RIYADH — When King Abdulaziz began developing healthcare services, the challenge was not simply a shortage of hospitals.Disease itself posed a threat to communities.Epidemics were among the major health challenges facing the country, while organized medical services were limited. The annual arrival of pilgrims from different parts of the world added another dimension, making public health in Makkah and the holy sites an issue extending beyond local communities.Healthcare therefore became part of the wider state-building effort.The King Abdulaziz Foundation for Research and Archives, known as Darah, records that King Abdulaziz paid particular attention to improving health conditions and combating epidemics as he developed public services across the country.A decisive step came in 1926.That year, the Public Health Department was established in Makkah.Its responsibilities extended beyond treating illness. It was charged with public health affairs and with providing medical care for pilgrims — placing prevention, healthcare administration and Hajj medicine within an organized government structure.The location was significant.Makkah brought together residents and large numbers of pilgrims arriving from abroad, making disease surveillance, sanitation and access to treatment particularly important.As government health services developed, hospitals and clinics were established and medical capabilities gradually expanded.King Abdulaziz also sought medical expertise from abroad to support the emerging system, while measures were taken to confront infectious diseases and improve health conditions.The objective was increasingly broader than responding to individual cases of illness: the state was assuming responsibility for the health of the population.That shift was especially visible during Hajj.Protecting pilgrims required medical facilities, preventive measures and organized supervision capable of operating during one of the world's largest recurring movements of people.Healthcare and the service of pilgrims consequently developed alongside one another.The institutional structure continued to evolve as the country's needs grew, laying the groundwork for a wider government health system.What began amid epidemics, scarce medical resources and the particular demands of the holy cities was becoming an organized public service.The significance of the transformation lay not in any single hospital or clinic.It was in the emergence of an idea that would shape the decades ahead:Public health had become a responsibility of the state.