The City of the Dead was once four separate graveyards, today on the same plots of land for over 400 years, the tomb cities have merged and are inhabited by more of the living than the dead. The oldest sections of the cemetery were built during the Mamluk period. Only a few of these original tombs remain. Most of the present structures date to the 1700s and 1800s.

The City of the Dead stretches for over 3 kilometers, south and east of the medieval core of Cairo. Major thoroughfares carry a constant flow of traffic on either side of the walls that enclose this old tomb city. The City of the Dead has become part of the "ring of poverty" that hems in nearly every parameter of today's central city. In nearly all the settlements that make up the slum ring basic amenities are either non-existent or haphazardly self-assembled; this is also true for the City of the Dead.

Originally, the cemetery was inhabited by tomb guardians, and although the physical boundaries of the city have remained quite stable over the years, the population has grown dramatically since 1955. The housing shortage and overpopulation problems in Cairo have influenced the number of poor rural migrants coming to live in the City of the Dead. Each new arrival increases the density of the living arrangements in the tomb city. Within the dense pattern of structures, the old tombs and newer dwellings form clusters as distinctive, close-knit neighborhoods and a strong sense of community is generated between the poor inhabitants which is reflected in the high degree of interdependence between the people.

As researched and reported by Helen Watson, many of the people living in the City of the Dead carry a heavy emotional burden with them because of the physical and cultural separation they experience from their rural villages. She writes that the rural lifestyle is an "ever-present" topic of conversation among the women living in the tomb city. The families from rural villages hold to very traditional Islamic teachings within their live in the cemetery's culture.

Women typically stay near their homes and refrain from interacting with men outside their families. In the close living quarters of the City of the Dead, the secluded living quarters for women that are ideal in traditional Muslim life are not attainable.  Women learn to accept their dense living arrangements by understanding their state of poverty and the necessity to work outside the home to earn an income for the family. Yet, from the families she interacted with, Watson heard the women stress their priority commitment to their homes.  She heard hopes of being able to move one day, to where a traditional Islamic lifestyle can be lived more fully.