Why did the civilization that invented the hospital stop inventing?

August 25, 2026

7 min read

Members of the Al-Qassam Brigades, the military wing of Hamas and mourners attend the funeral of Al-Qassam fighters who were killed during the war between Israel and Hamas in the Al-Shati camp, in Gaza City, February 28, 2025. Photo by Khalil Kahlout/Flash90

If you fell ill in the twelfth century, you wanted a Muslim or a Jewish doctor, and you did not want a Christian one. The bimaristan, the hospital of the medieval Islamic world, put patients in separate wards according to their illness, kept written records, paid its staff a salary, and treated the poor for free. Europe had nothing close to it. Baghdad and Cรณrdoba held the great libraries. Muslim scholars were working out algebra and mapping the stars while Europe was still arguing over whether the old Greek books should be read at all.

Europe took another six hundred years to figure out that doctors should wash their hands between patients. In the 1840s a Hungarian doctor named Ignaz Semmelweis proved that physicians were carrying deadly infections from the autopsy room to the maternity ward on their own hands. His colleagues drove him out of the profession, and he died in an asylum. Joseph Lister, the British surgeon who introduced antiseptic surgery a generation later, spent years being laughed at before doctors admitted he was right.

For roughly five hundred years, the Islamic world led the world in medicine, mathematics, and astronomy. Europe then overtook it, and the gap has widened ever since. Europe did not win that race by being smarter, richer, or luckier. The Islamic world handed the lead over, because its own rulers and religious authorities decided, again and again across several centuries, that certain questions were too dangerous to allow, and they had the power to stop people from asking them.

The Choice to Stop

Take the printing press. Gutenberg printed his Bible around 1455, and within fifty years European presses had turned out millions of books. The Ottomans banned printing in Arabic script instead. Setting the language of the Koran in metal type, their religious authorities held, was a desecration. The ban lasted roughly two and a half centuries, and the first Ottoman Turkish press did not run until 1727. The empire that governed the heart of the Muslim world sat out the greatest expansion of knowledge in human history, and by the 1800s Europeans were calling it the sick man of Europe.

Rulers are still making that same decision today, and they say so openly. Boko Haram means, roughly, “Western education is forbidden,” and the group lives up to its name by burning down schools and kidnapping schoolchildren. In Iran, a government ministry decides which books people may read, and Iran’s Supreme Leader put out a standing order to murder a novelist, an order a man finally tried to carry out on a New York stage in 2022. The Taliban has closed high schools and universities to half the population of Afghanistan, which means Afghanistan will produce roughly half the teachers and doctors it otherwise would have. European Union bodies have repeatedly criticized Palestinian schoolbooks for holding up martyrdom to children as something to aspire to. A society that raises its children to become suicide bombers has little use for calculus.

None of this comes from Islam. The men who built the bimaristan were Muslims, and so were the doctors who worked in it and the mathematicians who gave us the word algebra. Something else is doing this, and Arabic has a word for it.

What Jordan’s King Calls Them

Look at who these men actually kill. A 2009 study by the Combating Terrorism Center at West Point examined al-Qaeda’s victims and found that the great majority were not Westerners at all. They were Muslims, killed in Muslim countries, by men who claimed to be defending Islam.

Al-Qaeda members pose with grenades and rifles, 2010. By VOA via Wikipedia

There is an Arabic term for a Muslim who declares other Muslims to be traitors to the faith and then kills them for it. The act is called takfir, and the man who makes a career of it is a takfiri. The plural is takfiryun.

This is not a Western label. King Abdullah II of Jordan uses it. So do the scholars of Al-Azhar in Cairo, the oldest and most respected center of learning in Sunni Islam. In 2005, hundreds of Islamic scholars signed a declaration known as the Amman Message, which ruled that no Muslim may brand another Muslim a traitor to the faith, and that the men who do so have placed themselves outside Islam altogether.

I use their word rather than ours on purpose. The usual phrase, “Islamist extremist,” gives away too much. It suggests these men are practicing a harsher version of Islam. The king of Jordan and the senior clerics of Egypt both say they are practicing something else entirely.

They call themselves Muslims, of course. So did the men who assassinated Anwar Sadat, and so did the men who bombed mosques in Peshawar. I am not saying they lack some certificate. I am saying that the Muslim world’s own highest religious authorities looked at the question and ruled against them, and that the body count backs the ruling up.

Nazism with a Different Slogan

Takfirism runs on the same three engines that powered Nazism. It tells its followers they are born superior to everyone else. It claims the right to rule the world. And it splits humanity in two, with everyone on the far side belonging to the Dar al-Harb, the House of War. That phrase does the same work the Nazis got out of Untermenschen. It means people whose lives do not count.

Hamas built a children’s television show on exactly that foundation. Groups that translated Tomorrow’s Pioneers recorded episodes teaching small children that they belong to a master people, that the Jews will be wiped out, and that a caliphate will rule the earth. Change the language and the script would have played comfortably on German radio in 1938.

This way of thinking is old. Tamerlane, or Timur, was a warlord who conquered Central Asia, Persia, and northern India in the late 1300s. He called himself the Sword of Islam and used the title to justify killing on a scale the twentieth century needed factories to match. Estimates of his body count run as high as seventeen million, and historians treat that number with justified doubt, but nobody doubts his methods. When he took Baghdad in 1401, he ordered every soldier to bring him two severed heads. His men ran out of enemies, so they killed prisoners who were worth good money as slaves, and by some accounts they killed people in their own households to fill the quota. He stacked the skulls into towers. ISIS, Hamas, and al-Qaeda work from the same manual, and Erdogan’s Turkey keeps hinting that it would like to do to Israel what it did to Armenians and Pontic Greeks in 1915.

Erdogan has learned nothing from his own country’s history. He accuses Israel of “settler colonialism” on land the Ottomans conquered and then ruled for four hundred years, until they lost a world war and had it taken away. The only Ottoman Empire he is likely to rule is a furniture store.

Why They Blame Us

A society that forbids questions cannot build much, and rulers who cannot build have to explain to their people why life is so hard. Gaza shows what that explanation sounds like.

Gaza and Israel share a coastline, a climate, and a complete absence of oil, which strips away most of the usual excuses. Israel runs desalination plants and sells medical technology around the world. Gaza, after nearly twenty years of self-rule and billions of dollars in foreign aid, has produced tunnels. Any Gazan can see the difference from his own roof, and sooner or later he asks why it is there.

His leaders never answer the question he asked. They do not say where the billions went, and they do not explain why the concrete went underground instead of into apartments. They talk about Israel instead. Israel steals Gaza’s water, Israel strangles its economy, and Israel would be strangling it far harder if his leaders were not fighting back so bravely on his behalf. In one move, the men who wasted his inheritance turn themselves into the only thing standing between him and something worse.

That lie works because it flatters the man who hears it, and Shakespeare understood why four hundred years ago. In Henry VI, Jack Cade leads a peasant revolt, and his followers do not want to learn to read. They want to hang everybody who can. The C student who will not open a book never decides to study harder. He decides the A student is a teacher’s pet, and he points out that his big brother could beat that kid up. A man who cannot build himself up will settle for tearing somebody else down, because the other fellow’s success feels like an accusation aimed at him.

Look at what the takfiryun destroy and you see the same impulse. Their answer to the World Trade Center was to hijack other people’s airplanes and fly them into it. ISIS answered the Great Mosque of al-Nuri in Mosul, a masterpiece of Islamic architecture that had stood for more than eight hundred years, by packing it with explosives and blowing it up in 2017. They destroyed their own inheritance because they could never have built anything like it.

Where This Leaves Us

Countries run by takfiryun end up poor, violent, and backward, and that has nothing to do with geography, colonialism, or the price of oil. It comes straight out of a belief system that forbids the questions that create wealth, and then treats everyone else’s wealth as an insult that must be answered with force.

That is why they cannot stand Israel next door, and why Europe and America look like enemies from thousands of miles away. Their whole account of the world says the West is rich because it robbed them, even though their own history is full of violent conquest, slave trading, and occupation. A free country that works proves that account false simply by continuing to work. Our success is the insult, so no concession we offer and no restraint we show will calm them down. Only our failure would do that.

The bigger tragedy belongs to the Muslim world, not to us. The descendants of the men who built the bimaristan now live, in far too many places, under men who burn schools. Their ancestors chose to stop asking questions, which means their descendants can choose to start again. The scholars who signed the Amman Message are in a far better position to make that argument than we are.


Bill Levinson is the author of numerous articles and books on manufacturing, quality, and industrial productivity, and a student of history and psychological warfare. He helped expose antisemitic and other hate speech at MoveOn.org in 2006, and questionable activities by the original Million Mom March in 2000.

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