The hospital was established in 1865, before the Liberation of Bulgaria from Ottoman rule, as a waqf treatment center under the personal orders of Midhat Pasa. Its first location was on the grounds of the local imaret, and its staff at the time consisted only of a foreign military doctor and two servants. He died in 1869, and was replaced by Dr. Robert Geiser, a Swiss national who was in charge of the hospital until 1877.
Georgi Stranski, the hospital's first manager
During the Russo-Turkish War of 1877–1878, numerous Russian surgeons were active in the area during the Siege of Plevna. Nikolay Pirogov was among them, and Bulgarian physician Georgi Stranski, a close friend of revolutionary Hristo Botev, was also present. Shortly after the war—in 1879—Stranski became the hospital's first manager, albeit only for a year. The hospital was enlarged and moved to its current location in 1896.