Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 049
Guide XI-049

Prophetic medicine, ruqya and hijama

Ibn Qayyim al-Jawziyya1300Islamic world
A 35 · L 54 · M 1115 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Prophetic medicine as presented in Ibn Qayyim al-Jawziyya's Medicine of the Prophet (al-Tibb al-Nabawi, from Zad al-Ma'ad; trans. Penelope Johnstone, Islamic Texts Society, 1998); ruqya as defined by the General Iftaa' Department of Jordan, fatwa no. 672 "Treatment with Quran" (27 April 2010), with Dein and Illaiee (2013) for its clinical context; hijama (wet cupping) as regulated by Saudi Arabia's National Center for Complementary and Alternative Medicine (2015) and Qatar's Ministry of Public Health (circular DHP/2026/33) and as described by the Dutch RIVM (2023); the psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and Kleinman's explanatory-model questions.

What it is. This entry covers three related but distinct things, none of which is a psychotherapy and none of which the psychotherapist performs:

  • Prophetic medicine (al-Tibb al-Nabawi): a body of Islamic writing that combines religious and medical guidance on preserving and restoring health in line with the Qur'an and the Prophet's hadith. Its best-known text is by the fourteenth-century theologian Ibn Qayyim al-Jawziyya (d. 751 AH / 1350 CE). His publisher describes it as a summary of how the Prophet's guidance can be followed and of how Muslims of the thirteenth and fourteenth centuries understood health, sickness and cures. [source: Islamic Texts Society catalogue] Remedies often associated with it include black seed and honey [uncertain: not verified]. In a UK case report, a ruqya practitioner recommended olive oil and Qur'an-blessed water. [source: Dein and Illaiee 2013]
  • Ruqya: the recitation of Qur'anic verses or divine names for protection or cure, sometimes with blowing or wiping, or recitation over water or oil that the person then drinks or applies. [source: Dein and Illaiee 2013; Jordan Iftaa' fatwa 672] Jordan's General Iftaa' Department treats it as established in the authentic Sunnah and permissible under three conditions: it uses God's words, names and attributes or prophetic supplications; it is in Arabic or another language that keeps the meaning; and practitioner and patient hold that the ruqya has no power of its own and that healing comes from God alone. [source: Jordan Iftaa' fatwa 672] It is used, among other things, for illness attributed to jinn, sihr (sorcery or black magic) and the evil eye (al-'ayn).
  • Hijama (wet cupping): an invasive procedure in which the skin is scratched or incised before cupping. Its users include many Muslims, who regard it as a Sunnah practice [uncertain: not verified], and some athletes. [source: RIVM 2023; Richmond special-treatment list] The Dutch public-health institute states that its effectiveness has not been proven, because large, high-quality studies are too few. [source: RIVM 2023]

How change is understood. Within the tradition, healing comes from God: ruqya and remedies are means, and their effect depends on God's will. [source: Jordan Iftaa' fatwa 672; Dein and Illaiee 2013] Jinn are described in Islamic scholarship as created beings made of smokeless fire who can be good, evil or neutral. Most scholars accept that jinn can possess people, while some hold that they can only influence them, and both views require clear criteria before a problem is attributed to jinn. Protection is sought through religious obligations, prayer, Qur'an recitation and the Sunnah. [source: Dein and Illaiee 2013] These are the tradition's own beliefs, reported here without endorsement or dismissal.

The psychotherapist's role. Many Muslim clients hold these beliefs. In a UK sample (n=111), most believed in jinn, black magic and the evil eye, about half said these could cause physical and mental health problems, and about half said such problems should be treated by both doctors and religious figures. [source: Khalifa et al. 2011] Pew's 39-country survey found that belief in jinn was held by a majority of Muslims in 13 of 23 countries asked (e.g. 86% Morocco, 84% Bangladesh), with wide variation by region. [source: Pew 2012] The psychotherapist's work is culturally responsive assessment and therapy alongside the client's religious care: understanding the client's explanatory model, assessing carefully, collaborating with imams, chaplains and recognised practitioners when the client wishes, supporting safe choices, and safeguarding against abuse presented as ruqya. A therapist does not recite ruqya, recommend verses or remedies, or perform or arrange hijama. [synthesis]

2. Framework

Prophetic medicine, ruqya and hijama have no session protocol for psychotherapists. The phases below are the psychotherapist's own process, built from the CFI and the clinical guidance cited; their order and timing are [synthesis].

Who holds authority.

  • Ruqya and prophetic medicine: religious authority rests with Islamic scholars and official fatwa bodies (e.g. Jordan's General Iftaa' Department), local imams and Muslim chaplains. Scholarly views differ, for example on whether jinn possess or only influence people. [source: Dein and Illaiee 2013; Jordan Iftaa' fatwa 672] No state licensing scheme for ruqya practitioners (raqis) is documented in the sources cited [uncertain: not verified].
  • Hijama: authority rests with health regulators, and arrangements differ sharply by country.
    • Saudi Arabia: licences are issued by the National Center for Complementary and Alternative Medicine, under rules approved by the Ministry of Health (announced 17 February 2015). Applicants must be registered health practitioners with the Saudi Commission for Health Specialties, complete NCCAM training and pass its test, and be free of HIV, hepatitis B and C and tuberculosis. Clinics must employ at least one general practitioner to assess clients. [source: Saudi MOH 2015]
    • Qatar: the Ministry of Public Health's Department of Healthcare Professions (circular DHP/2026/33, 6 July 2026) sets an 18-month transitional pathway to license practitioners without a medical background. It requires accredited training with a supervised-case logbook, an exam and an interview. Practice is limited to licensed health facilities, under infection-control policies and with field inspections. Accredited training bodies listed include Saudi Arabia's NCCAM and, under the UK, the Institute of Clinically Applied Hijama Therapy, the British Cupping Society, TOCCA and Hijama Nation. [source: Qatar MoPH circular DHP 33]
    • Netherlands: only BIG-registered professionals (such as doctors) may legally perform wet cupping. The Health and Youth Care Inspectorate oversees alternative care, and the national hijama association was inactive when the study was done. [source: RIVM 2023]
    • United Kingdom: regulation depends on the local authority. A London list under the London Local Authorities Act 1991 (as at 2011) did not class cupping as a "special treatment" and notes that authorities interpret treatments differently. [source: Richmond special-treatment list] Outside London, registration under the Local Government (Miscellaneous Provisions) Act 1982 covers acupuncture, tattooing, cosmetic piercing, semi-permanent skin colouring and electrolysis. One council policy does not list cupping, so whether hijama is covered has to be checked with each council. [source: Lichfield policy 2019] [uncertain: not verified]

Phase A: Engagement and cultural assessment (sessions 1-2, or within intake).

  • Goals: a safe alliance; the client's own account of the problem; screening for risk.
  • How: use the core CFI (16 questions in four domains), which the APA intends for any clinician in any care setting. It supports clinical judgement and is not to be the only basis for a diagnosis. [source: APA CFI; APA Section III]
  • Time: the DSM-5 field trial found that later CFI interviews took less time. A minute figure is [uncertain: not verified]. [source: Lewis-Fernández et al. 2017]
  • Move on when: you can state the client's explanatory model (e.g. jinn, sihr, evil eye, illness, or several at once), their current or planned ruqya, remedies or hijama, and their immediate risk.

Phase B: Differential assessment and formulation (sessions 2-4).

  • Goals: distinguish culturally held belief and practice from psychosis, dissociative disorders, mood disorders and other conditions, without pathologising or missing illness. [source: Dein and Illaiee 2013]
  • How: use the supplementary modules (Spirituality, Religion and Moral Traditions; Explanatory Model; Coping and Help-Seeking; Cultural Identity; Immigrants and Refugees) and the Informant Version where family is involved. [source: APA CFI Supplementary Modules; APA CFI Informant]
  • Move on when: you have a shared formulation the client recognises, and consultation with a community member or imam (with consent) where the picture is unclear.

Phase C: Collaborative plan (from about session 3 onward).

  • Goals: agree with the client how psychological, medical and religious care fit together, and with whom you will liaise (imam, chaplain, raqi, GP, psychiatrist).
  • Move on when: the client has given informed, specific consent for each contact, and safety screening for any planned hijama is complete (see 4.9).

Phase D: Therapy alongside religious care (ongoing; typical weekly sessions).

  • Goals: usual evidence-based treatment for the presenting problem, with the client's faith-based coping included where they wish, and regular review of benefit and harm from all sources of help.
  • Move on when: you are reviewing again rather than moving phase. Repeat the CFI modules if the explanatory model shifts, since the APA notes they can be used repeatedly during treatment. [source: APA CFI Supplementary Modules]

Phase E: Safeguarding response (at any point).

  • Triggers: beating, restraint, forced drinking or immersion, isolation, starvation, sexual contact, sedation, or withholding of urgent medical care presented as ruqya. These move you immediately to the safeguarding procedure (see 4.13 and Harm account). [source: La Libre 2012; ITV 2021; Hespress 2023]

3. Guiding principles

  1. Describe, do not adjudicate, the spiritual. Jinn, sihr and the evil eye are the client's and their tradition's concepts, neither confirmed nor dismissed. In practice: you never tell a client jinn are or are not real. [source: Dein and Illaiee 2013] [synthesis]
  2. Know the explanatory model. In practice: ask, early and in the client's words, what they call the problem and what caused it, because clinicians need "to be aware of the explanatory models adopted by their patients." [source: Dein and Illaiee 2013; Kleinman et al. 1978]
  3. Neither over- nor under-diagnose. Culturally held possession beliefs are not by themselves psychotic symptoms. In practice: do not start the route to antipsychotics on belief alone, and do not let a jinn explanation hide a psychosis that goes "undetected and untreated." [source: Dein and Illaiee 2013]
  4. Religious authority belongs to religious authorities. In practice: questions about permissibility, verses or whether a symptom is jinn-related go to the client's imam, chaplain or scholar, not to you. [source: Dein and Illaiee 2013; Jordan Iftaa' fatwa 672] [synthesis]
  5. Collaborate with imams when the client wishes. In practice: offer joint working, because the clinical literature calls for collaboration "with imams in the provision of holistic mental healthcare." [source: Dein and Illaiee 2013] Trials of collaborative care with faith healers support this in other settings (see 4.8). [source: COSIMPO; Ofori-Atta et al.]
  6. Respect the client's rationale to support engagement. In practice: link treatment to the client's own frame (e.g. medication and ruqya can both be means), because the authors advise "embracing the service user's rationale of illness" to help acceptance of medication. [source: Dein and Illaiee 2013] Any medication question goes to the prescriber.
  7. Mainstream ruqya is not abuse. The fatwa forbids "whatever is harmful to one's health." An imam told a UK court that ruqya never involves drugs or sedation. In practice: name harm plainly and do not let it be framed as faith. [source: Jordan Iftaa' fatwa 672; ITV 2021]
  8. Consent is specific and ongoing. In practice: each liaison contact, informant interview and shared document needs its own consent. For any physical procedure a client undergoes elsewhere, they have the right to refuse or stop at any time. The therapist never touches in connection with these practices. [synthesis]
  9. Never advise on remedies or medicines. In practice: record what the client takes (black seed, honey, oils, recited-over water) and route any question about interactions, starting or stopping to the prescriber or pharmacist. [synthesis]
  10. Physical safety before physical procedures. In practice: a client planning hijama is encouraged to get medical clearance where they have conditions that regulators list as exclusions (see 4.9). [source: Saudi MOH 2015]
  11. Gender and modesty norms matter. The fatwa recommends a mahram (close male relative) be present for a female patient, with decency observed. In practice: ask about the client's preferences for clinician gender and chaperones, and treat a ruqya session held alone with a male stranger as a risk to explore. [source: Jordan Iftaa' fatwa 672; Hespress 2023] [synthesis]
  12. Cultural humility includes the service. In practice: name past criticism of UK services as insensitive to religious needs, and invite the client to tell you when you get it wrong. [source: Khalifa et al. 2011] CFI Q16 explores the clinician-patient relationship, including perceived racism and language barriers. [source: APA CFI]
  13. Safeguarding overrides deference. In practice: when ruqya or hijama is linked to injury, sexual abuse, coercion or a child at risk, follow your reporting duties whatever the stated religious rationale. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own. None involves performing ruqya, recommending verses, remedies or hijama, or touching the client. Example language is illustrative unless quoted.

4.1 Cultural humility and self-examination

  • Purpose and when: before and throughout work with Muslim clients who use or are considering ruqya, prophetic remedies or hijama. It helps you notice your own reactions to talk of jinn, sihr or the evil eye (scepticism, discomfort, over-identification or assumed shared faith). [synthesis]
  • Steps:
    1. Before the first session, note your assumptions about Islam, possession and religious healing, including any from your own faith or secular training.
    2. Treat Muslims as diverse: belief in jinn, sorcery and the evil eye varies widely between and within countries. [source: Pew 2012]
    3. Notice whether you are tempted to dismiss the belief or to defer to it uncritically, and take this to supervision.
    4. If you are Muslim, do not assume your school of thought or practice matches the client's. [synthesis]
  • Example language (illustrative): "People hold a wide range of views about jinn and ruqya, and I don't want to assume yours. Will you tell me how you see it?"
  • Watch for: the client editing their account to sound "less religious" or "more medical"; you steering away from the topic. It is working when the client brings up spiritual explanations without prompting.

4.2 Core Cultural Formulation Interview

  • Purpose and when: at intake or early assessment, to understand the problem as the client and their network see it, their sources of help and their expectations of you. It has 16 questions in four domains. [source: APA CFI]
  • Steps (structure only; the APA form is free for clinicians to reproduce for use with their patients): [source: APA CFI]
    1. Cultural definition of the problem (Q1-3): what the client calls it and what troubles them most.
    2. Cultural perceptions of cause, context and support (Q4-10): causes (listen for jinn, sihr, evil eye, divine test, stress or illness, often several at once), stressors and supports, and the role of cultural identity.
    3. Self-coping and past help seeking (Q11-13): ask specifically about prayer, Qur'an recitation, ruqya, prophetic remedies, hijama, imams and raqis, and about barriers.
    4. Current help seeking (Q14-16): preferences, and the clinician-patient relationship, including perceived racism and language barriers.
    5. Record answers in the client's words. Use the result to inform, not replace, diagnosis. [source: APA CFI]
  • Example language (illustrative): "Some people find that prayer, ruqya or seeing a sheikh helps when they are struggling. Have you tried anything like that, and how did it go?"
  • Watch for: brief, guarded answers to the help-seeking questions, which may mean the client expects disapproval. Also listen for fear that speaking about jinn could provoke them: women in a BBC investigation feared jinn might retaliate if they spoke out. [source: Hespress 2023] It is working when the client describes religious help alongside medical help without hesitation.

4.3 CFI supplementary module: Spirituality, Religion and Moral Traditions

  • Purpose and when: when the client's religion is central to how they understand or manage the problem. It can be used as an add-on or alone, at first evaluation or repeatedly. [source: APA CFI Supplementary Modules]
  • Steps:
    1. Explore the client's religious identity, practice and community (mosque, scholar or tradition they follow).
    2. Ask how their faith helps and whether any part of it feels like a burden at present.
    3. Ask who in their community they trust on religious questions (imam, chaplain, scholar, family elder).
    4. Note any distinction the client draws between ruqya they consider proper and practices they distrust. [synthesis]
  • Example language (illustrative): "Whose guidance do you trust on religious questions like this: an imam, a scholar, someone in your family?"
  • Watch for: religious guilt or shame (e.g. belief that illness reflects weak faith), which the tradition itself links to vulnerability to jinn. [source: Dein and Illaiee 2013] It is working when you can name a trusted religious figure the client would be willing to involve.

4.4 Explanatory-model inquiry (Kleinman; CFI Explanatory Model module)

  • Purpose and when: whenever the client attributes symptoms to jinn, sihr or the evil eye, or holds a mixed model. [source: Kleinman et al. 1978; APA CFI Supplementary Modules]
  • Steps: work through Kleinman's eight areas in your own words: [source: Tanenbaum handout]
    1. What the client calls the problem (e.g. "mass", "sihr", "nazar", "depression").
    2. What caused it.
    3. Why it started when it did.
    4. What it does to them and how it works.
    5. How severe it is, and whether it will be short or long.
    6. What treatment they think they should receive.
    7. The chief problems it has caused.
    8. What they fear most about it.
    Then write a short shared summary in the client's terms and check it with them.
  • Example language (illustrative): "You've said this may be the evil eye. What do you think it is doing to you, and what are you most afraid will happen?"
  • Watch for: fear of the illness worsening, of family shame or of being labelled "mad", which can drive avoidance of services. It is working when the client sees their view reflected accurately in the summary.

4.5 Help-seeking inventory: ruqya, prophetic remedies and hijama

  • Purpose and when: at assessment and review, to know exactly what religious and traditional help the client is receiving, from whom, at what cost and with what effect. [source: APA CFI Supplementary Modules (Coping and Help-Seeking)] [synthesis]
  • Steps:
    1. Ask whether they recite for themselves, receive ruqya from family or an imam, or see a paid raqi.
    2. For a raqi, ask about who they are, where sessions happen, who else is present, fees, and anything that frightened or hurt them.
    3. Ask about remedies taken (e.g. black seed, honey, oils, water recited over) and record them for the prescriber. Do not comment on doses or combinations.
    4. Ask about hijama: where, by whom, and whether the practitioner is licensed or registered where the client lives. Ask about any after-effects.
    5. Ask whether anyone has advised them to stop medication or avoid doctors.
  • Example language (illustrative): "I'm not here to judge any of this. Knowing what you're already doing helps me work alongside it safely. Could you tell me about the sessions with the raqi: who's there, and what happens?"
  • Watch for: large or escalating payments; secrecy; sessions alone with an unrelated practitioner; physical force; advice to stop medicines; new symptoms after hijama. All of these are red flags (see 4.11 and Harm account). It is working when the client gives concrete detail and agrees to tell you about changes.

4.6 Differential assessment: culturally held possession belief or disorder

  • Purpose and when: when the client or family describes possession, jinn voices, sihr or uncontrollable episodes, to avoid both pathologising belief and missing illness. [source: Dein and Illaiee 2013]
  • Steps:
    1. Separate the belief ("a jinn is affecting me"), which many in the client's community share, from the experiences that accompany it: hallucinations, fixed ideas beyond shared belief, disorganisation, mood change, dissociation, compulsions. [source: Dein and Illaiee 2013] [synthesis]
    2. Check DSM-5-TR dissociative criteria. Dissociative identity disorder allows that identity disruption may be described as possession, but excludes disturbance that is a normal part of broadly accepted cultural or religious practice. Exact DSM-5-TR wording is [uncertain: not verified]. Other specified dissociative disorder includes dissociative trance (acute narrowing or loss of awareness of surroundings), which likewise does not apply to trance that is part of accepted collective cultural or religious practice. [source: Lewis 2023; PMC9199574]
    3. Check ICD-11. 6B62 Trance disorder and 6B63 Possession trance disorder (customary identity "replaced by an external 'possessing' identity") both require the state to be involuntary and unwanted, and not part of accepted cultural or religious practice. [source: PMC9199574; findacode ICD-11 mirror]
    4. Ask whether people in the client's own community see the experience as normal or as excessive. With consent, consult an imam or community member. [source: Dein and Illaiee 2013]
    5. Screen for psychosis, mania, depression with psychotic features, OCD (including religious scrupulosity), PTSD and organic causes such as epilepsy. Note that jinn have long been linked to madness and epilepsy. [source: Dein and Illaiee 2013] [synthesis]
    6. Refer for psychiatric and medical assessment where indicated, and explain why in the client's frame.
  • Example language (illustrative): "Many people in your community believe jinn can affect a person, and I'm not questioning that. I'd also like to check whether something medical, like sleep or the brain's chemistry, is adding to this, so you get every kind of help."
  • Watch for: command hallucinations, suicidal ideation, aggression, severe self-neglect, or family plans for intensive or forced "treatment". These need urgent psychiatric and safeguarding responses. Assessment is working when your formulation explains the symptoms without contradicting the client's faith.

4.7 Informant interview with family

  • Purpose and when: when family are involved in decisions about ruqya, raqis or treatment, or the client cannot give a full account. The CFI Informant Version (17 questions) asks first about the informant's relationship with the patient, then covers the same four domains. [source: APA CFI Informant]
  • Steps:
    1. Obtain the client's consent and agree what may be shared.
    2. Interview the family member separately where possible, using the informant structure.
    3. Explore the family's explanatory model and any treatment they are arranging (who, where, cost, methods).
    4. Return to the client with what may be shared, and agree next steps.
  • Example language (illustrative): "Your family clearly want to help. Would it be all right if I spoke with your mother about what she thinks is happening and what she's arranged?"
  • Watch for: family pressure on the client to undergo repeated or residential sessions, isolation from outside contact, or blame placed on the client. In the Brussels case, the woman was cut off from the outside world and emergency help was delayed. [source: La Libre 2012] It is working when family and client describe one agreed plan.

4.8 Collaboration with imams, Muslim chaplains and recognised ruqya practitioners

  • Purpose and when: when the client wants religious and psychological care to work together, or when religious authority is needed to address a belief, a family dispute or a risky practice. The clinical literature calls for collaboration with imams in holistic mental healthcare, and for consulting the patient's religious community. [source: Dein and Illaiee 2013] Evidence from other faith-healing settings:
    • COSIMPO (Nigeria and Ghana): collaborative care between traditional and faith healers and primary-care workers reduced psychotic symptoms more than usual care. Harmful practices fell from 57% to 9%, against 42% to 10% in controls. [source: COSIMPO (PubAnnotation); Centre for Global Mental Health]
    • Ghana prayer camp: adding psychiatric medication to prayer-camp care reduced symptoms but did not significantly reduce days in chains. [source: Ofori-Atta et al.]
  • Steps:
    1. Ask whom the client trusts. Prefer a mosque imam, a hospital or university Muslim chaplain, or a raqi the client's own scholars recognise. [synthesis]
    2. Obtain written, specific consent: who, what will be shared, and for what purpose.
    3. In the first contact, explain your role and ask the religious colleague about theirs. Agree that religious questions are theirs and clinical ones are yours.
    4. Agree shared safety lines: no physical force, no stopping prescribed medicine without the prescriber, urgent medical help for warning signs, and appropriate chaperoning.
    5. Plan how you will communicate (e.g. joint meeting, brief updates) and review with the client what each contact adds.
  • Example language (illustrative), to the client: "Would it help if your imam and I spoke, so that the support you get at the mosque and the work we do here pull in the same direction?" To an imam: "I'm not here to comment on the religious side. I'd value your view on how [client] understands this, and I want to agree how we keep them safe if things get worse."
  • Watch for: a religious contact who opposes all medical care, or who proposes force or isolation. Discuss this with the client and seek another recognised authority. Also watch for breaches of confidentiality in a close community. It is working when the client reports less conflict between faith and treatment.

4.9 Supporting a safe, informed choice about hijama

  • Purpose and when: when a client has had, or plans, hijama. It is invasive, and the therapist's task is to support informed choice and physical safety, not to recommend or discourage it on religious grounds. [synthesis]
  • Steps:
    1. Ask whether the practitioner is licensed or registered where the client lives. In Saudi Arabia, licensed practitioners are registered health professionals trained and tested by NCCAM. In Qatar, practice is limited to licensed facilities. In the Netherlands, only BIG-registered professionals may perform it. In the UK, council requirements vary, so the client should check with the local authority. [source: Saudi MOH 2015; Qatar MoPH circular DHP 33; RIVM 2023; Richmond special-treatment list; Lichfield policy 2019]
    2. Encourage the client to speak to their GP first if any condition applies that the Saudi regulator lists as an exclusion: age under 12; cancer or current chemotherapy or radiotherapy; severe or chronic kidney or liver failure; blood disorders such as haemophilia; a pacemaker; varicose veins; anticoagulant medication such as warfarin. [source: Saudi MOH 2015] Pregnancy, anaemia, diabetes and immunosuppression are further reasons to seek medical advice [uncertain: not verified].
    3. Discuss infection control in general terms. Regulators and public-health bodies emphasise single-use sterile blades and needles, disposable cups, gloves, protective equipment, clinical waste disposal and hepatitis B vaccination for practitioners. The main concern is blood-borne viruses (hepatitis B and C) where hygiene fails. [source: RIVM 2023; Wang et al. 2023]
    4. Consent and touch: the client chooses which body areas are treated and may stop at any time, and a chaperone or same-gender practitioner can be requested. Any sexual or genital touching is abuse and a reportable matter. [synthesis]
    5. Give the after-care warning signs reported in the literature: persistent or worsening pain, swelling, redness, skin lesions or fever near the sites, usually within a week. These need urgent medical care. [source: Wang et al. 2023]
    6. Do not discuss sites, timing, number of cuts or other technique.
  • Example language (illustrative): "I'm not going to tell you whether to have hijama. Because it breaks the skin, can we just check a few safety things, like whether the practitioner is licensed and whether your GP needs to know about your blood thinners?"
  • Watch for: repeated hijama for low mood or anxiety in place of mental-health care; fainting, dizziness or anaemia; scarring; signs of infection. Rare serious cases include epidural abscess and necrotising fasciitis, mostly after delayed presentation. [source: Wang et al. 2023] It is working when the client makes a deliberate choice with medical input and knows when to seek help.

4.10 Including the client's own faith-based coping in therapy

  • Purpose and when: when the client draws strength from prayer, dhikr, Qur'an recitation or ruqya they perform themselves, and wants this acknowledged. The tradition describes these as forms of protection. [source: Dein and Illaiee 2013] [synthesis]
  • Steps:
    1. Ask which practices help and when (e.g. before sleep, during panic).
    2. Fold them into the treatment plan as the client's own coping, alongside evidence-based techniques for the presenting problem. Do not prescribe or lead them.
    3. Track their effect with the client, as you would any coping strategy.
    4. Check for scrupulosity or compulsive repetition (e.g. hours of recitation driven by fear), and treat that as a clinical target with religious consultation where needed. [synthesis]
  • Example language (illustrative): "You said reciting at night helps you feel protected. How would you like that to fit alongside the breathing work we've been practising?"
  • Watch for: practices turning into rituals that increase distress or take up the day; guilt when practice "fails". It is working when practices calm rather than escalate fear.

4.11 Helping the client tell mainstream ruqya from harmful practice

  • Purpose and when: when the client sees, or plans to see, a raqi, or reports frightening sessions.
  • Steps:
    1. Explore what the client's own scholars consider proper ruqya: one official fatwa limits it to God's words, names and prophetic supplications, in Arabic or an equivalent language. The fatwa forbids what harms health, recommends a mahram be present for women, and says a patient should not be forced to drink. [source: Jordan Iftaa' fatwa 672]
    2. Compare the client's experience with red flags documented in courts, investigations and the press:
      • beating, holding underwater, forced drinking or vomiting, near-starvation, scalding baths or isolation [source: Bladi 2012; La Libre 2012]
      • drugs or sedation [source: ITV 2021]
      • sexual contact presented as treatment, or claims that a jinn caused a pregnancy [source: Hespress 2023; Gulf News 2018]
      • selling "illusions" for profit, or financial blackmail [source: Gulf News 2018]
    3. Offer to involve a trusted imam or chaplain to give a religious view on what the client experienced.
    4. Move to safeguarding (4.13) if any red flag is present.
  • Example language (illustrative): "From what scholars have said, proper ruqya is recitation. It shouldn't involve hitting, forcing you to drink, drugs, being alone in a way that feels unsafe, or touching your body. Has anything like that happened?"
  • Watch for: the client defending the practitioner out of fear of the jinn or of losing a cure; shame after sexual abuse. It is working when the client can describe what happened and chooses a safer source of help.

4.12 Interpreters and cultural brokers

  • Purpose and when: when language differs, or religious terms (e.g. sihr, 'ayn, mass) carry meanings you need explained. The CFI treats language barriers as part of the clinician-patient relationship. [source: APA CFI] [synthesis]
  • Steps:
    1. Use a professional interpreter, not family, and ask the client's preference about the interpreter's gender and community ties.
    2. Brief the interpreter to translate religious terms without softening or medicalising them.
    3. Where meaning is unclear, ask the client first. With consent, ask a cultural broker or chaplain about meaning only, not about the client.
  • Example language (illustrative): "When you say 'sihr', I want to make sure I understand what that means for you. Could you tell me in your own words?"
  • Watch for: the client withholding detail because the interpreter is from their community; the interpreter adding their own view. It is working when the client's terms appear accurately in your notes.

4.13 Safeguarding and reporting

  • Purpose and when: whenever ruqya, exorcism or hijama is linked to injury, coercion, sexual abuse, sedation, starvation, isolation, delay of urgent care or risk to a child. [synthesis]
  • Steps:
    1. Assess immediate danger. Call emergency services for collapse, breathing difficulty, near-drowning, severe weakness or infection signs. In the Brussels case, help was called only after a day of sharp decline, and the woman died in hospital. [source: La Libre 2012]
    2. Follow your jurisdiction's adult and child safeguarding procedures and your professional code. Consult your safeguarding lead.
    3. For children: apply child protection procedures without delay, never name the child in shared documents beyond what procedures require, and consult safeguarding professionals about religious context. The Saudi regulator bars cupping under age 12. [source: Saudi MOH 2015] [synthesis]
    4. Report unlicensed or unsafe hijama to the relevant regulator or local authority environmental health team, as the jurisdiction allows. [source: RIVM 2023; Lichfield policy 2019] [synthesis]
    5. Report sexual offences and assault according to law and the client's wishes where they are an adult with capacity, unless others are at risk.
    6. Document facts, not judgements of faith.
  • Example language (illustrative): "What you've told me is serious, and it isn't part of your religion's healing. I need to make sure you're safe, and I'll explain each step I take."
  • Watch for: retraction under family or community pressure; fear of jinn retaliation [source: Hespress 2023]. It is working when the client is safe and stays engaged.

4.14 Processing harmful or frightening ruqya and exorcism experiences

  • Purpose and when: with clients who went through coercive, violent or sexual "treatment", or who were frightened by sessions. [synthesis]
  • Steps:
    1. Stabilise first: safety, sleep and grounding.
    2. Separate the harm from the faith. Many clients need to hear that abuse is not ruqya, and an imam or chaplain can confirm this. [source: ITV 2021] [synthesis]
    3. Assess PTSD, depression, dissociation and spiritual distress (e.g. fear that the jinn remains, or anger at God or the community).
    4. Offer evidence-based trauma treatment adapted to the client's frame, and consider religious consultation for spiritual concerns.
  • Example language (illustrative): "What was done to you was abuse. Your faith and your wish to get better were used against you. We can work on the fear and the memories at a pace that feels safe."
  • Watch for: self-blame ("my faith was weak"); avoidance of mosque or community; re-traumatisation if pressed to seek another exorcism. It is working when symptoms ease and the client's relationship to their faith feels less frightening.

4.15 Liaison with prescribers on medicines and remedies

  • Purpose and when: when a client takes prophetic remedies alongside medication, or is advised to stop medicine for ruqya. Respecting the client's rationale can support medication acceptance. [source: Dein and Illaiee 2013]
  • Steps:
    1. Record the remedies the client names, without comment on safety or dose.
    2. With consent, tell the prescriber or pharmacist and encourage the client to raise interactions with them.
    3. If the client wants to stop medication, ask them to discuss this with the prescriber first. Do not advise either way.
  • Example language (illustrative): "I can't advise on medicines or remedies, but your doctor or pharmacist can check that the black seed oil and your tablets are fine together. Shall we let them know?"
  • Watch for: abrupt stopping of medication, relapse, or bleeding risk where anticoagulants and hijama combine. [source: Saudi MOH 2015] It is working when the prescriber knows everything the client takes.

5. Handling problems

The sources give little direct guidance on therapy process problems. Responses below are [synthesis] unless a source is cited.

  • The client asks whether you believe in jinn.
    • Response: answer honestly about your role without ruling on the belief, and return to their experience. [synthesis]
    • (Illustrative) "Whether jinn are involved is a question for your scholars. My job is to understand what you're going through and help with it. What matters most to you about my view?"
  • The client asks you to recite ruqya, recommend verses, or suggest a raqi or remedy.
    • Response: decline warmly, explain that this is outside your role, and offer to support a link with their imam or chaplain (4.8). [synthesis]
  • The client or family refuses psychiatric assessment because "it is jinn, not illness".
    • Response: work within the client's frame. Offer assessment as one more means, alongside ruqya, rather than a replacement, as Dein and Illaiee advise embracing the client's rationale. Involve a trusted imam, and document risk. [source: Dein and Illaiee 2013] If there is serious risk, follow mental-health law and safeguarding procedures.
  • Rupture: the client feels dismissed or diagnosed as "mad".
    • Response: name it, apologise for the impact, and revisit the explanatory-model summary (4.4). Use CFI Q16 on the clinician-patient relationship. [source: APA CFI] [synthesis]
  • Fear of jinn retaliation blocks disclosure or reporting.
    • Response: acknowledge the fear as real for the client and go at their pace. Offer an imam's or chaplain's support, and keep safety planning concrete. Women in the BBC investigation cited this fear and fear of being blamed. [source: Hespress 2023]
  • Overwhelm or dissociation in session when talking about possession.
    • Response: slow down, ground, and stop the topic if needed. Reassess for dissociative disorder or trauma (4.6, 4.14). [synthesis]
  • Non-adherence: medication stopped on a raqi's or family's advice.
    • Response: explore without blame and inform the prescriber with consent (4.15). If the raqi is advising this, discuss involving a different recognised religious authority. [synthesis]
  • Stuck: repeated ruqya or hijama with no relief and growing despair.
    • Response: review all sources of help with the client and reformulate, considering missed diagnoses. Ask whether their own scholars see value in also seeking medical and psychological care. Khalifa et al. found that about half of UK respondents favoured treatment by both doctors and religious figures. [source: Khalifa et al. 2011] [synthesis]
  • Escalating payments to a raqi.
    • Response: discuss costs openly, compare with what scholars consider proper ruqya (4.11), and consider financial-abuse safeguarding. [source: Gulf News 2018] [synthesis]
  • Physical symptoms after hijama.
    • Response: urge same-day medical review for pain, swelling, redness, lesions or fever near the sites. Do not wait for the next session. [source: Wang et al. 2023]
  • Religious scrupulosity mixed with jinn fear (e.g. compulsive recitation or washing).
    • Response: assess for OCD. Treat with evidence-based therapy adapted with religious consultation, so the client can hear from a scholar what their faith requires. [synthesis]
  • Confidentiality in a small community (interpreter, imam or family knows the client).
    • Response: agree limits of sharing in advance, offer an interpreter from outside the community, and share the minimum necessary. [synthesis]
  • Gender-related discomfort.
    • Response: offer a same-gender clinician or a chaperone where possible, and respect the client's norms. [source: Jordan Iftaa' fatwa 672] [synthesis]
  • The therapist's own reactions (anger at abuse, or pressure to "fix" belief).
    • Response: use supervision. Keep your stance on harm clear and your stance on belief neutral. [synthesis]
  • A child is involved (exorcism of a minor, cupping of a young child, family plans).
    • Response: follow child protection procedures immediately (4.13). The Saudi regulator bars cupping under 12. [source: Saudi MOH 2015]

Harm account

This section describes documented abuse carried out under the name of ruqya or exorcism, and documented hijama complications. Mainstream ruqya, as official fatwa bodies describe it, is recitation, and it forbids what harms health. [source: Jordan Iftaa' fatwa 672] The cases below were presented by perpetrators as ruqya, and courts and commentators rejected that framing.

What was actually done

  • Latifa Hachmi, Brussels, 2004. Hachmi, a 23-year-old woman, underwent "roqya" sessions meant to expel jinn said to prevent her from conceiving. [source: Bladi 2012; La Libre 2012]
    • The sessions began in June 2004 and resumed on 23 July 2004. They involved forced drinking of large amounts of "holy water", forced vomiting, baths (reported as scalding), beatings with a stick inscribed with Qur'anic verses, and near-starvation. She was cut off from the outside world.
    • She deteriorated sharply on 4 August, and emergency services were not called until the next day. She died in hospital.
    • On 11 June 2012 the Brussels-Capital Assize Court convicted six adults of torture:
      • her husband Mourad Mazouj, and Xavier Meert, who led the final sessions: 9 years each
      • Jamila Zian and Fatima Zekhnini: 5 years suspended, for torture causing death
      • Abdelkrim Aznagui, who began the sessions, and Hayate Saïf Nasr: 3 years suspended, for torture without the aggravating circumstance
  • Hossam Metwally, Grimsby, UK (sentenced 20 September 2021). Metwally, a hospital anaesthetist, was convicted at Sheffield Crown Court of injecting his partner with anaesthetic drugs during a series of ceremonies he filmed while chanting. The press described these as a "dangerous perversion" of ruqya. He was also convicted of voyeurism against two patients. [source: ITV 2021]
    • On 4 July 2019 his partner was found in a deep coma, close to cardiac arrest, with multiple organ failure.
    • The judge called the acts "sham religious acts" with nothing to do with legitimate Islamic practice. An imam told the court that ruqya never involves drugs or sedation.
    • Metwally was sentenced to 14 and a half years.
  • Sexual abuse by spiritual healers, Morocco and Sudan (BBC investigation, reported 2023). Over two years, the BBC gathered 85 women's testimonies accusing 65 healers of sexual misconduct, ranging from harassment to rape. They included a woman who said she was drugged and raped in a private session, and whose resulting pregnancy the healer attributed to jinn. [source: Hespress 2023]
  • Financial and sexual exploitation, Saudi Arabia (2018). A Saudi social researcher, Abdul Aziz Al Zeer, said that most practitioners had turned ruqya into a business "selling illusions". He described financial and sexual blackmail and untrained people setting up as raqis. These are his estimates and accounts, not audited figures. [source: Gulf News 2018]
  • Hijama complications.
    • Minor events are reported as relatively frequent and usually self-limiting: scarring, burns, headache, itching, dizziness, anaemia and panniculitis.
    • Infections are rare but can be serious: Staphylococcus aureus (including MRSA), Pseudomonas, mycobacteria and herpes simplex, with epidural abscesses, limb necrosis, septic arthritis and osteomyelitis. One patient with necrotising fasciitis died after delayed presentation. [source: Wang et al. 2023]
    • Studies link wet cupping to higher hepatitis C risk in Egypt and Saudi Arabia. An acute hepatitis B case in The Hague in 2012 was linked to a wet-cupping practice. [source: RIVM 2023]

How it caused harm

  • Physical force, water and deprivation: forced fluids, immersion, beating and starvation caused injury and death. In the Hachmi case, forensic doctors found near-drowning from repeated holding underwater, about a hundred bruises and strangulation. [source: La Libre 2012]
  • Delay of urgent care: waiting for sessions to work, or fearing outside involvement, delayed emergency treatment. [source: La Libre 2012]
  • Sedation: anaesthetic drugs given outside medical care caused coma and organ failure. [source: ITV 2021]
  • Sexual abuse and coercion: healers used private access, belief in jinn and fear of blame to abuse women, who often told neither family nor police. [source: Hespress 2023]
  • Financial exploitation: payments for repeated "treatments", with blackmail in some accounts. [source: Gulf News 2018]
  • Delayed psychiatric care: attributing psychosis wholly to jinn can leave it "undetected and untreated". [source: Dein and Illaiee 2013] The collaboration trials show harmful practices (such as chaining) persisting where care is not joined up. [source: COSIMPO; Ofori-Atta et al.]
  • Hijama: a broken skin barrier allows bacterial infection. Unsterile blades or poor hygiene allow blood-borne virus transmission. Case reports often involved unqualified practitioners or self-treatment. [source: Wang et al. 2023; RIVM 2023]
  • Who was most at risk: young women whose families arranged sessions; people isolated from outside contact; people with psychosis or other illness attributed to jinn; clients of unlicensed practitioners; and, for hijama, people with bleeding risks or exclusions listed by regulators. [source: La Libre 2012; Hespress 2023; Saudi MOH 2015] [synthesis]

Recognising it today

  • Red flags in a raqi's or group's practice:
    • hitting, pressing on the throat or chest, holding underwater, forced drinking or vomiting
    • long or residential sessions with restricted food or contact
    • drugs, cannulas or injections
    • sessions alone with an unrelated practitioner, any touching of intimate areas, or sexual "cures"
    • escalating fees or payment for guaranteed results
    • instructions to stop medicine or avoid doctors
    • claims that the jinn is speaking through the client's refusal or distress
    • secrecy or threats [source: La Libre 2012; ITV 2021; Hespress 2023; Gulf News 2018] [synthesis]
  • Rationales to listen for: "the jinn must be beaten out"; "the pain is the jinn's, not hers"; "don't tell anyone or it will come back" [illustrative, synthesis].
  • How legitimate versions differ: in the official account, ruqya is recitation of God's words and prophetic supplications in an intelligible language. It forbids harm to health, does not force a patient to drink, and recommends a mahram for women. [source: Jordan Iftaa' fatwa 672]
  • Hijama red flags: no licence or registration where one is required; reused blades or cups; no gloves; no health questions before treatment; treatment of young children; treatment of people on anticoagulants without medical advice. [source: Saudi MOH 2015; Qatar MoPH circular DHP 33; RIVM 2023]

What to do instead and how to help those harmed

  • Safer alternatives: mainstream ruqya from trusted imams or recognised practitioners chosen with the client's own scholars, alongside evidence-based psychological and psychiatric care. Collaborative care models with faith healers are one option. [source: Dein and Illaiee 2013; COSIMPO] For hijama, use only licensed or registered practitioners where such schemes exist, after medical clearance. [source: Saudi MOH 2015; Qatar MoPH circular DHP 33]
  • Working with imams and Muslim chaplains: involve them to confirm that abuse is not ruqya, to support survivors spiritually, and to help families choose safe help. [source: ITV 2021; Dein and Illaiee 2013] [synthesis]
  • Assessment of those harmed: check medical sequelae (injury, infection, blood-borne virus testing via a doctor where hijama hygiene was poor), PTSD, depression, dissociation, spiritual distress and ongoing coercion. [source: RIVM 2023] [synthesis]
  • Treatment: see 4.13 and 4.14 (stabilisation, trauma-focused therapy adapted to the client's frame, religious consultation where wanted). [synthesis]
  • Ethical, reporting and legal duties: follow adult and child safeguarding procedures. Report crimes such as assault, torture, sexual offences and administering drugs as the law and the client's capacity and wishes allow. Report unsafe hijama to the regulator or local authority. Document carefully, without judging the faith. [source: La Libre 2012; ITV 2021; RIVM 2023] [synthesis]

Sources

Web sources:

Books cited:

  • Ibn Qayyim al-Jawziyya (1998). Medicine of the Prophet. Trans. Penelope Johnstone. Cambridge: Islamic Texts Society (place of publication [uncertain: not verified]).
  • Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251-258.
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