Haj welcomes over two million Muslims from around the world. This year, the annual pilgrimage is expected to occur for six days between June 14 and June 19. Temperatures in Mecca at this time of the year can reach above 50 degrees Celsius. These extreme conditions pose a significant health risk for pilgrims, especially older adults and those with underlying health issues.
Last year, more than 2,000 pilgrims suffered heat stress during the Haj pilgrimage. Pilgrims face a heightened risk of heat stroke with a potential fivefold increase from global temperatures rising by 1.5 degrees Celsius compared to pre-industrial times.
The Saudi Arabian government is exploring new strategies to mitigate extreme heat by using advanced rain enhancement techniques such as cloud seeding to create a more comfortable environment for the pilgrims. Other steps to mitigate the effects of heat include providing free water, misting stations, and well-equipped healthcare facilities. Educational campaigns will encourage pilgrims to wear light clothing, stay hydrated, and limit daytime activities.
The Haj pilgrimage is mandatory for all adult Muslims who are financially and physically able to perform Haj at least once. It is the fifth pillar of Islam and the most significant manifestation of the Islamic faith and unity. It is the largest pilgrimage of its kind where people gather in a small and geographically confined area with an extremely hot and arid climate.
Pilgrims must perform many compulsory activities related to Haj rituals. During their pilgrimage, they must visit key sites during specified days and times. The sites are Masjid al-Haram, Mina, Mozdalifa, and Mount Arafat, all within 20 kilometres of one another.
The high cost of Haj, which requires years of savings, contributes to a demographic skew towards older participants. Elderly pilgrims often face additional challenges due to limited access to comfortable and conducive accommodation.
These older pilgrims and those with chronic illnesses like diabetes and heart disease visiting the holy sites for Haj rituals are at increased risk of suffering from heat-related ailments. Additionally, they also tend to carry heavy objects, go out at noon, and visit the Masjid al-Haram several times a day, all of which may expose them to health hazards arising from the heat and humidity of Mecca.
Exposure to excessive heat is associated with a range of illnesses that may be as mild as heat cramps, oedema, prickly heat, and fainting to serious conditions such as heat exhaustion or heat stroke.
The long distances travelled, carrying heavy items, with limited access to cool spaces exacerbate the risks.
When the body temperature goes beyond 40 degrees Celsius, rapid cellular damage takes place and this can lead to serious organ damage that can end in death.
In mass gatherings, heat-related illnesses are often of primary public health concern due to the risk of many infectious and non-infectious diseases, and even stampedes and road accidents. Hot weather and large crowds during Haj can lead to more cases of diarrhoea, food poisoning, respiratory tract infections, and skin problems from sweating.
The ability of human beings to dissipate heat from the body resides mainly in the effective cardiovascular system. However, many chronic medical problems increase the adverse effects of heat stress, and prominent among these are diabetes and malnutrition. Having a chronic illness makes it harder to cope with the extreme heat during Haj. Not only are people with chronic illnesses more likely to get sick in the heat, but the heat can also make their existing conditions worse.
A study among Saudi pilgrims found that 18.4 percent reported chronic health conditions. Among these conditions, diabetes was the most prevalent (55.7 percent), followed by hypertension (60.7 percent), other cardiac diseases (7.5 percent), and bronchial asthma (11.5 percent).
The pilgrims come from diverse backgrounds, countries and ethnicities. Some pilgrims come from hotter tropical countries and can better adjust to the hot weather while pilgrims from cooler climates may not be accustomed to Mecca's extreme heat.
Pilgrims from developing nations, typically with lower or middle levels of education, may face challenges in mitigating heat-related health risks. Those with higher education are more likely to understand health warnings and implement preventative measures to minimise the risks.
Pilgrims who previously visited Mecca are better equipped to manage heat-related risks based on their prior knowledge and experience.
Haj authorities and health officials worldwide in Malaysia, Indonesia, and Pakistan have played a critical role in educating pilgrims about the prevention of heat stroke. By promoting awareness and implementing preventative measures, a safe and healthy Haj experience can be ensured for all.
Here are steps pilgrims can take to mitigate heat stroke risk:
Pre-departure training and monitoring: Pre-Haj health education campaigns can equip pilgrims with knowledge about heat stroke prevention. The Haj and health authorities of each country should inform and educate pilgrims about the precautions to deal with exposure to excessive heat during Haj. The health authority that accompanies each group of pilgrims should give more attention to older people and those with existing comorbidities.
Hydration: Drinking plenty of water throughout the day is crucial.
Limit daytime movement.
Protective clothing: Wearing loose, lightweight, and breathable clothing helps with perspiration.
Sun protection: Staying out of direct sunlight and umbrellas can shield pilgrims from the harsh UV rays.
Prof Ibrahim Ali Kabbash is a professor of Public Health and Community Medicine, Faculty of Medicine at Tanta University, Egypt. His main research areas are in the epidemiology of communicable and non-communicable diseases, reproductive and adolescent health, and HIV/AIDS. He is also a consultant for HIV/AIDS prevention and control for UN agencies and civil society organisations and Egypt's Ministry of Health National AIDS Control Program.
