Understanding Traditional Emirati Medicine: Insights,Challenges,and a Call to Action

Abstract

Although the United Arab Emirates was founded in 1971 as a federation of 7 emirates with Abu Dhabi serving as its capital, the peoples who have inhabited its lands since antiquity have long-standing beliefs and practices for preventing, diagnosing, and treating ill-health and for maintaining health. Traditional Emirati Medicine exists as unwritten healing practices, beliefs, and knowledge communicated through poems, stories, sayings, songs, and proverbs and Islamic teachings and literature. Research is needed to understand Traditional Emirati Medicine’s scope, proper usage, efficacy, active ingredients and mechanisms of action, safety, and quality assurance, and we encourage government and non-government entities to formulate action plans and policies. A strong and up-to-date knowledgebase will inform decisions and recommendations concerning the future of Traditional Emirati Medicine including establishing best practices and health policies, regulating medicines and practitioners to protect consumers, and integration of traditional medicine and modern medicine.

Although the United Arab Emirates (UAE) was founded in 1971 as a federation of 7 emirates (an emirate is a political territory ruled by a sheikh, that is, a traditional sheikhdom based on tribal genealogy and cultural heritage) with Abu Dhabi serving as its capital, the peoples who have inhabited its lands since antiquity have long-standing beliefs and practices for preventing, diagnosing, and treating ill-health and for maintaining health. Healing customs of the cultural and tribal groups brought together within Emirati citizenship during the formation of the country can be characterised as ‘Traditional Emirati Medicine’ (or as ‘Emirati medicine' or ‘UAE Medicine’), a form of traditional medicine that was the mainstay of medical treatment in the Arabian Peninsula until very recently (there are obvious limitations of labelling ‘Emirati medicine’ as ‘traditional’ and Western medicine as ‘modern’, for example, the assertion of Western norms of power, privilege, and Othering, and we use these labels loosely to follow conventions in literature and to encourage debate without any implied meanings of inferiority or superiority). Traditional Emirati Medicine exists as unwritten healing practices, beliefs, and knowledge communicated through poems, stories, sayings, songs, and proverbs and Islamic teachings and literature. However, research about healing traditions in the UAE is inadequate. A greater understanding of traditional medicine can also improve modern medicine in the UAE. For example, many people in the UAE take herbal medicines along with modern medicines, either for natural recovery or to reduce side-effects. Modern medicine can learn from people’s long-standing traditions and experiences of dealing with diseases and health problems characteristic of a desert environment in the tropical and subtropical zones and their interaction with rapid urbanization and development.

A starting point is to critically reflect on the definition and scope of Emirati medicine which are unclear in literature. ‘Emirati’ as a new identity, ethnic group, or cultural group representing the citizens of the UAE came into being in 1971, and yet the ancestry of its members is diverse and includes indigenous tribes and migrants with Arabian, North African, and Persian heritage (a tribe is group of people who trace their lineage to a supposed common ancestor, and most tribes in the UAE consist of thousands of members and multiple branches, although ‘tribe' is a contested concept in social sciences). Tribal customs and structures constitute the basic foundations of culture, society, and, therefore, traditional medicine in the UAE. For example, the Bedouin—pastorally nomadic Arabic-speaking Arab tribes which historically inhabited and moved around desert regions of the Arabian Peninsula in search of grazing areas, and now regarded as an anchor of the Emirati national identity—have particular healing beliefs and practices (i.e., Bedouin medicine) which come under the umbrella of Traditional Emirati Medicine along with the traditions of other ancestral groups as not every Emirati is Beduoin. While kinship and tribal relationships remain a significant source of identity, as does an emirate (regional) identity, being Emirati also involves a sense of belonging to a unified national identity with shared values and culture and way of life. Research can better understand and map out the character, treatments, and diversity of Traditional Emirati Medicine and their interplay with tribal features and the creation and development of the UAE. Furthermore, since people in the UAE retain strong kinship bonds with people on the Arabian Peninsula, for example, the Bedouin are present in the deserts of Iraq, Saudi Arabia, Jordan, and Yemen, the medical traditions in these places are also important to consider. The UAE’s location between the tropical zone and subtropical zone has varied natural landscapes including sand deserts, oases, mountains with river valleys (wadis), gravel plains, marshes, mangroves salt plains, coasts, and islands, all with different plants and herbs and animals used as medicinal ingredients, and this also contributes to diversity within Traditional Emirati Medicine. Islam, the state religion of the UAE, is a major source of health beliefs and practices and underpins respect for traditional medicine and confidence in its efficacy. According to popular belief, illnesses and their causes, effects, and cures come from Allah, and medicine and medical practitioners are the means to achieve God’s will. ¹ Traditional Emirati Medicine is closely linked to Prophetic Medicine (‘Medicine of the Prophet’, known as al-Tibb al-Nabawi in Arabic) which includes prayer and reading and writing from the Qur’an (Ruqyah) and certain remedies and physical treatments. ¹

Traditional treatments in Emirati Medicine include cupping (wet cupping, hijama; or dry cupping, takhbeen), the placement of glass suction cups (made of goat horns in the past) on the patient’s back to stimulate blood flow; cautery (wasm/kaii/kowie), the brief placement of a red hot iron rod or fine wire to specific cautery points on the skin; bone setting (al Tajbeer), the use of plaster made from seed resin and egg to set bone fractures; and small surgical interventions (e.g., uvulectomy). Traditional healers (tabib shaabi) specialize in different areas of medicine, for example, herbalists (attareen/ashshab) prepare and prescribe remedies made from plants, herbs, and minerals, although remedies can now be purchased from some pharmacies; healers (al mutabbib) perform physical treatments, diagnose conditions, and prescribe herbal medicine; and religious elders and leaders (al mutawa) provide counselling. Although traditional healers are respected, their numbers have declined in recent decades. Young Emiratis now enrol in universities to study modern medicine, and almost all traditional healers are elderly.

Modern medicine was introduced in the mid-1950s by Christian missionaries but was not accessible to most people until the creation of the national healthcare system. During the 1960s and 1970s, Western medicine was promoted as the solution for all health issues whereas Traditional Emirati Medicine received little support. ¹ In the intervening decades, the UAE has transformed into one of the world’s richest countries using revenues from oil and it now boasts world-class hospitals and clinics catering for every medical speciality and equipped with the latest technology. The exceptionally high immigration rate and cultural diversity, with immigrants accounting for 88.5% of the ethnically diverse population compared to 11.5% Emiratis, ² has led to the availability of traditional, complementary, and alternative medicines from around the world including acupuncture, ayurveda, chiropractic, homeopathy, and naturopathy. These forms of medicine do not fall within the scope of Traditional Emirati Medicine but should be considered in future research on the use of traditional medicine in the UAE. Although Emiratis today live in a modern world, traditional beliefs and practices are respected and people are religiously conservative; and those born prior to the 1970s were raised in a way of life completely different from today and are nostalgic for the days gone by. It is well established in literature that traditional beliefs do not change as quickly as the material surroundings. ³ By the mid-1980s, many Emiratis had started to return to the use of traditional medicine as an acknowledgement of their Arab and Islamic heritage as well as resistance against the pervasiveness of Western cultural influences. ¹ It has been reported that Emiratis continue to rely heavily on herbal medicines and have knowledge of medicinal plants and herbs for common malaises which they treat themselves.^4,5 Our students in the United Arab Emirates University tell us that they are familiar with traditional medicine since their parents and grandparents often administer home remedies for minor ailments such as a colds, stomachaches, and bruises, and some have visited traditional healers, but they do not have as much knowledge about traditional medicine as their elders. Traditional Emirati Medicine is not regarded as the mainstay of their healthcare, but it is seen as an integral part of Emirati culture. Our students also tell us that traditional medicine feels more personal and connected to family, heritage, and being Emirati. The Government has launched initiatives to promote cultural heritage and to actively reinforce a national identity, for example, by funding cultural centres, traditional crafts, and museums. Therefore, research on traditional medicine should consider all these issues.

Research is needed to understand Traditional Emirati Medicine’s scope, proper usage, efficacy, active ingredients and mechanisms of action, safety, and quality assurance, and we urge government and non-government entities to formulate action plans and policies. A strong and up-to-date knowledgebase will inform decisions and recommendations for its future including establishing best practices, health policies, regulating medicines and practitioners to protect consumers, and integration of traditional medicine and modern medicine. There is no regulatory control of herbal medicines in the UAE even though they are widely and freely available⁴. The UAE Government has standards and licensure for ayurveda, homeopathy, traditional Asian medicine, therapeutic massage, naturopathy, osteopathic medicine, chiropractic medicine, and Unani medicine, but not for Traditional Emirati Medicine. There are no formal training programs or schools, although a professional qualification as a Hijama Therapist exists. ⁶