Hospitals

From Places to Die to Centres of Healing

By Isabelle Devos

Medical care in Belgium has not always looked the way it does today.

The modern hospital, equipped with advanced technology, specialist teams, and universal access, is the result of more than a century of transformation.

Medical care in Belgium evolved from care for the most vulnerable in small charitable institutions to a nationwide, highly organised system serving the entire population.

Poor Houses

Until the mid-nineteenth century, hospitals in Belgium were very different from those we know today. Most people were cared for at home by family members or friends, sometimes with help from a doctor or a barber-surgeon (see article on ‘Doctors’).

Hospitals were not primarily places of medical treatment. Instead, they were part of the system of poor relief. Their main purpose was social: they offered food, shelter, and basic care to the poor, the homeless, and the chronically ill.

Many of these institutions dated back to the Middle Ages or early modern period. They were run by local authorities and largely staffed by Catholic nuns or brothers. Doctors played only a secondary role.

Mortality was very high in these institutions: partly because they cared for the most vulnerable, and partly because medical knowledge was very limited at the time.

Conditions inside hospitals made matters even worse. Wards were overcrowded, patients often shared beds, ventilation was poor, and infectious diseases spread quickly.

Common treatments such as bloodletting, purging, and the use of opium or alcohol were often ineffective and sometimes even harmful. As a result, many people saw hospitals not as places of healing, but as places where one went to die.

The word hospital comes from the Latin hospitale (meaning inn or guesthouse) and ultimately from hospes, which means guest or stranger. Originally, a hospital or guesthouse was a place where strangers and pilgrims could stay overnight and find lodging. Over time, these places also began to care for people who were ill.

A Fragmented System

Hospitals in Belgium, 1850 versus 1890

Sources: 1850: Ducpetiaux, Institutions de Bienfaisance de la Belgique, 1852; Exposé décennal sur la situation administratieve du Royaume 1841-1850; 1890: Moniteur Belge, 24 April 1890.

Today, Belgium has 103 hospital organizations spread across 189 locations.

Figuring out how many hospitals existed in the nineteenth century is much more difficult, as most institutions combined medical and social care.

The hospital system was fragmented and locally organized. Civil authorities, religious groups, and private medical initiatives all ran hospitals, often side by side, and sometimes overlapped. The central government had little direct control.

In 1850, many hospitals were still continuations of medieval and early modern hospices. They were often located along major roads and trade routes.

Hospital care was concentrated in large cities such as Brussels, Antwerp, Ghent, and Liège.

Smaller market towns and former religious centres also had hospitals, because they had long served as places of transit and care, such as Ypres, Tournai, Zomergem, Zottegem, and Braine-le-Comte.

Vast areas of the countryside, especially in West Flanders, Antwerp, Limburg, and the southern part of Belgium, had no or few hospitals. As a result, most rural people had little access to institutional care.

Medical Innovation

Hospitals changed dramatically in the second half of the nineteenth century, thanks to major medical discoveries.

In Belgium, as in much of Europe, medical science progressed rapidly. One key breakthrough was the introduction of anaesthesia in the 1840s. Substances such as ether and chloroform allowed doctors from then on to operate without causing extreme pain. This made longer and more complex surgeries possible.

Another major breakthrough was the development of germ theory in the late nineteenth century. This new idea held that diseases were not caused by “bad air” or fate, but by tiny microorganisms (germs) that could be identified and controlled.

This discovery transformed both medical treatment and hospital design. Hospitals introduced stricter hygiene measures: wounds were cleaned more carefully, instruments were sterilised, and wards were kept cleaner to prevent infection. Gradually, surgery moved from private homes into hospitals.

From the mid-nineteenth century onward, medicine became increasingly specialised.

Some doctors began focusing on specific parts of the body, such as the heart, lungs, or stomach, and followed additional training. New medical disciplines developed, often supported by professional associations. In Belgium, these included anatomopathology (1857), psychiatry (1869), public health (1889), gynaecology (1889), and surgery (1892), among others.

Hospitals became the main centres for this growing specialisation. They also developed into key places for medical training and research. Students learned to work with laboratories, microscopes, chemical tests, and new diagnostic instruments. Universities in Leuven, Ghent, Brussels, and Liège expanded their buildings and facilities to support this more scientific approach to medicine.

After 1880, hospitals added operating rooms and laboratories and followed new hygiene principles, including improved ventilation and separate wards for different diseases. Specialised hospitals such as maternity hospitals, children’s hospitals, and hospices, also became more common. By the end of the nineteenth century, hospitals had become centres of treatment, learning, and medical innovation.

Yet for much of the population, especially in rural Flanders and Wallonia, the village doctor remained the main point of care, treating a wide range of illnesses. This situation created a growing gap between modern urban hospital care and more traditional rural practice.

By 1890, the number of hospitals in Belgium had grown significantly, especially in cities and in the northern parts of the provinces of East Flanders and Antwerp, notably in the area between Antwerp, Ghent, and Bruges (Figure 1b). However, large rural regions were still underserved. Southern Belgium could even be described as a ‘medical desert’ due to the shortage of both hospitals and physicians (see section on doctors).

Toward better access

Hospitals in Belgium, 1939

Figure 3a. Hospitals in Belgium ca. 1939. (Sources: 1939: Annuaire de la Santé Publique, 1939).

The early twentieth century marked the start of a more structured hospital network across the country.

Brussels and central Belgium developed into major hospital hubs, while cities such as Ghent, Liège, and Antwerp strengthened their regional roles.

By 1939, hospital care had expanded significantly, reducing some regional inequalities. This development reflected growing public involvement in healthcare, marked by the creation of Belgium’s first Ministry of Public Health in 1936.

This increasing government attention to health went hand in hand with the rise of mutual health insurance funds since the late nineteenth century, which played a crucial role in making medical care more widely available.

By this time, the medical profession had also become highly specialised, with growing numbers of trained experts working in hospitals, universities, and public health institutions across the country.

Still, peripheral regions such as the Ardennes and parts of Limburg and Luxembourg province continued to lag behind (Figure 3a).

After the Second World War, medical infrastructure in Belgium improved in many ways. The government expanded the welfare state, introducing compulsory health insurance, which made healthcare more affordable for everyone. People could now visit a doctor or go to a hospital and worry less about the cost.

Hospitals also entered a new era. New technologies like X-rays, antibiotics, and heart monitors, allowed doctors to diagnose and treat illnesses more effectively. Medical care became more organised and team-based, with doctors, nurses, and specialists working together. Patients were no longer just treated, they were monitored, tested, and followed up. The family doctor remained the first point of contact and referred patients to hospitals when complex care was needed.

By 1970, Belgium had achieved near-universal hospital coverage, with 458 hospitals (Figure 3b). Nearly everyone lived within five kilometres of a hospital, apart from some rural areas in the Ardennes, Limburg and West Flanders. Major cities developed dense concentrations of large and specialized institutions.

Hospitals in Belgium, 1939 versus 1970

Figure 3b. Hospitals in Belgium 1970 (Sources: Annuaire de la Santé Publique, 1970).

Increasing specialisation and integration

From the 1980s onward, medicine became even more specialised.

Many disciplines were divided into smaller subspecialties. For example, cardiology split into interventional cardiology, cardiac imaging, and the treatment of heart rhythm disorders. This allowed for more precise and targeted care. At the same time, patients were increasingly treated by teams of specialists rather than by a single doctor.

Hospitals also became more technological. They were equipped with advanced machines such as MRI and CT scanners, instruments for keyhole surgery, and other high-tech equipment.

Medical care became more dependent on technology, scientific research, and teamwork. However, this growing complexity also brought challenges, especially rising costs and fragmented care.

In the past decade, healthcare policy in Belgium has therefore placed greater emphasis on integration. General practitioners and specialists are encouraged to collaborate more closely, using digital tools and shared electronic health records.

Hospital mergers have also taken place, often leading to the closure of smaller hospitals in small cities, to improve efficiency. As a result, patients increasingly receive coordinated care in large-scale institutions, where treatments are based on the latest scientific research.

TODAY, Belgium has seven university hospitals that combine specialized care with academic research and medical education:

UZ Leuven,
UZ Gent,
UZ Antwerpen,
UZ Brussel,
Hôpital Erasme,
CHU de Liège, and
Cliniques universitaires Saint-Luc.

UZ Leuven has the oldest origins, tracing back to the Sint-Pietershospital founded in 1080, and evolved into a modern multi-campus university hospital during the twentieth century.

UZ Gent grew out of nineteenth-century medical training at the Bijloke city hospital, with construction of a dedicated medical institute beginning in 1937 and its official opening in 1959.

In Brussels, UZ Brussel, Cliniques universitaires Saint-Luc, and Hôpital Erasme were founded in the 1970s as university hospitals closely linked to the VUB, UCLouvain, and ULB.

UZ Antwerpen, opened in 1979, and CHU de Liège, founded in 1989, complete the academic hospital landscape.

Want to Read More?

Jan De Maeyer, Lieve Dhaene, Gilbert Hertcant en Karel Velle (red.), Er is leven voor de dood. Tweehonderd jaar gezondheidszorg in Vlaanderen, Kapellen: Pelckmans, 1998.
Robrecht Van Hee, Het Stuivenbergziekenhuis (1879-2022), een erfgoedicoon in Antwerpen,2022.

Sources

L’Atlas Ineqkill des inégalités de mortalité en Belgique fournit des informations détaillées sur la mortalité et les maladies en Belgique de 1820 à 2025.