly 55 years. With the progression of his illness, and because of his tracheostomy due to bronchitis, Hawking became unable to speak or move his arm or foot, that is, he became completely unable to

ican company Intel Corporation for processors and digital systems in Santa Clara, California (in the Silicon Valley), has developed a special computer system connected to his chair, through which Hawking can control the movement of his chair, communicate sing an electronic generator voice, and issue commands

through the movement of his eyes and head, as he outputs data previously stored in the device representing words

Although the church was never a part of Hawking's life, first Catholic wife left him because of

54

his atheism, the family decided to hold a burial ceremonyin the church to avoid criticism and curse after his death.There were 500 invited guests to Hawking's funeral (heldMarch 31, 2018) at St Mary's Great Churc(England). Despite Hawking's atheism, his childrenLucy, Robert, and Tim chose this prestigious church tobid him farewell. His children issued a statementjustifying this: "Our father's life and work mean many things to many people, religious and nonTherefore, the service will be both inclusive andtraditional, reflecting the breadth and diversity of hislife."

Such great wisdom can be classified under two major headings: medical wisdom and religious (Islamic)wisdom.

A. Medical wisdom (Pure):

Perhaps starting with medical reasons is appropriate hereto satisfy the cross-section of sceptics and atheists in Godas a material evidence and concrete proof (beforetackling religious wisdom, although both are linked to thedivine will):

1. For the advancement of medicine, surgery,midwifery, medical laboratory analyses andpharmacology for diseases that were previouslyunknown to be treated, such as diabetes and thediscovery of insulin for its treatment, treatment of fevers and infectious diseases by the discovery ofpenicillin, and for advanced treatment againstviruses, microbes and various parasites: And GodAlmighty has spoken the truth by saying: (And Hecreates what you do not know) ال تعلمون )ماNow, syphilis, tuberculosis, smallpox, cholera,plague, and polio have all become diseases of theancient past due to the discovery of vaccines andantibiotics. The same will be applied to COVIDvaccination.

2. To show the weakness and insiarrogant Man, since the simplest organisms suchas viruses, bacteria and parasites can cause him diseases that can exhaust him and weaken him, asa deterrent to keep him humble. the words of the international actor Clint Eastwothe end of the movie (Magnum Force 1973) in his famous saying: (A men got to know hislimitations).

his atheism, the family decided to hold a burial ceremony in the church to avoid criticism and curse after his death. There were 500 invited guests to Hawking's funeral (held March 31, 2018) at St Mary's Great Church in Cambridge (England). Despite Hawking's atheism, his children Lucy, Robert, and Tim chose this prestigious church to bid him farewell. His children issued a statement justifying this: "Our father's life and work mean many

us and non-religious alike. Therefore, the service will be both inclusive and traditional, reflecting the breadth and diversity of his

Such great wisdom can be classified under two major religious (Islamic)

Perhaps starting with medical reasons is appropriate here section of sceptics and atheists in God

as a material evidence and concrete proof (before although both are linked to the

For the advancement of medicine, surgery,midwifery, medical laboratory analyses and

that were previouslyunknown to be treated, such as diabetes and the

treatment, treatment offevers and infectious diseases by the discovery ofpenicillin, and for advanced treatment againstviruses, microbes and various parasites: And GodAlmighty has spoken the truth by saying: (And He

ما ال تعلمونويخلق ( . Now, syphilis, tuberculosis, smallpox, cholera,

and polio have all become diseases of theancient past due to the discovery of vaccines andantibiotics. The same will be applied to COVID-19

To show the weakness and insignificance ofarrogant Man, since the simplest organisms suchas viruses, bacteria and parasites can cause himdiseases that can exhaust him and weaken him, asa deterrent to keep him humble. How sweet arethe words of the international actor Clint Eastwood atthe end of the movie (Magnum Force 1973) in his

got to know his

3. In order to know locations of the epidemic, as noone goes to the places of infection for the sake of‘Quarantine Principle’principle engineered by the Propheticepidemic (plague) befalls a land, do not enter it, orleave it, in order to escape from it (epidemic or the plague)].

4. For the livelihood, livelihood of medicalprofessional earnings of doctors, surgeons,laboratory analysts, pharmacists, midwives.

5. To balance the numbers of human beings, birthversus death, as deadly diseases and fatal accidentsput the scales back in line in balance with theborns.

6. To activate and strengthen the immune system against diseases by forming antibodies.

7. To regenerate tissues in the affected organ by theprocess of wound healing in order to replace the deadand the old tissues with new active one.

8. Human life has become longer than in the past due to advances in treating diseases and foodsciences. Perhaps the average lifespan of theJapanese is the longest in the world (80 years) due totheir fondness for eating raw and cooked fish, whilethe average lifespan of Africans is the shortest in theworld due to the spread of infectious diseases and therampant violence.

9. For self-education and prophylaxis and how totreat diseases by self-pain, indigestion, diarrhoea, dyspepsia, cough onlyby living through it and learning how to treat it andto prevent it. The flu remains unknown, no matter how much we talk about it, until you are beinginfected by it, so the lesson is takefrom infected people and by immunization. For instance, food poisoning due to mayonnaise (raweggs) in hot climate is better to be avoided in summerand in tropicalareas.Food poisoning due tocontamination during cooking as in Delhi bellyBaghdad belly.

10. To adapt to the new food (dieting orwisdom of the ancients: the stomach is the homeof disease and dieting is half the medicine, and inthe Arabic advice: We are a people who do not eatuntil we are hungry, and if we ea

Islam & Health

In order to know locations of the epidemic, as noone goes to the places of infection for the sake of‘Quarantine Principle’, which is a great Islamicprinciple engineered by the Prophetic hadith: [if anepidemic (plague) befalls a land, do not enter it, orleave it, in order to escape from it (i.e., from theepidemic or the plague)].

For the livelihood, livelihood of medicalprofessional earnings of doctors, surgeons,laboratory analysts, pharmacists, nurses, and

To balance the numbers of human beings, birth, as deadly diseases and fatal accidents

put the scales back in line in balance with the new-

To activate and strengthen the immune systemagainst diseases by forming antibodies.

in the affected organ by theprocess of wound healing in order to replace the deadand the old tissues with new active one.

has become longer than in the pastdue to advances in treating diseases and food

Perhaps the average lifespan of theJapanese is the longest in the world (80 years) due totheir fondness for eating raw and cooked fish, while

of Africans is the shortest in theworld due to the spread of infectious diseases and the

education and prophylaxis and how to-education, you only know

pain, indigestion, diarrhoea, dyspepsia, cough onlyby living through it and learning how to treat it andto prevent it. The flu remains unknown, no matterhow much we talk about it, until you are beinginfected by it, so the lesson is taken by staying awayfrom infected people and by immunization. Forinstance, food poisoning due to mayonnaise (raw

hot climate is better to be avoided in summerand in tropicalareas.Food poisoning due tocontamination during cooking as in Delhi bellyand in

To adapt to the new food (dieting or Behriz) (thewisdom of the ancients: the stomach is the homeof disease and dieting is half the medicine, and inthe Arabic advice: We are a people who do not eatuntil we are hungry, and if we eat, we do not fill-

55

up). Eat what is suitable for the stomach. Refrainingfrom spices, pepper, pickles, citrus,and by eating dairy products (such as nonbuttermilk, cheese, custard, and ice cream) and freshnatural food in its season instead of canned foodpreserved with artificial and harmful preservatives ispreferable.

11. To control genetic and family diseasesgenetic conditions appear in consanguineousmarriages. And here comes the prophetic wisdom inthe miraculous hadith: “get married to nonso that you are not weakened” ال تضووا حتى ) اغتربواThat is, marrying strangers to prevent offspringweakness.

12. To consult a doctor early. Pain, lack of appetite,nausea and vomiting may be an incentive to discovera disease earlier as in cancer and treat it in its earlystages before it eventually spreads and becomes anincurable disease. It is noticeable that Westernpatients go to the doctor at the beginning of thedisease because of health education and thephilosophical vision that the worldly life iseverything there, while the Eastern people soughtmedical advice late, not afraid of death, contrary tothe wonderful prophetic advice:(O’ servants of God, seek medical treatment, for Godhas not sent down a disease without a remfor death) فإن هللا ما أنزل داء إال له دواء إال هللا تداووا عباد

).الموت أي –السام

13. Economically, sickness is a blessing in disguise, it is a reason for job-rest by taking extended andrenewable sick leave with full salary.causes functional disability, disability benefit will begiven, especially in the West, and the disabled personqualifies for early retirement (Early retirement on illbasis).

14. Illness is a station for contemplation, and selfreview and audit before death, and the patientbecomes wise after illness before death, so he beginsto take matters seriously making dangerous decisionsin distributing his possessions and properties, whilealive. An incurable disease, especially cancer, is anopportunity to contemplate ‘Bucket list’ or wish listof the dying patients, mobilizing his energy tothem before death is too late. Therewith incurable and fatal stomach or colon diseaseswho made their wills before death by donating theirproperty and money to hospitals and charities.

Eat what is suitable for the stomach. Refraining citrus, and fried food;

and by eating dairy products (such as non-sour buttermilk, cheese, custard, and ice cream) and fresh

stead of canned food preserved with artificial and harmful preservatives is

To control genetic and family diseases whengenetic conditions appear in consanguineousmarriages. And here comes the prophetic wisdom in

arried to non-relatives,اغتربوا حتى ال تضووا(

That is, marrying strangers to prevent offspring

Pain, lack of appetite,nausea and vomiting may be an incentive to discover

er as in cancer and treat it in its earlystages before it eventually spreads and becomes anincurable disease. It is noticeable that Westernpatients go to the doctor at the beginning of thedisease because of health education and the

that the worldly life iseverything there, while the Eastern people soughtmedical advice late, not afraid of death, contrary to

(O’ servants of God, seek medical treatment, for Godhas not sent down a disease without a remedy, except

إال يا( دواء له إال أنزل داء هللا ما عباد هللا تداووا فإن

Economically, sickness is a blessing in disguise, itrest by taking extended and

renewable sick leave with full salary. If the diseasecauses functional disability, disability benefit will begiven, especially in the West, and the disabled personqualifies for early retirement (Early retirement on ill

Illness is a station for contemplation, and self-, and the patient

becomes wise after illness before death, so he beginsto take matters seriously making dangerous decisionsin distributing his possessions and properties, whilealive. An incurable disease, especially cancer, is an

‘Bucket list’ or wish listof the dying patients, mobilizing his energy to fulfil

late. There are rich peoplewith incurable and fatal stomach or colon diseases

before death by donating theirproperty and money to hospitals and charities.

15. Illness is an opportunity for the patient tocontemplate on his deathbed to reconsider thepriorities in life. Many Westerners have convertedto Islam, as in the case of the international singer ‘Cat Stevens’ after his tuberculosis and drowningwhile swimming in Malibu when he almost died. In his near-death experience, he sworn If God saves hislife and heals him, he will embrace Islam, so he didand changed his name to ‘Yusuf Islam’. The patientmay write a will to transfer his property to charitableorganizations. For example, the Superman character,represented by ‘Christopherfrom Tetraplegia, after falling from a horse, began tofeel the pain of others with spinal cord injuries. Hesubsequently donated his money to fund research onthe growth and repair of nerve tissue in the spinalcord; Perhaps research on stem cells was one of thefruits of this effort.

16. Patients with incurable diseases such as cancers,colon diseases and heart fconstitute a good sampleresearch on drug experiments and othertherapeutic interventions in order to find an idealtreatment to help others.

17. The dying patient in the West is encouraged todonate his organs afteorgan transplantation in donation of the cornea ofliver, lungs and, more recently, facetransplantation, provided that the death of thepatient is not due to septicaemiabrain cancer that It is allowed because it does notusually spread outside the skull). Also, fatal viraldiseases induce blood withdrawal and transfusion,especially the extraction of blood serum, for example, from patients with deadsave others.

18. Just as illness is a source of livelihood for doctors,pharmacists, and laboratory analysts, death afterillness is also a source of livelihood for“mortician”, “funeral director”, and ““to bury the dead, in addition to purchasing lands andburial grounds for the dead, and in the West, thereare places for crematorium.

B. The Religious (Islamic) wisdom

1. To know the grace of God upon us with health byits loss (by disease) and twellness by its existence (things are known by their

Islam & Health

Illness is an opportunity for the patient tocontemplate on his deathbed to reconsider the

Many Westerners have convertedto Islam, as in the case of the international singer

after his tuberculosis and drowningwhile swimming in Malibu when he almost died. In

death experience, he sworn If God saves hislife and heals him, he will embrace Islam, so he didand changed his name to ‘Yusuf Islam’. The patient

will to transfer his property to charitableorganizations. For example, the Superman character,

‘Christopher Reeve’, after sufferingfrom Tetraplegia, after falling from a horse, began tofeel the pain of others with spinal cord injuries. Hesubsequently donated his money to fund research onthe growth and repair of nerve tissue in the spinalcord; Perhaps research on stem cells was one of the

Patients with incurable diseases such as cancers,colon diseases and heart failure, for example,

good sample for a fertile field ofresearch on drug experiments and othertherapeutic interventions in order to find an idealtreatment to help others.

The dying patient in the West is encouraged todonate his organs after death for the purpose of organ transplantation in neighbourhoods such as donation of the cornea of the eye, kidney, heart, liver, lungs and, more recently, face

provided that the death of the septicaemia or cancer (except for

brain cancer that It is allowed because it does not usually spread outside the skull). Also, fatal viral diseases induce blood withdrawal and transfusion, especially the extraction of blood serum, for example, from patients with deadly viral infections to

Just as illness is a source of livelihood for doctors,pharmacists, and laboratory analysts, death afterillness is also a source of livelihood for“mortician”, “funeral director”, and “undertaker,

bury the dead, in addition to purchasing lands andburial grounds for the dead, and in the West, thereare places for crematorium.

The Religious (Islamic) wisdom of the disease:

To know the grace of God upon us with health byand to appreciate the blessing of

wellness by its existence (things are known by their

56

contrasts).Ibn Taymiyah says in the Minhaj of theProphetic Sunnah: (The creation of one of theopposites contradicts the creation of the other opposite, for the creation of the disease that bringsabout the servant’s humiliation to his Lord, hissupplication, his repentance from his sins, and hisatonement for his sins, and softening his heart, andremoving his pride, grandeur, and aggression, isagainst the creation health, with which these interestsdo not occur).

2. Then to thank God and praise Him when patient has recovered from what have afflicted othersin the famous saying (Praise be to God who saved usfrom what afflicted others),

)غيرناالحمد الذي عافنا مما ابتلى به ( because (Health is acrown on the heads of the healthy), so Man is filledwith peace of mind

3. He learns from illness to be content with God’sdecree and predestination:بقضاء هللا وقدرهThe companions of the Messenger of God, may God bless him and grant him peace, gave us the mostwonderful examples in this regard, and they achievedthe highest ranks in that, realizing in that his saying, peace and blessings be upon him: (And to believe indestiny, its good and its evil). God creates everythingas much. So, he knows that the disease that isdestined for him is only a test, (Perhaps a harmfulevent is beneficial) )نافعةرب ضارة ( (It may be that youhate a thing and God will make in it a lot of good)An-Nisa: 19.

Sickness is a divine gift that comes in the form ofan ordeal. “If God wants good for a servant, He testshim,”. The Prophet, may God’s prayers and peace beupon him, says: (If God wants good for Hisservant, He hastens the punishment for him inthis world, and if He intends evil for HiHe withholds from him his sin until Herecompenses him for it on the Day ofResurrection) Narrated by Alauthenticated. Al-Hassan Al-Basri said:the calamities that occur and the curses that occur, because in what you hate is your salvation,and in a matter, you like, is yourdestruction).Illness is the permanent law of lifethat a person learns that his worldly life is apermanent test, and his faith in God’s decree anddestiny increases, whether it is good or evil(apparently evil, as it seems to us).

contrasts).Ibn Taymiyah says in the Minhaj of the Prophetic Sunnah: (The creation of one of the opposites contradicts the creation of the other

the disease that brings about the servant’s humiliation to his Lord, his supplication, his repentance from his sins, and his atonement for his sins, and softening his heart, and removing his pride, grandeur, and aggression, is

with which these interests

Then to thank God and praise Him when patienthas recovered from what have afflicted others, as

(Praise be to God who saved us

because (Health is acrown on the heads of the healthy), so Man is filled

He learns from illness to be content with God’sبقضاء هللا وقدره يقنع

The companions of the Messenger of God, may Godnd grant him peace, gave us the most

wonderful examples in this regard, and they achievedthe highest ranks in that, realizing in that his saying,peace and blessings be upon him: (And to believe indestiny, its good and its evil). God creates everything

he knows that the disease that isdestined for him is only a test, (Perhaps a harmful

It may be that youhate a thing and God will make in it a lot of good)

comes in the form of“If God wants good for a servant, He tests

him,”. The Prophet, may God’s prayers and peace be(If God wants good for His

servant, He hastens the punishment for him inthis world, and if He intends evil for His servant,He withholds from him his sin until Herecompenses him for it on the Day of

Narrated by Al-Tirmidhi andBasri said: (Do not hate

the calamities that occur and the curses thatate is your salvation,

and in a matter, you like, is yourdestruction).Illness is the permanent law of life, sothat a person learns that his worldly life is apermanent test, and his faith in God’s decree anddestiny increases, whether it is good or evil

The Almighty said: (We shall test you withsomething of fear, hunger, lack of money and livesand fruits, and glad tidings to the patients) Cow: 155.The acts of God are all full of wisdom.

Ibn al-Qayyim says in ‘igathe sick: (The Lord, Glory be to Him, never doesevil, but rather His actions are all good, wise, as the Almighty said: (In Your hand is thegood) ) بيدك الخير ( (Al Imran: 26). He does not createpure evil from all aspects).Ibn Uthaymeen said: (God created everything goodand evil, but evil is not attributed to Him, becauseHe created evil for wisdom, thusit is converted togood in His wisdom. Things created can be one of3 types: Pure evil, such as fire and Sat

their selves; but considering the wisdom forwhich God created them, it is good

Pure good, such as heaven, angels.

There is good and evil in itjinn, and animals. (Fatwas of Ibn Uthaymeen).

4. With sickness, a person shows all kinds ofdevotion to God, such as fear and humility. Illnessinflicts upon a Muslim a lot of harm andadversity, which leads him to fears, until it leadshim to monotheism, and his heart becomeattracted to his Lord alone, so he calls Hisincerely to heal him.It is narrated that when bin Al-Zubayr was inflicted by gangrene of theleg(likely to be diabetic), he said:seven sons, so You took one and kept six, and Ihad four limbs, so You took one limb and kept three, and if I was afflicted, I recovered.” And ifyou took something, youlooked at his leg in the basin after it had been cut off and said: God knows that I have never led youto sin, and I know. Al-Fadl bin Sahl, the minister of alill one day, and when he recovered, he sat down tothe people, so they congratulated him and said:the ills, there are blessings that sane people shouldknow. A scrutiny of guilt and exposure to thereward of patience, awakening from negligence, aremembrance of grace in a state of health, asummons to repentance, an exhortation to charity,and faith in God’s decree and destiny after giventhe choice .“

5. Encouragement and Incitement to supplication: Imam Ahmad and Ibn Majah narrated on the

Islam & Health

The Almighty said: (We shall test you with something of fear, hunger, lack of money and lives and fruits, and glad tidings to the patients) Cow: 155. The acts of God are all full of wisdom.

Qayyim says in ‘igathat al-lahfan’ or healing (The Lord, Glory be to Him, never does

evil, but rather His actions are all good, good, and wise, as the Almighty said: (In Your hand is the

(Al Imran: 26). He does not create all aspects).

(God created everything good and evil, but evil is not attributed to Him, because He created evil for wisdom, thusit is converted to

Things created can be one of

, such as fire and Satan, considering their selves; but considering the wisdom for which God created them, it is good.

, such as heaven, messengers, and

There is good and evil in it, such as humans, and animals. (Fatwas of Ibn Uthaymeen).

a person shows all kinds ofdevotion to God, such as fear and humility. Illnessinflicts upon a Muslim a lot of harm andadversity, which leads him to fears, until it leadshim to monotheism, and his heart becomeattracted to his Lord alone, so he calls Him

It is narrated that when Urwa was inflicted by gangrene of the

leg(likely to be diabetic), he said: “Oh God, I had seven sons, so You took one and kept six, and I had four limbs, so You took one limb and kept

d if I was afflicted, I recovered.” And if something, you kept something. Then he

looked at his leg in the basin after it had been cut off and said: God knows that I have never led you

Fadl bin Sahl, the minister of al-Ma’munbecame ill one day, and when he recovered, he sat down to the people, so they congratulated him and said: “In the ills, there are blessings that sane people should know. A scrutiny of guilt and exposure to the

ard of patience, awakening from negligence, a remembrance of grace in a state of health, a summons to repentance, an exhortation to charity, and faith in God’s decree and destiny after given

Incitement to supplication:Imam Ahmad and Ibn Majah narrated on the

57

authority of Thawban, that the Messenger of God,may God’s prayers and peace be upon him, said(Nothing will turn back fate except supplication,and nothing will increase life except righteousness).

)إال الدعاء وال يزيد في العمر إال البر

6. The rule of isolation (Quarantine Principle)treat God’s destiny by God’s destinyAl-Khattab went out to Syria, and when he reached‘Sar’a’, he met people of Ajnad battle (Abu Ubaidahbin Al-Jarrah and his companions), so they told himthat the epidemic had occurred in the Levant, Ibn Abbas said: Omar said: Call for me the firstimmigrants So I called them, so he consulted themand told them that the epidemic had occurred in theLevant, but they differed (in opinions).

Some of them said: You have come out for aand we do not think you should turn back from it,and some of them said: The rest of the people and thecompanions of the Messenger of God, may God’sprayers and peace be upon him, are with you, and wedo not think that you should precede them over thisepidemic. He said: leave me alone and call the Ansar (the supporters), but they took the same path of theEmigrants, and they differed as their differences, sohe said: Invite the sheikhs of Quraysh from theEmigrants of the Conquest, so I called them, and twomen did not disagree about it, they said: We see thatyou return the people and do not lead them to this epidemic, so Omar called out to the people: I amwaking in the morning and at noon, they came to him. ‘Abu Ubaidah bin Al-Jarrah’ said: Fleeing fromGod’s decree?! Omar said: “If someone else said it,O Abu Ubaidah - and Omar hated disagreeing withhim — yes, we flee from God’s destiny by God’sdestiny. What do you think if you hdescended into a valley that had two areas, one of them fertile and the other barren, is graze them the lush, you graze them by destiny of God, and if you graze them the barren, you grazethem by destiny of God?” He said:Rahman bin Auf’ came and was absent engaged insome of his needs, and said: I have the knowledge ofthis, I heard the Messenger of God, may God blesshim and grant him peace, say: [if an epidemic(plague) befalls a land, do not enter it, or leavin order to escape from it (i.e. from the epidemicor the plague)]. Omar Ibn Al-Khattab said: Praisebe to God, then he left.

authority of Thawban, that the Messenger of God, may God’s prayers and peace be upon him, said: (Nothing will turn back fate except supplication, and nothing will increase life except

وال يزيد في العمر إال البرال يرد القدر ( إال الدعاء

The rule of isolation (Quarantine Principle) and to God’s destiny by God’s destiny: Omar Ibn

Khattab went out to Syria, and when he reached , he met people of Ajnad battle (Abu Ubaidah

and his companions), so they told him that the epidemic had occurred in the Levant, Ibn Abbas said: Omar said: Call for me the first immigrants So I called them, so he consulted them and told them that the epidemic had occurred in the

ered (in opinions).

Some of them said: You have come out for a matter, and we do not think you should turn back from it, and some of them said: The rest of the people and the companions of the Messenger of God, may God’s

with you, and we do not think that you should precede them over this epidemic. He said: leave me alone and call the Ansar (the supporters), but they took the same path of the Emigrants, and they differed as their differences, so

hs of Quraysh from the Emigrants of the Conquest, so I called them, and two men did not disagree about it, they said: We see that you return the people and do not lead them to this epidemic, so Omar called out to the people: I am

at noon, they came to Jarrah’ said: Fleeing from

God’s decree?! Omar said: “If someone else said it, and Omar hated disagreeing with

destiny by God’s . What do you think if you had camels? and

descended into a valley that had two areas, one of it not that if you

lush, you graze them by destiny of barren, you graze

them by destiny of God?” He said: So ‘Abd al-Rahman bin Auf’ came and was absent engaged in some of his needs, and said: I have the knowledge of this, I heard the Messenger of God, may God bless

[if an epidemic (plague) befalls a land, do not enter it, or leave it, in order to escape from it (i.e. from the epidemic

Khattab said: Praise

The witness in the story here is the words of Umar, may God be pleased with him, to Abu Ubaidah: “we flee from God’s destiny by God’s destinyThis word that the inspiring Caliph uttered hasbecome immortal and clarifies the matter decisively.

7. Giving reasons to see doctors, not just treatment by performing the legal ‘ruqyah’, and drinkingholly water of Zamzamdespairing. For example, having cancer does notmean death from it or the inability to recover from itas some might imagine. Imam Muslim narrated onthe authority of Jaber, that the Prophet, may God’s prayers and peace be upon him, disease there is a cure. And the appropriatemedicine hit that particular disease, he will becured, God willing.

On the authority of Anas, he said: The Messenger ofGod, may God bless him and grant him peace, said:“God the Mighty and tthat wherever the disease is created, the medicineis created too, so seek medical treatment.”Narrated by Ahmad on the authority of Osama binSharik, he said: The Bedouins said: O Messenger of God, shall we not seek medical treatment(Yes, O servants of God, seek medication, for Godhas not created a disease without creating a curefor it, except for one disease. They asked: OMessenger of God, what is it? He said: AlHaram). Narrated by Alterminal disease and weakness of the elderly, and ithas no cure.

8. For the sake of illness, he learned patience,endurance and strong will. Patience in this worldwill bring about a high degree on the Day of Resurrection (Only the patient will be paid theirwages without reckoning)

.)إنما يوفى الصابرون أجورهم بدون حسابNarrated that Anas: (The greatest reward goes to thegreatest affliction, and that if God loved folk, Hetests them, whoever is pleased God will be pleasewith him, and whoever has discontent, God will bediscontented with him.” Narrated by Al

وإن هللا إذا أحب قوما ابتالهم، فمن عظم البالء، عظم الجزاء من إن)رضي فله الرضا، ومن سخط فله السخط

Thus, the greater the affliction, the greater thereward, for the easy affliction has a small reward,and the severe affliction has a great reward, and thisis from the grace of God Almighty over His servants.

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The witness in the story here is the words of Umar, may God be pleased with him, to Abu Ubaidah: “yes,

destiny by God’s destiny.” This word that the inspiring Caliph uttered has

clarifies the matter decisively.

Giving reasons to see doctors, not just treatmentby performing the legal ‘ruqyah’, and drinking

of Zamzam, and praying a lot, and notFor example, having cancer does not

mean death from it or the inability to recover from itas some might imagine. Imam Muslim narrated onthe authority of Jaber, that the Prophet, may God’sprayers and peace be upon him, said: “For everydisease there is a cure. And the appropriatemedicine hit that particular disease, he will be

On the authority of Anas, he said: The Messenger ofGod, may God bless him and grant him peace, said:“God the Mighty and the Majestic commanded

the disease is created, the medicineis created too, so seek medical treatment.”

n the authority of Osama binSharik, he said: The Bedouins said: O Messenger ofGod, shall we not seek medical treatment? He said:(Yes, O servants of God, seek medication, for Godhas not created a disease without creating a curefor it, except for one disease. They asked: OMessenger of God, what is it? He said: Al-

by Al-Tirmidhi. (Al-Haram) is theterminal disease and weakness of the elderly, and it

For the sake of illness, he learned patience,endurance and strong will. Patience in this worldwill bring about a high degree on the Day of

(Only the patient will be paid theirwages without reckoning)

إنما يوفى الصابرون أجورهم بدون حساب(Narrated that Anas: (The greatest reward goes to thegreatest affliction, and that if God loved folk, Hetests them, whoever is pleased God will be pleased with him, and whoever has discontent, God will be discontented with him.” Narrated by Al-Tirmidhi.

فمن ( ابتالهم، قوما أحب هللا إذا إن عظم الجزاء من عظم البالء، وإنرضي فله الرضا، ومن سخط فله السخط

Thus, the greater the affliction, the greater the reward, for the easy affliction has a small reward, and the severe affliction has a great reward, and this is from the grace of God Almighty over His servants.

58

This does not contradict the legitimacy of asking God for wellness, guarding against the and calamity, and searching for medicine andtreatment after a disease has occurred. Grumbling iscontrary to contentment with God destiny. There isnothing wrong with showing one's pain, just as thereis nothing wrong with seeking medicabecause of illness.

The poet says: Patience like its name, its taste isbitter,but its consequences are sweeter than honey

العسل من أحلى عواقبه لكن * مذاقته مر

Patience is the path to healing, safety, and glory, andone of the greatest advantages of leadership, as AbuAli al-Baghdadi says: Do not count glory as dates you eat @ You will notreach glory until you lick the patience

لن تبلغ المجد حتى تلعق الصبرا * آكله أنت تمرا

9. Illness is a test to erase bad deeds and increasegood deeds. Al-Bukhari narrated that the Prophetsaid: “No illness, anxiety, sadness, or harm befalls abeliever, not even a thorn that pricks him, but thatGod erases some of his sins through it.”

هم وال حزن وال أذى، حتى الشوكة ما يصيب المؤمن من وصب وال)يشاكها إال كفر هللا بها من خطاياه

That testing is:

A- Sometimes, it is to erase sins and bad deeds.

B-Sometimes, it is to raise degrees and increase good deeds, as is the case in God’s testing of his prophets. TheMessenger of God, peace and blessings be upon him, said: “The most severely tested people are the prophets,then the next best, then the next… The affliction does notend with the servant until he leaves him walking on theearth with no sin on him.”) Narrated by Al

األنبياء، ثم األمثل فاألمثل فما يبرح البالء بالعبد حتى ... أشد الناس بالء )يتركه يمشي على األرض وما عليه خطيئة

C-For scrutiny of believers to distinguish them from the hypocrites, the Almighty said: (We have tried thosebefore them so that God knows who the honest from theliars) Spider:3.Thus, God tests His servants so that the true believersmay be distinguished from others, and that those who arepatient in affliction may be known from those who arenot.

D-And sometimes the believer is punished withcalamity for committing some sins, as the Messenger,

This does not contradict the legitimacy of asking God for wellness, guarding against the causes of illness and calamity, and searching for medicine and treatment after a disease has occurred. Grumbling is contrary to contentment with God destiny. There is nothing wrong with showing one's pain, just as there is nothing wrong with seeking medical advice

The poet says: Patience like its name, its taste is its consequences are sweeter than honey

مر اسمه مثل والصبر

Patience is the path to healing, safety, and glory, and one of the greatest advantages of leadership, as Abu

Do not count glory as dates you eat @ You will not reach glory until you lick the patience

تمرا المجد تحسب ال

o erase bad deeds and increaseBukhari narrated that the Prophet

said: “No illness, anxiety, sadness, or harm befalls a believer, not even a thorn that pricks him, but that God erases some of his sins through it.”

وال( وصب ما يصيب المؤمن منيشاكها إال كفر هللا بها من خطاياه

Sometimes, it is to erase sins and bad deeds.

Sometimes, it is to raise degrees and increase goodas is the case in God’s testing of his prophets. The

Messenger of God, peace and blessings be upon him,said: “The most severely tested people are the prophets,then the next best, then the next… The affliction does not

s him walking on the Narrated by Al-Bukhari.

فاألمثل( األمثل أشد الناس بالء األنبياء، ثمخطيئة يتركه يمشي على األرض وما عليه

For scrutiny of believers to distinguish them fromthe Almighty said: (We have tried those

before them so that God knows who the honest from the

Thus, God tests His servants so that the true believersmay be distinguished from others, and that those who are

wn from those who are

And sometimes the believer is punished withas the Messenger,

may God’s prayers and peace be upon him, said: (A manis deprived of sustenance by a sin that afflicts him, andnothing faces fate except by supplication, and the lifeonly increases by righteousness) Narrated by Ahmad, andothers. There are 2 other sayings for the Prophet(Wonderful is the affair of the believer, for all his affair is good, and this is not for anyone except forIf good things befall him, then he is thankful to God, hewill have a reward, and if adversity befalls him, he ispatient, then he will have a reward, so all of God’s decreefor the Muslim is good).

خير، وليس أمره كله ألمر المؤمن، إن ذلك ألحد إال للمؤمن، إن عجبافله أجر، وإن أصابته ضراء فصبر فله أجر، فكل هللا فشكر سراء أصابه

(Indeed, a man will have a rank with God, so he does notreach it with action, so he continues to afflict him withwhat he hates until he reachwho experiences prosperity and grace and thanks hisLord will achieve good, and that is because God loves thethankful and increases them from His blessings, theAlmighty said: (If you are thankful, I will surely increaseyou) Ibrahim:7 هللا المنزلة فما يبلغها بعمل، فما يزال يبتليه بما عند له ليكون إن الرجل

10. Responding to the patient's supplication forhimself and for others,to God spiritually and with him. His visitors askpatient to supplicate for them, because illness bringsthe sick closer to God Almighty, and this is a specialcloseness. God Almighty says in the Qudsi hadith:(Son of Adam, my servant was visit him, but if you visited him, you wwith him), Narrated by Muslim,

فلم تعده، أما لو عدته لوجدتني )عندهمرضam at the broken hearted)

11. God made disease a station to break the Caesars,break theKhosrau’s, and to size. Nimrod of Iraq was killed by an insect,and the Pharaoh of Egypt was tortured by liceand locusts.

12. To strengthen social bonds at the patient's bedbetween the patient's relatives, peers. Paying a visit to ththe Muslim (a Muslim has to visit his brother if hebecomes ill, and to walk in his funeral if he dies).

13. To know the nature of his family and to know hisenemy from his friend:real brothers, and (may God have a brother for you that your mother did not give birth to).

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may God’s prayers and peace be upon him, said: (A man is deprived of sustenance by a sin that afflicts him, and

e except by supplication, and the life only increases by righteousness) Narrated by Ahmad, and others. There are 2 other sayings for the Prophet ملسو هيلع هللا ىلص: (Wonderful is the affair of the believer, for all his affair is good, and this is not for anyone except for the believer. If good things befall him, then he is thankful to God, he will have a reward, and if adversity befalls him, he is patient, then he will have a reward, so all of God’s decree

وليس( عجبا ألمر المؤمن، إن أمره كله خير،فكل أجر، فله فصبر أصابه سراء فشكر هللا فله أجر، وإن أصابته ضراء

).قضاء هللا للمسلم خير(Indeed, a man will have a rank with God, so he does not reach it with action, so he continues to afflict him with what he hates until he reaches that rank). The believer who experiences prosperity and grace and thanks his Lord will achieve good, and that is because God loves the thankful and increases them from His blessings, the Almighty said: (If you are thankful, I will surely increase

فما يزال يبتليه بما ( يبلغها بعمل، إن الرجل ليكون له عند هللا المنزلة فما). يكره حتى يبلغه إياها

Responding to the patient's supplication forhimself and for others, for the patient is very closeto God spiritually and with him. His visitors ask thepatient to supplicate for them, because illness bringsthe sick closer to God Almighty, and this is a specialcloseness. God Almighty says in the Qudsi hadith:(Son of Adam, my servant was sick, and you did not visit him, but if you visited him, you would find me with him), Narrated by Muslim, )بن آدم، عبدي فالن يا ا

عدته لوجدتني أما لو and he also said: (I مرض فلم تعده،am at the broken hearted) )أنا عند المنكسرة قلوبهم. (

God made disease a station to break the Caesars,s, and reduce the unjust rulers

to size. Nimrod of Iraq was killed by an insect,and the Pharaoh of Egypt was tortured by lice

To strengthen social bonds at the patient's bedbetween the patient's relatives, families, and

a visit to the sick is one of the rights ofthe Muslim (a Muslim has to visit his brother if hebecomes ill, and to walk in his funeral if he dies).

To know the nature of his family and to know hisenemy from his friend: in adversity you know the

ay God have a brother for youthat your mother did not give birth to).

59

)رب أخ لك لم تلده أمك( Friend in need is friend indeed

14. In the aggravation and spread of infectiousdisease, people are urged to support one anotherin social solidarity, when fighting epidemics anddiseases.

Friend in need is friend indeed.

n the aggravation and spread of infectiousdisease, people are urged to support one another

fighting epidemics and

15. Sickness encourages charity. And the hadithsof the Prophet (PBUH) are among themasterpieces in this field: (Treat yourpatients with charity deeds protect from bad endings). )صنائع المعروف تقي مصارع السوء

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Sickness encourages charity. And the hadithsof the Prophet (PBUH) are among themasterpieces in this field: (Treat yourpatients with charity -sadaqa). (Doing gooddeeds protect from bad endings).

صنائع المعروف تقي مصارع السوء( )بالصدقةداووا مرضاكم (

60

Dr Hussein Nagi

Pain consultant, City Hospital, Birmingham, UK

hnagi11@hotmail.com

The only commodity in life that is given to all mankindin absolute equality is time. We all share the same 24hours a day, 7 days through the week and 365 days per year. Yet only two variables differ; how many years eachof us is given and how we spend this time, the formerbeing uncontrollable, the latter being in our grasp. One ofthe first things that each one of us will be questionedabout by God Almighty is our time. The Islamicliterature does not go into detail regarding what the unitof time is that we are going to be accounted for. Is itevery second, minute, day? But from that sense of responsibility, I’ll try to shed some light on how tomanage our precious time.

The aims of this article are:

1. To enable you to make the most of your time

2. To become more efficient in day-to-day activities.

3. To be more reliable and efficient

4. To achieve a better work-life balance.

5. To educate others around you not to be trapped bytheir bad time management.

Before learning about time management there is aquestion that must be asked. Why do you want to manageyour time better? What is your motivation? What is your goal? Do you have that sense of valuing your time andwhat are you going to do if you have more of it?

To put it another way, if you have 26 hours a day or 8days a week, will that make a difference to you? Whatare your wishes or goals in the short and long term?

For most of us, our starting point is to create a “to do list”for both the short- and long-term. Such lists should besplit according to two classifications; importance andurgency, both of which are further subdivided into high and low. High importance and high urgency items (

Pain consultant, City Hospital, Birmingham, UK

hnagi11@hotmail.com

The only commodity in life that is given to all mankind in absolute equality is time. We all share the same 24 hours a day, 7 days through the week and 365 days per year. Yet only two variables differ; how many years each

is time, the former being uncontrollable, the latter being in our grasp. One of the first things that each one of us will be questioned about by God Almighty is our time. The Islamic literature does not go into detail regarding what the unit

t we are going to be accounted for. Is it every second, minute, day? But from that sense of responsibility, I’ll try to shed some light on how to

To enable you to make the most of your time

day activities.

life balance.

To educate others around you not to be trapped by

Before learning about time management there is a ust be asked. Why do you want to manage

your time better? What is your motivation? What is your goal? Do you have that sense of valuing your time and what are you going to do if you have more of it?

another way, if you have 26 hours a day or 8 ays a week, will that make a difference to you? What

are your wishes or goals in the short and long term?

For most of us, our starting point is to create a “to do list” term. Such lists should be

ications; importance and urgency, both of which are further subdivided into high and low. High importance and high urgency items (A in

the table) are the highest priority, but too many of themwill burn you out. High importance, low urgency tasks(B) can be set aside until there is time available to planthem properly. Low importance, high urgency tasks (can be delegated to others or be taught to others so thatthey no longer need to be undertaken by you. Finally, low importance and low urgency tasks (relaxation and hobbies, should not be sacrificedotherwise burnout may occur in the long run. (Table 1).

Table 1:

High Importance

High Urgency

A (no delegation)

Low Urgency

B (plan for later)

It would be important to follow a

1. Make your ‘To Do List’

2. Prioritize it according to your goals

3. Fill in the week

4. Give double the time you expect for each task

5. Leave gaps for unexpected tasks

6. Fill in the gaps.

7. Learn how to deal with time wasters.

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the table) are the highest priority, but too many of them will burn you out. High importance, low urgency tasks

be set aside until there is time available to planthem properly. Low importance, high urgency tasks (C)can be delegated to others or be taught to others so thatthey no longer need to be undertaken by you. Finally,low importance and low urgency tasks (D), such asrelaxation and hobbies, should not be sacrificedotherwise burnout may occur in the long run. (Table 1).

High Importance Low Importance

A (no delegation) C (others badly managed)

B (plan for later) D (relaxed time)

It would be important to follow a step-by-step guide:

Prioritize it according to your goals

Give double the time you expect for each task

Leave gaps for unexpected tasks

to deal with time wasters.

61

Giving double the time will give you more confidenceand may create more relaxation time…enjoy it as areward. Filling the gaps in your day can be looked at likea jar full of big pieces of rocks presenting your categoryA, the highly important, highly urgent tasks. Then comethe smaller-sized pieces representing the less important,less urgent tasks. Finally comes the sand that will fill allsmall spaces i.e., almost every minute of your day.

There are so many time wasters in our day, one of thembeing telephone calls. Every one of us has one or two people who we know call us just for a chat or to kill fewprecious minutes of our time. One of the ways to dealwith such calls is the GROW model:

G: what is the goal of the call?

R: establish the reality of the situation. For example, so,you are calling me now to chat about your booked holiday.

O: options; for example, by saying: can we have a chatabout it later on tonight or when we meet on theweekend?

W: what will you decide or wrapping it up and endingthe call.

Paperwork is another known time trap, and we can dealwith it in one or two ways. The Salami, or Pastrami, waymeaning bit by bit, spending short spells of time, even 510 minutes at a time, to start sorting files ain three piles: urgent, filing and binning. The alternativeway is to dedicate a whole day and decide to take amassive action of sorting all these files in one go.

Procrastination, meaning delaying decisions or actionsand letting an issue or a decision that needs to be faced todrag on and on. Fear, frustration or simply a lack of courage or knowledge are all known reasons why wedelay things and most of us have been in this situation atleast once, however this should not paralyse us or outeams from moving forward. It usually leads to spendingmore time on tasks in the long term. Take for examplehow much time we spend trying to find something in themiddle of a disorganized cupboard or a room. The delayin taking the decision and sorting that room or drawer outbecause of the fear that it may take a long time actuallyresults in wasting more time in the longfind an item in the middle of the chaos. So, one tool of dealing with this handicapping shortfall is to ask why youare delaying facing the issue at hand, then try to find asolution to address these reasons. Facing these reasons is

Giving double the time will give you more confidence and may create more relaxation time…enjoy it as a reward. Filling the gaps in your day can be looked at like a jar full of big pieces of rocks presenting your category

highly important, highly urgent tasks. Then come sized pieces representing the less important,

less urgent tasks. Finally comes the sand that will fill all small spaces i.e., almost every minute of your day.

r day, one of them being telephone calls. Every one of us has one or two people who we know call us just for a chat or to kill few precious minutes of our time. One of the ways to deal

R: establish the reality of the situation. For example, so, you are calling me now to chat about your booked

O: options; for example, by saying: can we have a chat about it later on tonight or when we meet on the

e or wrapping it up and ending

Paperwork is another known time trap, and we can deal with it in one or two ways. The Salami, or Pastrami, way meaning bit by bit, spending short spells of time, even 5-10 minutes at a time, to start sorting files and documents in three piles: urgent, filing and binning. The alternative way is to dedicate a whole day and decide to take a massive action of sorting all these files in one go.

Procrastination, meaning delaying decisions or actions r a decision that needs to be faced to

drag on and on. Fear, frustration or simply a lack of courage or knowledge are all known reasons why we delay things and most of us have been in this situation at least once, however this should not paralyse us or our teams from moving forward. It usually leads to spending more time on tasks in the long term. Take for example how much time we spend trying to find something in the middle of a disorganized cupboard or a room. The delay

that room or drawer out because of the fear that it may take a long time actually results in wasting more time in the long-term trying to find an item in the middle of the chaos. So, one tool of dealing with this handicapping shortfall is to ask why you re delaying facing the issue at hand, then try to find a

solution to address these reasons. Facing these reasons is

the best way to take the first step towards dealing withany of them.

Delegation is key for more achievement so you can havetime to do more or to progress to the next level of your planned goals. There is a science and an art to delegationto make it work for you and your time. Knowing who todelegate to, what to delegate and when to delegate are allessential for delegation to work for anyonfollow up and feedback from and to the person you havedelegated to are essential ingredients of the wholeprocess. We all understand the sequence of see one, doone and teach one when we are learning new skills andtaking new responsibilities and roles. As a general rulewe start by delegating the least urgent, least importanttasks then move upward gradually when becoming moreconfident and trusting of our team members.

One final skill that we need not only to learn but to master is how to do more tasks simultaneously. Multitasking is being practiced by almost all of us, butwe do not realise that we are already doing it. We alllisten to our patients while taking history andsimultaneously typing or writing few words at the sametime. How about if you can have someone watching you doing this as part of their training? So here you are, youhave already added a third task. You may even add to that the organising of some leaflets, in advance, of mostof the conditions or procedures that you your patients and so on.

Two concepts that many scientists are probably shy totalk about is the blessing in time and the blessed time. The blessing in time is what most of us will callefficiency in utilising our time, i.e., achieving morminimum time. This efficiency, or what Muslim scholarscall blessing, is based on a balance between both tangibleand spiritual factors as a general Islamic concept in looking at life as a whole. Planning, prioritising, preparedness, and self-discrequirements, and the spiritual element of praying,knowing your self-limitation and above all focusing onthe ultimate goal that whatever you are doing is, aboveall, to please your Creator and to be in harmony withyour well recognised values in life. This balance gives usall that extra energy and efficiency, which early scholarssimply called blessing.

The blessed time is that time of the day where you aremost fresh, eager to perform and full of energy. Most ofthe great Muslim scholars historically identify that timeas being the time after their early morning (dawn) prayer.Provided that you had good quality sleep, this is where

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the best way to take the first step towards dealing with

Delegation is key for more achievement so you can have or to progress to the next level of your

planned goals. There is a science and an art to delegation to make it work for you and your time. Knowing who to delegate to, what to delegate and when to delegate are all essential for delegation to work for anyone. Supervision, follow up and feedback from and to the person you have delegated to are essential ingredients of the whole process. We all understand the sequence of see one, do one and teach one when we are learning new skills and

ties and roles. As a general rule we start by delegating the least urgent, least important tasks then move upward gradually when becoming more confident and trusting of our team members.

One final skill that we need not only to learn but to to do more tasks simultaneously.

Multitasking is being practiced by almost all of us, but we do not realise that we are already doing it. We all listen to our patients while taking history and simultaneously typing or writing few words at the same

w about if you can have someone watching you doing this as part of their training? So here you are, you have already added a third task. You may even add to that the organising of some leaflets, in advance, of most of the conditions or procedures that you need to give to

Two concepts that many scientists are probably shy to talk about is the blessing in time and the blessed time. The blessing in time is what most of us will call efficiency in utilising our time, i.e., achieving more in the minimum time. This efficiency, or what Muslim scholars call blessing, is based on a balance between both tangible and spiritual factors as a general Islamic concept in looking at life as a whole. Planning, prioritising,

discipline are all basic requirements, and the spiritual element of praying,

limitation and above all focusing on the ultimate goal that whatever you are doing is, above all, to please your Creator and to be in harmony with

ed values in life. This balance gives us all that extra energy and efficiency, which early scholars

The blessed time is that time of the day where you are most fresh, eager to perform and full of energy. Most of

holars historically identify that time as being the time after their early morning (dawn) prayer. Provided that you had good quality sleep, this is where

62

your body and mind are fresh to tackle what was plannedfor already, like studying, revising etc.

To summarise then, we must have a goal or goals to useour time successfully. We start with a ‘to do list’,prioritize the items on that list according to level of urgency and importance. Fill in the weekdays spreading these items according to your timetable.double the initial expected time for each task. Leave gapsin between for unexpected tasks then fill in the gaps withother smaller tasks. Learn how to deal with time wastersby developing your own strategies that work best for you.Finally celebrate your achievements to boost your energy

your body and mind are fresh to tackle what was planned

summarise then, we must have a goal or goals to use our time successfully. We start with a ‘to do list’, prioritize the items on that list according to level of urgency and importance. Fill in the weekdays spreading these items according to your timetable. Give each item double the initial expected time for each task. Leave gaps in between for unexpected tasks then fill in the gaps with other smaller tasks. Learn how to deal with time wasters by developing your own strategies that work best for you.

ly celebrate your achievements to boost your energy

before moving on to the next goal. Be aware of theblessing that you have the option to spend time on different tasks and keep the balance between the four mentioned squares of importance and urgency.

Further recommended reading:

Effective Time Management Skills for Doctors(Developmedica): Making the Most of the Time You Have (Progressing Your Medical Career): Making theMost of the Time You Have (Developmedica)– 31 Oct. 2009. By Sarah ChristieISBN-13 : 978-1906839086

Islam & Health

before moving on to the next goal. Be aware of the blessing that you have the option to spend time on different tasks and keep the balance between the four mentioned squares of importance and urgency.

urther recommended reading:

Effective Time Management Skills for Doctors (Developmedica): Making the Most of the Time You Have (Progressing Your Medical Career): Making the Most of the Time You Have (Developmedica) Paperback

Sarah Christie .

63

Lina Haitham, Mohammad Alhasan

Dr Fadi Alhalabi, MD Fadi.h@multiaidprograms.org

Lebanon currently has the highest proportion of Syrianrefugees in the world relative to the number of citizens,with 855,172 registered Syrian refugees according to theUnited Nations High Commissioner for Refugees (UNHCR) office in Lebanon (1).

The disruption in the formation of the government over several non-consecutive years affected the Lebanesehealth care system, which was already suffering frommany challenges even before hosting refugees and led tomore difficulties. According to the VulnerabAssessment of Syrian Refugees in Lebanon (VASyR)the poverty rate among Syrian refugees has risen to 75percent. Moreover, their purchasing power has decreased due to the deterioration of the Lebanese currencyexchange rate. The demand for healthamong Syrian refugees has declined since 2019 becauseof various factors associated with the Lebanese economiccrisis(3), which has led to an unprecedented increase inprices, including high fees for hospitals and doctors, drugprices and transportation costs, and has therefore affectedthe extent to which refugees consider their health needs apriority.

The Lebanese situation and the current healthcarerealities means that the state is losing the capacity toprovide healthcare services on its own due to its limitedfinancial means and strategic planning to meet the needsof the population, including refugees. Healthcare inLebanon is mostly executed by the private sectorit more expensive for the vast majority of refugees, lessable to accommodate them, and inaccessible to themajority of the population. Most secondary and tertiaryhealth care institutions (specialized and highlyspecialized) are private, making the high financial cost of medical services a major challenge to Syrian refugees inLebanon.(4). Lebanon's health care system is alsoheavily dependent on international funding for refugeehealth care, making it more vulnerable to economic crises

Lina Haitham, Mohammad Alhasan, Fadi Alhalabi

Dr Fadi Alhalabi, MD - General Director of the Multi Aid Programs (MAPS), Lebanon

Lebanon currently has the highest proportion of Syrian refugees in the world relative to the number of citizens, with 855,172 registered Syrian refugees according to the United Nations High Commissioner for Refugees

disruption in the formation of the government over consecutive years affected the Lebanese

health care system, which was already suffering from many challenges even before hosting refugees and led to more difficulties. According to the Vulnerability Assessment of Syrian Refugees in Lebanon (VASyR)(2), the poverty rate among Syrian refugees has risen to 75 percent. Moreover, their purchasing power has decreased

he deterioration of the Lebanese currency exchange rate. The demand for health-care services among Syrian refugees has declined since 2019 because of various factors associated with the Lebanese economic

, which has led to an unprecedented increase in rices, including high fees for hospitals and doctors, drug

prices and transportation costs, and has therefore affected the extent to which refugees consider their health needs a

The Lebanese situation and the current healthcare hat the state is losing the capacity to

provide healthcare services on its own due to its limited financial means and strategic planning to meet the needs of the population, including refugees. Healthcare in Lebanon is mostly executed by the private sector, making it more expensive for the vast majority of refugees, less able to accommodate them, and inaccessible to the majority of the population. Most secondary and tertiary health care institutions (specialized and highly

he high financial cost of medical services a major challenge to Syrian refugees in

Lebanon's health care system is also ependent on international funding for refugee

health care, making it more vulnerable to economic crises

and increased donor burdens. The system has becomeheavier and increasingly unable to cope with thesituation, especially as a result of the current bucrises in the country (5). Several actors have respondedjointly to the health needs of Syrian refugees in Lebanonover the past eight years. These actors consist of thenetwork of primary healthcare centers of the Ministry ofPublic Health (MOFH), UNHCR, local NGOs, (6) other international NGOs and humanitarian agencies such asWHO. (7)

The UNHCR in Lebanon covers approximately 85% ofprimary health care expenses for refugees in some casesthat need urgent interventions, as UNHCR contractsannually with medical institutions to provide medicalservices for free or at low cost in primary health carecenters and Lebanese hospitals. In addition to UNHCR, the World Bank and several NGOs play active roles inproviding healthcare services to Syrian refugLebanon, by establishing health centers and providingfree medical consultations and medicines. (8)

Main healthcare Challenges Faced by SyrianRefugees in Lebanon:

According to more than 15 academic studies on thehealth needs of Syrian refugees health care is the most prevalent health need, followed by mental health, infectious diseases, and vaccinations. (7)

General Difficulties and Challenges:

The difficulties preventing access to health care servicesinclude several factors such as the complex healthcaresystem in Lebanon; geographical barriers such as thehigh cost of moving between areas; the high cost ofobtaining medical services; structural barriers such as thecomplex medical referral system;(8) a lack of necessaryawareness and knowledge about symptoms of diseases,

Relief

General Director of the Multi Aid Programs (MAPS), Lebanon

and increased donor burdens. The system has become heavier and increasingly unable to cope with the situation, especially as a result of the current build-up of

Several actors have responded jointly to the health needs of Syrian refugees in Lebanon over the past eight years. These actors consist of the network of primary healthcare centers of the Ministry of

, UNHCR, local NGOs, (6) other international NGOs and humanitarian agencies such as

The UNHCR in Lebanon covers approximately 85% of primary health care expenses for refugees in some cases that need urgent interventions, as UNHCR contracts

ly with medical institutions to provide medical services for free or at low cost in primary health care centers and Lebanese hospitals. In addition to UNHCR, the World Bank and several NGOs play active roles in providing healthcare services to Syrian refugees in Lebanon, by establishing health centers and providing free medical consultations and medicines. (8)

Main healthcare Challenges Faced by Syrian

According to more than 15 academic studies on the health needs of Syrian refugees in Lebanon women's health care is the most prevalent health need, followed by mental health, infectious diseases, and vaccinations. (7)

General Difficulties and Challenges:

The difficulties preventing access to health care services rs such as the complex healthcare

system in Lebanon; geographical barriers such as the high cost of moving between areas; the high cost of obtaining medical services; structural barriers such as the complex medical referral system;(8) a lack of necessary wareness and knowledge about symptoms of diseases,

64

treatment, available services and how the system works;prejudice against refugees; discrimination from healthcare providers;(8)and finally the perceived lack of attention and care from service providers.

Nonexistence of Identification Documents:

Some primary health care centers and hospitals askSyrian refugees for their identity documents in exchangefor the health service, which is difficult to obtain byrefugees who have lost or not issued theirdocuments and/or cannot return to Syria to extract analternative. (10)

Challenges Facing Syrian Healthcare Workers:

The path to the official employment of Syrian healthcareworkers in the health sector is not available in the firstplace. As the Ministry of Labor has prohibited foreigners,including Syrians, from undertaking their liberalprofessions, which include medicine and pharmacyrelated sectors, and limited these professions, in additionto businesses, professions, as well as job and traadministration, banking, insurance, and education to theLebanese, and only excluded Syrian workers from theban on work in the agricultural, construenvironmental sectors (11). Refugees also facenumerous organizational, administrative, lprofessional barriers to formal practice. For example,Syrian doctors in Lebanon face difficulties in obtaininglegal work permits, inability to secure licenses to practicewithout incurring unusual costs, and other relatedchallenges that prevent entry into the labourmarket. (12)

Random Costs of treating Refugees:

Hospitals and health centers are taking on additionalcosts due to higher prices for medical equipment withouta change in the pricing of various medical procedures,(12) by the official Ministry of Health, which led to theimposition of random prices and charging additionalprices, especially on Syrian refugees who may not beaware enough of the financial details of their treatmentbills. Hospitals do not hand over an invoice in caseUNHCR contributes to part of the cost and are thereforeable to increase the prices charged without bringing it tothe attention of the patient or even the contributor.

Syrian Refugees and the COVID-19 Pandemic:

Although Syrians constitute approximately 20% of thepopulation in Lebanon, and the registration process onthe electronic platform to receive vaccine doses does not

treatment, available services and how the system works; prejudice against refugees; discrimination from health care providers;(8)and finally the perceived lack of attention and care from service providers.(7)

Nonexistence of Identification Documents:

Some primary health care centers and hospitals ask Syrian refugees for their identity documents in exchange for the health service, which is difficult to obtain by refugees who have lost or not issued their identity documents and/or cannot return to Syria to extract an

Challenges Facing Syrian Healthcare Workers:

The path to the official employment of Syrian healthcare workers in the health sector is not available in the first

e Ministry of Labor has prohibited foreigners, including Syrians, from undertaking their liberal professions, which include medicine and pharmacy related sectors, and limited these professions, in addition to businesses, professions, as well as job and trades in administration, banking, insurance, and education to the Lebanese, and only excluded Syrian workers from the ban on work in the agricultural, construction and

Refugees also face numerous organizational, administrative, legal, and professional barriers to formal practice. For example, Syrian doctors in Lebanon face difficulties in obtaining legal work permits, inability to secure licenses to practice without incurring unusual costs, and other related

t entry into the labourmarket. (12)

Hospitals and health centers are taking on additional costs due to higher prices for medical equipment without a change in the pricing of various medical procedures,

ial Ministry of Health, which led to the imposition of random prices and charging additional prices, especially on Syrian refugees who may not be aware enough of the financial details of their treatment bills. Hospitals do not hand over an invoice in case the UNHCR contributes to part of the cost and are therefore able to increase the prices charged without bringing it to the attention of the patient or even the contributor.

19 Pandemic:

Although Syrians constitute approximately 20% of the population in Lebanon, and the registration process on the electronic platform to receive vaccine doses does not

base an assumption on nationality at all, the percentageof Syrians registered, accordingMinistry of Health vaccine platform, does not exceed97.611 (4.3%) people, compared to 2,227,427registeredfrom all nationalities on the platform as of August 9th,2021. (14)

Relevant Laws and Policies:

Article 12 of the InternationalSocial and Cultural Rights indicates that the right to health is not limited to the right to medical care, butrather considers the right in its broadest sense, whichguarantees the enjoyment of the highest attainablestandard of physical and mental health. Indeed, itembraces many social and economic factors thatdetermine what is healthy, including food and nutrition, housing, access to drinking water and sanitation, healthyand safe working conditions, as well as a cleanenvironment.

Article 12 also affirms the state's obligations towardsindividuals under its jurisdiction in terms of securing ahealth protection system that provides equalopportunities for all to obtain the highest attainablestandard of health. Accordingly, the sand primary responsibility in this, and in the second placecomes its duty to resort to and allow organizations andother bodies to carry out part of these responsibilitieswhen the state is not able to fulfill its obligations, withthe state’s continuing responsibility for organizing and supervising these processes to ensure the maximumextent possible of the protection of individual rights inthis context. Moreover, a state cannot be sustainablyunable to fulfil its obligations, as thCovenant requires states to permanently and/or graduallyendeavor to meet these obligations. States must ensure“the right of the entire population to the enjoyment of thehighest achievable standard of physical and mentalhealth,” and states must ensure “the establishment ofconditions that secure 'for all' medical services andmedical attention in case of illness.”(10) Consequently,the state bears the responsibility to provide theappropriate and required conditions to spare thepopulation, to the maximum extent possible, the lack ofstandards of physical and mental health. Here, the right toadequate housing, adequate sanitation and access to cleanwater and food cannot be separated from this right, andtherefore the state must take careobligations towards those rights in the context of fulfilling its obligations regarding the right to enjoy thehighest possible standards of mental and physical health(15). Depriving some Syrians of their right to health for

Relief

base an assumption on nationality at all, the percentage of Syrians registered, according to the data of the Ministry of Health vaccine platform, does not exceed 97.611 (4.3%) people, compared to 2,227,427registered from all nationalities on the platform as of August 9th,

Relevant Laws and Policies:

Article 12 of the International Covenant on Economic, Social and Cultural Rights indicates that the right to health is not limited to the right to medical care, but rather considers the right in its broadest sense, which guarantees the enjoyment of the highest attainable

ical and mental health. Indeed, it embraces many social and economic factors that determine what is healthy, including food and nutrition, housing, access to drinking water and sanitation, healthy and safe working conditions, as well as a clean

Article 12 also affirms the state's obligations towards individuals under its jurisdiction in terms of securing a health protection system that provides equal opportunities for all to obtain the highest attainable standard of health. Accordingly, the state bears the first and primary responsibility in this, and in the second place comes its duty to resort to and allow organizations and other bodies to carry out part of these responsibilities when the state is not able to fulfill its obligations, with

e state’s continuing responsibility for organizing and supervising these processes to ensure the maximum extent possible of the protection of individual rights in this context. Moreover, a state cannot be sustainably unable to fulfil its obligations, as the International Covenant requires states to permanently and/or gradually endeavor to meet these obligations. States must ensure “the right of the entire population to the enjoyment of the highest achievable standard of physical and mental

es must ensure “the establishment of conditions that secure 'for all' medical services and medical attention in case of illness.”(10) Consequently, the state bears the responsibility to provide the appropriate and required conditions to spare the

n, to the maximum extent possible, the lack of standards of physical and mental health. Here, the right to adequate housing, adequate sanitation and access to clean water and food cannot be separated from this right, and therefore the state must take care of fulfilling its obligations towards those rights in the context of fulfilling its obligations regarding the right to enjoy the highest possible standards of mental and physical health (15). Depriving some Syrians of their right to health for

65

reasons related to identification papers, for example, isnot considered a legal justification, as the state’s inabilityto fulfill other rights that lead to such conditions does notplace responsibility on the refugees themselves. The dutyof the Lebanese state to respect the right to health of Syrian refugees within its jurisdiction requires not todeny or limit their equal access to the health servicesavailable in the country. The state's duty to protect this right also dictates that it prevents non-state actors frprohibiting Syrian refugees from having equal access tothese services, especially if this prohibition is ondiscriminatory grounds. As for the state’s duty to fulfillthe right to health, it must provide everyone withoutdiscrimination with healthcare, especially in the time of epidemics, when it must secure access to immunizationand awareness programs as well as measures to containthe pandemic.

1. Situation Syria regional refugee response [Internet].Unhcr.org. [cited 2021 Aug 9]. Availablhttps://data2.unhcr.org/en/situations/syria/location/71

1. Lyons A, Kass-Hanna J, Montoya Castano A,Greenlee A. A multidimensional approach tomeasuring vulnerability to poverty of Syrian refugeesin Lebanon. Available at SSRN 3787795. 2021.

2. Rischke R, Talebi N. Lebanon at a criticalconjuncture-Perspectives of Syrians and Lebanese inLebanon 2019-2021. Available at SSRN 3848223.2021.

3. El-Jardali F, Hammoud R, Fouad F, Bou K. K2PBriefing Note: Promoting Access to Essential HealthCare Services for Syrian Refugees in Lebanon.Beirut: Knowledge to Policy (K2P) Center Beirut.2014:6.

4. Karasapan O. The challenges in providing health careto Syrian refugees [Internet]. Brookings. 2018 [cited2021 Aug 9]. Available from:https://www.brookings.edu/blog/futuredevelopment/2018/11/15/the-challengesproviding-health-care-to-syrian-refugees/

5. Trovato MG, Al-Akl N, Ali D. Displaced Syrians inLebanon: Protection amidst Crises AUB final report.

6. El Arnaout N, Rutherford S, Zreik T, Nabulsi D,Yassin N, Saleh S. Assessment of the health needs of

ted to identification papers, for example, is not considered a legal justification, as the state’s inability to fulfill other rights that lead to such conditions does not place responsibility on the refugees themselves. The duty

spect the right to health of Syrian refugees within its jurisdiction requires not to deny or limit their equal access to the health services available in the country. The state's duty to protect this

state actors from prohibiting Syrian refugees from having equal access to these services, especially if this prohibition is on discriminatory grounds. As for the state’s duty to fulfill the right to health, it must provide everyone without

especially in the time of epidemics, when it must secure access to immunization and awareness programs as well as measures to contain

Situation Syria regional refugee response [Internet].Unhcr.org. [cited 2021 Aug 9]. Available from:https://data2.unhcr.org/en/situations/syria/location/71

Hanna J, Montoya Castano A,Greenlee A. A multidimensional approach to

lity to poverty of Syrian refugeesin Lebanon. Available at SSRN 3787795. 2021.

Rischke R, Talebi N. Lebanon at a criticalPerspectives of Syrians and Lebanese in

2021. Available at SSRN 3848223.

d F, Bou K. K2PBriefing Note: Promoting Access to Essential HealthCare Services for Syrian Refugees in Lebanon.Beirut: Knowledge to Policy (K2P) Center Beirut.

Karasapan O. The challenges in providing health careto Syrian refugees [Internet]. Brookings. 2018 [cited2021 Aug 9]. Available from:https://www.brookings.edu/blog/future-

challenges-in-refugees/

Akl N, Ali D. Displaced Syrians inLebanon: Protection amidst Crises AUB final report.

erford S, Zreik T, Nabulsi D,Yassin N, Saleh S. Assessment of the health needs of

Syrian refugees in Lebanon and Syria’s neighboringcountries. Conflict and Health. 2019;13(1):31.

7. Nabulsi D, Ismail H, Abou Hassan F, Sacca L,Honein-AbouHaidar G, Jomaa L. vulnerable: Exploring the livelihood strategies,coping mechanisms and their impact on foodinsecurity, health, and access to health care among Syrian refugees in the Beqaa region of Lebanon.PloS one. 2020 Dec 2;15(12): e0242421.

8. FAWAZ M. BARRIERS FACED BY SYRIANREFUGEES IN ACCESSINGHEALTHCARE INURBAN AREAS IN LEBANON. BAU JournalHealth and Wellbeing. 2018;1(3):32.

9. Documentation and access to healthcare for refugeesin Lebanon [Internet]. Nrc.no. 2020 [cited 2021 Aug9]. Available from:https://www.nrc.no/globalassets/pdf/briefingnotes/documentation-andrefugees-in-lebanon/icla_briefingnote_documentation-andhealthcare_may2020.pdf

10. A decision regarding the professions and crafts thatshould be restricted to the Lebanese [Internet].Gov.lb. 2017 [cited 2021 Aug 9https://www.labor.gov.lb/Temp/Files/4bff7fea497f-bbec-f1c804fbbaf9.pdf

11. Ismail S, Coutts AP, Rayes D, Roborgh S, Abbara A,Orcutt M, et al. Refugees, healthcare and crises:informal Syrian health workers in Lebanon. 2018.

في المستشفيات... بين التهديد .12 برفع التعرفة مطالبةراحت على المواطنAnnahar.com. [cited 2021 Aug 9]. Available from:https://www.annahar.com/arabic/section/5%D8%B5%D8%AD%D8%A9/17022021043205125

13. COVID-19 Coronavirus Lebanon Cases [Internet].Gov.lb. [cited 2021 Aug 9]. Available from:https://www.moph.gov.lb/maps/covid19.php

14. CESCR General Comment No. 14: The Right to theHighest Attainable Standard of Health (Art. 12)[Internet]. Refworld.org. 2000 [cited 2021 Aug 9].Available from:https://www.refworld.org/pdfid/4538838d0.pdf

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Syrian refugees in Lebanon and Syria’s neighboring countries. Conflict and Health. 2019;13(1):31.

Nabulsi D, Ismail H, Abou Hassan F, Sacca L,AbouHaidar G, Jomaa L. Voices of the

vulnerable: Exploring the livelihood strategies,coping mechanisms and their impact on foodinsecurity, health, and access to health care amongSyrian refugees in the Beqaa region of Lebanon.PloS one. 2020 Dec 2;15(12): e0242421.

RRIERS FACED BY SYRIANREFUGEES IN ACCESSINGHEALTHCARE IN URBAN AREAS IN LEBANON. BAU Journal-Health and Wellbeing. 2018;1(3):32.

Documentation and access to healthcare for refugeesin Lebanon [Internet]. Nrc.no. 2020 [cited 2021 Aug9]. Available from:https://www.nrc.no/globalassets/pdf/briefing-

and-access-to-healthcare-for-lebanon/icla_briefing-

and-access-to-healthcare_may2020.pdf

A decision regarding the professions and crafts thatshould be restricted to the Lebanese [Internet].Gov.lb. 2017 [cited 2021 Aug 9]. Available from:https://www.labor.gov.lb/Temp/Files/4bff7fea-2cfa-

f1c804fbbaf9.pdf

Ismail S, Coutts AP, Rayes D, Roborgh S, Abbara A,efugees, healthcare and crises:

informal Syrian health workers in Lebanon. 2018.

مطالبة برفع التعرفة في المستشفياتعلى المواطن .[Internet] ”والواقع ”راحتAnnahar.com. [cited 2021 Aug 9]. Available from: https://www.annahar.com/arabic/section/5-%D8%B5%D8%AD%D8%A9/17022021043205125

19 Coronavirus Lebanon Cases [Internet].Gov.lb. [cited 2021 Aug 9]. Available from:https://www.moph.gov.lb/maps/covid19.php

CESCR General Comment No. 14: The Right to theHighest Attainable Standard of Health (Art. 12)[Internet]. Refworld.org. 2000 [cited 2021 Aug 9].Available from:https://www.refworld.org/pdfid/4538838d0.pdf

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Book reviewed by Prof Glen M. Cooper,

(Extracted from the “Forward” by Prof. G. Cooper)

glenmcooper@gmail.com

The author of the book was a prolific amateur historianof medicine, Dr Rabie Abdel-Halim was also an emeritusprofessor of urology from the Department of Urology atKing Saud University Medical College, Riyadh, SaudiArabia. His main urological research interest was urinarystone disease, about which he published a book:Urolithiasis in the Western Region of Saudi Arabia: A Clinical, Biochemical and Epidemiological Study (KingAbdulaziz City for Science and Technology, 1996). was a great privilege to be asked to review his magnumopus history of Islamic medicine, although unfortunatethat I was unable to discuss it with him. Dr Rabiecompleted this great work the night before he died

The book, Introduction to the History oMedicine would not be considered academic history, assome of his methods and perspectives would not agreewith those of professional historians. However, that doesnot detract from its usefulness and contribution. In my view, the great value of the book is twopracticing physician Dr Rabie brought to the subjectvaluable insights about medicine that are not possessedby a non-physician professional historian such as myself.And this reminds us that for the history of Islamicmedicine, both historians and physicians are neededas the broader history of Islamic science requireshistorians and technical specialists. And second is thefeature that I shall discuss in more detail, namely, hisdeep religious faith and his insights into how the spirit ofIslam not only made Islamic civilization possible, butmore importantly for our present discussion, how itcreated within Islamic civilization an environmentwherein science could flourish. So, I would like to focuson this theme of his work, which he also expressed in hispublication that was included with your conferencematerials, the article entitled: “The Spirit of ScientificEnquiry in the Early Islamic World.” Acknowledgingthat the science of today is “a joint global contribu

Glen M. Cooper, Ph.D., Brigham Young University,

(Extracted from the “Forward” by Prof. G. Cooper)

glenmcooper@gmail.com

The author of the book was a prolific amateur historian was also an emeritus

professor of urology from the Department of Urology at King Saud University Medical College, Riyadh, Saudi

His main urological research interest was urinary stone disease, about which he published a book: Urolithiasis in the Western Region of Saudi Arabia: A Clinical, Biochemical and Epidemiological Study (King Abdulaziz City for Science and Technology, 1996). It was a great privilege to be asked to review his magnum opus history of Islamic medicine, although unfortunate that I was unable to discuss it with him. Dr Rabie completed this great work the night before he died.

The book, Introduction to the History of Islamic Medicine would not be considered academic history, as some of his methods and perspectives would not agree with those of professional historians. However, that does not detract from its usefulness and contribution. In my

the book is two-fold. First, as a practicing physician Dr Rabie brought to the subject valuable insights about medicine that are not possessed

physician professional historian such as myself. And this reminds us that for the history of Islamic

icine, both historians and physicians are needed--just as the broader history of Islamic science requires historians and technical specialists. And second is the feature that I shall discuss in more detail, namely, his

into how the spirit of Islam not only made Islamic civilization possible, but more importantly for our present discussion, how it created within Islamic civilization an environment wherein science could flourish. So, I would like to focus

his work, which he also expressed in his publication that was included with your conference materials, the article entitled: “The Spirit of Scientific Enquiry in the Early Islamic World.” Acknowledging that the science of today is “a joint global contribution”

of many civilizations, Dr Rabie focuses on one of themost creative periods in the history of this global science,namely, that of Islamic civilization. He finds that themost important factor in the contribution of Islam waswhat he calls “The spirit of scientific inquiry.”

The spirit of scientific inquiry is an attitude and orientation toward nature that affects the way of handlingempirical data, and fosters a community of sharedpractices, beliefs, and criteria for scientists to assess each another’s work. DrRabie finds the ultimate source of thisspirit in the Qur’an and the Sunnah of the Prophet.Islamic science began with the divine command to search for knowledge that became ingrained in the Muslimheart, the command to use the divine gif

Book Review

Ph.D., Brigham Young University, USA

Rabie focuses on one of the most creative periods in the history of this global science, namely, that of Islamic civilization. He finds that the most important factor in the contribution of Islam was

pirit of scientific inquiry.”

The spirit of scientific inquiry is an attitude and orientation toward nature that affects the way of handling empirical data, and fosters a community of shared practices, beliefs, and criteria for scientists to assess each another’s work. DrRabie finds the ultimate source of this spirit in the Qur’an and the Sunnah of the Prophet. Islamic science began with the divine command to search for knowledge that became ingrained in the Muslim heart, the command to use the divine gift of reason to

67

contemplate the world and the cosmos, and to avoidintellectual taqlid, or blind imitation of past authorities.Islamic jurisprudence is the central Islamic disciplinewhere this rational, scientific spirit was furtherdeveloped. The importance of gathering corroboratingevidence and testimony, as well as recognizing theinherent uncertainties within all intellectual constructs,were at work in the source methodology of Islamicwhich sought to discover God’s law for specificsituations. Even the notion of natural law owessomething to the Islamic notion of nature having its own God-given sunnah, or habitual patterns of behaviour,which in the simplest case is understood as God’s ownsunnah as he works His will through the natural world.

Dr Rabie also taught that Islamic society fostered thebrotherhood of intellectuals through the exercise ofreason, a fraternity that transcended ethnic and religiouslines, which came about as a result of this spirit of scientific inquiry. As Aristotle would civilization, reason was a good in itself, with applicationsin all fields. Dr Rabie sees these seeds of this spirit in thevery first verse of the Qur’an: Read! In the name of thyLord and Cherisher, Who created man out of a (mere) clot of congealed blood. Read! and thy Lord is MostBountiful, He Who taught (the use of) the Pen, Taughtman that which he knew not” (Qur’an, Sura 96, verses 150). The emphasis of the Divine Word here is on readingand writing, the tools through which the newof Islam would be fulfilled. There are many other versesin the Qur’an that command mankind to seek and acquireknowledge, and to not be content with what one thinks one already knows, but to seek more knowledge andunderstanding. Knowledge is central to the Qur’anicrevelation and is contrasted with the“ignorance” that prevailed before. God commands mankind to observe and contemplate the world, and theobjects of nature. For example, in anotherof the Qur’an: And He has subjected to you, as fromHim, all that is in the heavens and on earth: Behold, in that are Signs indeed for those who reflect” (Qur’an, Sura45, verse 13). Everything in the natural world is encompassed by this command. The signs, of course,point to something (as all signs do), namely, to God’sactivity in the cosmos. The true believer sees the naturalworld as “an ongoing epiphany”, i.e., a continuousrevelation of divine activity. Dr Rabie calls the search fortruth the “method of Islam”, which is an inphrase because of its resonance with the ancient Greekphilosophical schools, each with their methods for livinga complete life in accord with what the respective schoolvalued most. Specific to medicine is the ethicaldimension of Islam. The human body and the quality of

contemplate the world and the cosmos, and to avoid intellectual taqlid, or blind imitation of past authorities. Islamic jurisprudence is the central Islamic discipline where this rational, scientific spirit was further

nce of gathering corroborating evidence and testimony, as well as recognizing the inherent uncertainties within all intellectual constructs, were at work in the source methodology of Islamic fiqh, which sought to discover God’s law for specific

Even the notion of natural law owes something to the Islamic notion of nature having its own

given sunnah, or habitual patterns of behaviour, which in the simplest case is understood as God’s own sunnah as he works His will through the natural world.

Rabie also taught that Islamic society fostered the brotherhood of intellectuals through the exercise of reason, a fraternity that transcended ethnic and religious lines, which came about as a result of this spirit of

say: for Islamic civilization, reason was a good in itself, with applications in all fields. Dr Rabie sees these seeds of this spirit in the very first verse of the Qur’an: Read! In the name of thy Lord and Cherisher, Who created man out of a (mere)

of congealed blood. Read! and thy Lord is Most Bountiful, He Who taught (the use of) the Pen, Taught man that which he knew not” (Qur’an, Sura 96, verses 1-50). The emphasis of the Divine Word here is on reading and writing, the tools through which the new revelation of Islam would be fulfilled. There are many other verses in the Qur’an that command mankind to seek and acquire knowledge, and to not be content with what one thinks one already knows, but to seek more knowledge and

central to the Qur’anic revelation and is contrasted with the jahiliyya “ignorance” that prevailed before. God commands mankind to observe and contemplate the world, and the objects of nature. For example, in another sura and aya

subjected to you, as from Him, all that is in the heavens and on earth: Behold, in that are Signs indeed for those who reflect” (Qur’an, Sura 45, verse 13). Everything in the natural world is encompassed by this command. The signs, of course,

thing (as all signs do), namely, to God’s activity in the cosmos. The true believer sees the natural world as “an ongoing epiphany”, i.e., a continuous revelation of divine activity. Dr Rabie calls the search for truth the “method of Islam”, which is an intriguing phrase because of its resonance with the ancient Greek philosophical schools, each with their methods for living a complete life in accord with what the respective school valued most. Specific to medicine is the ethical

an body and the quality of

the Muslims’ lives are important in Islam. So, medicine,which is concerned with maintaining and restoring thewell-being of the body and its healthSina’s famous Introduction to medicine in his Canon of Medicine, as well as with the relief of suffering, these arevirtuous acts of worship and are essential religious duties.

Furthermore, the Qur’an chastises those who insist onfollowing old ways over discovering and adopting newknowledge. Dr Rabie sees this asknown critical attitude of Muslim scientists, such as alRazi and Ibn al-Haytham, toward established authorities,like Galen and Ptolemy. The seeker after truth mustquestion everything said by these authorities and test itagainst his own first-hand experience. He must “makehimself the enemy of all he reads”, in the words of Ibn alHaytham. Dr Rabie observes the curious fact that many of the intellectual tools later applied to the sciences werefirst developed within and by the thinkthe religious sciences of Islam. He is careful not tosuggest that this means that the religious scholars wereall therefore naturally inclined to accept the sciences,which they were not, as the wellconflicts between some scientists and some moreconservative ulamā’ show.

However, the mere fact that so many of the greatestscientific thinkers in Islam were also known as religiousscholars strongly indicates that there was an essentialaffinity between these two spheres oThis fact refutes the commonly held view that scienceand religion are and always will be essentiallyincompatible and always in conflict with each other, aview that has, unfortunately, prevailed in the West andhas retarded scholarship. Within the Golden Age ofIslamic science, however, it was not the case that scienceand religion were essentially incompatible andinescapably in conflict with one another. Rather, thereeventually developed a harmony between them, whichcould serve as a model for our present age. Aristotle hasshown how all scientific activity must rest on ametaphysics which, by its very nature is speculative, since it deals with things that are unobservable, things that pre-condition what we do observe in the natworld. And so, a metaphysics that is given by revelationmay be a superior place for science to begin than onederived from human wisdom alone, the latter being thepreferred perspective in secular science today. In effect,Dr.Rabie describes the setting up of an intellectual milieuwithin a society that was organized around Islamic ideals,in which the sciences could flourish, and scientificknowledge could advance. This milieu is an entirecosmology, and a complete existential way of being for a

Book Review

the Muslims’ lives are important in Islam. So, medicine, which is concerned with maintaining and restoring the

being of the body and its health—to paraphrase Ibn Sina’s famous Introduction to medicine in his Canon of

e, as well as with the relief of suffering, these are virtuous acts of worship and are essential religious duties.

Furthermore, the Qur’an chastises those who insist on following old ways over discovering and adopting new knowledge. Dr Rabie sees this as reflected in the well-known critical attitude of Muslim scientists, such as al-

Haytham, toward established authorities, like Galen and Ptolemy. The seeker after truth must question everything said by these authorities and test it

hand experience. He must “make himself the enemy of all he reads”, in the words of Ibn al-Haytham. Dr Rabie observes the curious fact that many of the intellectual tools later applied to the sciences were first developed within and by the thinkers who created the religious sciences of Islam. He is careful not to suggest that this means that the religious scholars were all therefore naturally inclined to accept the sciences, which they were not, as the well-known historical

scientists and some more

However, the mere fact that so many of the greatest scientific thinkers in Islam were also known as religious scholars strongly indicates that there was an essential affinity between these two spheres of intellectual activity. This fact refutes the commonly held view that science and religion are and always will be essentially incompatible and always in conflict with each other, a view that has, unfortunately, prevailed in the West and

arship. Within the Golden Age of Islamic science, however, it was not the case that science and religion were essentially incompatible and inescapably in conflict with one another. Rather, there eventually developed a harmony between them, which

e as a model for our present age. Aristotle has shown how all scientific activity must rest on a metaphysics which, by its very nature is speculative, since it deals with things that are unobservable, things

condition what we do observe in the natural world. And so, a metaphysics that is given by revelation may be a superior place for science to begin than one derived from human wisdom alone, the latter being the preferred perspective in secular science today. In effect,

ing up of an intellectual milieu within a society that was organized around Islamic ideals, in which the sciences could flourish, and scientific knowledge could advance. This milieu is an entire cosmology, and a complete existential way of being for a

68

Muslim seeker after truth. This milieu rests on the centralimperative that God-given rationality is to be used notonly to further the cause of Islam, which is also the causeof mankind generally, but also that knowledge, likereason, is a universal good, and knows no ethnic,sectarian, or religious boundaries.

Moreover, Islam is essentially a culture of healing, areligious tradition that has had a deep affinity with medicine from its beginning. The relationship of Islamand healing, as Dr Rabie taught, isconcerned with the two-fold healing of the body andmind of a person. That Muslim medical thinkers wereconcerned to heal the body is obvious from thecontributions to medicine that we have been discussing atthis Congress. The second part, namely, the healing ofthe mind, may be less clear to us moderns. Islam aims toheal people’s minds from ignorance or lack ofunderstanding of the pure principles of Islam, which arethe essential principles of human existence. (Rememberthat the pre-Islamic period in Arabia is called jahiliyya, “[The era of] ignorance”). For some Muslim thinkers,this healing of the minds or psyches involves asystematic organization of the whole body of rationalthought, as Ibn Sina sought to do in his Kitāb alvast encyclopaedia of knowledge. In his history of Islamic medicine, DrRabie begins with the revelation of Islam and the creation of the Islamic community.

Proceeding from there, he describes how the Islamicconquests and translations brought the medicalknowledge of Greece, India, and Persia to the Muslims,and how they assimilated and appropriated ittheir own. In his book, as I have indicated, Dr Rabiewrote much about the compatibility of Islam and science.In the first part he showed how the revelation given to theProphet enjoins mankind to use reason and to seekknowledge, and how the systematic working out ofIslamic Law requires both reason and data/evidence,which are also the two pillars of science, namely, theoryand data. This essential connection of Islam and reason is found in the commandment, mentioned above from theQur’an, to apprehend the many signs in God’s creation,and to follow them rationally to the object toward whichthey point, which object is the existence of the Creatorand his attributes. (This is related to the famous medievalEuropean argument for God’s existence, “The Argumentfrom Design”). The signs do not point to God’s being perse, which could not be apprehended even if they did, butrather to His activities, or His energies, to employ auseful expression from Orthodox Christian theology, namely, His activities in our world—profoundly expressed by the 99 Beautiful Names of God,

im seeker after truth. This milieu rests on the central given rationality is to be used not

only to further the cause of Islam, which is also the cause of mankind generally, but also that knowledge, like

knows no ethnic,

Moreover, Islam is essentially a culture of healing, a religious tradition that has had a deep affinity with medicine from its beginning. The relationship of Islam and healing, as Dr Rabie taught, is that Islam is

fold healing of the body and mind of a person. That Muslim medical thinkers were concerned to heal the body is obvious from the contributions to medicine that we have been discussing at

amely, the healing of the mind, may be less clear to us moderns. Islam aims to heal people’s minds from ignorance or lack of understanding of the pure principles of Islam, which are the essential principles of human existence. (Remember

c period in Arabia is called jahiliyya, “[The era of] ignorance”). For some Muslim thinkers, this healing of the minds or psyches involves a systematic organization of the whole body of rational thought, as Ibn Sina sought to do in his Kitāb al-Shifā’, a ast encyclopaedia of knowledge. In his history of

Islamic medicine, DrRabie begins with the revelation of Islam and the creation of the Islamic community.

Proceeding from there, he describes how the Islamic conquests and translations brought the medical knowledge of Greece, India, and Persia to the Muslims, and how they assimilated and appropriated it—making it their own. In his book, as I have indicated, Dr Rabie wrote much about the compatibility of Islam and science.

revelation given to the Prophet enjoins mankind to use reason and to seek knowledge, and how the systematic working out of Islamic Law requires both reason and data/evidence, which are also the two pillars of science, namely, theory

al connection of Islam and reason is found in the commandment, mentioned above from the Qur’an, to apprehend the many signs in God’s creation, and to follow them rationally to the object toward which they point, which object is the existence of the Creator and his attributes. (This is related to the famous medieval European argument for God’s existence, “The Argument from Design”). The signs do not point to God’s being per se, which could not be apprehended even if they did, but

His energies, to employ a useful expression from Orthodox Christian theology,

—that which is profoundly expressed by the 99 Beautiful Names of God,

such as the one in Dr Rabie’s own name (“the Forbearing”, or my personal favourite (Wālī “the Protecting Friend.”

DrRabie is correct, I think, that there never was a religionand a culture more compatible with the investigation of nature and the activity of science than Islam. The rapid assimilation of the essential intellectual tools from othertraditions into Abbasid culture, which parallels the rapid military conquests of the Umayyads, is proof enough of that. And then there was the flowering of the sciencesunder the auspices of Islamic civcreatively shaped the ancient tools into something newand original. And space was opened for Christians andJews to participate in these efforts, because reason as an activity transcends the boundaries of culture, religion,and language. The Baghdad Renaissance of the 10thCentury under Buyid rule is the first major demonstrationof this principle. At that point, the fruits of the firstseveral generations of translations were being studied by Muslims, Jews, and Christians, and thinthese groups were discussing and arguing with oneanother in Baghdad, in a grand intellectual enterprise,using Arabic as well as reason, the universal language. What Muslim thinkers were creating was a science thatwas embedded within an reminder that science is never without a cosmologythere’s no such thing as a metaphysicswhether that be a religious, philosophical, or secularmaterialist. One of the greatest achievements of Muslimthinkers, in my view, has had a profound effect on thedevelopment of science in later cultures. Muslim thinkersdemonstrated how faith and philosophy, religion andscience, revelation and reason could not merely cobut thrive together in harmony within a monotheicosmology. (See Ibn Rushd’s Decisive Treatise).Thereare certain fundamental incompatibilities betweenscience as expressed in Aristotelian philosophy andrevealed religion—for example, the issue of the creation.Aristotle’s view was that the world hathat it has been in a state of perpetual change. (He was,no doubt, thinking of the paradox of beginnings: howcould anything ever get started, when every starter itself must have a starter? With the motions of the spheres, hecould stop with the Prime Mover, but that option was notsatisfactory to him where the existence of the wholecosmos was concerned.)

In Islam (and the other Abrahamic religions) the universewas created by an eternal selfMuslim philosophers such as Ibn Sina and Ibn Rushdshowed how both points of view could be true. Well,without these philosophical tools from Islamic

Book Review

such as the one in Dr Rabie’s own name (الحليــم (al-Hālim ng”, or my personal favourite (الوالــي (al-

Wālī “the Protecting Friend.”

DrRabie is correct, I think, that there never was a religion and a culture more compatible with the investigation of nature and the activity of science than Islam. The rapid

lation of the essential intellectual tools from other traditions into Abbasid culture, which parallels the rapid military conquests of the Umayyads, is proof enough of that. And then there was the flowering of the sciences under the auspices of Islamic civilization when thinkers creatively shaped the ancient tools into something new and original. And space was opened for Christians and Jews to participate in these efforts, because reason as an activity transcends the boundaries of culture, religion,

guage. The Baghdad Renaissance of the 10th Century under Buyid rule is the first major demonstration of this principle. At that point, the fruits of the first several generations of translations were being studied by Muslims, Jews, and Christians, and thinkers from each of these groups were discussing and arguing with one another in Baghdad, in a grand intellectual enterprise, using Arabic as well as reason, the universal language. What Muslim thinkers were creating was a science that

Islamic cosmos. This is a reminder that science is never without a cosmology—there’s no such thing as a metaphysics-free science—whether that be a religious, philosophical, or secular-materialist. One of the greatest achievements of Muslim

view, has had a profound effect on the development of science in later cultures. Muslim thinkers demonstrated how faith and philosophy, religion and science, revelation and reason could not merely co-exist, but thrive together in harmony within a monotheistic cosmology. (See Ibn Rushd’s Decisive Treatise).There are certain fundamental incompatibilities between science as expressed in Aristotelian philosophy and

for example, the issue of the creation. Aristotle’s view was that the world has always existed, that it has been in a state of perpetual change. (He was, no doubt, thinking of the paradox of beginnings: how could anything ever get started, when every starter itself must have a starter? With the motions of the spheres, he

with the Prime Mover, but that option was not satisfactory to him where the existence of the whole

In Islam (and the other Abrahamic religions) the universe was created by an eternal self-existent creator God.

ch as Ibn Sina and Ibn Rushd showed how both points of view could be true. Well, without these philosophical tools from Islamic

69

philosophy, Christian philosophers, such as Thomas Aquinas, might not have been able to accomplish thesame type of reconciliation between reason and faith for Christianity, and thus science might not have developedin Christian society when and as it did, and the history ofscience would have been very different. In medicine, theIslamic principle that God, the Creator, placed purin everything, helped to advance the study of anatomy and physiology. In the first place, this idea made Galenthe favoured Greek physician, whose treatise On theUsefulness of the Parts was an extended effort to showhow the Divine Wisdom is manifest in bodily structureand function. Moreover, the legacy of Islamic medicineto Europe was more than just hospitals, surgical tools,and medical theories, etc. There was, I believe, something even more significant for the development of science that came with the medicine: the whole empiricalattitude toward nature that reached maturity under Islam.

Medicine is essentially empirical and is a model for howpractical sciences actually work, as it shows how theempirical and the rational must work together increation of new scientific knowledge. To adapt a famousquote by Albert Einstein: “Theory without empiricism islame, empiricism without theory is blind”. The originalquote, “Science without religion is lame, religion withoutscience is blind,” would be appropriate in this context,since the dyad “science and religion” was a live issue for Muslim thinkers of all fields and in all periods. Westernscience before the “reawakening” in the 12th and 13thCenturies was notoriously slanted toward the theoretat the expense of the empirical, although with a fewimportant exceptions.

As I am trying to demonstrate in my own research intoIslamic astronomy and medicine, these tools, whenappropriated by Western thinkers, spurred thedevelopment of science at a crucial time. Basically,physicians required the empirical data of the stars toassist them in giving prognoses for patients in a kind of scientific astrology—a kind of astrology that wasdistinctly removed from the superstitious sort of astrology, and so within that medical

philosophy, Christian philosophers, such as Thomas Aquinas, might not have been able to accomplish the

on between reason and faith for Christianity, and thus science might not have developed in Christian society when and as it did, and the history of science would have been very different. In medicine, the Islamic principle that God, the Creator, placed purposes in everything, helped to advance the study of anatomy and physiology. In the first place, this idea made Galen the favoured Greek physician, whose treatise On the Usefulness of the Parts was an extended effort to show

t in bodily structure and function. Moreover, the legacy of Islamic medicine to Europe was more than just hospitals, surgical tools, and medical theories, etc. There was, I believe, something even more significant for the development of

ith the medicine: the whole empirical attitude toward nature that reached maturity under Islam.

Medicine is essentially empirical and is a model for how practical sciences actually work, as it shows how the empirical and the rational must work together in the creation of new scientific knowledge. To adapt a famous quote by Albert Einstein: “Theory without empiricism is lame, empiricism without theory is blind”. The original quote, “Science without religion is lame, religion without

be appropriate in this context, since the dyad “science and religion” was a live issue for Muslim thinkers of all fields and in all periods. Western science before the “reawakening” in the 12th and 13th Centuries was notoriously slanted toward the theoretical at the expense of the empirical, although with a few

As I am trying to demonstrate in my own research into Islamic astronomy and medicine, these tools, when appropriated by Western thinkers, spurred the

t a crucial time. Basically, physicians required the empirical data of the stars to assist them in giving prognoses for patients in a kind of

a kind of astrology that was distinctly removed from the superstitious sort of

so within that medical-astrological

context, the relationship between theory and practicebecame highly developed.

To conclude, in presenting significant historical Muslimcontributions to medicine, Dr Rabie has invited us toassume a perspective on thenot been the popular or dominant one. He invites us tofollow him to a vantage point where we can see that,within Islamic civilization, the fundamental tenets of thereligion harmonize with the fundamental principles of scientific method. From that perspective it seems thatthere should be a natural affinity between Islam andscience, one that is closer than that between science and any other religious tradition. How, then, can we accountfor the well-attested conflicts betweereligion that have occurred historically? If Dr Rabie iscorrect, then such conflicts can be shown to have beenmotivated by political and social factors, rather than by purely scientific or theological ones. Dr Rabie’sachievement reminds us that a responsible history of science must not only keep track of these multiple factorsfor the culture and period under investigation but mustalso attend to the ways that these factors interact with oneanother. If we do this, then many of the misconceabout the historical relationship between science and religion will evaporate. Attending to these details willalso help us to avoid projecting the issues of our presentage back onto the subjects of our study. This includesdiscarding “grand narratives” about the history of sciencethat centre on the West and its supposed destiny, whileminimizing the pivotal contributions of Islamiccivilization, without which world science would not havebecome what it is.

The kindle edition of the book can be obtained through the link below:

https://www.amazon.co.uk/1History-Medicine-ebook/dp/B098BJGQ27/ref=sr_1_1?dchild=1&keywords=1001+cures&qid=1625501527&s=digital

Book Review

context, the relationship between theory and practice

To conclude, in presenting significant historical Muslim contributions to medicine, Dr Rabie has invited us to assume a perspective on the history of medicine that has not been the popular or dominant one. He invites us to follow him to a vantage point where we can see that, within Islamic civilization, the fundamental tenets of the religion harmonize with the fundamental principles of

tific method. From that perspective it seems that there should be a natural affinity between Islam and science, one that is closer than that between science and any other religious tradition. How, then, can we account

attested conflicts between science and religion that have occurred historically? If Dr Rabie is correct, then such conflicts can be shown to have been motivated by political and social factors, rather than by purely scientific or theological ones. Dr Rabie’s

that a responsible history of science must not only keep track of these multiple factors for the culture and period under investigation but must also attend to the ways that these factors interact with one another. If we do this, then many of the misconceptions about the historical relationship between science and religion will evaporate. Attending to these details will also help us to avoid projecting the issues of our present age back onto the subjects of our study. This includes

ives” about the history of science that centre on the West and its supposed destiny, while minimizing the pivotal contributions of Islamic civilization, without which world science would not have

of the book can be obtained through

https://www.amazon.co.uk/1001-Cures-Introduction-

ebook/dp/B098BJGQ27/ref=sr_1_1?dchild=1&keywords=1001+cures&qid=1625501527&s=digital-text&sr=1-1

70

Aiman Alzetani

Consultant Cardiothoracic SurgeonTrust, Southampton

Aiman.alzetani@uhs.nhs.uk

Dear Editor

There is a high prevalence of enddysfunction within Asian population in general and theMuslim communities are a sizable component of thoseethnicities. Renal failure secondary to diabetes is top of the list1.

32% of patients waiting for a kidney are from Black, Asian and minority ethnic communitieshave a significantly longer wait for a successful matchdue to a shortage of suitably matched donors coupled with a shortage of suitably tissueorgans due to lack of Asian donors. Weincreased HLA tissue typing mismatch is a risk factor forrejection 4.

When considering the Muslim population, we have avariety of opinions regarding organ donations from theprogressive opinions that sees this as an act of ongoingcharity beyond death offering the gift of life to needyindividuals5. Fatwas (religious opinion) have been issuedby a UK-based Sunni scholar, Mufti Mohammed Zubair Butt, a Juris consult from the Institute of IslamicJurisprudence in Bradford who In June 2019, produced afatwa, Organ Donation and Transplantation in Islam: AnOpinion and a similar one in 2000 from the EuropeanCouncil for Fatwa and Research6,7.

On the other extreme, there is a sizable body of scholarlyopinion that considers organ donation to(Haram) and a form of body mutilation and desecrationof its sanctity. The body should be buried whole withoutsubjecting it to any unnecessary procedaway any parts from, these are same views to thoseagainst autopsy it8,9.

Letters to the Editor& Short Communications

Consultant Cardiothoracic Surgeon, University Hospital Southampton NHS Foundation

Aiman.alzetani@uhs.nhs.uk

There is a high prevalence of end-stage organ dysfunction within Asian population in general and the Muslim communities are a sizable component of those

secondary to diabetes is top of

32% of patients waiting for a kidney are from Black, Asian and minority ethnic communities2. They often

a successful match due to a shortage of suitably matched donors 3. This is coupled with a shortage of suitably tissue-matched

donors. We know that an increased HLA tissue typing mismatch is a risk factor for

When considering the Muslim population, we have a garding organ donations from the

progressive opinions that sees this as an act of ongoing charity beyond death offering the gift of life to needy

religious opinion) have been issued based Sunni scholar, Mufti Mohammed Zubair

utt, a Juris consult from the Institute of Islamic Jurisprudence in Bradford who In June 2019, produced a fatwa, Organ Donation and Transplantation in Islam: An Opinion and a similar one in 2000 from the European

is a sizable body of scholarly donation to be forbidden

(Haram) and a form of body mutilation and desecration of its sanctity. The body should be buried whole without subjecting it to any unnecessary procedures or taking away any parts from, these are same views to those

The mainstream view within the Muslim is moreundecided due to the ignorance of the progressive pointsof view and the apprehension of the unknown andmisconceptions of how the body is treated such as loss of dignity and the delay in expeditious burial which is veryimportant in Islam 10.

Research has shown that many families are not aware of their members wishes to become organ donors or thatthey’ve signed up to the register. With such differingopinions on organ donations within the Muslimcommunities and within the same families it becomes even more important to have an honest and frankdialogue amongst those families on this subject. Thewishes of those who agree to it should be well known,respected, and accepted and thereafter honoured if theytragically die and the family is approached by the donor team11.

1. Mathur R, Dreyer G, Yaqoobdifferences in the progression of chronicdisease and risk of death in a UK diabeticpopulation: an observational cohort studyOpen 2018;8:e020145. doi:020145

2. https://www.nhsbt.nhs.uk/howinvolved/community-investmentdonation-projects/

3. https://www.organdonation.nhs.uk/hdecide/organ-donation-and

Letters to the Editor& Short Communications

University Hospital Southampton NHS Foundation

The mainstream view within the Muslim is more undecided due to the ignorance of the progressive points of view and the apprehension of the unknown and

s of how the body is treated such as loss of dignity and the delay in expeditious burial which is very

Research has shown that many families are not aware of their members wishes to become organ donors or that

he register. With such differing opinions on organ donations within the Muslim communities and within the same families it becomes even more important to have an honest and frank dialogue amongst those families on this subject. The

ee to it should be well known, and accepted and thereafter honoured if they

tragically die and the family is approached by the donor

Yaqoob MM, et al, Ethnic differences in the progression of chronic kidney disease and risk of death in a UK diabetic population: an observational cohort studyBMJ

doi: 10.1136/bmjopen-2017-

https://www.nhsbt.nhs.uk/how-you-can-help/get-investment-scheme/organ-

https://www.organdonation.nhs.uk/helping-you-to-and-ethnicity/

71

4. Zachary AA, Leffell MS. HLA Mismatching Strategies for Solid Organ Transplantation A Balancing Act. Front Immunol. 2016;7:575. Published 2016 Dec 7. doi:10.3389/fimmu.2016.00575

5. Source: Ṣaḥīḥ Muslim 1631

6. https://nhsbtdbe.blob.core.windows.net/umbracoassets-corp/16300/organ-donation-fatwa.pdf

7. https://www.e-cfr.org/%D9%86%D9%82%D9%84%D8%A7%D9%84%D8%A3%D8%B9%D8%B6%D8%A7%D8%A1/

Letters to the Editor& Short Communications

Zachary AA, Leffell MS. HLA MismatchingStrategies for Solid Organ Transplantation -

. 2016;7:575.

https://nhsbtdbe.blob.core.windows.net/umbraco-fatwa.pdf

cfr.org/%D9%86%D9%82%D9%84-%D8%A7%D9%84%D8%A3%D8%B9%D8%B6%

8. Khan, Arshad (2003). Islam, Muslims, and America.Algora Pub. p. 210. ISBN

9. https://emedicine.medscape.com/article/1705993overview

10. https://religionmediacentre.org.uk/factsheets/deathfuneral-rituals-in-world-

11. https://www.organdonation.nhs.uk/getinvolved/news/hundredsyear-because-families-donwanted/

Letters to the Editor& Short Communications

Islam, Muslims, and America.ISBN 9780875861944

https://emedicine.medscape.com/article/1705993-

https://religionmediacentre.org.uk/factsheets/death-religions/

https://www.organdonation.nhs.uk/get-involved/news/hundreds-of-transplants-missed-each-

don-t-know-what-relative-

72

Mohamed Abdelaty, MBBCh, MRCS

SpR in Plastic Surgery, West Yorkshire

mmamdoh89@gmail.com

Dear Editor,

COVID 19 pandemic took the whole world by surpriseand left policy makers and clinicians with a series of ethical dilemmas(1). The unprecedented number ofhospital admissions following COVID 19 infections hadexhausted the previously struggling healthcare systems globally. The decision to prioritise the vastly expandingmedical need against patients who already suffered fromdebilitating disease (cancer patients for eamong many who had to pay an expensive price debitedfrom their health; unfortunately, not all these patientswere able to afford this.

Frameworks and flowcharts have been devised to helpclinicians prioritise hospital admissions for this selection is a matter of intense ethicalquestioning. Among the highlights of selection criteriaare the likelihood of survival following this hospitaladmission and the overall long-term survivability. Although extremely difficult to predict especially with anew disease that we still know so little about, itrepresents a huge responsibility on the decision makerswhen it’s a matter of life or death. These lists howeverare not limited to clinical based decisions,extends to a shocking level of de-prioritise patients who have “particular narrow social utility to others in apandemic”(1).

Attempts to obtain an Islamic perspective to tackle thesedilemmas have been initiated by various scholars. Padelaet Al (3) have explored the conflicting concepts of prioritising patients with higher societal input with theIslamic notion of almaslaha which might imply thatthose, if survived, can help save more lives.contradicted with the concept of universal human

Letters to the Editor& Short Communications

, MRCS

SpR in Plastic Surgery, West Yorkshire

mmamdoh89@gmail.com

pandemic took the whole world by surprise and left policy makers and clinicians with a series of

The unprecedented number of dmissions following COVID 19 infections had

exhausted the previously struggling healthcare systems globally. The decision to prioritise the vastly expanding medical need against patients who already suffered from debilitating disease (cancer patients for example) are few among many who had to pay an expensive price debited

all these patients

Frameworks and flowcharts have been devised to help clinicians prioritise hospital admissions (1)(2). The basis for this selection is a matter of intense ethical questioning. Among the highlights of selection criteria are the likelihood of survival following this hospital

term survivability. xtremely difficult to predict especially with a

new disease that we still know so little about, it represents a huge responsibility on the decision makers when it’s a matter of life or death. These lists however are not limited to clinical based decisions, but it also

prioritise patients who have “particular narrow social utility to others in a

Attempts to obtain an Islamic perspective to tackle these e been initiated by various scholars. Padela

have explored the conflicting concepts of prioritising patients with higher societal input with the

which might imply that can help save more lives. This

contradicted with the concept of universal human karama

which calls for equal treatment of all human beings regardless of their social status or benefit as their value isequally sacred (4).

The Islamic bioethical approach to this crisis can beconstructed based on religious and historical evidence(5). Further engagement of religious leaders in theprocess of delineating the framework for individualMuslims in the face of this dilemma is beneficial.

1. Robert R, Kentish-Barnes N, Boyer A, Laurent A,Azoulay E, Reignier J. Ethical dilemmas Covid-19 pandemic. Ann Intensive Care.2020;10(1):84.

2. White DB, Lo B. A Framework for RationingVentilators and Critical Care Beds During theCOVID-19 Pandemic. JAMA. 2020;323(18):1773

3. Padela AI, Ali M, Yusuf A. Aligning Medical andMuslim Morality: An Islamic Bioethical Approach toApplying and Rationing Life Sustaining Ventilatorsin the COVID-19 Pandemic Era. Journal of IslamicEthics. 2021:1-36.

4. Kamali MH. The Dignity of Man: An IslamicPerspective: Islamic Texts Society.

5. Al Eid NA, Arnout BA. Crisis and disastermanagement in the light of the Islamic approach:COVID-19 pandemic crisis as a model (a qualitativestudy using the grounded theory). J Public Aff.2020:e2217

Letters to the Editor& Short Communications

which calls for equal treatment of all human beings regardless of their social status or benefit as their value is

The Islamic bioethical approach to this crisis can be constructed based on religious and historical evidence

ent of religious leaders in the process of delineating the framework for individual Muslims in the face of this dilemma is beneficial.

Barnes N, Boyer A, Laurent A,Azoulay E, Reignier J. Ethical dilemmas due to the

19 pandemic. Ann Intensive Care.

White DB, Lo B. A Framework for RationingVentilators and Critical Care Beds During the

19 Pandemic. JAMA. 2020;323(18):1773-4.

Padela AI, Ali M, Yusuf A. Aligning Medical andrality: An Islamic Bioethical Approach to

Applying and Rationing Life Sustaining Ventilators19 Pandemic Era. Journal of Islamic

Kamali MH. The Dignity of Man: An IslamicPerspective: Islamic Texts Society.

Al Eid NA, Arnout BA. Crisis and disastermanagement in the light of the Islamic approach:

19 pandemic crisis as a model (a qualitativestudy using the grounded theory). J Public Aff.

73

Sofian Hamodeh, MD

Anaesthetist in Al-Maqased Hospital

sdhamoudeh@gmail.com

Al Aqsa Mosque has suffered for decades from clearneglect by those responsible for it, especially in terms of health, medical facilities, and clinics. Despite thepresence of tens of thousands of worshippers in itscourtyards and corridors during the days

Perhaps (for me) as a doctor who was born in Jerusalemand grew up there, educated in its schools, worked in thecity, moved between its hospitals, and spent his life in thevicinity of al Aqsa Mosque, I can say that I lived thistragedy in its vastness. Perhaps what increased theemergence of this tragedy is what happened during themonth of Ramadan of this year which showed the extentof the suffering experienced by health sector amongArabs in the city of Jerusalem and al Aqsa Mosque inparticular.

Perhaps the conflict of sovereignty over al Aqsa Mosquebetween the Islamic Awqaf department and the Israeliauthorities, and elements of bureaucracy from thesedepartments has led to an increase in the gap in thedeliberate neglect of the mosque. The actions of theIsraeli police who stormed al-Aqsa mosque aheadJerusalem Day march earlier this year made mattersdifficult. (1).

For example, the mosque only contains one medicalclinic that is not equipped with the necessary medicalequipment and has a narrow space that is not sufficient toprovide first aid to the injured patients. And there is nodoctor, except one nurse. And there is a small open cartto transport patients on stretchers on it. There are also noumbrellas in the mosque courtyards to prevent sun strokewhich expose the worshippers in the month of Ramadanto heat stroke, dehydration, and loss of consciousness.Adding to that, the overcrowding in its courtyards whichmakes it difficult to transport the injured patients to theemergency clinic when necessary. This sort of help hasbeen requested before. (2)

Letters to the Editor & Short Communications

Maqased Hospital, East Jerusalem, West Bank, Palestine

sdhamoudeh@gmail.com

Al Aqsa Mosque has suffered for decades from clear neglect by those responsible for it, especially in terms of health, medical facilities, and clinics. Despite the presence of tens of thousands of worshippers in its

of the year.

Perhaps (for me) as a doctor who was born in Jerusalem and grew up there, educated in its schools, worked in the city, moved between its hospitals, and spent his life in the vicinity of al Aqsa Mosque, I can say that I lived this

its vastness. Perhaps what increased the emergence of this tragedy is what happened during the month of Ramadan of this year which showed the extent of the suffering experienced by health sector among Arabs in the city of Jerusalem and al Aqsa Mosque in

Perhaps the conflict of sovereignty over al Aqsa Mosque between the Islamic Awqaf department and the Israeli authorities, and elements of bureaucracy from these departments has led to an increase in the gap in the

The actions of the Aqsa mosque ahead of

earlier this year made matters

For example, the mosque only contains one medical clinic that is not equipped with the necessary medical

and has a narrow space that is not sufficient to provide first aid to the injured patients. And there is no doctor, except one nurse. And there is a small open cart to transport patients on stretchers on it. There are also no

yards to prevent sun stroke which expose the worshippers in the month of Ramadan to heat stroke, dehydration, and loss of consciousness. Adding to that, the overcrowding in its courtyards which makes it difficult to transport the injured patients to the

ergency clinic when necessary. This sort of help has

Other suffering for doctors is when they’re called to enterthe mosque to help injured patients. By closing the gatesof the mosque and isolating it from areas around it andpreventing anybody from entering or leaving whichexacerbates injuries and delays the arrival of assistance toinjured people in good time.

There is no health relief system that includes al AqsaMosque or the worshippers in it similar to the reliefsystem in the city of Jerusalem which is entirely under Israeli Sovereignty at least. The BBC reported thatPalestinians were injured in Israeli crackdown with morelikely not to have been documented.

Despite the complicated health situation in the city, health associations operate shyly and humbly with their simple capabilities to serve the worshippers inside themosque. However, they lack the trained persons, thenecessary equipment, and the medical expertise toassume these responsibilities, especidisastrous situation that occurred in the month ofRamadan this year.

1. Al Aqsa Mosque must be identified from any otherconflicts in the region and dealt with as a smallvillage that has its own peculiathe world (Al-Aqsa capacity can reach 180.000 200.000 of worshipers) (4).

2. Improving the status of clinics inside the mosque,either by expanding them or increasingin addition to improving their performance andefficiency and training their medical staff.

3. Providing an ambulance inside the courtyards of themosque to transport injured patients.

4. Increasing and developing awareness and guidance infirst aid and disaster management, especially in areas

Letters to the Editor & Short Communications

Palestine

Other suffering for doctors is when they’re called to enter the mosque to help injured patients. By closing the gates of the mosque and isolating it from areas around it and

eventing anybody from entering or leaving which exacerbates injuries and delays the arrival of assistance to injured people in good time.

There is no health relief system that includes al Aqsa Mosque or the worshippers in it similar to the relief

in the city of Jerusalem which is entirely under Israeli Sovereignty at least. The BBC reported that 90 Palestinians were injured in Israeli crackdown with more likely not to have been documented. (3)

Despite the complicated health situation in the city, some health associations operate shyly and humbly with their simple capabilities to serve the worshippers inside the mosque. However, they lack the trained persons, the necessary equipment, and the medical expertise to assume these responsibilities, especially like the disastrous situation that occurred in the month of

Al Aqsa Mosque must be identified from any otherconflicts in the region and dealt with as a smallvillage that has its own peculiarity for all Muslims in

Aqsa capacity can reach 180.000 -000 of worshipers) (4).

Improving the status of clinics inside the mosque,either by expanding them or increasing their numbersin addition to improving their performance and

iency and training their medical staff.Providing an ambulance inside the courtyards of themosque to transport injured patients.Increasing and developing awareness and guidance infirst aid and disaster management, especially in areas

74

that are difficult for beneficiaries and ambulances toreach.

5. Increasing the efficiency and training of the workingstaff and employees there.

6. Establishing special courses and training sessions onhow to deal with difficult conditions, places forevacuation and how to manage in the event of closing gates of the mosque.

7. Unifying the efforts of health associations andinstitutes in operation there and providing aneffective communication network among them.

8. Protecting the rights of doctors and patients andavoiding assaulting them or preventing them fromperforming their humanitarian role towards patients.

9. Al Aqsa Mosque should receive greater attentionfrom all Muslims around the world. It should also bepresent in their minds, spreading its news innewspapers, magazines, and publications.the truth of what is being plotted against it in the cityof Jerusalem, and receiving moral and materialsupport.

Letters to the Editor & Short Communications

for beneficiaries and ambulances to

Increasing the efficiency and training of the working

Establishing special courses and training sessions onhow to deal with difficult conditions, places for

age in the event of

Unifying the efforts of health associations andinstitutes in operation there and providing aneffective communication network among them.Protecting the rights of doctors and patients and

ing them or preventing them fromperforming their humanitarian role towards patients.Al Aqsa Mosque should receive greater attentionfrom all Muslims around the world. It should also bepresent in their minds, spreading its news in

and publications. Clarifyingthe truth of what is being plotted against it in the cityof Jerusalem, and receiving moral and material

1. https://www.google.co.uk/amp/s/amp.theguardian.com/world/2021/may/10/dozensover-israeli-settlements-aheadmarch

2. https://m.facebook.com/PAMApalestinian/posts/urgent-masjid-al-aqsa-criticalpama-in-supporting-medical/2779733685577162/?locale=ne_NP

3. https://www.bbc.com/news/world57034237.amp

4. https://www.alhadath.ps/article/40179/

ألكثر-من-180- ألف-مصل

Letters to the Editor & Short Communications

https://www.google.co.uk/amp/s/amp.theguardian.com/world/2021/may/10/dozens-injured-in-clashes-

ahead-of-jerusalem-day-

https://m.facebook.com/PAMApalestinian/posts/urgecritical-medical-situationjoin-

medical-/2779733685577162/?locale=ne_NP

https://www.bbc.com/news/world-middle-east-

https://www.alhadath.ps/article/40179/ - خاص-هندسياالمسجد-األقصى-ال-يتسع-ألكثر

75

Marium Husain, MD, MPH,

Hematology /Oncology Fellow, Ohio, USA. Vice President, Islamic Medical Association of North America (IMANA). Board member, Nagamia Institute of Islamic Medicine and Science (NIIMS)

Correspondence mariumhn@gmail.com

Dr Husain Nagamia, age 81, of Tampa, passed away on June 4, 2021 at the age of 81. He was born June 29, 1939 in Baroda, India, son of the late Fakhruddin and Kamaljehan (Refai) Nagamia. His wonderfulachievements leave a positive legacy and there is much tocelebrate when assessing all that he did.

History class in the U.S. consisted of reading about theGreeks, Romans, and then fast forward to the conqueringof England and the European Renaissance. Although themain goal at that time was to not fall asleep, it wasn’thard to notice this huge gap in our history education.That gap that neglected to mention the vital contributionsfrom the Middle East and North Africa was normalized. Inever really questioned this until I truly learned about thehistory of Islam and science, specifically medicine, fromDr. Husain Nagamia. To the world he was theChairman/Founder of the International Institute of Islamic Medicine (IIIM), a Cardiothoracic surgeon, PastPresident of the Islamic Medical Association of NorthAmerica (IMANA), member of the Founder’s Committeeof the Islamic Society of North America (ISNA), Editorin-Chief of the Journal of the Islamic MedicalAssociation of North America (JIMA). To me, he wasUncle.

I was a resident when we first implemented an IIIMessay competition for undergraduate and medicalstudents about the history of Islam in medicine. I didn’tknow much about IIIM and only knew of Dr. Nagamiathrough a family friend connection. But I quickly learnedof his genuine passion for educating young Muslimprofessionals about their history in their own field, and ultimately their identity. I didn’t realize at the time howthat would shape me. We did this essay competition for afew years, where we learned about surgical instruments

Letters to the Editor

Hematology /Oncology Fellow, Ohio, USA. Vice President, Islamic Medical Association of North America (IMANA). Board member, Nagamia Institute of Islamic Medicine and Science (NIIMS)

mariumhn@gmail.com

age 81, of Tampa, passed away on He was born June 29, 1939

in Baroda, India, son of the late Fakhruddin and Kamaljehan (Refai) Nagamia. His wonderful achievements leave a positive legacy and there is much to

History class in the U.S. consisted of reading about the Greeks, Romans, and then fast forward to the conquering of England and the European Renaissance. Although the main goal at that time was to not fall asleep, it wasn’t

to notice this huge gap in our history education. That gap that neglected to mention the vital contributions from the Middle East and North Africa was normalized. I never really questioned this until I truly learned about the

specifically medicine, from Dr. Husain Nagamia. To the world he was the Chairman/Founder of the International Institute of Islamic Medicine (IIIM), a Cardiothoracic surgeon, Past President of the Islamic Medical Association of North

r of the Founder’s Committee of the Islamic Society of North America (ISNA), Editor-

Chief of the Journal of the Islamic Medical Association of North America (JIMA). To me, he was

I was a resident when we first implemented an IIIM on for undergraduate and medical

students about the history of Islam in medicine. I didn’t know much about IIIM and only knew of Dr. Nagamia through a family friend connection. But I quickly learned of his genuine passion for educating young Muslim

ionals about their history in their own field, and ultimately their identity. I didn’t realize at the time how that would shape me. We did this essay competition for a few years, where we learned about surgical instruments

developed by Muslims during the Gadvances in the understanding of the circulatory system

and optics by Muslim physicians. We learned about allthe papers Dr. Nagamia wrote and published about the

history of Islamic medicine and surgical procedures andNeo-Islamic medicine throughout the years. Despite his amazing achievements, wealth of knowledge and beingso busy, he always reached out to me and included me inthe planning of these competitions. He expressly wantedyouth involvement in these efforts because he knewit wasn’t about him, but about the mission and vision,whether he was there for it or not.

Letters to the Editor& Short Communications

Board member, Nagamia Institute of Islamic Medicine and Science (NIIMS)

developed by Muslims during the Golden Age of Islam, advances in the understanding of the circulatory system

and optics by Muslim physicians. We learned about all the papers Dr. Nagamia wrote and published about the

history of Islamic medicine and surgical procedures and edicine throughout the years. Despite his

amazing achievements, wealth of knowledge and being so busy, he always reached out to me and included me in the planning of these competitions. He expressly wanted youth involvement in these efforts because he knew that it wasn’t about him, but about the mission and vision, whether he was there for it or not.

76

Because of the success and growth of the IIIM since1992, eventually NIIMS was born in 2019, the NagamiaInstitute of Islamic Medicine and Science. Dr. Nagamiaoversaw the creation of an independent institution solelydedicated to Islamic medicine and science history, thefirst of its kind in the United States. An institution thengages with and teaches local students, showcases aunique and rare Qur’an exhibit, provides monthly education webinars on medical advances both current andhistorical. Dr. Nagamia’s vision became a physicalreality. He was also a well published authovariety of publications and academic articles on differenttopics. These include: Islamic Medicine History and the current practice Prophetic Medicine: ‘A Holistic Approach to

Medicine’ New Definition of Islamic Medicine: 'Neo

Medicine' A Museum and Library of Islamic Medical History: A

new perspective The Great Physician Historian During the Golden

Islamic Medical History - Ibn Abi Usaybi'aa Abū Zayd Ḥunayn ibn Isḥāq al-‘Ibādī: A Physician

Translator Par Excellence Ibn A-Nafis The Bukhtīshū’ Family: A Dynasty of Physicians in

the Early History of Islamic Medicine What is Wrong with American Medicine? The Role of

IMANA

This vision and passion weren’t singular events. Thisjourney was 25 years in the making, to which Dr.Nagamia dedicated a lifetime. Understanding that our Islamic history isn’t just for one culture or group, hecollaborated with leaders and motivated people aroundthe world to spread this knowledge and passion for our

Letters to the Editor

Because of the success and growth of the IIIM since was born in 2019, the Nagamia

Institute of Islamic Medicine and Science. Dr. Nagamia oversaw the creation of an independent institution solely dedicated to Islamic medicine and science history, the first of its kind in the United States. An institution that engages with and teaches local students, showcases a unique and rare Qur’an exhibit, provides monthly education webinars on medical advances both current and historical. Dr. Nagamia’s vision became a physical reality. He was also a well published author and wrote a variety of publications and academic articles on different

Islamic Medicine History and the current practiceProphetic Medicine: ‘A Holistic Approach to

New Definition of Islamic Medicine: 'Neo-Islamic

A Museum and Library of Islamic Medical History: A

The Great Physician Historian During the GoldenIbn Abi Usaybi'aa

‘Ibādī: A PhysicianNafis

ukhtīshū’ Family: A Dynasty of Physicians inthe Early History of Islamic Medicine What is Wrong with American Medicine? The Role of

This vision and passion weren’t singular events. This journey was 25 years in the making, to which Dr.

ated a lifetime. Understanding that our Islamic history isn’t just for one culture or group, he collaborated with leaders and motivated people around the world to spread this knowledge and passion for our

history. This led to multiple presentations at inteIMANA meetings, to collaborative research projects, tothe creation of the International Society for the History ofIslamic Medicine (ISHIM), and many other internationalconventions. Dr. Nagamia was atevery year and was only forced to stop because of theCOVID-19 pandemic. These meetings created lifelongfriendships, friends who are now feeling the pain of theloss of Dr. Nagamia. His legacy invigorated people to know their history, and ultimately know themselves.

Dr. Nagamia knew who he was. Born in 1939 in Baroda,India he remained connected to his roots where hestudied medicine. He was one of the founding membersof the American Federation of Muslims of Indian origin, dedicated to the universal education for minorities inIndia to achieve 100% literacy. He had all theseaccomplishments and was still working in his busyclinic! But his main passion and dedication was to hisfamily. He was married to Dr. ZubedaNagamia for 55years, traveling together around the world as they spreadthis passion for Islamic history. His daughter, Dr. AfshanAhmed, son, Dr. Sameer Nagamia, and grandchildrenwere his pride and focus as he attended every majorevent, most recently his youngest grandchhighschool graduation.

Dr. Nagamia was one of those people with the greatblessing to have changed their community so muchduring their time here on Earth, and also leaving a legacythat is a Sadaqahjariyah. He was one of a kind, and willbe dearly missed. Though we grieve, he would urge us tocontinue the work because it wasn’t just his; he madesure it was ours.

Letters to the Editor& Short Communications

history. This led to multiple presentations at international IMANA meetings, to collaborative research projects, to the creation of the International Society for the History of

), and many other international conventions. Dr. Nagamia was attending these meetings every year and was only forced to stop because of the

19 pandemic. These meetings created lifelong friendships, friends who are now feeling the pain of the loss of Dr. Nagamia. His legacy invigorated people to

y, and ultimately know themselves.

Dr. Nagamia knew who he was. Born in 1939 in Baroda, India he remained connected to his roots where he studied medicine. He was one of the founding members of the American Federation of Muslims of Indian origin,

d to the universal education for minorities in India to achieve 100% literacy. He had all these accomplishments and was still working in his busy clinic! But his main passion and dedication was to his family. He was married to Dr. ZubedaNagamia for 55

s, traveling together around the world as they spread this passion for Islamic history. His daughter, Dr. Afshan Ahmed, son, Dr. Sameer Nagamia, and grandchildren were his pride and focus as he attended every major event, most recently his youngest grandchild’s

Dr. Nagamia was one of those people with the great blessing to have changed their community so much during their time here on Earth, and also leaving a legacy

. He was one of a kind, and will missed. Though we grieve, he would urge us to

continue the work because it wasn’t just his; he made

77