Whatever the fez and the Arabic name suggest, the Shrine's substantial activity is a hospital system. The first Shriners Hospital for Children opened in 1922, and the network has treated children with orthopaedic conditions, burns, cleft lip and palate and spinal cord injuries since, historically at no charge to families and now on a basis that does not turn on ability to pay. It is funded by the membership and by public fundraising, and it is the largest philanthropic operation attached to any fraternal order.
The order itself was founded in New York in the early 1870s by two Masons who wanted a body for enjoyment rather than instruction. The oriental theming was invented for the occasion, drawing on the nineteenth century fashion for the imagined East, and the founding legend about an Arabian order is understood by the Shrine as a founding legend. It has no connection with Islam and does not claim one. Read now, the costume, the name and the ritual are a clear example of period orientalism, and that is worth saying rather than passing over.
Membership requires being a Master Mason. In practice the Shrine has often been the most visible face of Freemasonry in American public life, through parades, circuses and hospital fundraising, which puts the least esoteric part of the structure at the front.