Think the Black Death was bad in Europe? Incredibly, in these countries it was even worse

On an autumn day in 1347, a ship docked in the ancient Egyptian harbor of Alexandria. This port was the gateway to the Mamluk Sultanate, a powerful Islamic realm. The ship had set sail from the Black Sea. It carried 32 merchants, a large crew, and hundreds of slaves who were destined for sale in Egypt. But during the voyage, a strange and merciless disease swept through the vessel. Some passengers were tortured by grotesque swellings and tumors, while others coughed up torrents of blood. By the time the ship made landfall, only a few people remained alive. They all died in the port within days.

The arrival of this ship marked the start of the Black Death in Alexandria. We often think of this 14th-century pandemic as a European event. However, the disease spread far beyond Europe. It traveled along well-established trade routes that linked the East and West. The Black Death arrived in Egypt at roughly the same time it landed in Sicily. In fact, it was arguably most destructive in the Muslim world of North Africa and the Middle East. The Mamluk Sultanate, once a force that had defeated the Mongols and crushed the Crusaders, was crippled by the plague. It was eventually overrun by the Ottomans.

The devastating impact of the plague in the Mamluk state can be explained in part by orthodox Islamic theology. Muslims believed that plague was a gift from God. This view came from the teachings of the Prophet Muhammad. When the Syrian poet Ibn al-Wardi described how the Black Death struck his home city of Aleppo in 1348, he called it a "punishment" for non-Muslims. For believers, however, he said it should be seen as a "martyrdom and a reward."

Islamic teachings held that plague was not contagious. Instead, those who got sick were selected by Allah. Fleeing from outbreaks or traveling to affected areas was strictly forbidden. Ibn al-Wardi witnessed the disease kill his city’s people. He compared its attacks to a deadly arrow or a ravenous lion. Yet he held firm to these religious beliefs. He survived nine months of the pandemic but died in 1349.

These religious rules stood in stark contrast to attitudes in medieval Europe. In Europe, many people fled outbreaks. This difference had profound consequences for the spread of the Black Death.

In European cities like London, Florence, and Paris, about 50 percent of the population died. In the Mamluk Sultanate’s largest cities, Damascus and Cairo, the death rate was much higher. It may have been closer to 80 percent. Before the plague, Damascus had a population of about 80,000. When fatalities peaked in late 1348 and early 1349, one chronicler wrote that the plague was "like a king on a throne." It killed more than 1,000 people daily. Damascenes were terrified by the piles of corpses. People stopped asking for permission to bury their dead. Bodies were abandoned in gardens and on roads.

The same disaster played out in Egypt. The Mamluk capital of Cairo had a population of 500,000. During the winter of 1348–1349, the situation was even worse. At its height, perhaps 20,000 people died each day in Cairo alone. The city became an "abandoned desert" with no one walking in the streets. You could not pass a house without hearing the howling of grief. Over 250,000 lives were lost in Cairo. One observer wrote that the plague "destroyed mankind" in the city.

The mass mortality of the Black Death made it nearly impossible for communities to bury their dead. In Venice, islands were used as emergency burial grounds. In London, new cemeteries were built outside the city walls. In Europe, bodies were treated with care. They were lowered into graves and placed east to west, following Christian custom.

In Cairo, the sheer number of corpses overwhelmed the Mamluk government. Normal burial customs collapsed. Mosques filled with the dead. Makeshift benches for washing bodies had to be built from any available material. Bodies were carried on wooden planks, ladders, or doors. Sometimes, two or three bodies were placed on a single plank. The surge in deaths drove burial charges to huge levels. Porters demanded six silver dirhams to carry a body. Grave diggers charged 50 dirhams. Most of these workers died before they could earn any money.

By January 1349, bodies piled up in roads and markets. Teams were appointed to carry out burials. Pious people recited funeral orations in prayer places. With public highways filled with corpses and cemeteries full, authorities broke Islamic customs. They began using mass graves. Chroniclers wrote that they dug pits and threw in 30, 40, or more corpses at once.

Despite the high death toll, the Muslim world avoided the social fragmentation seen in Christian Europe. In places like Avignon, physicians, friends, and even family members abandoned the sick. People were terrified of infection. There is no evidence that Muslims neglected their plague-stricken relatives. Ibn al-Wardi criticized his fellow citizens in Aleppo for running away from funeral processions. However, he noted they did not refuse to stay with the dying. Muslims struck by the plague were not routinely neglected.

The Islamic world also avoided the violent persecution of religious minorities seen in Europe. In Catholic Europe, tens of thousands of Jews were executed. People falsely accused them of poisoning water sources to cause the plague. In contrast, Christians and Jews living under Muslim rule in the Levant faced no maltreatment.

When plague hit Damascus, people of different faiths came together. On the night of July 24, 1348, Muslims, Jews, and Christians crowded into the great Umayyad Mosque. They spent the night in prayer. At dawn, they processed barefoot and weeping to another mosque. There, they prayed together before imprints said to be the footprints of Moses and Muhammad. They sought God’s favor through their respective holy books and prophets.

While the Muslim world maintained social cohesion during the immediate crisis, it struggled to adapt to the long-term effects. Ibn Khaldun, a pre-eminent Muslim historian, wrote about this time. He was a teenager when the plague killed his parents in Tunis. He later developed a theory that plagues played a key role in the rise and fall of civilizations. He wrote that mankind "approached the point of annihilation" during the pandemic.

The plague did not end with the Black Death. It returned in the early 1360s and then re-emerged every 10 to 15 years for centuries. This period is known as the Second Plague Pandemic. The Mamluk Sultanate endured 43 outbreaks by its collapse in 1517. These later epidemics were shorter and less deadly than the first Black Death. However, they made the disease a constant threat. The population continued to decline for five generations.

In Western Europe, society slowly adapted. Governments learned to manage outbreaks. They recommended avoiding close contact with the sick. In 1377, the city of Ragusa imposed the first quarantine rules. Merchants from plague areas had to isolate for 30 days. Venice followed suit and extended the period to 40 days. This time span is called quaranta giorni in Italian, which is where the word "quarantine" comes from.

These measures did not stop all deaths immediately. However, the frequency and lethality of outbreaks declined by the end of the 15th century. European populations slowly began to recover.

In the Muslim world, no similar adjustment occurred. Theologians held firm to the belief that plague was not contagious. In the 1440s, the Egyptian writer Ibn Hajar al-Asqalani published a treatise refuting contagion. He forbade flight from plague zones, even though he had lost three daughters to the disease. As a result, polities like the Mamluk Sultanate continued to suffer.

The disease ravaged the region in 60 out of 170 years. In 1429–1430, a wave known as the "Great Extinction" killed around 45 percent of Cairo’s population. Another 80,000 died in 1460. These repeated deaths crushed any hope of population recovery. They also weakened the Mamluks’ ability to fight wars. Worse, the repeated crises eroded the regime’s ability to maintain the Nile’s irrigation system. When this complex system broke down, agriculture in the Nile Delta faltered. The empire’s main source of wealth dried up.

By the end of the 15th century, the Mamluk Sultanate entered a terminal spiral of decay. It fell to the Ottoman Turks. The Ottomans had a nomadic lifestyle that protected them from the initial spread of the plague. They also moved troops out of affected areas during later outbreaks. In 1516, Ottoman forces invaded Mamluk Syria. They conquered Egypt the following year. The Islamic polity that had dominated the eastern Mediterranean for 250 years ended. It was brought to its knees, in part, by the ravages of the Black Death and the Second Plague Pandemic.