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In Babylonian mythology Irkalla is ruled by the goddess Ereshkigal and her consort Nergal or Ninazu. Ghosts spent some time travelling to the netherworld, often having to overcome obstacles along the way. The Anunnaki, the court of the netherworld, welcomed each ghost and received their offerings. The court explained the rules and assigned the ghost his fate or place. Another court was presided over by the sun god Shamash, who visited the netherworlds on his daily round, Shamash might punish ghosts who harassed the living, and might award a share of funerary offerings to forgotten ghosts.

The Babylonian netherworld was populated by an array of monsters and demons. However, within the netherworld the ghosts existed in a manner similar to the living. They had houses and could meet with deceased family members and associates

The Epic of Gilgamesh revolves around a relationship between the hero-king Gilgamesh and his close companion, Enkidu. It may loosely refer to a real king of the 27th century BCE. Part of the story relates Enkidu's death, the adventures of his ghost in the underworld, and the eventual return to the world when Gilgamesh breaks a hole in the earth.

The Babylonians believed that life in the underworld could be made more tolerable if the surviving relatives made regular ancestor worship offerings of food and drink. The ghosts of people without children to make these offerings would suffer more, while people who died in fire or whose body lies in the desert would have no ghost at all. If the relatives failed to make offerings, the ghost could become restless and visit sickness and misfortune on them.

Physical ailments resulting from hearing or seeing a ghost included headaches, eye and ear problems, various intestinal pains, shortness of breath and dizziness, fever and neurological and mental disorders. Cures involved ritual performances with use of offerings, libations, figurines, ritual burial and dispatch, encirclement, amulets, fumigants, bandages, salves, potions, washes, and suppositories. Other Mesopotamian diseases were blamed on gods or ghosts, each causing a particular sickness