The following health advisory have been provided by Dr Salim Parker (www.hajjdoctor.co.za) who has been accompanying Hujjaaj for more than 20 years. He is a travel medicine practitioner who serves on the executive boards of the International Society of Travel Medicine (ISTM) and the South African Society of Travel Medicine (SASTM), and serves as a medical consultant for the Global Center For Mass Gathering Medicine.
More than 50% are older than 50 years and a third have some medical condition. It is therefore important to optimise the control of all medical conditions before departure. Hajj will take place in temperatures exceeding 40 degree Celsius for the next 10 years. Hujjaaj are advised to travel to the Holy Land for as long as possible (work leave and budget permitting) to acclimatise to the extreme weather conditions.
The Saudi authorities require all Hujjaaj to produce a certificate proving evidence of vaccination against meningitis (5-year validity) before arriving in the kingdom. Yellow fever vaccination (lifelong validity) used to be embassy requirement for the issuance of a Hajj visa. Currently people flying certain airlines may be required to show proof it and the situation may change. It is best to check with the travel agent. Pregnant women, those over 60 and certain other categories are exempted from yellow fever vaccination. The influenza vaccine is strongly recommended as the condition is common and debilitating and can inhibit enjoying the spiritual journey. Older adults and those with medical conditions such as diabetes, asthma and heart conditions are advised to take the pneumococcal vaccine. Currently the COVID-19 vaccine is mandatory, but this may change.
Up to 90% of pilgrims suffer from respiratory conditions during the journey, with pneumonia being the most frequent cause of hospital admission. The more vulnerable are strongly advised to take the appropriate vaccines, wear masks, and observe cough etiquettes. If symptoms of fever, sore throat and coughing occur, medical advice should be sought immediately, and rest is paramount during the recovery process. The cough associated with some chest infections may persist for up to two months.
The skin dries out quickly and pilgrims cover vast distances, and chapped feet are common. It is imperative to use moisturizers. Wearing socks if used to doing so is advised. If the chapped feet become painful, red or contain puss, medical advice should be sought, especially in those living with diabetes. Ill-fitting sandals further compound feet problems. A good pair should be acquired and worn even before departing for Arabia.
Very high midday temperatures, together with the congestion in buses and tents, are ideal conditions for skin fungal infections. Males tend to get this in the groin area and women under the breasts. An antifungal cream, like Travacort (which is quite cheap in Arabia) is handy for this problem. Scarves and umbrellas should used be freely to prevent exposure to the midday sun, as sunburn can be quite irksome. Sunscreens should be used liberally.
The old adage of ‘peel it, cook it, boil it or leave it’ is a time-honoured rule for preventing major stomach problems. It is easy to say but difficult to obey! Food in Arabia ranges from bland to exotic dishes. However, Hujjaaj should consume foods that they are already accustomed to at home. Always keep Imodium handy in case of diarrhoea. Constipation is a common occurrence especially in females and it is important to consume enough liquids. Zam-Zam is freely available and should be consumed whenever possible.
Despite careful planning and rigorous adherence to medical advice, the stress of travel can lead to menstrual irregularities. Periods can be difficult to manipulate especially after the age of thirty. Aeysha, the wife of our beloved Prophet Muhammed (SAW) had her ghaid during Hajj.
There is no such concept as being ‘clean’ on Arafat! Plan to return home a week after hajj if problems are anticipated. If planning to manipulate the menstrual cycle, a doctor should be consulted at least three months before departing for Hajj. The Hanafi Madhab advises against menstrual manipulation. Breakthrough bleeding possibilities should be discussed with doctors and written advice taken with. If problems persist in Makkah, medical advice should be sought before Hajj. It is easy to stop unexpected bleeding if a lady is on no medication at all. Remember that only the Tawaaful Ifaadah requires a lady not to be menstruating.
Anxiety, uncertainty and worry are expected, especially for the first-time traveller. The best way to deal with this is to familiarize oneself well with the rituals of Hajj. Acquire a map of the important sites, travel in groups and keep required medication within reach. People on the medication for anxiety and depression must take their medication with them together with a doctor’s letter. Sleeping tablets and sedatives are not available in Arabia and are illegal. Mobile phones should have enough data for communication purpose, and power banks are advised to be always on hand.
The high temperatures expected for the next decade coupled with the crowded conditions (up to 9 people per square meter), predisposes to heat injuries. Heat stroke is a potentially fatal condition and the elderly with underlying medical conditions are especially prone to it. Many measures are in place to prevent it which included sprinkler systems, adequate access to water and shaded areas. Pilgrims should prevent exposure to extreme heat, wear loose, well-ventilated clothing and use umbrellas if needed. More than 1300 pilgrims dies due to heat illness during the 2024 Hajj
The Hajj rituals require the sequential mass co-ordinate movement between different sites. This inevitably results in some walking of a distance of at least 5km. Pilgrims have a few months once accredited to get fully walking fit and are encouraged to join programmes such as Fit For Hajj. Studies have shown that those who are fit have less injuries and illnesses compared to those who are not. The aim should be to cover 10km in a time of about 2-3 hours, which is the longest single stretch that may be required if busses are problematic.
All Hujjaaj with medical conditions must have a letter from their doctor stating their illnesses and medications. This aids in management should they get sick in Saudi Arabia. The South Africa Hajj and Umrah Council (SAHUC) have free clinics in Madinah and Makkah, managed by South African medical personnel. Basic and emergency medication is stocked there. If more expensive or unusual medication is needed, a script will be issued, and the patient can buy it at any pharmacy. All Hujjaaj should budget about R500 for medication. Bear in mind that the clinics cannot stock all chronic medicines for conditions like asthma, diabetes, hypertension, and heart failure. Patients must take enough stocks with them. SAHUC and every hotel and Hajj operator should be able to direct a sick person to Saudi medical facilities, which are excellent for serious conditions such as heart attacks.
Our Creator is infinitely merciful and even those who fall really sick before Hajj will be supported. Ambulances have transported Hujjaaj hooked onto drips to Arafat so that they could spend a few minutes there as it is an absolute Hajj requirement. Most other rituals can be delayed, be done by a fellow pilgrim on behalf of the sick, or be paid compensation for if missed. Physical and medical preparation should start once the Nieyah is made to perform Hajj. Hajj Maqbool and Mabroor.
More information can be found at:
https://wwwnc.cdc.gov/travel/yellowbook/2024/itineraries/saudi-arabia-hajj-and-umrah-pilgrimages
Dr Salim Parker: salimparker@yahoo.com November 2024