Historical analysis reveals diverse fates of closed hospitals, highlighting the restoration efforts of El Maristán de Granada.
Restoration of a hospitalHospitals have a history that spans more than 3000 years, with evidence of their existence as early as the end of the 2nd millennium BCE in Mesopotamia and in the 5th century BCE in India. 1 They have evolved since then to become progressively more scientific in approach and business-like, and less personal. 2During this evolution and their proliferation, many, including those of repute and historical importance, conversely and inevitably have had to close operations.The reasons behind hospital closures have been varied and welldocumented, particularly in the modern era and in the developed world. 3Common drivers that lead to hospital shutdowns are financial or related to regulatory requirements. 4The fate of the closed hospitals has also been varied.Some have been turned into museums while others have taken on a more functional role, including as a school, residence, boarding school, hotel, or commercial office. 5-7A more saddening cause for hospitals to cease to exist is destruction in times of armed conflicts.Such circumstances lead to loss of key infrastructure at a critical time and tragic deaths of innocent civilians. 8Some but not all hospitals destroyed in armed conflicts over the years have managed to resume operations after reconstruction. 9,10ne such hospital, with a unique history, is El Maristn de Granada. 11Maristan (shortened version of 'Bimaristan') translates to 'place for the sick' in Persian.Maristans were a series of hospitals that proliferated in the historic Islamic world.El Maristn de Granada was built in 1365 during a time when the Moors ruled Spain.It was commissioned by Sultan Muhammad V and took about 2 years to complete.The hospital was built along the Darro river at the foot of the Alhambra in Al-Andalus. 12The origins of the hospital lie in the hundreds of years of Arab medical advancement from the 8th century CE onward during the Islamic golden age.Moors came to Spain in the 8th century CE as mercenary soldiers and brought with them their culture, language, architecture and science.They maintained close contact with key Caliphates of the Arab world and thus with the developments in chemistry, mathematics, physics and medicine. 13The key figures of Islamicera medicine, including the legendary Persian polymath Avicenna, worked in Al-Andalus.Architecturally, El Maristn de Granada was a two-story brick structure with plaster cover and could house about 200 patients in rooms connected by galleries (Fig. 1).The design was typical Moorish.The central courtyard was decorated splendidly, and strategically for the hot summers, by a pool fed by fountains with statues of lions spraying water. 11,12The exquisite quality of decorations is evident in the two lions, which are currently on display at the Alhambra museum. 12,13El Maristn de Granada provided inpatient care including, for the first time ever, to the mentally ill in Europe.Its care model likely influenced the later developments in Christian Spain and the rest of Europe.The hospital is also thought to have been one of the centres of a historically important and early movement that propagated medicalized view of neuropsychiatric conditions. 11nfortunately, El Maristn de Granada was dealt a major blow in 1495 with the Reconquista when the Moors were driven out of Spain, and Catholic rule was re-established.The building was converted at first to a royal mint, and later functioned as a convent, then as a wine store and finally as a prison before being destroyed in 1843. 13Later, the regional government in Andalucia in the late 20th century resolved to restore the building.And with the help of 1.3 million Euros from the European Regional
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