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Hajj Rulings
Hajj Fatwas
Hajj is a unique Islamic season when more than two million Muslims from all over the world gather in one place for several weeks. There is no doubt that Hajj imposes certain demands on the one who performs it. There are the hardships of travel, walking while performing religious rites, fluctuations of the weather in Makkah and Madeenah during summer, and so on.
It is not surprising that many pilgrims feel tired and exhausted due to the changing conditions, which may also overburden the heart, chest and kidney functions of those who suffer from chronic diseases.
Since all the rituals of Hajj are performed at a specified time, and despite the fact that free health services for pilgrims are offered by the Government of the Kingdom of Saudi Arabia, many pilgrims do not seek medical advice. Moreover, many of them do not spend the requisite time in hospitals out of keenness not to miss any of the rituals of Hajj.
Since all the rituals of Hajj are performed at a specified time, and despite the fact that free health services for pilgrims are offered by the Government of the Kingdom of Saudi Arabia, many pilgrims do not seek medical advice. Moreover, many of them do not spend the requisite time in hospitals out of keenness not to miss any of the rituals of Hajj.
Fortunately, a number of medical studies have been recently published in some medical journals, discussing this topic. Some of these studies deal with the topic of heat strokes which afflict pilgrims; others discuss other medical and surgical problems in general, kidney problems, meningitis and others.
Gastroenteritisis the most widespread disease during Hajj. A study by Dr. Hasan Ghaznawi of King Abdulazeez University (KAU) in Jeddah published in 1988 by the Saudi Medical Journal, included a survey of a number of pilgrims and showed that gastroenteritiswas the most common disease among the pilgrims, especially those from Egypt and Syria. The elderly were more vulnerable to infection. The second most common disease was pneumonia, which accounted for a high proportion of deaths among those over fifty years of age.
Heatstroke was found to be the main cause of death among the pilgrims, which claimed the lives of 28 percent of the deceased pilgrims. The elderly and women were more likely to die because of suffocation due to overcrowding at the time of throwing the pebbles.
Heart diseases among pilgrims:
There is no doubt that there are many heart patients who come to Hajj every year. Dr. Muhammad Yoosuf of King Abdulazeez University Hospital in Madeenah conducted a study in the Hajj season in 1413 A.H. During that season, 754 pilgrims were admitted to hospitals with internal medical problems. The proportion of people with chest diseases was 73%. Meanwhile, the proportion of people with heart diseases was 61%. One-fourth of the heart patients were suffering from diseases in the coronary arteries. The last fourth was afflicted with high blood pressure.
The proportion of those who suffered myocardial infarction (heart attack) was 16 % of total cases. Unfortunately, most of the patients suffered from more than one disease. 57 pilgrims died during this period, and myocardial infarction was the main cause behind the death of half of them.
During the meeting of the Heart Association in 1995, the researcher asserted that patients' negligence of medicine brought many of them to hospitals. 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.
Heatstroke among pilgrims:
Heatstroke is an ambulatory medical condition with symptoms of high body temperature exceeding 40 degrees, lack of sweating, disorders of the nervous system ranging between mental disturbance and loss of consciousness (coma). In Saudi Arabia, where the heat during the summer reaches more than 48 degrees, few cases of heatstroke occur among people living there because they are used to the high temperature. Nonetheless, heatstroke significantly increases during the Hajj season, particularly when it coincides with summer.
Cases of heatstroke usually occur during the first two weeks of the month of Thul-Hijjah on the road from Makkah to ‘Arafaat to Mina to Makkah again due to overcrowding, hot weather and several other causes. The government of the Custodian of the Two Holy Mosques has made special arrangements for the prevention and treatment of heatstroke in specialized centers in Makkah, Mina and ‘Arafah. These centers have special units to cool the body named (Makkah Body Cooling Units).
The Saudi Medical Journal published a study in 1986 where a comparison was made between two methods of cooling:
First: the rapid cooling by the Makkah Body Cooling Units.
Second: the simple traditional method for cooling by covering the patient's body with rolls of moist gauze with normal water spray at room temperature while allowing airflow from all directions through electric fans. There was no significant difference in the time of cooling or the final results between the two methods. This suggests that the first normal and traditional method is still effective in treating these cases.
Researchers attribute the high incidence of heatstroke among pilgrims to several causes, including:
1. High temperature and humidity during the night when the Hajj season is in summer.
2. Overcrowding of pilgrims which causes lack of air movement.
3. Not being accustomed to hot weather.
4. Difficult acts performed by pilgrims such as walking, especially in the middle of the day, as well as the persistence of some pilgrims to climb Mount Ar-Rahmah on the Day of ‘Arafah and walking several kilometers.
5. Traffic jams and lack of air conditioners in many cars and buses.
6. Many pilgrims already suffer from diseases, such as diabetes and heart disease.
7. Obesity.
5. Traffic jams and lack of air conditioners in many cars and buses.
6. Many pilgrims already suffer from diseases, such as diabetes and heart disease.
7. Obesity.
8. Drought.
9. Old age.
Cardiovascular changes due to heatstroke:
In 1994, the Journal of Saudi Heart Association published several studies submitted by researchers during the Heart Diseases Conference, held in the city of Dammam in January 1994. Dr. Leith Memish of the King Faisal Specialist Hospital in Riyadh, along with his colleagues, studied changes that occur in the Electrocardiography (ECG) of 28 patients suffering from heat exhaustion and 34 patients suffering from heatstroke. They found out that the ECG was abnormal in 29 out of 34 patients.
Sinus Tachycardia was common among many patients. There were also alterations in the ECG suggesting a state of myocardial ischemia.
Prof. Dr. Muhammad Nooh of King Khalid University Hospital in Riyadh, presented a study which included 51 pilgrims suffering from heatstroke and he used the ECG with ultrasound. He discovered that 17% of the patients suffered from topical disorder in the functioning of the heart muscle. Also, one-fourth of the patients developed pericardial effusion (the membrane enveloping the heart muscle).
Parasitic diseases in Hajj:
Dr. Sirwat of Al Noor Hospital in Makkah conducted a study published in the Journal J. Egypt Soc. Parasitology in 1993 about developing parasitic diseases by pilgrims. Diarrhea was the most common disease due infection with the Giardia parasite. The disease is common in developing countries, and it can be easily identified by stool examination. It can be easily treated by a drug called (Flagyl) metronidazole. There were also some cases of malaria and Schistosomiasis. Researchers stressed that urine and stool examination is still very effective in diagnosing diseases.
Before coming to Hajj, the pilgrim is recommended to visit his doctor and obtain a medical report of his condition. He is also recommended to have a sufficient quantity of the drugs he uses.
General tips for pilgrims:
1. Taking care of the cleanliness of food and drink, and carefully washing vegetables and fruits.
2. Avoiding exposure to the sun for long periods, and staying away from crowded places as much as possible.
3. Getting enough rest and sleep.
4. Wearing light cotton clothes which are loose and light colored.
5. Having plenty of fluids on hot days, especially on the Day of ‘Arafah.
6. Reducing physical exertion by avoiding activities like walking in the market, especially during the times of intense heat.
7. Consulting a doctor as soon as one feels any discomfort or illness.
