Al-Walid ibn Abd al-Malik's bimaristan

A bimaristan, or maristan as people shortened it, is a house where the sick are gathered and looked after by physicians. In his Khitat, al-Maqrizi says that the first to build a maristan, a house for the sick, in Islam was al-Walid ibn Abd al-Malik in 88 AH: he placed physicians in it on paid allowances, ordered the lepers confined so that they would not go out, and gave allowances to them and to the blind ¹. Older sources record al-Walid's gifts to lepers, the chronically disabled and the blind without mentioning a building ^{2 4}, and the TDV encyclopedia names Rufayda's tent before it as the first bimaristan ³. This house is the first permanent hospital the sources ascribe to the Islamic state, and its claim to be first is disputed.

The word is Persian, made of bimar, "sick", and the place suffix -stan: a house of the sick. The TDV encyclopedia notes that ordinary speech shortened it to maristan, which came to mean mostly an asylum, and that the Arab world today says mustashfa ⁵. Al-Maqrizi quotes al-Jawhari's dictionary al-Sihah that the maristan is the house of the sick, a word taken into Arabic ¹.

What al-Maqrizi describes for al-Walid is an institution with three parts: a fixed place for the sick; physicians paid from the treasury rather than by the patient; and a regular allowance for those who could not earn, the lepers and the blind. With it came an order to keep the lepers apart from other people ¹. This sets it apart from a tent pitched on a campaign and struck afterwards, and from a physician treating patients in his own house.

The hospital was not new to the world. Al-Maqrizi himself opens his chapter on maristans with what came before Islam. He quotes Ibrahim ibn Wasif Shah's Akhbar Misr that King Manaqiyush ibn Ashmun, one of the first Coptic kings, was the first to make bimaristans to treat the sick, stocking them with drugs and staffing them with physicians; and he quotes Abu Sa'id Mansur ibn Isa that the first to invent the maristan was Hippocrates, who set aside a separate place for the sick in a garden near his house, put servants there to treat them, and called it "Asdulin", meaning a gathering of the sick ¹. The TDV encyclopedia calls Manaqiyush a mythological king and reads the name of Hippocrates' house as xenodokeion ³.

Closer at hand was the hospital of Jundishapur in Persia, a Sasanian hospital and medical school where al-Harith ibn Kalada, the Arab physician of the Prophet ﷺ's time, had studied. The TDV encyclopedia suggests that because Jundishapur was called a bimaristan, the word was taken up by the Arabs early on ⁵.

Within Islam itself, the TDV encyclopedia points to the tent of Rufayda al-Aslamiyya in the Prophet's mosque at the time of the Trench and calls it the first bimaristan, a mobile war hospital ³.

Al-Walid came to the caliphate on the nomination of his father Abd al-Malik ibn Marwan in Shawwal 86 AH. In 87 AH he began building the Great Mosque of Damascus and wrote orders for the Prophet's Mosque to be enlarged and rebuilt ⁴. Ibn Jarir, reporting from al-Mada'ini as Ibn Kathir quotes him, says that building was al-Walid's passion, and that he built mosques in Damascus and set up minarets ².

In 88 AH, al-Maqrizi says, al-Walid built the maristan; he was the first to build one in Islam, and also the first to set up a guest house. He placed physicians in it and paid them allowances, ordered the lepers confined so that they would not go out, and gave allowances to them and to the blind ¹. Al-Maqrizi names neither the city where it was built nor the physicians who worked in it.

Al-Mada'ini keeps the other side of the report: al-Walid gave to the lepers and told them, "Do not beg from people," and gave every person unable to walk a servant and every blind person a guide ². Al-Suyuti says he had orphans circumcised and appointed tutors for them, assigned attendants to the chronically ill and guides to the blind, and gave stipends to scholars, the poor and the weak, forbidding them to beg and granting them enough to live on ⁴.

Al-Walid was not a physician, and he did not invent the idea of a hospital, which Persia and Byzantium had before him. His part in this record is that of the one who ordered the building and paid for it: he built the house and paid the physicians and the sick, as al-Maqrizi says ¹.

The sources disagree in their judgement of al-Walid himself, and this record gives each view in the name of the one who held it. Al-Suyuti quotes Abu Ikrima al-Dabbi that al-Walid was "a tyrant and unjust", and Umar ibn Abd al-Aziz that the earth was filled with injustice when al-Walid ruled Syria and al-Hajjaj Iraq; then he writes, "But he upheld the jihad in his days, and great conquests were made in his caliphate," and lists his provision for the disabled and the blind ⁶. Al-Mada'ini reports that the people of Syria held al-Walid the best of their caliphs ².

The sources read do not describe the inside of al-Walid's house. What they give is its system: resident physicians paid by the state; lepers kept apart from other people on a regular allowance; the blind with an allowance and a guide; the disabled with a servant ^{1 2}.

On the next page of the Khitat, al-Maqrizi describes how a maristan worked about two centuries later, that of Ahmad ibn Tulun at Fustat. When a sick person was brought in, his clothes and money were taken and kept by the trustee of the maristan; he was given clothes and a bed, and medicines, food and physicians came to him morning and evening until he recovered. When he could eat a chicken and a loaf of bread, he was told to leave and given back his money and his clothes ⁷. That is a description of a later maristan, not of al-Walid's house.

The sources read do not trace al-Walid's house into later ones. The TDV encyclopedia says that the bimaristans whose building began under the Umayyads reached their first flowering under the Abbasids, multiplied in Baghdad, Fustat, Cairo and Damascus, and were followed by the houses of healing of the Seljuks and Ottomans ³. It also quotes Ibn Duqmaq that the house of Abu Zubayd in the lane of the lamps at Fustat was turned into a bimaristan under the Umayyads ³.

• Rufayda's tent for the wounded: the TDV encyclopedia calls it the first bimaristan in Islam, some eighty years before al-Walid ³. No source read links it to al-Walid's house.
• The hospital of Jundishapur: a Sasanian hospital and medical school, through which the name bimaristan became known among the Arabs ⁵.
• The house for the sick ascribed to Hippocrates, with the report of the Coptic king Manaqiyush, as al-Maqrizi gives them for the first hospitals before Islam ¹.

• Harun al-Rashid's bimaristan in Baghdad: Harun had Jibril ibn Bukhtishu build a hospital like Jundishapur's on the Karkhaya canal, with Abu Yuhanna Masawayh at its head, and it became a model for later bimaristans in Baghdad and elsewhere ³.
• Ahmad ibn Tulun's maristan at Fustat: built in 259 or 261 AH, "and there was no maristan in Egypt before it". Ibn Tulun endowed houses and two baths for it, spent sixty thousand dinars on it, and rode there every Friday to inspect its stores, its physicians, its patients and the insane held in it ⁷.
• Nur al-Din's bimaristan in Damascus: founded in 1154 with the ransom of a captured Frankish king. Ibn Jubayr saw its physicians make their rounds early each morning and set the medicines and food for each patient. It is the oldest hospital of the Seljuk age still standing in its original form ³.
• The Mansuri bimaristan in Cairo: founded in 1284 by Sultan Qalawun on the model of Nur al-Din's, with medical teaching and a large library that held Ibn al-Nafis's books; in the seventeenth century it was still the most famous hospital in the Islamic world ³.

On al-Maqrizi's account, the sick now had a known place to go and a physician who did not take his fee from them ¹. On al-Mada'ini's, the leper had an allowance that spared him from begging, the person unable to walk had a servant, and the blind had a guide ². Care for those who could not care for themselves moved from private charity to organised provision by the state.

Al-Maqrizi puts al-Walid at the head of a long line of maristans, which he goes on to list one after another: Ibn Tulun's, then Kafur's, then others ^{1 7}. The TDV encyclopedia says that in Muslim cities the bimaristan became an institution that treated every kind of patient, even the insane, and taught medicine, as at the bimaristans of Nur al-Din and Qalawun ³.

The sources agree that hospitals were known before Islam, and differ over the first hospital in Islam:

• Al-Maqrizi says the first to build a maristan in Islam was al-Walid ibn Abd al-Malik, in 88 AH ¹.
• Al-Mada'ini, as quoted by Ibn Kathir, and al-Suyuti record al-Walid's organised provision for lepers, the disabled and the blind, but mention neither a building nor physicians ^{2 4}.
• The TDV encyclopedia, an academic reference, makes Rufayda's tent the first bimaristan. It then reports al-Maqrizi; the Ottoman historian Bostanzade Yahya Efendi's statement, without a source, that al-Walid was the first to build hospitals for diseases of the mind and body; and Ibn Duqmaq on the house of Abu Zubayd at Fustat. It does not decide between them ³.

The disagreement is over what "first" means: the first place where the wounded were treated, or the first permanent house for the sick with physicians paid by the state. That is why the claim to be first is recorded here as disputed.

No known trace of al-Walid's house survives, and the sources read do not name its site. The bimaristan lived on as a name and an institution, and the TDV encyclopedia notes that the Arab world today says mustashfa ⁵.

Nothing survives that can be tied to al-Walid's own house. The photograph on this page shows the entrance of the Nur al-Din bimaristan in Damascus, which still stands, one of the hospitals that came after it {cite:wikimedia-commons File:Bimaristan_of_nur_al-din,_damascus,_syria,easter_2004(1524490934).jpg} ³.

The sources keep two faces of al-Walid as people of his time saw him. Ibrahim ibn Abi Abla said: "Where is there another like al-Walid? He conquered India and al-Andalus, built the mosque of Damascus, and used to give me silver bowls to share among the Qur'an readers of the mosque of Jerusalem" ⁴. Al-Mada'ini relates that he would stop at a greengrocer, pick up a bunch of greens and ask its price; when told one fals, he would say, "Put more in it, and you will still profit" ². Against this stand the voices, given above, that called him unjust. Anything more a source confirms will be added.

About thirteen hundred years ago, the caliph al-Walid loved to build, and he built great mosques.

The historian al-Maqrizi says he also built a house for the sick and put doctors in it, paid by the state, to look after them. Al-Walid gave every blind person someone to guide them and everyone who could not walk someone to help them, so that none of them had to beg ^{1 2}.

• Taqi al-Din al-Maqrizi, al-Mawa'iz wa-l-i'tibar bi-dhikr al-khitat wa-l-athar (al-Khitat), Maktabat Madbuli, scan pp. 2336–2337 (printed pp. 545–546), chapter on the maristans. ¹
• Ibn Kathir, al-Bidaya wa-l-nihaya, Dar al-Kutub al-Ilmiyya, vol. 5, p. 176 (al-Walid's obituary, year 96 AH). ²
• Jalal al-Din al-Suyuti, Tarikh al-Khulafa, Dar al-Minhaj, pp. 366–367. ⁶
• TDV Encyclopedia of Islam, "BÎMÂRİSTAN", online edition. ³
• Wikimedia Commons, photograph of the entrance of the Nur al-Din bimaristan in Damascus, 2004. {cite:wikimedia-commons File:Bimaristan_of_nur_al-din,_damascus,_syria,easter_2004(1524490934).jpg}