Nearby localities include the district center al-Suqaylabiyah to the south, Bureij and Karnaz to the southeast, Kafr Nabudah to the east, al-Huwash to the north, Huwayjah al-Sallah and Shathah to the northwest and Al-Tuwayni and Ennab to the west.

In 891 Arab geographer al-Yaqubi visited Afamiyya, noting that it consisted of the ruins of an "ancient Greek city ... situated on a large lake.

[10] In 1106 the citadel of Afamiyya (Qal'at al-Madiq), which overlooked the ancient ruins, was purchased by the Nizari Isma'ilis (also known as the Assassins) under the leadership of Abu Tahir al-Sa'igh, making it the first castle to be acquired by the group in the Levant.

Abu Tahir was encouraged by Ridwan, the Seljuk ruler of Aleppo, to take the fortress, believing the Ismailis would be more ambitious in strengthening its defenses against the Crusaders of Antioch.

Initially, Tancred besieged the fortress and subsequently made terms with the Ismailis in return for tribute, but later captured it in a second assault.

[11] According to his own memoirs, Usama ibn Munqidh led a small force from Shaizar, together with several Bedouin raiders, to launch an attack against the Crusader garrison in Afamiya and to plunder its cultivable lands, in 1119.

In 1811 the fortified town, which virtually guarded the entrance to the al-Ghab plain, was commandeered by Mulla Isma'il, an autonomous Kurdish warlord who rebelled against the Ottoman authorities in Syria after falling from their grace.

Services are provided to Qalaat al-Madiq's residents by rebel groups in the town, the largest of which is Suqour al-Ghab faction which fights under the banner of the Free Syrian Army.

[19] In March 2012 Qalaat al-Madiq was shelled and targeted by heavy fire for a successive 17 days by the Syrian Army in an attempt to oust rebel forces.

[20] Since the March clashes, there has been a relative ceasefire between the two sides,[19] with a few incidents where the army has allegedly attacked demonstrations, which have continued in Qalaat al-Madiq, as of late November 2012.