بسم الله الرحمن الرحيم
Islam Obliges State Provision of Free Healthcare of High Standards
Introduction: Seeking a Cure for Illness
With the increased interest in the great Deen of Islam over the last three decades, there has been a corresponding increase in the interest in Islam’s guidelines regarding healthcare. This has been in parallel with the increased interest in other aspects of Islam, such as education, finance and the political unity of the Islamic Ummah. The renewed interest in the healthcare during the era of the Khilafah is not a discovery as such but a recovery of sorts, a recovery of hundreds of years of immense and ground-breaking achievements in the field of medicine and healthcare. It rests upon us now to examine in detail Islam’s guidelines on healthcare.
The Blessed Sunnah Mandates State Patronage of Healthcare
Islam obliges the state patronage of both medicine and surgery, whilst permitting private healthcare. State healthcare must be free of charge for all the citizens of the Khilafah, Muslims and non-Muslims. The healthcare service must be available, rapidly deployed, consistent and of high standards. The Messenger of Allah (saw) was given a physician as a gift, whom he (saw) did not use himself exclusively and who was made available to all the Muslims as well. This constitutes an evidence that medicine is an interest from the people’s interests. We also see similar evidence (daleel) regarding surgery in trauma cases. In an authentic narration from 'Aisha (ra) she said, أُصِيبَ سَعْدٌ يَوْمَ الْخَنْدَقِ رَمَاهُ رَجُلٌ مِنْ قُرَيْشٍ يُقَالُ لَهُ ابْنُ الْعَرِقَةِ رَمَاهُ فِي الأَكْحَلِ فَضَرَبَ عَلَيْهِ رَسُولُ اللَّهِ صلى الله عليه وسلم خَيْمَةً فِي الْمَسْجِدِ يَعُودُهُ مِنْ قَرِيبٍ “Sa’d was injured on the day of Al-Khandaq (Battle of the Trench), having been hit by an arrow in the medial artery of the arm by a Qurayshi man called Ibn Al-Ariqa, and so the Messenger of Allah (saw) set up a tent for him in the mosque to look after him.” [Bukhari and Muslim]. It is understood from the head of the state, the Messenger (saw), attending to Sa’d’s surgical care that the Islamic state is responsible for such care. Bone setting, cauterization and cupping (hajama) were standard practices in the mobile trauma surgical units that were part of the vanguard of the armies of the Messenger (saw) as they expanded through Islamic conquests.
The Khulafaa’ Rashidoon followed the blessed Sunnah and ensured state patronage of healthcare. Al-Hakim narrated in Al-Mustadrak from Zayd b. Islam from his father who said,مرضت في زمان عمر بن الخطاب مرضاً شديداً فدعا لي عمر طبيباً فحماني حتى كنت أمص النواة من شدة الحمية “I fell severely ill in the time of Umar b. Al-Khattab and so Umar called a physician for me. He warmed me up to the point I would suck on date pits due to the intense heat.” In later periods of the Khilafah, hospitals were funded by charitable religious endowments called waqf, though money from the state coffers was also used for the maintenance of some hospitals. A hospital was called a bimaristan, often contracted to maristan, from the Persian word bimar, ‘ill person’ and stan, ‘place.’ The staff included pharmacists and a roster of physicians who were required at appointed times to be in attendance to make the rounds of patients, taking history, performing clinical examination and prescribing medication
The ﬁrst organised hospital was built in Cairo between 872 and 874. The Ahmad ibn Tulun (أحمد بن طولون) Hospital treated and gave medicine to all patients free of charge. It was named for the Wali, the provincial ruler appointed by the Khaleefah. With gender segregated bathhouses, a rich library and a mental illness wing, it was a highly advanced institution by the standards of the day. Patients deposited their street clothes and their valuables with the hospital authorities for safekeeping before donning special ward clothes and assignment to their dedicated beds.
The ninth-century Al-Qayrawan (ٱلْقَيْرَوَان) Hospital was also a state-of-the-art institution for the time. It was named for the capital of the Wilayah of Qayrawan (ولاية قيروان) in Morocco (Maghreb) where a Wilayah is an administrative unit of the Khilafah. It had well-organised halls including waiting rooms for visitors, female nurses for female patients, a masjid for patients to pray and study, regular physicians and teams of Fuqaha al-Badan (jurists of the body). The latter were a group of jurists who practiced medicine and whose medical services included cupping, bone setting, and cauterisation.
The Al-Adudi (العضدي) Hospital was founded in 981 CE by the ruler of Baghdad, Adud al-Dawlah, and was also named after him. It was run by the famous administrator, Abu-Bakr al-Razi. The 1284 CE Al-Mansuri Hospital of Cairo was built with four entrances, each having a fountain in the centre. The Mamluk Sultan Qalawun ensured that it was properly staffed with physicians and fully equipped for the care of the sick. He appointed male and female attendants to serve patients who were housed in separate wards. Beds had mattresses and specialized areas were maintained. Running water was provided in all areas of the hospital.
The state closely supervised the running of the hospitals as a function of the judiciary of the Khilafah. Neglect in healthcare was not left to private litigation. The following is evidence for the judiciary’s looking into matters that endanger the public rights, where the judge is known as the Muhtasib. The Messenger of Allah (saw), said, «لَيْسَ مِنَّا مَنْ غَشَّ» “He who deceives has nothing to do with us.” (reported by Ahmad and Ibn Maja from Abu Hurayrah). He (saw) also used to confront the cheaters and punish them. The responsibilities of the Qaadi Muhtasib regarding healthcare included ensuring that the correct weights and measures were employed in medication dosages, insistence upon proper hygiene, condemning ramshackle buildings and ensuring a supply of clean water and other related matters.
Teaching and Training According to Prophetic Tradition
There are two aspects to the education of the Islamic physician or surgeon. Treating patients is an act of worship for which there are specific Islamic legal rulings which are to be taught in medical college. In addition, medicine is a subject of technical expertise which includes basic medical sciences as well as clinical medicine.
It is incumbent upon the Muslim physician to know the Islamic rulings related to his work, as it is something which has to be known from Islam by necessity. Consider the rukhsah (رُخْصَةً) from ghusl over the head for the head injury case. Abu Daud narrated that Jabir (ra) said,
رَجْنَا فِي سَفَرٍ فَأَصَابَ رَجُلاً مِنَّا حَجَرٌ فَشَجَّهُ فِي رَأْسِهِ ثُمَّ احْتَلَمَ فَسَأَلَ أَصْحَابَهُ فَقَالَ هَلْ تَجِدُونَ لِي رُخْصَةً فِي التَّيَمُّمِ فَقَالُوا مَا نَجِدُ لَكَ رُخْصَةً وَأَنْتَ تَقْدِرُ عَلَى الْمَاءِ فَاغْتَسَلَ فَمَاتَ فَلَمَّا قَدِمْنَا عَلَى النَّبِيِّ صلى الله عليه وسلم أُخْبِرَ بِذَلِكَ فَقَالَ " قَتَلُوهُ قَتَلَهُمُ اللَّهُ أَلاَّ سَأَلُوا إِذْ لَمْ يَعْلَمُوا فَإِنَّمَا شِفَاءُ الْعِيِّ السُّؤَالُ إِنَّمَا كَانَ يَكْفِيهِ أَنْ يَتَيَمَّمَ وَيَعْصِرَ" . أَوْ "يَعْصِبَ" . شَكَّ مُوسَى "عَلَى جُرْحِهِ خِرْقَةً ثُمَّ يَمْسَحَ عَلَيْهَا وَيَغْسِلَ سَائِرَ جَسَدِهِ
“We set out on a journey. One of our people was hurt by a stone that injured his head. He then had a wet dream. He asked his fellow travellers: Do you find a concession for me to perform tayammum? They said: We do not find any concession for you while you can use water. He took a bath and died. When we came to the Prophet (saw), the incident was reported to him. He said: They killed him, may Allah fight them! Could they not ask when they did not know? The cure for ignorance is enquiry. It was enough for him to perform tayammum and to pour some drops of water or bind a bandage over the wound (the narrator Musa was doubtful); then he should have wiped over it and washed the rest of his body.” In Islamic jurisprudence, one of the ruksah for tayyamum is the presence of a wound that can reopen through passing water over it, leading to death. Similarly, there are many Islamic rulings related to patient care, such as the permission of looking upon the awrah for clinical examination, the prohibition of khulwa of a male doctor with a female patient and the detestability of using alcohol in medication. Thus, as part of the medical teaching and training in the Khilafah, physicians and surgeons are educated in the relevant fiqh.
This specific fiqh was from the aspect of knowledge mandated by the Deen. As for technical expertise, the Islamic physicians and surgeons acquired teaching and training within the dynamic environment of hospitals. Treating the patient, removing the harm and granting relief are sources of great reward. To fulfil their duties, Muslim doctors must be mindful of sababbiyah (causality), examining carefully the causes and their effects, as the Companions (ra) of the Messenger of Allah (saw) did in all matters of technical expertise. Thus, within medicine, Muslim doctors observed dietary restrictions, medication by nutrition as well as medication by herbs and minerals. They reviewed cases and undertook audits in order to improve clinical care. It was a thorough scientific tradition that extended over centuries.
In one part of the Al-Mansuri Hospital building, the physician-in-chief was given a room for teaching and lecturing. There were no restrictions to the number of patients who could be treated and the in-house dispensary provided medicines for patients to take home. Teaching hospitals were the foundation of training for new medical students just as they often are today. Eight hundred years ago, these teaching hospitals provided practical and theoretical lessons for students. Teaching took place both in groups and on a one-to-one basis just like today. Lectures were held in a large hall at the hospital and the subject matter was usually a reading from a medical manuscript by the so-called reading-out physician. After the reading, the chief physician or surgeon took questions. Many students studied texts with well-known physicians and since paper was plentiful in the Muslim world, manuscripts that were written for personal use have also been preserved. In Europe, these same texts were scarce and seldom owned by the student.
Besides teaching, clinical training was established with groups of students following the attending physician or surgeon on ward rounds. More advanced students observed the doctor taking history and examining patients whilst formulating prescriptions for them in the outpatient department of the hospital. One of these medical schools was in the Al-Nuri Hospital in Damascus. Under the direction of the physician Abu al-Majid al-Bahili, the twelfth-century ruler Nurudin ibn Zangi (1118-1174) founded the hospital. It was named after Nurudin and he equipped it with supplies of food and medication whilst also donating a large number of medical books which were housed in a special hall.
There was a system of graduation and specialization. As an example, eye specialists were to be qualified on the basis of the book Ten Treatises on the Eye (كتاب الأطروحات العشر للعين) written by Hunayn ibn Ishaq, which elaborated the functional anatomy and physiology of the eyes as well as defining modes of treatment. A physician in the Islamic world was granted a license (ijazah) following the completion of his education. As an example, there is a signed statement made by Ibn al-Nafis (d. 1288/687 H), that his student, a Christian named Shams al-Dawlah Abu al-Fadl ibn Abi al-Hasan al-Masihi, had read and mastered a treatise of Ibn al-Nafis. The certificate is in the handwriting of Ibn al-Nafis himself and dated the 29th of Jumada I in 668 H (25 January 1270). Ibn Nafis authored “Commentary on Anatomy of the Canon” (شرح تشريح القانون) and predated Harvey in the discovery of pulmonary circulation.
Every Disease (دَاء) Has a Curing Medication (دَوَاء), Except for Senility (Old Age الْهَرَمُ)
Abu Daud narrated in his Sahih that the Messenger of Allah (saw) said,
تَدَاوَوْا فَإِنَّ اللَّهَ عَزَّ وَجَلَّ لَمْ يَضَعْ دَاءً إِلاَّ وَضَعَ لَهُ دَوَاءً غَيْرَ دَاءٍ وَاحِدٍ الْهَرَمُ»
“Medicate for Allah has not made a disease without appointing a medication for it, with the exception of one disease, namely old age.” Imam Ahmad narrated in his Musnad, that the Messenger (saw) said,
«إِنَّ الله لم ينزل داء إلّا أنزل شِفَاءً، عَلِمَهُ مَنْ عَلِمَهُ وَجَهِلَهُ مَنْ جَهِلَهُ» “Allah (swt) has not sent down a disease except that He sent down its cure, whoever knows it, knows it and whoever is ignorant of it, is ignorant of it.” [An-Nisa’i, Ibn Majah, Al-Hakim and Ibn Hibban].
If the right treatment for the disease is discovered, then cure is achieved by the Will (Iraadah) of Allah (swt). Some people will know and some people will not. The knowledge of medication will be known to the experts, whether they are Muslims or non-Muslims. It extends to all forms of medication, including dietary restrictions, nutrition, herbs, minerals or derived salts and compounds. These ahadeeth clarify that there is medication for each and every illness. Hence, they encourage medication which will lead to curing the illness, by the Iraadah of Allah (swt). The disease is from Him (swt) and the medication is from Him (swt). The cure (shifaa) is also from Him (swt). The cure is not from the medication in and of itself, innate to the medication. It is Allah (swt), Al-Qadeer, Who placed within the medication the capability (qudrah) to cure the disease.
In his explanation of such ahadeeth, the scholar of medicine, Ibn Qayyim said, فَقَدْ تَضَمَّنَتْ هَذِهِ الْأَحَادِيثُ إثْبَاتَ الْأَسْبَابِ وَالْمُسَبَّبَاتِ “These ahadeeth affirm there are causes for whatever occurs in this world and the removal of these causes.” He then added, وَلِهَذَا عَلَّقَ النَّبِيُّ صَلَّى اللَّهُ عَلَيْهِ وسلم الشّفاء على مصادفة الدواء للداء “Accordingly, the Prophet (saw) linked cure (شّفاء) with the correct medication for the disease.”
Thus, there is a state of disease and a state of health. If the disease becomes chronic, extending over years and decades, it is to be considered that there is something missing in the treatment, whether it is from the prevention of harm, nutrition, dietary restrictions or medication. The exception is the process of aging, the stage of senility, which is marked by the deterioration of the organs and functions of the human body. It is in senility that Allah (swt) prepares us for our return to Him (swt), removing our sins and purifying us for the Aakhira. May Allah (swt) grant us patience in our senility and respectful patience with our elders.
The Muslim doctor medicates his patients, using any appropriate medication. During the time of the Khilafah, the Muslims closely examined the available remedies, including the Unani (Greek) medication, adopting them and improving upon them. The Muslim doctors of today must do likewise. Medication is a field of expertise and must be referred to the experts in medication. Such an approach is seen in other matters of expertise in the blessed Sunnah, for example, in the military field. In every action whose subject requires understanding and contemplation, the Prophet (saw) gave preference to expert opinion over lay opinion, even if the lay opinion constituted the majority view. Evidence regarding this is reflected in the consultation (shura) of the Messenger of Allah (saw). When he (saw) halted the Muslim forces behind the nearest water (well) of Badr, Al-Hubab ibn ul-Munthir (ra) did not like the site since he (ra) was well acquainted with such places and an expert in warfare, so he (ra) said to the Messenger of Allah (saw): يَا رَسُولَ اللهِ ؛ مَنْزِلٌ أَنْزَلَكَهُ اللهُ لَيْسَ لَنَا أَنْ نَتَعَدَّاهُ ، وَلَا نُقَصِّرُ عَنْهُ ، أَمْ هُوَ الرَّأْيُ وَالْحَرْبُ وَالْمَكِيدَة “Is this the place which Allah has ordered you to occupy, so that we can neither advance, nor withdraw from it, or is it a matter of opinion, war and tactics?” The Messenger of Allah (saw) said:
«بَلْ هُوَ الرَّأْيُ وَالْحَرْبُ وَالْمَكِيدَةُ» “It is rather a matter of opinion, war and tactics.” Upon this Al-Hubab (ra) then pointed to another site. The Messenger of Allah (saw) and those with him advanced to encamp, such that the wells were behind the army, cutting them off from the enemy. In this hadith, the Messenger of Allah (saw) abandoned his opinion for that of the expert. He (saw) did not refer to the Muslims for a majority opinion. Above all, were it Revelation from Allah (swt), he (saw) never would have abandoned it.
The Revelation in the Blessed Sunnah is for legislation. It is an obligation to make military preparations and it is an obligation to provide healthcare. However, the specific styles and means are left to the experts in the field, whether it is military affairs or medicine. So, the opinions of the Prophet (saw) regarding specific medication are not binding or restrictive upon the Muslims, just as his personal opinion regarding the site of the military encampment at Badr was not binding. The Muslims can adopt from non-Muslims as long as it neither contradicts the Shariah rulings nor is related to the kufr beliefs of the non-Muslims. Seeking treatment is not limited to those treatments mentioned in the Qur’an and Sunnah, just as it is not limited to those promoted by pharmaceutical companies of today.
Seeking Medication is Rewarded But is Not an Obligation
Whilst it is obliged on the state to provide free healthcare, it is recommended for, but not obliged upon, Muslims to seek medication when they are ill. The command for medication is an indication and not an obligation. Imam Ahmad reported that Anas (ra) said that the Prophet of Allah (saw) said, «إِنَّ اللَّهَ عَزَّ وَجَلَّ حَيْثُ خَلَقَ الدَّاءَ خَلَقَ الدَّوَاءَ فَتَدَاوَوْا» “Allah almighty has created the illness and the medication, so medicate.” Abu Dawud and Ibn Majah narrated from Usama ibn Sharik that he was with the Prophet of Allah (saw) when some people came from the desert and asked him: “Should we seek medication for illness?” He (saw) said, «نَعَمْ، يَا عِبَادَ اللَّهِ تَدَاوَوْا، فَإِنَّ اللَّهَ عَزَّ وَجَلَّ لَمْ يَضَعْ دَاءً إِلَّا وَضَعَ لَهُ شِفَاءً» “Yes, O servants of Allah (swt), medicate, for Allah did not send an illness except that He (swt) placed a cure (shifaa) for it.” In the first Hadith, the Prophet (saw) commanded people to medicate. In the second hadith, he (saw) directed the people from the desert to seek cure, since Allah (swt) has given both the illness and the cure. The address (khitaab) in the two ahadeeth came in the form of a command. The command (amr) indicates a request. Such a request does not constitute an obligation, except when it is decisive (jaazim). To be decisive, a command will need another indication (qareenah).
There is no such qareenah in the above cited Sunnah to tell us that the command is an obligation. Moreover, there are other ahadeeth which indicate that it is allowed to abstain from treatment. This indicates that the command to seek treatment in the two hadith does not denote an obligation. Imam Muslim narrated on the authority of ‘Imran ibn Husayn that the Prophet (saw) said,
«يَدْخُلُ الْجَنَّةَ مِنْ أُمَّتِي سَبْعُونَ أَلْفًا بِغَيْرِ حِسَابٍ، قَالُوا: مَنْ هُمْ يَا رَسُولَ اللَّهِ؟ قَالَ: هُمْ الَّذِينَ لَا يَسْتَرْقُونَ، وَلَا يَتَطَيَّرُونَ، وَلَا يَكْتَوُونَ، وَعَلَى رَبِّهِمْ يَتَوَكَّلُونَ»
“Seventy thousand from my Ummah will enter Paradise without accounting.” They asked, “Who are they?” He said; “They are those who do not use ruqya (incantation), tatayur, iktiwa‘ (cauterisation), and they depend on their Lord (swt).” Imam Bukhari narrated that ibn Abbas said, ‘This Black woman came to the Prophet and said “I am an epileptic and when it happens to me, I get uncovered, so ask Allah (swt) to cure me.” He (saw) said,
«إِنْ شِئْتِ صَبَرْتِ وَلَكِ الْجَنَّةُ، وَإِنْ شِئْتِ دَعَوْتُ اللَّهَ أَنْ يُعَافِيَكِ» “If you want to be patient (with this illness), you will get Paradise and, if you wish, I can ask Allah to treat you.” She said “I will be patient.” Then she said, “I get uncovered; ask Allah for me not to be uncovered.” He (saw) asked Allah for her.’
The Sunnah therefore indicates that it is permissible not to seek treatment. In the first hadith, he (saw) said that among the people who will enter Jannah without accounting are those who do not do istirqa‘ (incantation) or iktiwa‘ (cauterization), which means they do not seek treatment. They leave the matter to their Lord (swt) and depend totally on Him (swt). Istirqa’ and iktiwa’ are forms of treatment. In the second hadith, the Messenger (saw) gave the black woman the choice between patience with her epilepsy, in return for Jannah, or his (saw) prayer to Allah (swt) for her cure. This indicates the permissibility of leaving medication.
Thus, the Sunnah establishes that there is no obligation in seeking medication. However, due to the strong insistence of the Messenger (saw) to medicate, the command (amr) is recommended (mandub).
Nutrition (غِذَاءِ) and Dietary Restrictions (حِمْيَةِ)
In the era of the Prophet (saw), amongst the various forms of treatment were dietary restrictions and nutrition. The Messenger of Allah (saw) directed the Muslims to use both to treat those who became ill. Again, it must be emphasised that seeking treatment is not limited to those treatments mentioned in the Noble Qur’an and the Blessed Sunnah. The obligation in the Deen is to provide healthcare, but the styles and means of treatment are left to the matters of Dunya.
As for dietary restrictions, Ibn Qayyim narrated that the Messenger of Allah (saw) said,
«إنَّ اللَّهَ إذا أحبَّ عبدًا حماه من الدُّنيا كما يحمي أحدُكُم مريضَهُ عن الطَّعامِ والشَّرابِ»
“When Allah loves a servant, He (swt) helps him observe abstinence from the life of the world, just as one of you would impose dietary restrictions upon a patient from food and drink.”
As an example of dietary restrictions, the Prophet (saw) advised this in the case of conjunctivitis (رَمَدٌ), excluding dates. It was narrated that Suhaib (ra) said,
«قَدِمْتُ عَلَى النَّبِيِّ صلى الله عليه وسلم وَبَيْنَ يَدَيْهِ خُبْزٌ وَتَمْرٌ فَقَالَ النَّبِيُّ صلى الله عليه وسلم ادْنُ فَكُلْ فَأَخَذْتُ آكُلُ مِنَ التَّمْرِ فَقَالَ النَّبِيُّ صلى الله عليه وسلم تَأْكُلُ تَمْرًا وَبِكَ رَمَدٌ قَالَ فَقُلْتُ إِنِّي أَمْضُغُ مِنْ نَاحِيَةٍ أُخْرَى فَتَبَسَّمَ رَسُولُ اللَّهِ صلى الله عليه وسلم»
“I came to the Prophet (saw) and in front of him there were some bread and dates. The Prophet (saw) said: ‘Come and eat.’ So I started to eat some of the dates. Then the Prophet (saw) said: ‘Are you eating dates when you have an inflammation in your eye?’ I said: ‘I am chewing from the other side.’ And the Messenger of Allah (saw) smiled.” (Ibn Majah).
The Prophet (saw) also advised dietary restrictions for the one who is convalescing after an illness. Umm al-Mundhar bint Qays al-Ansariyyah narrated,
«دَخَلَ عَلَىَّ رَسُولُ اللَّهِ صلى الله عليه وسلم وَمَعَهُ عَلِيٌّ عَلَيْهِ السَّلاَمُ وَعَلِيٌّ نَاقِهٌ وَلَنَا دَوَالِي مُعَلَّقَةٌ فَقَامَ رَسُولُ اللَّهِ صلى الله عليه وسلم يَأْكُلُ مِنْهَا وَقَامَ عَلِيٌّ لِيَأْكُلَ فَطَفِقَ رَسُولُ اللَّهِ صلى الله عليه وسلم يَقُولُ لِعَلِيٍّ مَهْ إِنَّكَ نَاقِهٌ حَتَّى كَفَّ عَلِيٌّ عَلَيْهِ السَّلاَمُ قَالَتْ وَصَنَعْتُ شَعِيرًا وَسِلْقًا فَجِئْتُ بِهِ فَقَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم يَا عَلِيُّ أَصِبْ مِنْ هَذَا فَهُوَ أَنْفَعُ لَكَ»
“The Messenger of Allah (saw) came to visit me, accompanied by Ali (ra) who was convalescing. We had some ripe dates hung up. The Messenger of Allah (saw) got up and began to eat from them. Ali (ra) also got up to eat but the Messenger of Allah (saw) said repeatedly to Ali (ra), stop, Ali, for you are convalescing and Ali (ra) stopped. She said, I then prepared some barley and chard and brought it. The Messenger of Allah (saw) then said, take some of this, Ali, for it will be more beneficial for you.” [Abu Daud].
The Prophet (saw) also spoke of cravings in the sick to guide nutrition. Ibn Majah narrated from Ibn ‘Abbas (ra) that the Prophet (saw) visited a man and said: «مَا تَشْتَهِي» “What do you crave for?” He said: “I long for wheat bread.” The Prophet (saw) said: «مَنْ كَانَ عِنْدَهُ خُبْزُ بُرٍّ فَلْيَبْعَثْ إِلَى أَخِيهِ» “Whoever has any wheat bread, let him send it to his brother.” Then the Prophet (saw) said: «إِذَا اشْتَهَى مَرِيضُ أَحَدِكُمْ شَيْئًا فَلْيُطْعِمْهُ» “If any sick person among you longs for something, then feed him.” It is to be noted here that there has been some work conducted regarding cravings and their link to nutritional deficiencies, during both pica in childhood and pregnancy.
Muslims during the time of the Khilafah developed treatment through dietary restrictions and nutrition. The physician in the era of the first generation, Al-Harith ibn Khaladah, stated that الْحِمْيَةُ رَأْسُ الدَّوَاءِ، وَالْمَعِدَةُ بَيْتُ الدَّاءِ، وَعَوِّدُوا كُلَّ جِسْمٍ مَا اعْتَادَ “Dietary restrictions is the head of medicine, whilst the gut is the home of disease, so give each person what he is accustomed to (of food and medicine).” Ibn Qayyim further opined, وَقَدِ اتَّفَقَ الْأَطِبَّاءُ عَلَى أَنَّهُ مَتَى أَمْكَنَ التَّدَاوِي بِالْغِذَاءِ لَا يُعْدَلُ عَنْهُ إِلَى الدَّوَاءِ “Physicians have consensus that whenever an illness can be medicated by nutrition (التَّدَاوِي بِالْغِذَاءِ), medication (الدَّوَاءِ) must be avoided.” In the book of Ibn Qayyim, there is a chapter entitled, فَصْلٌ فِي هَدْيِهِ صَلَّى اللَّهُ عَلَيْهِ وَسَلَّمَ فِي الْحِمْيَةِ “Chapter on the Guidance of the Prophet (saw) on Dietary restrictions” which reflects upon some of the ahadeeth.
There has been a vast amount of work conducted over the centuries spanning the Khilafah regarding dietary restrictions and medication by nutrition. There are extensive guidelines for many known diseases, including pleurisy, tonsillitis, hepatitis, angina and diabetes. Moreover, medication by nutrition (التَّدَاوِي بِالْغِذَاءِ) was part of the responsibility of doctors, as was dietary restrictions. This is sound and makes good sense. Doctors are the experts in aetiology, anatomy, physiology, pathology and pharmacology. Above all, physicians are the ones who have seen severe illnesses in a hospital setting. So they are best placed to discern when nutrition and dietary restrictions are sufficient or when formal medication (الدَّوَاءِ) is mandatory. They will also be best placed to deploy life-saving emergency medication appropriately.
During the Islamic rule, medication by nutrition was not delegated entirely to the nutritionist or the dietician for they were not skilled in hospital medication. Within the healthcare system in the time of the Khilafah, the role of the nutritionist and dietician was supplementary and secondary to that of the physician. Any such delegation would have been seen as dangerous as asking a pharmacist to prescribe medication to a patient. There is a saying in Urdu, transliterated as “neem hakeem, khatrah jaan,” which means “the novice physician is life threatening.” Wisdom based on experience is worthy of note and preferred to wisdom alone.
The concept of nutrition and dietary restrictions to treat illness is universal in worldly knowledge. Many quote “Let thy food be thy medicine and medicine be thy food,” ascribed in error to the expert in Greek (Unani) medicine, Hippocrates. There is also the quote from Thomas Edison, the genius polymath, who said, “The doctor of the future will give no medicine, but will interest his patient in the care of the human frame in diet and in the cause and prevention of disease.” It is in line with current medical understanding that conservative measures should be used, before resorting to medication. It is noted by hospital-trained doctors that Type II Diabetes can be reversed by dietary restriction whilst patients with kidney disease benefit from the exclusion of certain types of food, in what is known as a kidney diet.
Concerns have been raised by the global medical community as to how ultra-refined foods are contributing to obesity, diabetes and heart disease. Attention has been drawn to the benefits of nutrition that is rich in fruits, vegetables, oils, fats, legumes and nuts, with particular praise for “the Mediterranean diet.” The Mediterranean diet has been part of the gastronomic culture of the Muslims of Ash-Sham and the Maghreb for centuries.
The Use of Medication (دَوَاءٌ) for Illness
As the head of state, the Prophet (saw) gave suggestions for medication. The specific medication he (saw) mentioned are not part of Revelation and fall within the realm of the permitted worldly matters. So the Muslims are not bound and restricted to the medication mentioned in the Seerah.
By way of example, it was narrated that Asma’ bint ‘Umais said: “The Messenger of Allah (saw) said to me:
«بِمَاذَا كُنْتِ تَسْتَمْشِينَ» “What do you use as a laxative?” I said, ‘The shubrum (spurge – euphorb).’ He said: «حَارٌّ جَارٌّ» (It is) hot and powerful.’ Then I used senna as a laxative and he said: «لَوْ كَانَ شَىْءٌ يَشْفِي مِنَ الْمَوْتِ كَانَ السَّنَى» ‘If anything were to cure death, it would be Senna.’” (Ibn Majah). Senna glycoside, also known as Sennoside or Senna, is a medication used today to treat constipation and empty the large intestine before surgery, with widespread evidence from human trials.
Regarding the field of cardiology, Sa’d said that the Messenger of Allah (saw) said,
«إِنَّكَ رَجُلٌ مَفْئُودٌ ائْتِ الْحَارِثَ بْنَ كَلَدَةَ أَخَا ثَقِيفٍ فَإِنَّهُ رَجْلٌ يَتَطَبَّبُ فَلْيَأْخُذْ سَبْعَ تَمَرَاتٍ مِنْ عَجْوَةِ الْمَدِينَةِ فَلْيَجَأْهُنَّ بِنَوَاهُنَّ ثُمَّ لِيَلُدَّكَ بِهِنَّ»
“You are a man suffering from heart sickness. Go to al-Harith ibn Kaladah, brother of Thaqif. He is a man who gives medical treatment. He should take seven ajwah dates of Medina and grind them with their kernels, and then put them into your mouth.” [Abu Daud]. Dates of the Ajwa tree (Phoenix dactylifera L.) were widely used in the treatment of heart disease, throughout the lands of the Khilafah.
Regarding ENT (Ear, Nose and Throat) ailments, Umm Qasis, daughter of Mihsan said that the Messenger of Allah (saw) said,
«عَلاَمَ تَدْغَرْنَ أَوْلاَدَكُنَّ بِهَذَا الْعِلاَقِ عَلَيْكُنَّ بِهَذَا الْعُودِ الْهِنْدِيِّ فَإِنَّ فِيهِ سَبْعَةَ أَشْفِيَةٍ»
“Why do you afflict your children by squeezing the uvula (for tonsillitis)? Apply this Indian aloes wood, for it contain seven types of remedies.” Abu Dawud said: By aloes wood, he meant costus. Bukhari and Muslim reported that the Messenger of Allah (saw) said,
«لَا تُعَذِّبُوا صِبْيَانَكُمْ بِالْغَمْزِ مِنَ الْعُذْرَةِ عَلَيْكُمْ بِالْقُسْطِ»
“Do not afflict your children by squeezing the uvula (for tonsillitis), but apply costus.” For centuries Muslims used costus for tonsillitis and eastern herbal practitioners continue to do so today.
During the era of the Khilafah, there was a widespread use of herbs and minerals. In addition, there was a vibrant system of human trials and audits within the Khilafah’s hospitals, as well as close monitoring of dosages and quality control. The Qadi Muhtasib would monitor safety standards and medical negligence was liable to punishment by Islamic laws related to diyyah (blood money) and jinayaat (assault). Mufradat (single remedies) were preferred to Murakabaat (compound remedies) and the sign of medical expertise was using the simpler, single remedies, after prevention and medication by nutrition had been tried.
With state patronage and generous individual charitable endowments, the medical tradition of Muslims flourished and became dominant in the world for many centuries. The largest and most popular of the materia medica manuals of its era was written by Ibn al-Baytar, born in Malaga in Granada towards the end of the twelfth-century under the Islamic rule. It offered an alphabetical guide to more than 1,400 single remedies (mufradaat) taken from Ibn al-Baytar’s own observations as well as 150 from referenced written sources.
For well over a millennium, the competent treatment of the illnesses of the body (مَرَضُ الْأَبَدَانِ) was one of the Khilafah’s prominent features. There are various medical texts, including a section of Zad al-Ma’ad Fi Hadyi Khair Al ‘Ibaad (زاد المعاد في هدي خير العباد) “Provisions of the Hereafter in the Guidance of the Best of Servants.”
The author of the book is Ibn Al-Qayyim (ابن القيم) who died in 1292 AD, may Allah (swt) have mercy upon him. The book begins with the characteristics of the mercy to all humanity (rahamtul ‘alameen), the Prophet Muhammad (saw), including his (saw) advice regarding medical treatment of various diseases.
From the knowledge available at the time, Ibn Qayyim asserted,
قَوَاعِدَ طِبِّ الْأَبْدَانِ ثَلَاثَةٌ حِفْظُ الصِّحَّةِ، وَالْحِمْيَةُ عَنِ الْمُؤْذِي، وَاسْتِفْرَاغُ الْمَوَادِّ الْفَاسِدَةِ
“The principles of the medicine of the body are three, maintaining health, protecting against harmful substances and removing toxic materials.” Medicine in the era of the Khilafah was built upon establishing disease causation (aetiology), study of the bodily reactions to resist disease (aspects of functional anatomy and physiology), study of disease (pathology) and studying medication (pharmacology). Ibn Qayyim asserted,
وَأَمْرَاضُ الْمَادَّةِ أَسْبَابُهَا مَعَهَا تَمُدُّهَا، وَإِذَا كَانَ سَبَبُ الْمَرَضِ مَعَهُ، فَالنَّظَرُ فِي السَّبَبِ يَنْبَغِي أَنْ يَقَعَ أَوَّلًا، ثُمَّ فِي الْمَرَضِ ثَانِيًا، ثُمَّ فِي الدَّوَاءِ ثَالِثًا.
“The diseases caused by physical elements are accompanied by causes. In the cases of physical diseases, the consideration of the cause (سَّبَب) is the priority, followed by consideration of the disease secondly, whilst consideration of the medication (دَّوَاءِ) comes last.”
Ibn Qayyim also drew attention to an approach based on necessity in a measured and incremental approach. He said, وَقَدِ اتَّفَقَ الْأَطِبَّاءُ عَلَى أَنَّهُ مَتَى أَمْكَنَ التَّدَاوِي بِالْغِذَاءِ لَا يُعْدَلُ عَنْهُ إِلَى الدَّوَاءِ، وَمَتَى أَمْكَنَ بِالْبَسِيطِ لَا يُعْدَلُ عَنْهُ إِلَى الْمُرَكَّبِ “Physicians have consensus that whenever an illness can be medicated (تَّدَاوِي) by nutrition (غِذَاءِ), medication (دَّوَاءِ) must be avoided. They also agreed that whenever an illness can be treated by a single remedy (بَسِيط), compounds (مُرَكَّبِ) must be avoided.” The rationale is to avoid the adverse effects of any excessive or inappropriate intervention or medication.
Ibn Qayyim defined the physician by stating,
فَالطَّبِيبُ: هُوَ الَّذِي يُفَرِّقُ مَا يَضُرُّ بِالْإِنْسَانِ جَمْعُهُ، أَوْ يَجْمَعُ فِيهِ مَا يضره تفرقه، وينقص مِنْهُ مَا يَضُرُّهُ زِيَادَتُهُ، أَوْ يَزِيدُ فِيهِ مَا يَضُرُّهُ نَقْصُهُ، فَيَجْلِبُ الصِّحَّةَ الْمَفْقُودَةَ، أَوْ يَحْفَظُهَا بِالشَّكْلِ وَالشَّبَهِ، وَيَدْفَعُ الْعِلَّةَ الْمَوْجُودَةَ بِالضِّدِّ وَالنَّقِيضِ، وَيُخْرِجُهَا، أَوْ يَدْفَعُهَا بِمَا يَمْنَعُ مِنْ حُصُولِهَا بِالْحِمْيَةِ، وَسَتَرَى هَذَا كُلَّهُ فِي هَدْيِ رَسُولِ اللَّهِ صَلَّى اللَّهُ عَلَيْهِ وَسَلَّمَ شَافِيًا كَافِيًا بِحَوَلِ اللَّهِ وَقُوَّتِهِ، وَفَضْلِهِ وَمَعُونَتِهِ
“The physician is the one who elucidates what harms the human when exposed to it. He also elucidates what harms the human when deprived of it. The physician removes from the human what causes harm in excess, whilst he supplements that which is deficient.” The physician helps bring about good health or what preserves good health. He repels the existing cause with its opposite or alternative, or removes the cause, or repels the cause with whatever prevents it from occurrence through dietary restrictions (حِمْيَةِ). You will see that all these guidelines are in accordance with the guidance and advice of the Prophet (saw) by Allah’s Will, Power and Support.”
Conclusion: Allah (swt) Created the Human Body and Cures for Its Illness
Glory be to Allah (swt), Who created the human being in the best of all forms. It is a form which has built-in corrective measures to defend it from illnesses. It is a form that experiences thirst to prevent dehydration. It is a form that senses nutritional deficiencies and seeks food for replenishment. It is a form that coughs to expel the harmful substances that it breathes in and vomits out to expel the harmful substances that it consumes. It enters a state of fever to allow the eradication of disease and forms abscesses to contain harmful substances, rather than letting them spread throughout its form. Will we therefore not reflect and ponder carefully on what He (swt) has created?
Glory be to Allah (swt), Who created countless minerals, herbs and animal products that are a means of medication for the human form. It is these creations that are the wondrous manufacture of the Designer (as-Saani’a), the Organizer (al-Mudabbir), Who knows what is the best of favours for his most favoured creation, the human being. So which of the favours of our Lord will we deny?
Glory be to Allah (swt), Who sent the best of all humanity, the Imam of the Prophets (as), Sayyidinah Muhammad (saw), as a mercy to all of humanity, bringing warning, glad tidings and guidance. It is the Messenger of Allah (saw) that brought us a complete Deen that established the Islamic Ummah upon the firmest of foundations, raising it up as the best Ummah brought to humankind. In the era of Islam ruling, the Ummah excelled in all spheres of life, including medicine, bearing testimony of the greatness of its Deen, which is the soul of its life. And inshaa’Allah Islam will return as a Khilafah state to lead humankind according to the glad tidings of the Messenger (saw).
و آخر دعوانا ان الحمد ﷲ رب العلمین
Written for the Central Media Office of Hizb ut Tahrir by
Musab Umair – Wilayah Pakistan