Communicable diseases that threaten Muslim pilgrims during the annual Islamic pilgrimage

As the annual Hajj approaches, JOL examined what communicable diseases threaten the Muslim pilgrims as they perform one of the five pillars of Islam.
Mecca during the Hajj

The Hajj pilgrimage is one of the five pillars of Islam and every Muslim is obligated to fulfill this duty at least once in their lifetime. Due to these beliefs, the annual pilgrimage to Hejaz region in present day Saudi Arabia is one of the largest annual mass gatherings in the world. During the Hajj, over two million pilgrims from more than 180 countries meet in one of Islam’s holiest cities, Mecca. As Islam has gains adherents year after year, the projected number of pilgrims continues to grow as well.

The Hajj brings together a diverse population for a religious ritual in a concentrated physical space and time period. The Hajj summons Muslims from different socio-economic classes and a multitude of geographical origins who would never meet if not for the pilgrimage. The health risks for these pilgrims have been challenging Saudi Arabia for decades, as they go beyond the average risk of travel.

Within this context, JOL examined what communicable diseases threaten the Muslim pilgrims.

Respiratory Tract Infections

Respiratory tract infections (RTIs), mainly upper respiratory tract infections (URIs), have been threatening Hajj pilgrims for centuries. Many characteristics of the Hajj have been identified as contributing factors to the prevalence of URIs and their symptoms. Congestion in overcrowded areas by pilgrims from all over the world increases the likelihood of the spread of URIs. In addition to the simple crowding of too many people in too small a space, pilgrims often stop to perform required rituals inside Mecca’s Grand Mosque and use the enclosed tunnels.

Another factor contributing to the incidence of URIs is the fact that the date of the Hajj is set according to the Islamic lunar calendar and therefore varies from year to year. This means that the Hajj pilgrimage can occur during the coldest months of the winter, which is the season in which RTIs are the most common and contagious.

Meningococcal meningitis

Meningococcal meningitis is the bacterial form of meningitis (neisseria meningitides, N meningitides). This bacterium is the source of severe disease that causes inflammation of the membranes that cover the brain and spinal cord in an infected person’s body. As with RTIs, overcrowding and congestion are two main contributors to the spread of meningococcal meningitis. Additional characteristics that are highly associated with the Hajj pilgrimage and contribute to the spread of meningococcal meningitis are air pollution and high humidity.

Diarrhoeal Disease and Gastrointestinal Infections

Gastrointestinal infections pertain to any infection that causes gastroenteritis, commonly known as the stomach flu. Gastroenteritis causes inflammation of the gastrointestinal tract, meaning that both the stomach and the small intestine are infected. Diarrhoeal disease is the most common gastrointestinal infection and has been widely reported during the Hajj.

During the Hajj season, a number of factors contribute to the infection and spread of this disease. A pilgrim’s method of travel, food intake patterns, country of origin and the environmental conditions surrounding him can all effect his risk of being infected by a diarrhoeal disease. In addition, congestion, the challenge of preserving good hygiene, contaminated water and food poisoning are also causes that are commonly found in the Hajj environment and contribute to the development and spread of this disease.

Mecca during the 2015 Hajj Photo Credit: Reuters/Channel 2 News

Skin Infections

Mecca’s climate is considered to be relatively hot. Even in the winter, temperatures in Saudi Arabia range from 19-32 degrees C, which constitute a relatively warm winter for pilgrims who come from cooler climates. In the summer, temperatures can peak and reach 45 degrees C, and with Mecca’s average humidity rate being relatively high, the Hajj destination is one of the hottest locations in the world. The environmental change of temperatures is often a cause of infection in the body’s largest organ, the skin, which also happens to be the body’s frontier defense against the environmental challenges. Therefore, Mecca’s hot climate contributes to the initial infection and spread of skin diseases.

Other factors prevalent during the Hajj also contribute to the birth and spread of skin infections such as poor hygiene and congestion. The prevalence of these factors combined has help turn skin infections into one of the most common health problems among Hajj pilgrims.

The Kaaba, Mecca

Blood-borne Diseases

Blood-borne diseases have been a significant global health concern especially since the 1980s when the human immunodeficiency virus (HIV), which can lead to acquired immune deficiency syndrome (AIDS), was diagnosed in the United States. A person can be infected with a blood-borne virus through direct contact (e.g. via the touching of an open wound of an infected person with an open wound of another person) or indirect contact (via infected needles and razors).

According to the Center for Disease Control (CDC), the blood-borne diseases that are of the highest concern besides HIV are hepatitis B virus (HBV) and hepatitis C virus (HCV). The methods of transmission of these three viruses are commonly associated with sexual activity and blood transfusions. However, in the case of the Hajj, the spread of these diseases due to sexual activity is not a high concern because of the religious prohibitions during the sacred ritual of the pilgrimage.

The most common method of HIV, HBV and HCV transmittal during the Hajj is via the head shaving ritual. In order to mark the end of the Hajj, almost all male pilgrims have their heads shaved. This act is usually done by barbers or fellow pilgrims. These barbers or fellow pilgrims present a risk to male Hajj pilgrims who practice the head shaving ritual either through a cut on their hands, if they carry a blood-borne disease, or through the multiple use of a single razor, if a person whose head was shaved was also carrying a blood-borne virus.

Cuts on male pilgrims’ scalps due to razor nicks are very common. Through these cuts, blood-borne diseases can easily be transmitted either from an infected barber or an infected razor. In addition, these unlicensed barbers tend to practice another habit that might cause indirect blood-borne infection as they have been known to throw blades on the ground after their use. This act is significantly troubling due to the fact that many pilgrims tend to walk barefoot at all times during the Hajj pilgrimage.

This article is part 1 of a 5-part series regarding the Hajj and health risks. To find out what the Saudi government is doing in order to protect the Muslim pilgrims, look for the next article in the series.

To read part 2 of the series, click here

To read part 3 of the series, click here

To read part 4 of the series, click here

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