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The Hajj Health Requirements: time for a serious review?

2016; Elsevier BV; Volume: 387; Issue: 10021 Linguagem: Inglês

10.1016/s0140-6736(16)00505-5

1474-547X

Saber Yezli, B.M. Alotaibi, Abdulaziz A. Bin Saeed,

School Health and Nursing Education

More than 2 million Muslim pilgrims from around 180 countries congregate annually in Saudi Arabia for the Hajj religious mass gathering. This event can potentially affect global health security because of the possibility that infectious agents will spread beyond Saudi Arabia via returning pilgrims. The Hajj Health Requirements are a set of health conditions for individuals intending to do the Hajj pilgrimage aimed at preventing communicable diseases.1Alqarni H Memish ZA Assiri AM Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj)–2015.J Epidemiol Glob Health. 2015; (published online July 13.)https://doi.org/10.1016/j.jegh.2015.07.001Summary Full Text Full Text PDF Scopus (22) Google Scholar Historically, these illnesses were the largest cause of morbidity and mortality during the event, but non-communicable diseases are now the major burden. For instance, cardiovascular diseases now cause up to 64% of admissions to intensive care units and 46–66% of deaths among pilgrims during Hajj.2Pane M Imari S Alwi Q Nyoman K-I Cook AR Samaan G Causes of mortality for Indonesian Hajj Pilgrims: comparison between routine death certificate and verbal autopsy findings.PLoS One. 2013; 8: e73243Crossref PubMed Scopus (27) Google Scholar, 3Madani TA Ghabrah TM Albarrak AM et al.Causes of admission to intensive care units in the Hajj period of the Islamic year 1424 (2004).Ann Saudi Med. 2007; 27: 101-105Crossref PubMed Google Scholar, 4Al Shimemeri A Cardiovascular disease in Hajj pilgrims.J Saudi Heart Assoc. 2012; 24: 123-127Summary Full Text Full Text PDF Scopus (32) Google Scholar Despite this shift in priority, the Hajj Health Requirements remain unchanged, focused only on communicable disease prevention with no measures to reduce the burden of non-communicable diseases. Pre-Hajj medical status and individual pilgrims' characteristics have a direct effect on morbidity, and both the pattern and outcome of hospital admission during Hajj.2Pane M Imari S Alwi Q Nyoman K-I Cook AR Samaan G Causes of mortality for Indonesian Hajj Pilgrims: comparison between routine death certificate and verbal autopsy findings.PLoS One. 2013; 8: e73243Crossref PubMed Scopus (27) Google Scholar, 5Afshin-Nia F Dehkordi HM Fazel MR Ghanei M How to reduce cardiovascular mortality and morbidity among Hajj Pilgrims: a multiphasic screening, intervention and assessment.Ann Saudi Med. 1999; 19: 55-57PubMed Google Scholar Hence, we echo previous calls for pre-Hajj health screening for individuals2Pane M Imari S Alwi Q Nyoman K-I Cook AR Samaan G Causes of mortality for Indonesian Hajj Pilgrims: comparison between routine death certificate and verbal autopsy findings.PLoS One. 2013; 8: e73243Crossref PubMed Scopus (27) Google Scholar, 4Al Shimemeri A Cardiovascular disease in Hajj pilgrims.J Saudi Heart Assoc. 2012; 24: 123-127Summary Full Text Full Text PDF Scopus (32) Google Scholar, 5Afshin-Nia F Dehkordi HM Fazel MR Ghanei M How to reduce cardiovascular mortality and morbidity among Hajj Pilgrims: a multiphasic screening, intervention and assessment.Ann Saudi Med. 1999; 19: 55-57PubMed Google Scholar to select those deemed fit to undertake Hajj based on medically informed, evidence-based, and well formulated criteria. Such a health fitness test would screen pilgrims for risk factors, determine how well their chronic diseases are managed, and identify and exclude those with severe health conditions from undertaking the pilgrimage. Similar health screenings have been implemented in a number of countries, and have resulted in substantial reductions in rates of both hospital admission and mortality during Hajj.4Al Shimemeri A Cardiovascular disease in Hajj pilgrims.J Saudi Heart Assoc. 2012; 24: 123-127Summary Full Text Full Text PDF Scopus (32) Google Scholar, 5Afshin-Nia F Dehkordi HM Fazel MR Ghanei M How to reduce cardiovascular mortality and morbidity among Hajj Pilgrims: a multiphasic screening, intervention and assessment.Ann Saudi Med. 1999; 19: 55-57PubMed Google Scholar Pilgrims with serious disease or high-risk health conditions are participating in the event at a great risk to their own health and a substantial burden for the country. For example, pilgrims with severe cardiovascular diseases, kidney failure requiring dialysis or women in the late stages of pregnancy are allowed to attend Hajj. During the 2015 Hajj, 2200 kidney dialysis procedures, 27 open heart surgeries, and 688 cardiac catheterisation operations were done, in addition to seven birth deliveries. In view of the above, we call for a pragmatic review of the Hajj Health Requirements to extend beyond communicable disease prevention, and for a serious discussion among all stakeholders, both national and international, on whether certain pilgrims should be prevented from going to the Hajj pilgrimage on medical grounds for their own safety as well as to reduce morbidity, mortality, and associated burden. From a religious point of view, the Hajj is only required for those physically and financially able to perform it. We declare no competing interests. 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