The Hajj, the pilgrimage to Mecca, is the largest mass movement in the world. Each year, 2.5 million Muslims from over 160 countries travel to the same place to attend the annual pilgrimage. This concentrated gathering of millions of people at the same place and time naturally amplifies health risks, such as those from infectious diseases which vary each year. Notable, respiratory and gastrointestinal tract bacterial and viral infections spread rapidly and affect almost all pilgrims during Hajj.
Respiratory tract infections:
The hugely crowded Hajj condition is the main cause behind the spread of respiratory tract infections as they spread through coughing and sneezing. The infections include community-acquired pneumonia, influenza and tuberculosis (TB). The elderly and those with co-morbid diseases such as diabetes are particularly vulnerable to morbidity from respiratory illnesses.
Gastrointestinal disorders:
Contamination of food through unhygienic preparation, prolonged storage of food, drinking from contaminated water sources, and a shortage of water for hand washing are important factors responsible for increasing the spread of gastrointestinal diseases during the Hajj. Gastroenteritis due to Salmonella spp, rotavirus and norovirus are common during Hajj.
Acute food poisoning caused by toxins produced by Staphylococcus aureus and Bacillus cereus, is common during the Hajj. This can lead to diarrhea, vomiting, abdominal cramps, even fever and feeling weak. The risks of dehydration are heightened when Hajj occurs during summer months, owing to the extremely hot climate in Saudi Arabia at that time.
If you suffer from diarrhea, adjusting your diet is recommended. Avoid all fiber containing food such as whole grains, beans, most fruits, and vegetables. Stay away from milk if you are lactose intolerant. Fatty or fried food can upset your stomach and worsen your diarrhea. Take saline and plenty of fluid in sufficient amount to avoid dehydration.
Heat exhaustion and heatstroke:
Heat exhaustion and heat stroke are also very common; so, it is necessary to avoid direct sunlight for long hours. Cases of heatstroke usually occur during the journey when the pilgrims, at a stretch, have to travel from Makkah to ‘Arafaat to Mina to Makkah again – due to overcrowding, hot weather and other causes. If you experience symptoms of chills, headache, dizziness, and nausea, move away to a cool area and seek medical help.
Non-communicable diseases:
Many pilgrims both elderly and young have existing non-communicable diseases – such as diabetes, hypertension, arthritis, epilepsy, liver and kidney diseases – which can be worsened by strenuous Hajj conditions, or, if regular medications are neglected during the spiritual activities.
One of the problems that doctors face in the treatment of pilgrims is the difficulty of communicating with patients due to the barrier of language and the absence of medical reports for patients indicating their health condition before coming to Hajj.
So, please keep your medical reports which include your medical and drug history. Before coming to Hajj, the pilgrim is recommended to visit a doctor and obtain a medical advice.
General tips for pilgrims:
1. Take care of cleanliness of food and drink, and carefully wash vegetables and fruits. Avoid eating exposed food, and check the expiry date on canned food.
2. Moderation in consuming food is recommended in order not to overburden the stomach. The foods that cause indigestion and gases such as fatty foods should be avoided.
3. Take care of personal hygiene. Washing hands frequently, particularly before and after eating food, before and after treating a wound, after using the toilet and after blowing your nose, coughing or sneezing.Keeping small bottles of sanitizers during Hajj is a good idea because washrooms may not always be readily available. Use tissues when sneezing and having common cold.
4. Take plenty of fluids on hot days, especially on the Day of ‘Arafah.
5. Wear light cotton clothes which are loose and light-coluored.
6. Avoid exposure to sun for long periods and stay away from crowded places as much as possible.Pilgrims should use an umbrella and avoid making Tawaaf or Sa‘y in case of very hot weather.
7. Get enough rest and sleep. Take enough rest before and after performing every ritual of Hajj to refresh your body and help you to perform the rest of the rituals.
8. Reduce physical exertion by avoiding activities like walking in the market, especially during the times of intense heat.
9. Take a small medical bag with you containing the medication that you need to treat emergent diseases.
10. Carry a note containing phone numbers of hospitals, emergency, civil defense, ambulance; police and so on, to ask for help when needed.
11. Diabetic patients should take their injections or medication in time and have their meals on a regular basis to avoid a drop in their blood sugar level that may endanger their lives. It is recommended that they carry small sugar pills, candy, chocolates or dates to take upon experiencing symptoms of hypoglycemia, such as feeling of hunger or perspiration accompanied by heart beats.
12. Cardiac, Hypertensives, Asthmatic patient and patients suffering from other chronic disease, are advice to take their medications regularly and at a time.
13. Consulting a doctor as soon as one feels any discomfort or illness.Finally, we ask Allah The Almighty to Protect the pilgrims and Help them perform their rituals easily. We also ask Him to Forgive their sins, reward them and accept their deeds and Hajj.

The writer is a Consultant, Department of Diabetes & Endocrinology, Impulse Hospital

Dr A Hasnat Shaheen