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Epidemics & Global History: The Power of Medicine in the Middle East

In August 2018, the World Health Organization reported that cholera has infected 120,000 people in Yemen. Survivors and victims, alike, have had to endure varying degrees of the symptoms: diarrhoea, dry mouth, low blood pressure, muscle cramps, and death. Situated in the southern tip of the Arabian Peninsula, Yemen heralds as a country bound with aromatic Mokha coffee, centuries of coastal trade, and most recently the target of a Saudi-led war. The political tensions of the Middle East have generated a particular kind of crisis whereby hundreds of thousands of people are subjected to a double bind - the tragedy of war and the upsurge of an epidemic. Vibrio cholerae, the bacteria that causes cholera, has been isolated since the 1800s and its cure has been known since the following century. The disease is one of many that have been the harbinger for epidemics in the Middle East. Yet, that history is connected to a global transformation in medicine, sanitation, and capitalism since the early nineteenth century. The current cholera epidemic in Yemen can be understood in a vacuum with a myopic account focused on disease incidence and prevalence, or it can be interpreted through a broader lens, one that considers the various historical, political, and commercial actors that shape medicine and health.

The history of modern medicine in the Middle East is inseparable from the “global” insofar that these practices have a wide geographical and conceptual reach. Recent discussions about the term “global” have been problematized and disrupted in history of science along the lines of the local vs. the global, centre vs. periphery, and “Western” vs. “non-Western.” Medicine and health also feature in this discourse insofar as the priorities that have driven the provision of healing and therapeutics are dynamic, dialectic, and material. Medical practices and their epistemology expand across space and time and feature within the global and globalizing processes, especially as epidemics cross borders and enter into realms of war, yet there is a prehistory that shows a dynamic and complex environment for health and medicine.

Arab Christian, Jewish, and Islamic disease cosmology was traditionally linked to overlapping discourses about divine will, infection and death. ‘Adwā was synonymous with infection meaning that the disease could be transmitted through a vector or directly from the source. In the premodern period, contagion was a contested concept whereby disease transmission was attributed to anthropogenic forces, corrupt air, divine intervention, the environment, and evil spirits. Within the matter of practice, Jalāl al-Dīn Abū al-Faḍl ͑Abd al-Raḥmān ibn Abī Bakr al-Suyūṭī, Ṭibb al-Nabawī (Medicine of the Prophet), remarked that “Every plague (ṭā͑ūn) is an epidemic (wabā’), but not every epidemic (wabā’) is a plague (ṭā͑ūn).” In Tadhkirat, Da’ūd Ibn ‘Umar al-Anṭākī (d. 1599) a sixteenth-century Syrian Christian physician, argued that ṭā͑ūn (bubonic plague) was,

a speedy moldy carnage that appears in such flails and armpits. It is called pestilence because of how inseparable these features are. Otherwise, they are two common special effects. In fact, they are a vesicle like broad beans and the rotten blood increases its component. 1

His use of the image of broad beans visually dovetails with the structure of buboes. Additionally, the pustules that emerge from pierced buboes can generate a liquid containing blood. The intellectual dynamism between the tenth and fourteenth centuries set the stage for broader and more popular notions about medical, religious, legal, and moral milieu in the Middle East and North Africa. What was more distinct was considering the ways that therapeutics played a role in healing people.

Overall, domesticated plants played an important role in medieval Arab pharmacology and the remedies directly applied to boils. Herbs, ointments and spices were seen as both preventive and curative agents for the plague and were part of the political economy of therapeutics. Al-Suyūṭī (d. 911 AH/ 1505 CE) noted that people used violet infused ointments to prevent the buboes from spreading to other portions of the body. Violet was considered a curative agent well into the eighteenth century according to the Egyptian ͑ulamā͗ ‘Abd al-Mu’ṭā al-Sahalāwī in his plague treatise. Doctors, pharmacists, and bloodletters, who were connected to local merchants, would serve as mediators who advocated for a herb and provided it to their willing and sometimes dying patient.

Material culture also featured in therapeutics during epidemics. Amulets, incantations, and inscriptions were curative agents that were used by non-elites to deter the plague and other epidemics. These methods were part of a broader corpus that often got labeled as magic or popular medicine, and they can be understood within the context of material culture and warding off the evil eye or djinn. Magical practices could be seen as distinct from prayers. That is, prayers and inscriptions were primarily based on the many names of God, al-asmā al-ḥusnā’, which have mystic properties. Ibn Ḥajar advised reciting al-Kursi (the seat) and the subḥānallāh (glory to God) in treating the plague victim - one could recite them over the course of three consecutive nights as a preventive measure. The main Qur͗ānic verses that were believed to cure the plague included sūrah al-Yūnus, the sūrah an’ām, and fātiḥah of the Qur’ān. Similarly, Ibn Haydūr also recommended writing Qur’ānic prayers on paper and attaching those texts to the wall to prevent the bubonic plague from entering a household. In Shams al-ma’ārif al-kubrā, ͑Alī al-Būnī (d. 622 AH/1126 CE) recommended magic squares, cabalistic letters, and talismanic signs to prevent the plague from entering a household.

To what extent does this pre-modern history inform us about the cholera epidemic in Yemen today, or any epidemic? How do broader regimes disrupt the possibility for using traditional medicine and/ or providing curative agents? Reflecting on the historical congruent traditional and religious medical practices can sharpen our analysis by providing a “critical and people-centred approach both to and within global health.” 2 At the same time, it also allows us to problematize the term “global” in history. Yemen is a place, yet its history is connected to a set of global occurrences, including colonialism, structural adjustment programmes, and most recently, war. Disease proliferation and treatment access are not solely reliant on Yemen but are central to broader discourses concerning the continuous wars in the Middle East, mobility of travel, and sanitation regimes.

At the core of the cholera crisis are social and political events that can easily be resolved, as the World Health Organization has recommended, by terminating the war. Yet, that has not been the case even though the current “outbreak is the most serious on record.” 3 The war has exacerbated the epidemic insofar that hospitals have been targeted by airstrikes 4 , medical supplies have not been allowed to safely enter the country, and health practitioners are working under harrowing conditions. Outbreaks kill - but what is needed is the development of global health policies that provide care and humanity to those suffering from an epidemic.