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Table of Contents
VIEWPOINT
Year : 2022  |  Volume : 5  |  Issue : 4  |  Page : 372-378

The contributions of islam and muslim scholars to infection control: Dealing with contagious diseases and pandemics


Department of Medicine, University Sleep Disorders Center, College of Medicine; National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission10-Aug-2022
Date of Decision23-Aug-2022
Date of Acceptance26-Aug-2022
Date of Web Publication12-Oct-2022

Correspondence Address:
Ahmed S BaHammam
Department of Medicine, University Sleep Disorders Center, College of Medicine, King Saud University, PO Box: 225503, Riyadh 11324
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_109_22

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  Abstract 


Islam's teachings emphasize maintaining personal hygiene and isolating sick people, both of which are crucial in the present COVID-19 pandemic. Between the 7th and 15th centuries, Islamic and Arab civilizations produced significant advancements in science and medicine. These discoveries laid the groundwork for the development of the European Renaissance. In Islam, maintaining one's personal cleanliness and hygiene is a duty that Muslims have to do to worship Allah (God). In universal outbreaks such as plague pandemics, Islam recognized the risks and mandated precautions, prevention, and hygienic isolation. Islam took the lead in pioneering several health protection practices, such as the quarantine rule. If a contagious sickness manifests in a certain area or town, Prophet Muhammad instructed to forbid entry or exit to the affected town, now known as quarantine. The first documented application of quarantine, as we currently know, it was implemented by the Muslim scholar Avicenna (ibn Sina). According to Islam, protecting living creatures' lives equals protecting the faith. Therefore, all needed measures to reduce the risk of infection, including vaccines, should be rigorously applied in Islam. In this viewpoint, we discuss Islamic beliefs, the Prophet's practices and teachings, and Muslim scholars' contributions to lowering infections and putting specific regulations in place during pandemics that supplemented the development of infection control rules as we know them in modern medical practices through using the best available evidence.

Keywords: Arab, COVID-19, medieval, pandemic, quarantine, social distancing


How to cite this article:
BaHammam AS. The contributions of islam and muslim scholars to infection control: Dealing with contagious diseases and pandemics. J Nat Sci Med 2022;5:372-8

How to cite this URL:
BaHammam AS. The contributions of islam and muslim scholars to infection control: Dealing with contagious diseases and pandemics. J Nat Sci Med [serial online] 2022 [cited 2022 Nov 30];5:372-8. Available from: https://www.jnsmonline.org/text.asp?2022/5/4/372/358404




  Introduction Top


Religions, in general, enhance good practices and moral values and can be utilized to enhance good health practices, such as during pandemics. Islam appeared as a religion in the 7th century (610 C.E.), when Prophet Muhammad, peace be upon him (pbuh), began receiving revelations from Allah (God), known as the Holy Qur'an.

Muslims in most cultures (about 2 billion) are religious in spirit and practice; thus, they follow Islamic daily rules and regulations. In fact, Muslims view Islam as a way of life; hence, most Muslims adhere to its teachings in all aspects of everyday life. Furthermore, they follow the practices of Prophet Muhammad; peace be upon him (pbuh); a verse in a Sūra (chapter) of the Qur'an says, “Indeed, in the Messenger of Allah you have an excellent example for whoever has hope in Allah and the Last Day, and remembers Allah often.” (Sūra Al-Ahzab “Chapter 33 – verse 21”).

In a recent commentary in Newsweek magazine about recent health authorities' recommendations regarding the most efficient methods for containing contagious diseases, such as proper hygiene and quarantine; Dr. Craig Considine, a professor at the Department of Sociology at Rice University, wrote, “Do you know who else suggested good hygiene and quarantining during a pandemic? Muhammad, the Prophet of Islam, over 1300 years ago.”[1]

Islamic instructions strongly focus on personal hygiene and quarantining patients with contagious diseases, which are essential during infectious diseases breakdown like the current COVID-19 pandemic to lessen the spread of the effects of the infection. Therefore, in this viewpoint, utilizing the best available evidence, we discuss the Islamic views, the Prophet's practices and guidance, and Muslim scholars' contributions to reducing infections and implementing specific regulations during pandemics that complemented the development of infection control principles, as we know them in modern medical practices.


  Search Methods and Used Resources Top


The Holy Qur'an and Hadith (Sunnah) are the primary sources of Islamic legislation. There are 114 chapters (Sūra) in the Qur'an. On the other hand, Hadith is a collection of narrations about the Prophet Muhammad's (pbuh) sayings and acts. During the majority of the 8th and 9th centuries, Hadiths were examined and assembled into a sizable collection by several Muslim scholars.

After the Holy Qur'an, Hadith is the second source of authority for Muslims worldwide. Sanad (the chain of narrators of Hadith) and Matn (text or content of Hadith), are the essential factors in Hadith.[2] According to Hadith science, Hadith authenticity can be determined by the Sanad and Matn using stringent criteria and a systematic approach.[2] A collection of authorities who have reported a report (Hadith) of a speech, action, or endorsement of Prophet Muhammad (pbuh), one of his Companions (Ṣaḥābah), or a subsequent authority (Tabiʿī) is known as an “isnad” in Hadith science. The credibility of an isnād establishes the legitimacy of a Hadith. In this viewpoint, we only included Hadiths with the highest degree of authenticity (Hadith Sahih).[2]

In this article, quotes from the Qur'an are made using the chapter (Sūra name and number) and verse (Sūra-verse) designations; quotes to Hadiths are made using the sourcebook name and Hadith number. We used an English translation of the Qur'an that the Islamic University in Madinah Al-Munawarah and the Saudi Ministry of Islamic Affairs had accepted for the Hadith, we cited important literature that had been recognized by the Saudi Ministry of Islamic Affairs.[2],[3],[4]

We searched major Hadith and Fiqh (Islamic jurisprudence) books. We also searched PubMed, Google Scholar, and the Internet for publications, thesis, and conferences on infection control, contagious diseases, and quarantine in Islam in both Arabic and English. We used the following keywords, “Islam,” “Prophetic medicine,” “infection control,” “quarantine,” “vaccines,” “Sharia,” “COVID-19,” “Fatwa,” “contagious diseases,” “plague,” and “pandemic.”


  Islam and Infection Control Top


Infection control during a pandemic relies on hand cleanliness, isolation of patients with contagious diseases, and universal source control (e.g., covering the nose and mouth to contain respiratory secretions). The truth is that Islam's position on health, prevention of diseases, and safety of bodies is unparalleled at the levels of recognition of contagions, personal hygiene, social distancing, and quarantine.

Infection and contagion in Islam

More than 1400 years ago, at the time when some cultures were talking about evil breath and evil eye,[5] Islam affirmed the will of Allah in contagion and commanded precautions, prevention, and sanitary isolation in general epidemics such as plague, and even expanded the scope of prevention until it included the animals. It is narrated that the Prophet (pbuh) said, “The ill should not be taken to the healthy” (Sahih Muslim-2221);[6] this describes his instructions (pbuh) to a person whose camel is diseased; meaning that do not mix the sick and the mangy camels with the healthy ones.

Moreover, Islam discourages shaking hands with people with possible contagious diseases. It is reported that there was in the delegation of the Thaqif tribe to meet the Prophet, a man with leprosy; Allah's Prophet said to the leper: “We have accepted your allegiance, so you may go” (Imam Muslim- 2231),[6] avoiding shaking hand with him. Muslim scholars interpreted the Prophet's action as a preventive way to protect his healthy companions, as leprosy is a contagious disease, and may transmit to healthy people by direct touch and contact.[7]

The scholar Al-Albani said, “This is clear evidence that the Prophet (pbuh) used to believe that leprosy was a contagious disease, and therefore he took the reason that the disease was not transmitted to him from the leper.”[7]

Another Muslim scholar Almulaa Alharawi AlQariy (1606 C.E.), extrapolated from this Hadith that the imam (authority) should prevent a person with leprosy from interfering with people, and order him to stay at home.[7],[8] Therefore, Muslims realized 14 centuries ago that infections could transmit from the sick to the healthy and implemented preventive measures like avoiding shaking hands with sick patients with contagious diseases and not mixing with them to reduce the risk of spreading diseases.[9]

Health authorities encourage the public to cover the mouth and nose with a tissue when coughing or sneezing, “cough etiquette,” to reduce the risk of airborne infections.[10] Prophet Muhammad (pbuh) taught his companions and followers this preventive measure centuries before to reduce the risk of spreading infection. It has been narrated that when the Prophet (pbuh) sneezed, he would cover his face with his hand or his garment, and muffle the sound with it (Jami' at-Tirmidhi-2745).[11] From this context, it becomes clear to Muslims that using masks is encouraged in Islam because it serves the same purpose to prevent the transmission of infection from one person to another.

In the Book of the Prophet's Medicine (Altibi Alnabawii), in the course of his talk about the prohibition of mixing with lepers, Ibn al-Qayyim (C.E. 1292–1350) said, “The doctors command not to sit with patients with tuberculosis and leprosy.”[12]

Personal hygiene in Islam

Personal hygiene in Islam is worship and brings Muslims closer to Allah; in fact, it is one of Muslim's obligations. The books of Sharīʿa (Islamic law) begin the first chapters by endorsing purity and cleanliness.[6],[13] More than 1400 years ago, Prophet Muhammad (pbuh) taught his followers cleanliness and hygiene habits. For instance, Muslims do five daily prayers and are required to maintain physical purity by washing their hands, mouths, noses, and faces, wiping their heads and ears and washing their feet three times (wudu [ablution]) for each prayer. Five times a day of doing this creates a culture of cleanliness and lowers the chance of contracting infections.[14]

Handwashing served as the first line of defense against infectious and contagious diseases, such as respiratory and gastrointestinal infections. Imam Al-Bukhari (a Muslim scholar, C.E. 810–870) reported that the Prophet (pbuh) said, “Whoever wakes up from his sleep should wash his hands before putting them in the water, for ablution, because nobody knows where his hands were during sleep.” (Al-Bukhari 162).[13]

A verse in the Qur'an describes how purification brings Muslims closer to Allah,Surely Allah loves those who always turn to Him in repentance and those who purify themselves” (Sūra Al-Baqarah “Chapter 2 – verse 222”). The Prophet (pbuh) said, “Purity is half of iman (faith)” (Sahih Muslim- 223).[6] In this Hadith, the term “purity” is the half of faith here, and it includes the purity and cleanliness of the body, clothing, shoes, dwellings, yards, roads, utensils, drink, food, and all the tools a person uses.[15]

The Prophet (pbuh) said, “Ten things are part of the Fitrah (Innate): Trimming the mustache, trimming the nails, washing the joints, letting the beard grow, using the Siwak (Miswak stick for brushing the teeth), rinsing the nose, plucking the armpit hairs, shaving the pubes, and washing with water (after relieving oneself); the narrator said: I have forgotten the tenth unless it was rinsing the mouth.” (Sahih Muslim. 261).[6] The Hadith puts in perspective the importance of cleanliness in Islam.

Islam also stressed the importance of mouth hygiene more than 1400 years ago as a way to reduce the risk of infection and sickness.[16] The Messenger of Allah, may Allah bless him, said, “Were it not that I would be overburdening my community, I would have ordered them to use a tooth-stick (Miswak stick)” (Al-Bukhari-887).[13] Another Hadith by the Prophet, “The Miswak-stick is a means of purifying the mouth, and is pleasing to the Lord.” (Mishkat al-Masabih-381).[17] The use of Miswak, hence, oral hygiene has been deemed as pleasing to the Lord.

The “Arak” tree's (Salvadora persica) roots, twigs, and stems are called in Arabic the Miswak tooth-cleaning stick, which has qualities that include antibacterial, antifungal, antiviral, anticariogenic, and antiplaque [Figure 1].[18] The Prophet (pbuh) consistently used Miswak before retiring to bed, after waking up, entering the house, before and after meals, while fasting, and before reciting prayers, and reading the Qur'an.
Figure 1: Arak, Siwak, or Miswak (Arabic names) is obtained from “Arak” tree's (Salvadora persica) roots, twigs, and stems, which are used for tooth-cleaning stick. It has qualities that include antibacterial, antifungal, antiviral, anticariogenic, and antiplaque

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It is known that a major source of droplets is derived from saliva; therefore, promoting oral hygiene is an important step in preventing disease transmission in diseases like COVID-19. Consequently, it has been suggested that oral hygiene may reduce the risk of infection.[19],[20]

Islamic views on social distancing during infection

Social distancing has been adopted as a major method to reduce infection spread during pandemics. Through various strategies, social distancing seeks to minimize physical contact between people, and in turn, lower the likelihood of new infections.[21]

Although in the Islamic faith, visiting patients is one of the important deeds that bring Muslims closer to Allah, Prophet Muhammad (pbuh) promoted keeping social distance from patients with contagious diseases. In one narrated Hadith, the Prophet said, “One should run away from the leper as one runs away from a lion” (Al-Bukhari 5707).[13]

Unsurprisingly, we also have a case where Prophet Muhammad used social distance in his own life. In the Hadith discussed above, the man with leprosy who reportedly wanted to pledge his allegiance to Prophet Muhammad, which required him to touch or hold the Prophet's hand. Prophet Muhammad kept his distance, declined to shake hands with him, suggested sending him back [to his place of origin], and said that his vow had already been accepted (Sahih Muslim-2231).[6]

Several Muslim scholars commented on the above Hadiths; Ibn Habeeb (C.E. 790-853) said, “Likewise, a leper is prohibited from entering the mosque and entering between people and mixing with them.”[22] Similarly, Ibn Rajab (C.E. 1335-1392) said, “The leper is also prevented from mixing with people in their mosques, because of what was narrated about the order to flee from him.”[23] In the same context, the second Rashidun Caliph, Umar Ibn Al Khattab (Allah be pleased with him) (C.E. 590-644) is said to have once witnessed a woman with leprosy conducting the Ka'bah rite in Makkah. As it would be healthier for her (and others) to avoid spreading the illness to others, Umar advised the woman to stay home and not harm people.[24] Therefore, despite the importance of congregational prayer in Islam, a person with a contagious disease was advised not to attend the mosque.

Scholars have repeatedly emphasized the ruling on isolating the sick and preventing them from mixing with people. While explaining this incident, in his work, Ibn Abi Shaybah (C.E. 775-849) mentioned Hadiths about lepers within a chapter he named it “The license in the Tiara (pessimism) and the distance from the leper.”[25] To this meaning, while explaining the Hadiths about patients with leprosy, Al-Qastalani (C.E. 1447-1517) pointed out, “The disease is transmitted from body to body through contact, connection, and through smelled air, and therefore disease transmission in many occasions occurs via contact and mingling with sick people.”[26]

Quarantine in the Islamic culture

Following the instructions of international health authorities, most countries and towns adopted quarantine as a necessary precaution to protect the general public against infection during the COVID-19 pandemic. However, Islam had the lead of taking precedence in many health protection methods, including the rule of quarantine; if a contagious disease appeared in a specific area or town, then the Prophet's guidance came to prevent entry or exit to the affected town, and this is what is currently known today as a quarantine.[27] The Prophet (pbuh) said, “If you get wind of the outbreak of plague in a land, do not enter it; and if it breaks out in a land in which you are, do not leave it” (Al-Bukhari-5396).[13] For Muslims, visiting ailing people is the ultimate act of kindness.[28] However, the Prophet warned his followers against visiting locations known to be infected with diseases and urged those already living in affected areas or towns to stay put rather than leave and spread the affliction to others.

The Prophet's successors, the Caliphs, and all subsequent generations of Muslims engaged in this practice. For example, the Caliph, Umar (Allah be pleased with him), and his companions were traveling to Syria when he was informed of a plague that had started in Syria (Known as the Amwās plague during C.E. 634–644). After much discussion of the situation with his companions, Umar thanked Allah and returned to the city of Medinah to avoid exposing healthy people to infection.[29] When Umar decided to go back, an interesting discussion occurred between Caliph Umar and the head of the Muslim Army, Ubaidah ibn Jarrah (Allah be pleased with him); Ubaidah was discouraged and asked Umar, “Are you running away from what Allah had ordained?” Umar answered, “Yes, I am fleeing from the decree of Allah to the decree of Allah,” and added, “Don't you agree that if you had camels that went down a valley having two places, one green and the other dry, you would graze them on the green one only if Allah had ordained that, and you would graze them on the dry one only if Allah had ordained that?” (Al-Bukhari-5729).[29] The Caliph Umar's comment is a superb illustration of how to strike a balance between trusting in Allah, exercising adequate care, and taking measures to prevent disease.

In the current medical literature, the first documented quarantine, as we know it, was in C.E. 1377; Ragusa (modern Dubrovnik, Croatia) instituted the first recorded quarantine, requiring all newcomers to spend 30 days on the nearby island of Lokrum before being allowed to enter the city (quaranta giorni or quarantine).[30],[31] However, a long time before that, the first application of quarantine was implemented according to the recommendations of the Muslim scholar Avicenna (Ibn Sina in the Arabic language).[32],[33] Avicenna (Abu Ali Al Hussain ibn Ali ibn Sina, 980–1037 C.E.), who was born in the village of Afshona, near Bukhara, in present-day Uzbekistan, authored the famous medical encyclopedia the Canon of Medicine (Arabic: al-Qānūn fīaṭ-Ṭibb) in five books [Figure 2].[34],[35],[36],[37] The encyclopedia was written in Arabic and subsequently translated to several other languages, including Persian, Latin, and Hebrew, and was later printed in parts of Milan, Padua, and Venice.[38] Avicenna enjoyed great prestige in the West and gained wide fame in Europe, referred to in the Latin West as “princeps medicorum” (prince of physicians).[39] Some scholars in the West considered the Canon of Medicine the “Medical Bible.” It was the main reference for medicine, and it was taught in universities in France, Italy, Belgium, and other European countries.[38]
Figure 2: The title page (a) and the introduction (b) of the Canon of Medicine (Arabic: al-Qānūn fīaṭ-Ṭibb) The main source of Ibn Sina's (Avicenna) popularity in Europe is this work. After it was translated into Latin in the 12th century, it became a part of the required reading list for medical students until the late 17th century. The Canon of Medicine is divided into the following five books: (1) al-Umuīr al-kulliya fī’ilm al‑ṭibb (General medical principles): this includes the fundamental concepts of medicine; (2) al-Adwiya al-mufrada (Materia medica): It includes about 800 different medications that are derived from plants and minerals; (3) al-Amraīḍ al-juz'iya (Special pathology): it examines the conditions that affect specific organs; (4) al-Amraīḍ allatiī laī takhtaṣṣ bi 'udw bi 'aynihi (Diseases involving more than one member): it covers diseases such as poisons and fevers that impact the entire body; (5) al-Adwiya al-murakkaba wa al-aqraībaīdhiīn (Formulary): it lists 650 medical substances along with their effects and uses[36],[37] N. B. As indicated in the citations, these figures are from open public sources and do not require permission

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Most crucially, he believed that some diseases were spread by extremely microscopic creatures that were invisible to the human eye, like tuberculosis, and recommended that they should be isolated since they may be contagious.[38],[39] Therefore, he devised a system of quarantining the ill for 40 days, which he termed al-Arba'iniya (literally, “the forty” in Arabic, meaning 40 days), to stop individuals from passing these tiny organisms to one another.[32],[33] This is certainly the origin of modern quarantine, which is incredibly successful at stopping the spread of disease. Interestingly, the word “quarantine” corresponds to the Arabic “al-Arba'iniya;” thus, it is originally derived from the quarantine period of 40 days proposed by Avicenna (Italian: Quaranta giorni, meaning “40 days”). It was first employed in Venice during the 14th century to postpone foreign ship arrivals at the port.[40]

Since Muslims' writings from more than a thousand years ago are still relevant today, Islam and Muslim scholars' contributions to world science cannot be overstated.


  Islam Supports Disease Prevention and Vaccines and Seeking Treatment Top


Islam cares about the soul and the body and forbids everything that may cause disease to a person, even if it is an act of worship. Hence, it is permissible to break the fast for the patient due to the excuse of the disease. The traveler has to preserve his health and strength; thus, obligatory fasting is excused so that fasting does not take them away during travel. A verse in the Qur'an says, “So whoever is present this month, let them fast. But whoever is ill or on a journey, then ˹let them fast˺ an equal number of days ˹after Ramaḍân˺. Allah intends ease for you, not hardship, so that you may complete the prescribed period and proclaim the greatness of Allah for guiding you, and perhaps you will be grateful” (Sūra Al-Baqarah “Chapter 2– verse 185”).

Islam values the life of all creatures; according to the Qur'an, a verse states that “Whoever takes a life – unless as a punishment for murder or mischief in the land – it will be as if they killed all of humanity; and whoever saves a life, it will be as if they saved all of humanity” (Sūra Al-Mā'idah “Chapter 5 – verse 32”).

Islam also encourages its followers to seek medical treatment when sick; it was narrated that Muhammad (pbuh) said, “God has not sent down a disease without sending down remedy for it” (Mishkat al-Masabih-4514).[41]

The Prophet (pbuh) once observed a man who left his camel untied. He asked the man, “Why don't you tie down your camel?” The man answered, shall I tie it and rely (on Allah), or leave it loose and rely (upon Allah)?” He said: “Trust in Allah and tie your camel securely.” (Jami' at-Tirmidhi 2517).[11] It is deduced from the above that reliance on God (Allah) and belief in fate and destiny do not negate seeking prevention and treatment for diseases.

Based on the above, when Imam Shaikh Abd al-Aziz ibn Baz was asked about the legitimacy of turning to vaccinations in advance of the onset of diseases, the Imam, the Grand Mufti of the Kingdom of Saudi Arabia, from 1975 until his passing in 1999, responded in the affirmative.[3],[42] He clarified that receiving vaccines is not wrong if one is concerned about contracting the disease due to an impending epidemic, pandemic outbreak, or other potential disease causes.[42] He also emphasized that there was nothing wrong with giving individuals drugs to prevent illness. He supported his claim with the Hadith “He who ate seven “ajwa” dates in the morning, poison and magic will not harm him on that day” (Sahih Muslim-2047b).[6],[42] In other words, consuming those dates would prevent a problem before it arises. Similarly, vaccination against specific diseases would be a way to protect from health problems and infections.[42] Shaikh ibn Baz also commented on the harm that might occur after taking some vaccinations, such as developing fever and some temporary symptoms; he stated that such harms are forgiven and overlooked; in return for the great evil being spread, these diseases that kill a person or cause severe damage to his health or the functions of his organs.[43] He referred to the resemblance in some particulars in Sharīʿa (Islamic law) between vaccines and what happens in the circumcision of boys, and the severe pain that occurs to them. However, the pain is forgiven in return for circumcision's benefits.[43],[44]

Although Islam encourages followers to seek guidance from their religion, Prophet Muhammad (pbuh) clearly taught his companions to adopt safety precautions and seek treatment.


  Conclusions Top


This viewpoint explored the Islamic teachings that reformed the Muslim culture and contributed to establishing strategies for health and well-being, particularly for combating communicable diseases, which are still relevant in dealing with current outbreaks. The presented information demonstrated that religions could offer thorough guidance for health's preventive, therapeutic, and restorative elements. The precautions adopted during the current pandemic to stop the transmission of infection closely resemble the hygiene and infection control measures used in the Islamic civilizations throughout the middle Ages. The religious teachings of hygiene, infection control, social distancing, and quarantine could be delivered to reach millions of followers to correct the misconceptions of some Muslims about these measures and utilize these teachings to persuade them to abide by all infection control measures.

Islam is keen and attentive to protecting the body and soul, and preventing exposure to what would lead to their sickness, and this should be applied to the COVID-19 pandemic. According to Islam, protecting life is equal to protecting the faith.[35] Therefore, all needed measures to reduce the risk of infection, including vaccines, should be rigorously applied.

It is important to study and verify the Hadiths of the Prophet and the Prophetic medicine (Altibi Alnabawii), especially preventive medicine, and to link it to pandemics and medical catastrophes, applying it to daily practices, acting on it with knowledge and insight, and use these teachings to motivate people to follow infection control and protective measures.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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