بسم الله الرحمن الرحيم
Healthcare... Between Systems of Tax Collection and the System of Care
(Translated)
The health sector is considered one of the most important vital sectors in which misery and poor care appear, because it touches people’s lives directly. One look or one visit to one of the public health centers or government hospitals in any country of the Muslim lands is sufficient instead of much explanation in describing the reality of the situation: crumbling infrastructure, lack of medicines and treatments, shortage of medical supplies, and the exorbitant cost of treatment in private hospitals, which many people cannot afford in light of this poor care. Add to that corruption, favoritism, nepotism, procrastination, long procedures, and the failure to give doctors and medical staff their rights, and other matters...
Poor care and corruption in this field are not limited to the Muslim lands and poor countries, even if they are clearer there. The issue is not primarily the wealth or poverty of the countries; rather the matter is related to these states being states of tax extraction and not states of care. If we look at the Western states that have advancement in scientific and technological fields which has been reflected in the medical field, we see that the corruption of the capitalist principle, the materialistic outlook, and the pursuit of gains and profits have also been reflected in the health sector in these states, where it has been taken as one of the largest sources of profit-making, rivalling oil companies, arms companies, and information technology companies. We see that corruption appears in almost all aspects of healthcare in these states: in the health insurance system and its companies, in pharmaceutical companies and their research, in intellectual property and patents, etc.
In this article we will shed light on the policy of healthcare under the Khilafah (Caliphate) state, in which the concept of care and managing the affairs of the subjects becomes manifest in a way that leads to physical well-being and psychological safety.
Islam has given healthcare and medical treatment great attention. It is among the essential interests and needs without which people cannot do, just like security, food, clothing, and housing. The Messenger (saw) said:
«مَنْ أَصْبَحَ مِنْكُمْ آمِناً فِي سِرْبِهِ مُعَافًى فِي جَسَدِهِ عِنْدَهُ قُوتُ يَوْمِهِ فَكَأَنَّمَا حِيزَتْ لَهُ الدُّنْيَا»
“Whoever among you wakes up secure in his home, healthy in his body, and has his food for the day, it is as if the world has been gathered for him.” The Sharia has made healthcare the responsibility of the state and the Khalifah directly, acting upon the saying of the Messenger (saw):
«الإِمَامُ رَاعٍ وَهُوَ وَمَسْؤُولٌ عَنْ رَعِيَّتِهِ» “The Imam is a shepherd and he is responsible for his subjects.” The Islamic state gave healthcare great attention as one of the doors of caring for affairs which Islam made among the responsibilities of the Imam over the people. The Messenger of Allah (saw) ordered a tent to be built to treat wounded soldiers and provide medical care for them in the Battle of the Trench, inside the mosque in a tent under the care of Rufaidah al-Aslamiyyah. Thus, he prepared the first center or hospital for treating the sick and wounded in the Islamic state. The Prophet (saw), in his capacity as ruler, sent a physician to Ubayy ibn Ka‘b. Muslim narrated through Jabir who said:
«بَعَثَ رَسُولُ اللَّهِ ﷺ إِلَى أُبَيِّ بْنِ كَعْبٍ طَبِيباً فَقَطَعَ مِنْهُ عِرْقاً ثُمَّ كَوَاهُ عَلَيْهِ» “The Messenger of Allah (saw) sent a physician to Ubayy ibn Ka‘b who cut a vein and then cauterized it.” ‘Umar (ra), also in his capacity as ruler, called a physician to treat Aslam. Al-Hakim narrated in Al-Mustadrak from Zayd ibn Aslam from his father who said: "مَرِضْتُ فِي زَمَانِ عُمَرَ بِنَ الْخَطَّابِ مَرَضاً شَدِيداً فَدَعَا لِي عُمَرُ طَبِيباً فَحَمَانِي حَتَّى كُنْتُ أَمُصُّ النَّوَاةَ مِنْ شِدَّةِ الْحِمْيَةِ" “During the time of ‘Umar ibn al-Khattab I fell severely ill, so ‘Umar called for a physician for me and he put me on such a strict diet that I was sucking date stones due to the intensity of the diet.”
The Khulafa’ (Caliphates) and governors followed this path after them and established hospitals (bimaristans). Some were permanent and others mobile. The permanent hospitals were built in cities, while the mobile hospital traveled through distant villages, deserts, and mountains. It was supplied with medicines, food, drinks, clothing, physicians, and pharmacists. Its mission was to meet the needs of remote communities far from major cities and permanent medical institutions. It also provided mobile care for the governors and Khulafa themselves. During the rule of Sultan Muhammad al-Seljuqi at the beginning of the twelfth century, the mobile hospital was expanded until it required forty camels to transport it.
No hospital was without medicines or medical supplies. Special measures and procedures were taken to prevent the spread of infection. Inpatients were provided with clothing from the hospital manufactured in a central supply area, while their personal clothing was kept in the hospital storehouse. When they were taken to their designated wards, they would find beds covered with clean covers and padded mattresses. The hospital rooms were elegant and equipped with water fountains and reached by sunlight. The hospital also had a university attached to it to train physicians and provide them with housing, clothing, food, and travel needs. The state honored physicians and teachers for the important role they played in caring for the people’s health affairs.
Hospitals opened their doors to everyone around the clock, 24 hours a day. Male patients were assigned male physicians and female patients female physicians, while some preferred establishing separate wings with separate staff and facilities for each gender. For less serious cases there were outpatient clinics equipped with doctors who prescribed medicines for patients to take at home.
Islam prohibited the privatization of healthcare and made the expenditure required for it from the Bayt al-Mal. It obliged the state to provide treatment for the subjects free of charge regardless of whether they were wealthy and able to pay for treatment or poor and unable to pay. Abu Hurairah reported that the Messenger of Allah (saw) said: «مَن تَرَكَ مالاً فلِوَرَثَتِه، ومَن تَرَكَ كَلّاً فإلينا» “Whoever leaves wealth, it is for his heirs; and whoever leaves dependents or debt, it is upon us.” This applies regardless of whether they are Muslims or non-Muslims. In providing healthcare there is no consideration of religion, gender, race, age, or place of residence. The word “his subjects” mentioned in the saying of the Messenger (saw), «الإِمَامُ رَاعٍ وَهُوَ وَمَسْؤُولٌ عَنْ رَعِيَّتِهِ» “The Imam is a shepherd and he is responsible for his subjects,” is general and not restricted by any specification. Whoever examines the history of the Islamic state from the time it was established by the Messenger (saw) until it was destroyed by the disbelieving colonialist sees that it cared for the affairs of its subjects without discrimination. There were no first-class and second-class citizens as is the case today.
The fact that healthcare is not privatized does not mean individuals or companies in the Islamic state are prevented from providing private health services, or from opening private clinics and hospitals, or that people are prevented from seeking treatment in the private sector. The evidence for this is what Al-Bukhari narrated from Anas (ra) who said:
«دَعَا النَّبِيُّ ﷺ غُلاماً حَجَّاماً فَحَجَمَهُ، وَأَمَرَ لَهُ بِصَاعٍ أَوْ صَاعَيْنِ، أَوْ مُدٍّ أَوْ مُدَّيْنِ، وَكَلَّمَ فِيهِ فَخُفِّفَ مِنْ ضَرِيبَتِهِ»
“The Prophet (saw) called a young cupper who performed cupping for him, and he ordered that he be given a sa‘ or two sa‘s, or a mudd or two mudds, and he spoke about him so his tax was reduced.” So, the young man performed the cupping and received his payment from the Messenger (saw). However, whoever provides healthcare services in the private sector, whether an individual or a company, must adhere to the laws of the state and its supervision. It is also required that whoever provides any healthcare service be qualified to do so, whether working in the private or public sector. Anyone who provides healthcare without qualification is prevented by the state and punished, and if harm results from his action, then he is liable for the damage he caused by undertaking what is not his specialty.
Healthcare under the Islamic state is distinguished by speed and simplicity in providing medical services and treatment, something people lack today. Article 97 of the Constitution of the Khilafah State prepared by Hizb ut Tahrir states: “Article 97: The policy of the administration of services is based on simplicity of the system, speed in processing tasks and competence of the administrators.” One of the matters that reduces administrative complexities and procedures in managing healthcare is the unification of all healthcare services and institutions in the Islamic state under one single body.
This is only a drop from the ocean of the healthcare policy in the Khilafah state, which provided people with services at a high level of care, knowledge, and advancement, until the lands of the West sent their children to learn medicine at the hands of physicians in the Islamic state, and the example of healthcare under the Khilafah was cited even by its enemies before its own people. Among the proofs of that is this translation of a letter from a young Frenchman admitted to the Hospital of Cordoba in the 10th century CE, sent a letter to his father in which he wrote, “My Dear Father: In your previous letter, you mentioned that you would send me some money to assist with my treatment; however, I have absolutely no need for funds. Treatment at this Islamic hospital is entirely free of charge. In fact, the hospital even pays every recovered patient a sum of five gold dinars, along with a new set of clothes, upon their discharge, ensuring they are not compelled to work during their period of convalescence.
My Dear Father: Should you do me the honor of visiting, you will find me in the Department of Surgery and Orthopaedics. Adjacent to my room, you will see a library and a salon dedicated to reading and lectures, where physicians gather daily to attend the teachings of their professors. As for the Department of Gynecology, it is situated on the opposite side of the hospital courtyard, and men are strictly forbidden from entering it. To the right of the courtyard, you will discover a spacious salon reserved for patients who have recovered, where they spend their period of convalescence; this salon features a private library and musical instruments.
My Dear Father: Every corner and every space within this hospital is kept in a state of absolute cleanliness. The mattress and pillow upon which one sleeps are encased in white Damascene fabric, while the bedcovers are crafted from soft, exquisite velvet. All hospital rooms are supplied with fresh water delivered via a specialized piping system, and each room is equipped with a heater for the winter months. As for the food, it consists of chicken and vegetables, so delicious, in fact, that some patients are reluctant to leave the hospital, tempted by the quality of the cuisine." (Aljazeera)
How much we need today a state that cares for our affairs with the rulings of Islam and frees us from the hardship and misery that have afflicted us in the health field and in all aspects of life under the capitalist system and the systems of tax extraction that rule us. O Lord, honor us to live under the second Khilafah Rashidah (Rightly Guided Caliphate) on the method of the Prophethood, and make us among its soldiers and among its witnesses.
Written for the Central Media Office of Hizb ut Tahrir by
Bara’ah Manasrah
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