Before his death, Saladin had divided his dominions amongst his kin: Al-Afdal received Palestine and Syria, Al-Aziz was made ruler of Egypt, Al-Zahir received Aleppo, Al-Adil received Karak and Shawbak, and Turan-Shah retained Yemen. However, conflict soon broke out, and Al-Adil became the undisputed ruler of Syria, Upper Mesopotamia, Egypt, and Arabia. Al-Aziz Uthman succeeded his father and ruled between 1193 and 1198 AD.
Despite Al-Aziz's having specifically inherited suzerainty over the whole Ayyubid empire, soon he had to face the revolt of the Zengid emirs of Mosul and Sanjar and of the Artuqids in southern Iraq. When Al-Afdal expelled all the ministers left by his father to support him, they came to Egypt, asking al-Aziz to reconquer Syria. In [? year] al-Aziz besieged Damascus; Al-Afdal asked for help from Saladin's brother, Al-Adil, who met al-Aziz and managed to bring about a reconciliation. The following year al-Aziz attacked again Syria, but Al-Afdal was able to persuade some of the emirs of his army to desert. Later al-Adil allied with al-Aziz against al-Afdal, who was besieged and captured in Damascus on 3 July 1196. Al-Afdal was exiled to Salkhad, while al-Aziz was proclaimed supreme overlord of the Ayyubid empire; however, most of the effective power was in the hands of Al-Adil, who had installed himself in Damascus.
During his reign, he tried to demolish the Great Pyramids of Giza, Egypt, but had to give up because the task was too big. However, he did succeed in damaging Menkaure's Pyramid. al-Malik al-'Aziz Uthman also played an important role in the history of the building enterprises and construction at Banias and Subaybah.
He died in a hunting accident in late 1198. He was interred in the tomb of his elder brother al-Mu'azzam.
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