section_path: 14th-century plague/Transmission/West Asian and North African outbreak
section_name: West Asian and North African outbreak
paragraph_text: West Asian and North African outbreak
  
  The disease struck various regions in the Middle East and North Africa during the pandemic, leading to serious depopulation and permanent change in both economic and social structures.
  
  By autumn 1347, plague had reached Alexandria in Egypt, transmitted by sea from Constantinople via a single merchant ship carrying slaves. By late summer 1348, it reached Cairo, capital of the Mamluk Sultanate, cultural center of the Islamic world, and the largest city in the Mediterranean Basin; the Bahriyya child sultan an-Nasir Hasan fled and more than a third of the 600,000 residents died. The Nile was choked with corpses despite Cairo having a medieval hospital, the late 13th-century bimaristan of the Qalawun complex. The historian al-Maqrizi described the abundant work for grave-diggers and practitioners of funeral rites; plague recurred in Cairo more than fifty times over the following one and a half centuries.
  
  During 1347, the disease travelled eastward to Gaza by April; by July it had reached Damascus, and in October plague had broken out in Aleppo. That year, in the territory of modern Lebanon, Syria, Israel, and Palestine, the cities of Ascalon, Acre, Jerusalem, Sidon, and Homs were all infected. In 1348–1349, the disease reached Antioch. The city's residents fled to the north, but most of them ended up dying during the journey. Within two years, the plague had spread throughout the Islamic world, from Arabia across North Africa.
  
  The pandemic spread westwards from Alexandria along the African coast, while in April 1348 Tunis was infected by ship from Sicily. Tunis was then under attack by an army from Morocco; this army dispersed in 1348 and brought the contagion with them to Morocco, whose epidemic may also have been seeded from the Islamic city of Almería in al-Andalus.
  
  Mecca became infected in 1348 by pilgrims performing the Hajj. In 1351 or 1352, the Rasulid sultan of the Yemen, al-Mujahid Ali, was released from Mamluk captivity in Egypt and carried plague with him on his return home. During 1349, records show the city of Mosul suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease.