Fifty Muslim-Majority Countries Have Fewer COVID-19 Cases and Deaths Than the 50 Richest Non-Muslim Countries

By Ponn P. Mahayosnand, MPH; DM Sabra, ZM Sabra, Gloria Gheno

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Mahayosnand P, Sabra D, Sabra Z,  Gheno G. Fifty Muslim-majority countries have fewer COVID-19 cases and deaths than the 50 richest non-Muslim countries. HPHR. 2021;29.

Fifty Muslim-Majority Countries Have Fewer COVID-19 Cases and Deaths Than the 50 Richest Non-Muslim Countries



To determine the difference in the total number of COVID-19 cases and deaths between Muslimmajority and non-Muslim countries, and investigate reasons for the disparities. All Muslimmajority countries are considered partly or completely not free (in war), and 80% are LMICs (low- and middle-income countries). 


The 50 Muslim-majority countries have more than 50.0% Muslims with an average of 87.5% Muslims. The non-Muslim country sample consisted of 50 countries with highest GDP while omitting any Muslim-majority countries listed. Their average percentage of Muslims was 4.7%. All data was pulled on September 18, 2020. To measure incidence of COVID-19, three different Average Treatment Methods (ATE) were used to validate the results. 


Non-Muslim countries had significantly more COVID-19 cases, 3-times that of Muslim-majority countries. Non-Muslim countries had 1.86-times more COVID-19 deaths than Muslim-majority countries. These percentages were obtained by applying the simulation method to ATE’s results.


Despite most Muslim-majority countries being poor and all considered partly or completely unfree, 34/50 (68%) countries had shown a decline in active COVID-19 cases. This study shows that Muslims’ practice of tahara (purity or cleanliness) is similar to many COVID-19 containment measures and tawakkul (trust in Allah) helps them remain resilient and hopeful during difficult unpredictable times, such as living through a pandemic. Developed countries can benefit from the knowledge learned in this study. Research should be conducted with Muslims in

Muslim-majority and non-Muslim countries to further study the health benefits of adhering to Islamic practices, principles, and beliefs.


The objective of this research was to determine the difference in the total number of COVID-19 cases and deaths between Muslim-majority and non-Muslim countries, and investigate reasons for the disparities. 


There has been a disparity in the spread of COVID-19. LMICs (low- and middle-income countries) are more vulnerable to COVID-19 due to limited healthcare resources and poor living conditions. Healthcare systems are corrupt, limited, or under-resourced in LMICs.1 In regards to combating COVID-19, LMICs average 1-10 SAO (surgeons, anesthesiologists, and obstetricians) per 100,000 compared to the estimated need of 20 SAO per 100,000.2 It is estimated that LMICs have 0.1-2.5 ICU beds per 100,000 while higher-income countries have 530 in.


In Bangladesh, a Muslim-majority country, full lockdown was nearly impossible as there was a strong association between loss of livelihood and an increased unemployment rate due to full business shutdown.3 Partial lockdown with social distancing and multi-sectoral (health, economy, agriculture, food, etc.) collaboration was recommended. Identifying and isolating active COVID-19 cases, rapid testing, and contact tracing were found to be extremely difficult for under-resourced LMICs. In LMICs, a percentage of the population is dependent on daily wages (meaning funds are sufficient for only a day’s worth of food) both in the rural and urban settings.4 In the slums of India, a non-Muslim country, if people did not go to work, they had a high likelihood of losing their jobs. For individuals living in these situations, following social distancing or lockdown directives meant weighing the potential risks of COVID-19 versus the immediate risk of hunger.5 If governments want this population to stay home in hopes of reducing the spread of COVID-19, they must provide them daily income and necessary resources in order to survive.


LMICs currently in war and crisis face more imminent death and destruction as shown in the following examples of Muslim-majority countries: Afghanistan had trouble managing its wounded citizens, and Yemen faced daily airstrikes and the reemergence of diseases such as cholera, diarrhea, dengue, and measles.6,7 Both reports stressed that the United Nations should pressure for ceasefires to combat the expansion of COVID-19, and lfting blockades in Gaza would allow the transit of much-needed healthcare aid and assistance.8


Certain measures were conducive to possibly containing the spread of COVID-19. For example, Gaza’s borders were mostly closed during the early months of the outbreak which prevented travelers and foreigners from entering.9 Border quarantine and isolation of positive COVID-19 cases was said to inhibit the proliferation of the pandemic. Two methods reported to help contain COVID-19 in LMICs were found to be: (1) public education and community outreach, and (2) pragmatic multi-sectoral (health, business, schools, agricultural, etc.) collaboration in adhering to amended WHO COVID-19 guidelines after individual countries weighed the ethical and economical risks against their health and social benefits.10 Beneficial counseling included canceling elective medical procedures, seeking only emergency medical care, self-isolating if sick, and allocating limited PPE (personal protective equipment) usage for healthcare professionals. Appropriating resources for telepsychiatry services for the growing need during this pandemic was continuously recommended.2 

Religion and COVID-19

Growing objective scientific research suggests religious faith is an important resource for health and well-being and benefits the “immune functioning and vulnerability to infection.”11 Quoting various religions including Islam, Koenig stressed the importance of maintaining spiritual, mental, and physical resilience during the COVID-19 pandemic. Religious beliefs and practices helped individuals in their abilities to cope with disease, recover from hospitalization, and have positive attitudes.11 An Italian study showed that more severe COVID-19 affectees reported higher religious behavior and that Google searches across 95 countries for topics related to prayer increased during the pandemic.12

Religion and Cleanliness

Hand hygiene among health care workers was analyzed across eight religions.13 Islam was one of three religions that had precise rules for handwashing specified in sacred texts. Islam and two other religions emphasized the importance of cleanliness and personal hygiene. Their followers were encouraged to adhere to daily hygienic practices for individual, communal, and environmental benefits.

Litman et al. proved that individuals with both intrinsic and extrinsic religious motivation to maintain high levels of cleanliness were more interested in staying clean to remain physically and religiously cleansed. Litman recommended that further research be conducted to examine if enhanced religious cleanliness would translate into actual health benefits, such as reduced incidence of infectious diseases or food-borne illnesses.14


The 50 Muslim-majority countries had more than 50.0% Muslims with an average of 87.5%. The non-Muslim country sample consisted of 50 countries with the highest GDP while omitting any Muslim-majority countries listed. The non-Muslim countries’ average percentage of Muslims was 4.7%. Data pulled on September 18, 2020 included the percentage of Muslim population per country by World Population Review15 and GDP per country, population count, and total number of COVID-19 cases and deaths by Worldometers.16 The data set was transferred via an Excel spreadsheet on September 23, 2020 and analyzed. To measure COVID-19’s incidence in the countries, three different Average Treatment Methods (ATE) were used to validate the results. 


On September 27, 2020, Muslim-majority countries were defined as LMIC (40 of 50, 80%) by the World Bank, and active live COVID-19 cases was observed by the Worldometer.


On September 28, 2020, 14 of 50 (28%) Muslim-majority countries were classified as being in “war” by World Population Review17 and 50 of 50 (100%) countries were considered “partly” or “not free” by Freedom House.18


The dataset was composed from the first 50 countries, ranked by GDP. Among them, 9 were countries with a Muslim-majority. We analyzed the following hypotheses:

H1: Muslim-majority countries have fewer cases than non-Muslim countries

H2: Muslim-majority countries have fewer deaths than non-Muslim countries


If we want to analyze the causal effect of a treatment (𝑇) when random assignment is not possible, a matching method is advisable. In general, only in the presence of experiments it is possible. To analyze the effect of T, ATE (average treatment effect) is used 19


𝐴𝑇𝐸 = 𝐸[𝑌(1) − 𝑌(0)]

{𝑌(1), 𝑌(0)} ⫫ 𝑇 | 𝑋


where 𝑌(1) and 𝑌(0)  are the potential variables of interest when the individual 𝑖 is assigned to the treated or untreated group respectively 20. Conditioning on the variables X, the assignment of individuals to treatment is independent of Y. Many methods are proposed to estimate ATE. In this work, we considered the matching method 21,22, the non-parametric inference 20 and the augmented inverse propensity weighted estimator.19 The first method was composed from a nonparametric preprocessing and a parametric inference, the second from a nonparametric inference and the third from 2 parametric inferences.


The matching method 21,22 is divided into 2 steps. The first step modifies the dataset such that, eliminating or reducing the relation between 𝑇 and 𝑋 , the analysis becomes the difference in means of Y. The second estimates the linear regression


𝐸[𝑌i|𝑇i , 𝑋i ] = 𝛼 + 𝛽𝑇i + 𝛾𝑋i


and by it calculating  𝐸[𝑌i(0)] and 𝐸[𝑌i(1)] to estimate ATE. There are many proposed methods for the matching step. 22,23,24,25,26 In this work, we used the genetic matching proposed by Diamond and Sekhon.26


The nonparametric inference calculates ATE without specifying a regression model. The 140 estimated ATE is given by the following formula 20

where 𝑝̂k (𝑋i) and 𝑞k (𝑋i) are the weights obtained by the constrained minimization of the distance 145 between these and the uniform weights.

The Augmented Inverse Propensity Weighted Estimator (AIPW), proposed by Glynn and 147 Quinn, calculates the estimated ATE using this formula 19

where 𝜋(𝑋𝑖) is the weight obtained by the logit regression with 𝑋𝑖 regressors. The variance of ATE was calculated using the sandwich estimator.27

Table 1: ATE for hypothesis 1




95%. Lower

95%. Upper

Chan et al. (2016)


0.01 * 



Stuart et al. (2011)





Glynn and Quinn (2010)





Signif. codes:  0 ‘***’ 0.001 ‘**’ 0.01 ‘*’ 0.05 ‘.’ 0.1 ‘ ’ 

To validate the first hypothesis, we used the above-mentioned methods.19,20,22 The variable of interest 𝑌 is equal to the COVID-19 cases divided by the population, while 𝑋 is the ranked GDP. In all methods, ATE results negative and significant (Table 1), therefore, the hypothesis 1 was validated. Using the simulated values of 𝑌(0) and 𝑌(1), obtained by method proposed by Stuart et al. the percentage of the cases in the non-Muslim countries was about 3 times that of the Muslim countries.


To validate the second hypothesis, we used the methods proposed by Chan et al., by Stuart et al., and by Glynn and Quinn. In all methods, the variable of interest 𝑌 is equal to the deaths divided by the cases, while 𝑋 is a matrix composed by the ranked GDP and the cases divided by the population. AIPW permits to specify different models between treated and untreated, hence we introduced the interaction in Stuart’s model so that, also in this method, it was possible to specify 2 different models for the 2 groups. In Chan’s method and AIPW, ATE results were negative and significant, while in Stuart’s methods it was negative but not significant (Table 2). However, in Stuart’s method with interactions about 93.3% of values of ATE was negative, while in that without interactions they decreased to about 85.3%. Since 2 methods on 3 ATE were significant, the hypothesis 2 was validated. As previously, using the method proposed by Stuart et al. with interactions, the percentage of the deaths in the nonMuslim countries was about 1.86 times that of Muslim-majority countries.


Table 2: ATE for hypothesis 2





95%. Lower

95%. Upper

Chan et al. (2016)



0.05 .  



Stuart et al. (2011)







with interactions





Glynn and Quinn (2010)



0.025 *



Signif. codes:  0 ‘***’ 0.001 ‘**’ 0.01 ‘*’ 0.05 ‘.’ 0.1 ‘ ’ 1


Thirty-four of the 50 Muslim-majority countries (68%) showed active COVID-19 cases declining on or before August 15, 2020.28 Islamic faith and social connection helped Somalians cope with the COVID-19 pandemic, as well as other collective traumas.29 Social isolation, quarantine, and sanitation, as per the WHO pandemic guidelines, are in alignment with the Islamic faith. Islam also fosters tawakkul (trust in Allah) as a means of saving Muslims from issues such as depression and mental distress.30  

Islam and Health

The aim of medicine in Islam is to “preserve health, ward off disease, and restore health when it is lost.”31 There are 28 Quranic verses that focus on the importance of maintaining a healthy lifestyle, and promoting personal hygiene, good diet, nutrition, and alcohol abstinence.32 It is incumbent that Muslim physicians dissuade or prevent their patients from participating in hazardous behaviors that undermine individual and collective well-being.33 While Western cultures emphasize individual choice, individual autonomy is more limited in Islam, as beneficence to others is an act of worship emphasized in the Quran (9:7-8)34 and encouraged by the Prophet (PBUH*) (Muslim 16:1508).35


According to Amin “worldwide public health organizations are almost in line with the teachings of Islam.”36 Muslims perform daily ablution, wash hands after sleeping, cover one’s face when sneezing, and avoid hand shaking with a leper or infected person. 

Tahara (purity or cleanliness)

Tahara (purity or cleanliness) is an essential tenet of the Islamic faith analogous to common practices that prevent, treat, and reduce the chances of contracting or dying from COVID-19. While today’s experts highly recommend social distancing or quarantine to stop and reduce the spread of COVID-19, the Prophet (PBUH) told Muslims to avoid plagued lands 1400 years ago.37 Cleanliness is paramount in Islam. Muslims believe that “Cleanliness is half our [Muslims’] faith” (Muslim 223) and “Allah loves cleanliness” (Muslim 2230).35 The Quran also states that Allah loves those who cleanse and purify themselves (2:222).34 Therefore, the acts of cleanliness must precede all Muslims’ behaviors and activities.38


When the Ebola virus reached Nigeria, a Muslim-majority country, the federal government advised citizens to follow the words of the Prophet (PBUH) who urged Muslims to be clean and wash their hands frequently. Rassoul stressed that cleanliness has significant spiritual (intrinsic) and physical (extrinsic) importance in Islam, similar to Litman et al.’s reasonings explained in the Introduction.  

Tawakkul (trust in Allah)

The belief and practice of tawakkul helps Muslims to be more resilient during difficult and unpredictable times, such as a pandemic.39 The Muslim worldview on health and illness is unique, with Muslims “receiving illness and death with patience, meditation and prayers.”38 In a Belgian study, it was found that religion played a crucial role in how Muslim women percieved and dealt with illness.40 Health was interpreted to be a trust and blessing from Allah. Participants underlined the importance of accepting illness with gratitude as it is part of Allah’s divine decree. Muslims do so because they consider them natural parts of life and tests from Allah. They see illness as atonement for sins, and death as part of their journey to meet Allah. 


According to Hammoudeh et al., most elderly Palestinian women who participated in their study recognized faith and tawakkul as ways of coping, alongside physical activity and healthy eating.41 Muslims are required to work hard towards achieving a well-balanced life (religiously, academically or vocationaly, physically, nutritionally, emotionally, socially, etc.) and to have tawakkul.42 


While Muslims rely upon Allah, they must also do their part. When the Prophet (PBUH) was asked by a man whether he should tie his camel and rely upon Allah or leave it loose and rely upon Allah, the answer was, “Tie it and rely (upon Allah)” (at-Tirmidhi 4,11:2517).35 The Quran instructs Muslims “to obey Allah, and obey the Messenger (PBUH), and those in authority among you,” stressing the seeking of credible advice (4:59).34 When a man was injured and two doctors were called to examine him, the Prophet (PBUH) asked who was the better doctor, further indicating the need for superior consultation.43


Various religious practices, such as voluntary prayers, supplications, and Quranic recitations, serve as additional healing aids.40 The Quran mentions deeds that purify Muslims, including generosity (16:90), charity (3:42), compassion (17:23), obligatory prayers (9:103), and almsgiving. Muslims perform these deeds as testaments to their trust in Allah.34 In terms of health and disease, Muslims believe that there is a remedy for every illness or disease on earth, except old age (Sahih al-Bukhari 5678).35 As long as Muslims trust in Allah, their belief of acceptance leads to greater happiness as it includes contentment and peacefulness. 


Despite most (40/50, 80%) Muslim-majority countries being LMICs and 100% considered unfree, the majority (34/50, 68%) have shown a decline in active COVID-19 cases. While many Muslim-majority countries were not able to strictly follow social distancing, lockdown, testing, contact tracing, and PPE guidelines, the 50 richest non-Muslim countries had 3-times more COVID-19 cases and 1.86-times more deaths than the 50 Muslim-majority countries with statistical significance. 


This study shows that Muslims’ practice of tahara is similar to many COVID-19 containment measures, while tawakkul helps Muslims remain resilient and hopeful during difficult unpredictable times, such as living through a pandemic. Strong educational campaigns centered around religious faith that emphasized the practice of strict personal hygiene have proven beneficial for Muslims during this COVID-19 pandemic. It can be beneficial for developed countries to stress religious faith and cleanliness practices as a means of attaining greater overall health.


Research should be conducted in Muslim-majority countries and Muslims living in nonMuslim countries to further study the health benefits of adhering to Islamic practices, principles, and beliefs. For example, a number of Muslim countries are currently studying the medicinal benefits of black cumin seed in relation to COVID-19, because the Prophet said that it “can heal all diseases except death” (Sahih al-Bukhari 5687).26


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The authors would like to thank Samiha Ahmed for her technical editing assistance and insightful critiques, Dr. Tamseela M. Hussain for her medical consultation, Lisa Kahler for her thoughtful feedback, and Maryam O. Funmilayo, MA for her edits. The lead author would like to acknowledge SS for her astuteness; their discussions led to the hypotheses of this research project.  

About the Authors

Ponn P. Mahayosnand, MPH

Ponn P. Mahayosnand is a Research Scholar at Ronin Institute. She is a public health researcher focusing on Islam and Health, preventive and lifestyle medicine as it relates to Tibb al-Nabawi (medicine of Prophet Muhammad, peace be upon him), and health in Gaza, Palestine. She earned her BS in Biology, minor in Environmental Health, concentration in Health Policy and Management from Providence College, and MPH. from the University of Connecticut. Having embraced Islam twenty-two years ago, she opened or helped operate a full-time and multiple part-time Islamic schools or programs in three states.

DM Sabra

DM Sabra is with the Faculty of Medicine, Islamic University of Gaza.

ZM Sabra

ZM Sabra is with the Faculty of Medicine, Islamic University of Gaza.

Gloria Gheno

Gloria Gheno is with the Ronin Institute for Independent Scholarship.