HEALTH CARE

HEALTH CARE. Healing traditions of the Islamic world exhibit broad historical and sociocultural variation. Although a certain complex of therapeutic conventions is generally associated with Islamic societies, it represents but one expression of a dialectic of unity and diversity. Specific health practices are not distributed uniformly throughout Muslim communities. Neither are such elements of healing culture unique to these communities, reflecting the distribution of pre-Islamic therapeutic traditions over vast civilizational areas, and the protracted encounter between islamized peoples and non-Muslims.
Although the link between Arabic-Islamic and GrecoRoman medicine has been privileged in Eurocentric scholarship, cross-cultural appropriations and influences far exceed the bounds established by traditional historiography. Contemporary research has highlighted the diversity of health and medical traditions, suggesting that the conventional understanding of Islamic medicine be expanded beyond its common referents of Greco-Islamic and Prophetic healing to more accurately reflect the therapeutic heterogeneity of Islam. For instance, medieval Arabic-Islamic medicine was also informed by African and Asian literate medical traditions-including ancient Egyptian, Indian, Persian, and Syriac-as well as pre-Islamic popular health practices and local modes of organizing health maintenance in Islamized communities. Prophetic medicine, which in many respects resembles pre-Islamic bedouin healing traditions, attends to hygienic and dietary concerns, as well as psychosocial distress, including forms in which the spirit world, the evil eye, and sorcery are implicated. The barakah (blessing) of the Qur’an, its learned “carriers,” and holy descendants of the Prophet, are central to this tradition. And in Islamic humoralism, nature, with its four elements, and the human body, with its four humors, are focal in definitions of health-sickness and derivative healing regimens. Humoral conceptions of balance (health) and imbalance (sickness) involve notions of hot and cold and the interaction of natural elements with the four humors of the body (blood, phlegm, bile, and black bile). As with the integrative character of Islamic culture in general, pre-Islamic and Islamic health care practices and institutions have been adapted to different social and ecological conditions.
While religious teachings enjoin Muslims to protect and restore their health, there is no specification as to type of treatment. In fact, as noted by the fourteenthcentury social historian Ibn Khaldfin, Muslims are not obligated to follow the medical prescriptions handed down even in authentic traditions attributed to the Prophet. Among Indian Muslims, for example, reliance on the healing power of the Qur’an does not preclude resort to Ayurveda. Similarly, Arab Muslims are known to visit Christian places of worship in pursuit of restoration of health. And as recently as the middle of the twentieth century, some urban Egyptian families engaged Jewish religious specialists for the circumcision of their sons.
Elements of ancient and medieval healing traditions are but partial constituents of the Islamic world’s medical pluralism. Health care practices also reflect changes in political economies over the course of modern history. Thus, while Sufi holistic healing in the Arab world exemplifies the general association between healing and religion, its significance in addressing psychosocial problems from the sixteenth to the nineteenth century is related to modern global developments. It has been suggested that these regimens acquired particular significance in relation to the pressures of market forces linked to Western encroachment. Those segments of the population adversely affected by the new market relations found refuge in Sufi forms of socially grounded healing. On the other hand, ruling-class authorization of positivist biomedicine was consistent with the support of nineteenth-century periphery capitalism.
Today, the health policies of the Islamic world’s nation-states, like those of international health organizations, are based on the premises of pathology-focused biomedicine. The principles of this cosmopolitan healing tradition, rather than Islamic medical texts of the past or their popularized forms of the present, inform state regulation of health throughout the Islamic world. Although connected to ancestral Islamic empirical/literate traditions (such as those elaborated by al-Razi, Ibn Sina, Ibn Rushd, Ibn Maymun [Maimonides], and Ibn al-Nafis), modern biomedical traditions originate in a fundamentally different global system, with its particular state institutions, regulatory mechanisms, and local modes of organization. In this regard, the “Islamic Clinics” established in recent years represent a cultural veneer overlaying the basic conceptual framework of cosmopolitan medicine.
Tradition, Continuity, and Context. Coexisting with different forms of officially sanctioned, clinic-centered health care are numerous other healing practices utilized by members of Islamic communities around the world. These include household-based herbal medicine and dietary regimens for the maintenance or restoration of the body’s vitality. Also prevalent in Islamic communities are notions of the unity of soma and psyche, the ideal of exercising moderation in food, drink, and sex, reliance on the healing power of barakah, associated with Qur’anic texts and recitations, as well as visits to the shrines of holy persons. In addition, the protection or restoration of health may involve the use of amulets against the evil eye, and a variety of hygienic practices, ranging from male circumcision to the differentiation of the use of the right and left hands for the handling of food as opposed to “polluting” substances such as feces and urine. Spiritual healers, including those who possess Qur’anic knowledge, are also frequented for diagnosis of possession illness and pacification of the spirits believed to cause it, as well as the healing of sorceryinduced afflictions.
The health regimens of contemporary Islamic communities share certain structural features and specific practices with past cultures, including Mesopotamian, Egyptian, Phoenician, and medieval Islamic. Parallels include the dual role of central authorities in keeping order and regulating health, biological inheritance of the healing power of barakah, the close relationship between religion, magic, and medicine, the use of amulets against the evil eye, music therapy, exorcism of spirits, and the practice of cupping, bloodletting, and cauterization.
Beyond recognizing general similarities between health care practices of today’s Islamic world and historical therapeutic traditions, it is important to recognize that contemporary forms are not simply straightforward reproductions of past regimens. Among other examples of local particularity is the case of the Malay Peninsula, where treatment of the majority of illnesses entails restoration of the body’s humoral balance. Although many of the precepts of medieval Islamic theory were incorporated into Malay medicine, historically informed ethnographic analysis reveals that pre-Islamic aboriginal ideas continue to be operative. Furthermore, some radical alterations have affected the received theories of Islamic humoralism. Other examples of local specificity are disclosed by comparing the ways in which the risks to health of emotional distress are managed in different Muslim communities.
Working in Islamic communities in Iran, Turkey, Malay, Yemen, Egypt, and Morocco, some researchers suggest that formulations of Greco-Islamic medicine, notably those pertaining to reproductive health, and notions of health as a manifestation of humoral balance, continue to be significant as a basis of dietary regimens and the differentiation of states of compromised health among members of these communities. Addressing this issue on the basis of their experiences in some of the same Islamic societies, namely Yemen and Egypt, in addition to Islamic communities of Nigeria, other researchers report lesser evidence of the classical humoral theories than suggested by European-language literature. For example, in rural Egypt, where therapeutic measures similar to those of medieval Islamic medicine are practiced, their utilization is distanced from the coherent logical framework of classical humoralism. Bloodletting, for instance, is not linked to the elaborate medieval humoral model of balance (health) and imbalance (sickness). In other African societies, Prophetic components of Islamic medicine, rather than humoral concepts, have taken root as significant elements of medical pluralism. Among the Muslim Hausa of northern Nigeria, as elsewhere in the Islamic world, hygienic and dietary practices, as well as the use of Qur’anic charms associated with this therapeutic tradition, coexist with pre-Islamic practices of the pacification of spirits that are believed to precipitate illness. The possession cults of Sufi orders are also found throughout Islamic communities on the continent and beyond, including Morocco, Tunisia, Egypt, Senegal, Mali, Sudan, and Iran.
Biomedicine and the Colonial Legacy. Within the framework of nineteenth-century global political and economic relations, biomedicine gained prestige and legitimation through the patronage of indigenous rulers and the policies of colonial administrators. For example, Iran witnessed the decline of the indigenous decentralized bazaar system of healing in favor of the centralized biomedical form sanctioned by the shah. Competing for political influence and economic gain in the Iranian court, European powers were well served by the healing skills of their physicians. Mechanisms for regulating public health, namely quarantines and sanitary councils, were also deployed in the economic contests between European rivals.
In the colonized Muslim world, the primary concern of colonial administrators was the protection of their own subjects, military and civilian. For many nineteenth-century colonial administrators and medical personnel, the dangers of disease were taken for granted as part of a hostile, “tropical” environment. Although European healing during the early nineteenth century was no more effective than Greco-Islamic medicine, it was nevertheless asserted that only through European knowledge and intervention would it be possible to bring under control the diseases of the empire’s colonies. Supported by political and military power, European medicine was considered a form of progress toward a more “civilized” social and environmental order.
During the imperial age, “disease” constituted a central element of the conceptualization of the “tropical” colonized world, which was constructed as the antithesis of sanitary Europe. As Franz Fanon described for Muslim Algeria, this discourse of empire served as a rationale for “racialism and humiliation.” In Algiers and other North African cities of the nineteenth century, residential areas were segregated by the French. Under these conditions, the visit of the European doctor, often a military man, was by no means welcomed by the indigenous Muslim population. While some of the foreign doctors were considered skillful healers at whose hands relief from pain could be obtained, others were regarded with suspicion. Judged to be spies, some European physicians were murdered.
Propelled by “curative confidence,” biomedicine eclipsed earlier literate Islamic medical traditions. Simultaneously, it served as a mechanism of social control in colonized Islamic societies, but not without historically specific variations in local articulations, resistance, or acceptance.
In Egypt, biomedicine took root prior to the British occupation of 1882, coinciding with the nineteenth century rationalization of the economy during the reign of Muhammad `Ali (1805-1848). With the aim of creating a powerful army and a large productive labor force of men and women, the state’s public health program was designed to combat epidemics and reduce infant mortality. State-sponsored health care providers included women health officers. Countrywide vaccination campaigns involving trained local paramedics eliminated smallpox by mid-century.
But the establishment of biomedical health care in nineteenth-century Egypt was hardly a case of “modernity” landing on the virgin soil of “tradition.” Ibn Sina’s work had remained influential in Europe up to the sixteenth century. Thereafter Muslim scholars in Turkey and elsewhere followed its elaboration in Europe, in addition to other developments in positivist medicine. The philosophical legitimation of Muhammad `Ali’s reform policies derived from the Islamic tradition of kalam, wherein logic, argumentation, medicine, and the natural sciences were significant. Thus, local therapeutic traditions converged with Europe’s developing scientific trends. By the latter part of the nineteenth century, professional medical practitioners, by now committed to biomedicine’s normalizing knowledge of desocialized disease, came to regard psychosocially oriented healing regimens beyond their domain as “quackery.”
With the British occupation of 1882, and consistent with the colonial extractive strategies in the Egyptian “cotton farm,” hydraulics and agricultural modernization were given priority, to the detriment of public health and medical education. Colonial authorities privatized medical education and promoted this relationship in health care. With the Arabic language declared unfit for “scientific” study, the anglicization of curricula extended to medical education. Under pressure from nationalist forces, and with the failure of British physicians to “spread the light of Western science throughout the country” (as the British consul general, Lord Cromer, put it), the 1920s and 1930s witnessed the revival of some older public health strategies of the Muhammad `Ali era, albeit in greatly compromised form. For instance, the former era’s state-sponsored training of female medical officers in preventive health care, surgery, obstetrics, and gynecology was replaced by the Florence Nightingale model of hospital-based nursing.
In other parts of the Muslim world the ascendancy of biomedicine came about differently than in Egypt, where European doctors had been invited by Muhammad Ali for the express purpose of training Egyptians within the framework of an integrated state-centered development scheme. In Tunis the nineteenth-century colonial government severely undermined the role of indigenous doctors by restricting licensing to Europeans. Within a decade of the French occupation of 1881, indigenous doctors were reduced to the status of midecin tolire, and their practice was soon rendered less than legal.
Medical Pluralism in Nation-States. Beyond its political and economic instrumentality, cosmopolitan health care introduced in Islamic societies during the colonial era was very limited; most of the population continued to rely primarily on traditional forms of healing. Aside from variation in the extent of state commitment to provide public health care, skewed distribution of cosmopolitan medical services generally continued in the postindependence period.
Presently, the authoritative role of global biomedicine in regulating social life in Islamic nation-states underscores the conviction that societal homogeneity is a function, not of Islamic legal traditions, but of mechanisms of control perfected by modern nation-states. While officials of these states may continue to honor their Arabic-Islamic literate medical heritage, they are committed to cosmopolitan medicine as the foundation of medical education, research, and public health programs. Western professional accreditation remains a mark of distinction among physicians in Muslim countries. Similarly, among patients the resort to modern medicine is a symbol of social privilege.
In spite of the limitations surrounding access to cosmopolitan health services, legal sanction of healing remains limited to professional practitioners and, with the exception of midwives, does not extend to traditional healers. The 1983 National (Sudanese) Council for Research Act represents a rare form of official support for researchers “to evaluate TM (Traditional Medicine) in the light of modern science so as to maximize useful and effective practices and discourage the harmful.” Although not legally sanctioned, traditional healing continues to be tolerated by the authorities. In some cases it may be the only accessible form of health care. In others, it is preferred over biomedical care. For although biomedicine has gained popularity and prestige throughout the Islamic world, its utility in addressing culturally meaningful, socially defined afflictions remains limited.
Prevention is central to popular health care in Islamic societies. The “word of God,” either written or oral, is deemed effective in warding off evil, including sickness precipitated by the covetous gaze of the evil eye or spirit intrusion. Preventive health care is primarily householdcentered, with women shouldering major responsibility for the execution of preventive regimens and home remedies. Assistance during birth is also part of women’s responsibilities, whether as midwives or simply experienced elders.
Traditional healers, found throughout the Islamic world, include practitioners of natural medicine. Their practice is informed by certain variants of Islamic humoralism, knowledge of bonesetting, and herbal medicine. Spiritual healers, on the other hand, diagnose and treat sickness of supernatural etiology, including sorcery-induced afflictions and spirit possession. The literate among them rely on their knowledge of the Qur’an to gain access to the supernatural realm. Paramedical variants of health care are also significant to the socially disadvantaged sectors of Muslim societies. As in the case of pharmacists, paramedics provide advice on medication and administer injections.
Transcending the medical model of health care, some health activists in different parts of the Muslim world have emphasized sociopolitical conceptions of health. Reminiscent of al-Suyuti’s medieval treatise on the medicine of the Prophet, which recognizes deprivation as a cause of poor health, activists have stressed the relationship between health and, for instance, military occupation, or the distribution of health resources, including adequate nutrition, housing, and water supply. Feminists, in particular, have called attention to the impact of gender differentiation on health maintenance, and have defined the practice of genital surgery as both a human rights and health issue. Although statesponsored and international health programs often give priority to the regulation of Muslim women’s fertility, public policy affecting women’s lives and health does not reflect an awareness of the ways in which compromised health is socially produced. As official pledges of “Health for All” gave way to selective maternal and child health programs during the eighties, women were burdened with still additional responsibilities for their family’s health. Meanwhile, their own health continues to suffer as a result of laboring in the household, field, or factory, and associated exposure to smoke, pesticides, and industrial contaminants, respectively, in addition to malnutrition and infectious diseases, among other physical and mental afflictions.
Political Islam and Health Care. While Islamic teachings do not instruct Muslims to adopt specific forms of healing, the banner of Islam has served to lend legitimacy to one healing tradition or another. This was the case in nineteenth-century northern Nigeria, where health and healing were integral to the Fulani jihad. Under the leadership of Usuman dan Fodio, and later his successor as sultan of Sokoto, Muhammad Bello, the rural Hausa Qur’anic scholars known as malamai gained great authority. As a concerted effort was made to crush the power of the practitioners of pre-Islamic healing, Prophetic medicine, legitimated by political authority, gained prominence.
During the twentieth century, the relation between political and medical authority has not been lost to state managers. The religiously sanctioned provision of charitable health care has also been part of reformist Islamist agendas. In Egypt during the 1940s, the Muslim Brothers organized teams of physicians and students who engaged in public health education among the poor, particularly in rural areas. While physicians from among the Muslim Brothers operated charitable clinics, the brothers saw in Islamic teachings a more fundamental solution to health problems. Having defined poverty as a primary cause of compromised health, they advocated Islamic regulation of wealth distribution.
Although sharing other Muslims’ belief in the holiness of the Qur’an and the wisdom of Prophetic traditions, the Muslim Brothers’ health programs were clearly informed by biomedical logic. Today a similar scientific orientation is manifest in the practice of Muslim African-American physicians. In the Nation of Islam’s Abundant Life Clinic in Washington, D.C., AIDS patients are treated with Immuviron, a derivative of the drug Kemron.
The commitment to bio medicine is also evident in the Islamic Clinics established in some parts of the Muslim world, notably Jordan, Sudan, and Egypt, over the past decade. Although very little published material is available on the operation of these clinics, they are generally considered to be an expression of the rise of political Islam. For Sudan, anthropologist Ellen Gruenbaum (1989) notes that the establishment of private clinics by the National Islamic Front coincides with the coming to power in June 1989 of a new regime that implemented the Front’s policies. Through the Front, the clinics are financed by Islamic banks established with Saudi capital.
For Egypt, Islamic Clinics include numerous one- or two-room clinics established by religious voluntary associations and attached to modest mosques, as well as some major health care centers such as the Mustafa Mahmud Islamic Clinic. These health care facilities are dependent on financial contributions from nongovernmental sources. In addition to local charitable contributions, Gulf petro-wealth has served indirectly to support their low-priced medical services. In some cases, the Islamist private commercial and financial sectors contribute financially to Islamic Clinics, as well as the Physicians’ Syndicate, a stronghold of political Islam.
The “Islamic Alternative” in health care is presented by its advocates as a private initiative to address unmet health care needs at a time when state support of public health is less than adequate. Far from representing an alternative health care strategy that challenges state authority, the charitable health services offered by Islamist groups help maintain an indispensable component of the social welfare package. This in turn helps such groups gain legitimacy in, and affirm the legitimacy of, the established social order. Cognizant of the political value of such a reciprocal relationship, the Egyptian state has financed Islamic social service centers, including clinics, thus reinforcing the appearance of state commitment to Islamic tradition. But, as in other clinics, the health care provided by service centers remains distanced from the tenets of medieval Arabic-Islamic medicine. In fact, it does not even resemble such exceptional attempts as those undertaken by Essedik Jeddi’s team to integrate Arabic-Islamic healing into the biomedical psychiatric work conducted at Al-Razi University in Tunis during the 1970s.
As is the case of professional medical practitioners throughout the Islamic world, those working in Islamic Clinics are trained in biomedicine and committed to its practice. While the patrons of the clinics may be gratified by their proximity to a place of worship, they expect high-technology medical care, not Islamic medicine, whether in its Prophetic or humoral form. For their part, physicians serving in these clinics take pride in their access to the “most advanced” medical technology imported from the West.
Supporters of Islamic Clinics sometimes present them as an embodiment of the Prophet’s hadith describing science as a method blending theology and medicine (“the science of religion [theology] and the science of the body [medicine]”). Beyond such rationalizations, it is important to note the historical context of the establishment of these clinics, namely the development of a petro-economy in the Gulf and the regional development of political Islam, catalyzed by the Islamic Revolution in Iran.
As Gulf petro-wealth and Islamic political agendas left their mark on intellectual developments in the Muslim world, this extended to medical and health care. Professional and academic associations, such as the Kuwait Islamic Organization for Medical Sciences and the College of Medical Sciences at King Faisal University, launched various publications devoted to the relationship between Islam and medicine. The “authentication” of cosmopolitan medicine has been the subject of numerous international conferences held in different Islamic countries. Participants, including Muslim physicians and clerics, have attempted to define an Islamic perspective on a wide range of health issues, from preventive care, birth spacing, prenatal care, and breastfeeding, to the treatment of emotional disorders. Conferees have also addressed the religious/ethical implications of a variety of modern medical practices and biomedically defined altered states of health, including the implantation of body parts, artificial insemination, and AIDS.
International conferences in which scientific, including medical, phenomena are addressed in relation to Qur’anic knowledge have drawn criticism from some Muslim intellectuals. For example, Munawar Ahmad Anees has attached the designation “scientific fundamentalism” to the current trend of “islamization of knowledge.” Similarly, Pervez Hoodbhoy, in a book introduced by the Muslim physicist and Nobel laureate, Mohammed Abdus Salam, suggests that today’s socalled Islamic science, which seeks to capitalize on the science practiced by the early Muslims, betrays a fundamental misunderstanding of the scientific achievements of Islam’s golden age. Highlighting the works of the Muslim physicians al-Razi (865-925), Ibn Rushd (1126-1198), and Ibn Sind (980-1037), Hoodbhoy argues that these scholars, while deeply committed Muslims, practiced science of an essentially secular kind.
[See also Family Planning; Medicine; Science.]
BIBLIOGRAPHY
Earley, Evelyn. “The Baladi Curative System of Cairo, Egypt.” Culture, Medicine, and Psychiatry 12 (1988): 65-83.
Fanon, Franz. Studies in a Dying Colonialism. New York, 1965. Classic work on colonialism that includes insightful discussions of the politics of health in colonized North Africa.
Feierman, Steven, and John M. Janzen, eds. The Social Basis of Health and Healing in Africa. Berkeley, 1992. Excellent volume on African healing as a socially and historically constituted complex of traditions. Includes essential readings by Ismail H. Abdalla on the history of Islamic medicine in northern Nigeria, Bernard Greenwood on Moroccan therapeutics, and Murray Last on healing knowledge in Hausaland.
Gallagher, Nancy E. Medicine and Power in Tunisia, 1780-1900. Cambridge, 1983.
Gallagher, Nancy E. Egypt’s Other Wars: Epidemics and the Politics of Public Health. Syracuse, N.Y., 1990.
Gran, Peter. Islamic Roots of Capitalism: Egypt, 1760-1840. Austin, 1979. Focused on Egypt during the eighteenth and nineteenth centuries, this study of intellectual developments, including medical concerns, provides a refreshing alternative to modernization theorists’ tradition-modernity dualism.
Gran, Peter. “Medical Pluralism in Arab and Egyptian History: An Overview of Class Structures and Philosophies of the Main Phases.” Social Science and Medicine. 13B (1979): 339-348.
Greyhton, M. L. “Communication between Peasant and Doctor in Tunisia.” Social Science and Medicine ti (1977): 319-325. Gruenbaum, Ellen. “Changes in the Health of Women in Rural Sudan.” Paper presented at the Annual Meeting of the American Anthropological Association, 1989.
Hoodbhoy, Pervez. Islam and Science: Religious Orthodoxy and the Battle for Rationality. London, 1991.
Kuhnke, LaVerne. “The `Doctress’ on a Donkey: Women Health Officers in Nineteenth-Century Egypt.” Clio Medica 19 (1974) 193
205.
Kuhnke, LaVerne. Lives at Risk: Public Health in Nineteenth-Century Egypt. Berkeley, 1990.
Leslie, Charles, and Allan Young, eds. Paths to Asian Medical Knowledge. Berkeley, 1992. Informative volume on Asian medicine that includes contributions on Islamic humoral traditions in a chapter co-authored by Byron Good and Mary-Jo DelVecchio Good, and in another by Carol Laderman. Together these two chapters bring into focus the central elements of the debate on Islamic medicine as a living tradition.
Lewis, I. M., Ahmed El Safi, and Sayyid Hurreiz, eds. Women’s Medicine: The Zar-Bori Cult in Africa and Beyond. Edinburgh, 1991. MERIP Report 161 (1989). Special issue of the journal entitled “Health and Politics,” with articles on medical education, health under military occupation, medical technology, women and medicine, and occupational health.
Morsy, Soheir A. “Islamic Clinics in Egypt: The Cultural Elaboration of Biomedical Hegemony.” Medical Anthropology Quarterly 2.4 (1978) 355-369.
Morsy, Soheir A. Gender, Sickness, and Healing in Rural Egypt: Ethnography in Historical Context. Boulder, 1993
Munawar Ahmad Anees. “Islam and Scientific Fundamentalism.” New Perspectives Quarterly 158 (Summer 1993): 61-63.
Myntti, Cynthia. “The Social, Economic, and Cultural Context of Women’s Health and Fertility in Rural North Yemen.” In MicroApproaches to Demographic Research, edited by John C. Caldwell et al., pp. 165-169. London, 1988.
Paul, Jim. “Medicine and Imperialism.” In The Cultural Crisis of
Modern Medicine, edited by John Ehrenreich, pp. 271-286. New York, 1978. Critical commentary on colonial medicine in Morocco. Rahman, Fazlur. Health and Medicine in the Islamic Tradition. New York, 1987.
Sonbol, Amira El Azhary. The Creation of a Medical Profession in Egypt, 1800-1922. Syracuse, N.Y., 1991.
Wikan, Unni. “Bereavement and Loss in Two Muslim Communities: Egypt and Bali Compared.” Social Science and Medicine 27.5 (1988): 451-460.
SOHEIR A. MORSY