Although travelling to any part of the world carries certain health risks, embarking on Hajj or Umrah poses a number of additional challenges due to the hot climate, the strenuous nature of its rites as well as the gathering of large crowds.
Being aware of what to expect and preparing for your trip sufficiently can effectively minimise your chances of falling ill during your journey.
Common Illnesses and Health Risks in Saudi Arabia
Heat Exhaustion
Saudi Arabia has a desert climate which can get extremely hot during the day, with temperatures averaging about 45° C during the summer months. Readings in excess of 50° C are not unusual. Heat exhaustion can, therefore, be quite a common problem during Hajj or Umrah, particularly for those from countries with a cooler climate.
Makkah’s climate
There are a number of factors which may lead to heat exhaustion:
High temperature and humidity.
Overcrowding resulting in a lack of proper air movement.
Being unaccustomed to hot weather.
Performing certain rites of Hajj which may be physically demanding, especially in hot weather.
Traffic jams and lack of air conditioning in cars and buses.
Suffering from illnesses such as diabetes and heart disease.
Obesity.
Old age.
Heat exhaustion may cause dizziness, disorientation, fatigue, nausea, headache, muscle cramps, hallucinations and loss of consciousness. It is more likely to occur if you’re dehydrated and can lead to heat stroke. Heat stroke occurs when the body’s temperature increases to dangerous levels due to excessive heat exposure. The body begins to overheat as a result of the inability to cool itself down.
It’s very important to stay hydrated and protect yourself from the heat
There are a number of steps you can take to prevent heat exhaustion or to minimise its effects:
Drink plenty of liquids (water, juices etc.) to stay well hydrated.
Avoid prolonged exposure to the heat and the sun (although sometimes this may be unavoidable).
Use an umbrella (preferably light-coloured) or head cover (if you’re not in the state of Ihram) and keep in the shade as much as possible.
Wear loose, light clothes.
Avoid making excessive effort.
Rest sufficiently after performing Hajj and Umrah rituals.
If you or anyone amongst you is exhibiting signs of heat exhaustion, you should:
Cool the body down with water, ice, air conditioning etc.
Drink a lot of water – hydrate as fast as possible.
Move to a shaded area if you’re exposed to the sun.
Rest sufficiently.
Seek medical attention in severe cases.
Hydration
Water is readily available in Makkah and Madinah
Being sufficiently hydrated is vitally important to prevent heat exhaustion and other health risks. Copious amounts of water should be consumed during your stay.
Please be advised that tap water isn’t safe to drink in Saudi Arabia, although bottled water and Zamzam water is readily available.
Due to the hot conditions, the body conserves more water by concentrating urine and therefore, the need to pass urine is reduced. You must drink enough water such that the urine is clear, indicating good hydration.
As a general rule, you should aim to consume about three litres of liquid a day, with the vast majority of it coming from water although fruit juices and soups can be included in this amount. Tea and other caffeinated beverages may lead to dehydration because they can have a diuretic effect, so must be avoided or consumed in minimal amounts.
Respiratory Infections
Pilgrims wearing face masks
Due to the convergence and unavoidable closeness of hundreds of thousands of pilgrims from all over the world in large crowds, respiratory infections are very common. These infections spread through close contact with people who are talking, coughing, sneezing and blowing their noses. The most common form of infection is the Influenza virus with symptoms including a cough, runny nose, bodily aches and pains, fever, nausea and headache.
There are a number of preventative measures you can take to reduce the chances of contracting or spreading these infections:
Wash your hands frequently, especially after coughing, sneezing or using tissues.
Avoid close contact with those who are ill.
Wear a facemask, particularly in crowded places and importantly, if you suffer from an illness which has resulted in decreased immunity.
Use single-use tissues.
Cough or sneeze into your arm rather than your hand and turn away from people when doing this.
Don’t share towels, cups, dishes and other cutlery.
Constipation
Constipation may be caused by a change in diet and/or a lack of hydration. It may result in haemorrhoids and fissures which may severely negatively impact your Hajj or Umrah. To prevent constipation:
Maintain a high-fibre diet e.g. high fibre cereal, wholemeal bread, dried fruit, fresh fruit, vegetables etc.
Drink lots of liquid.
Diarrhoea
Diarrhoea is also common during Hajj or Umrah, often caused by consuming contaminated food or water. To prevent diarrhoea:
Wash your hands thoroughly with soap and warm water or use a disinfectant hand cleanser, especially after going to the toilet and before eating food.
Don’t share towels, cups, dishes and other cutlery.
Drink lots of liquid, preferably oral rehydrating fluids, such as Hydrol or Rehydrate.
Eat carbohydrates, fruit and vegetables.
Avoid taking anything to stop the diarrhoea if it is very frequent.
Avoid eating more if you’ve lost your appetite.
Avoid buying food from street vendors.
Avoid protein foods such as meat, chicken, fish, eggs and other dairy products.
Avoid fried and fatty foods.
Food Poisoning
Places to eat in Makkah
Food poisoning is another potential problem faced by pilgrims, mostly caused by staph infections and salmonella. Symptoms of food poising include abdominal cramps, diarrhoea, vomiting, fever, weakness, nausea and headaches. Food poisoning can be caused by:
Food that is uncooked thoroughly (particularly meat).
Food that needs to be chilled at below 5° C not correctly stored.
Leaving cooked food for too long at warm temperatures.
Not sufficiently reheating previously cooked food.
Someone who is ill or who has dirty hands touching the food.
Eating food that has passed its “use by” date.
The spread of bacteria between contaminated foods (cross-contamination).
Drinking unpasteurised milk.
To prevent food poisoning:
Wash your hands thoroughly with soap and warm water or use a disinfectant hand cleanser, especially after going to the toilet and before eating or handling food.
Don’t keep cooked food in buses when travelling between Hajj sites.
Wash raw vegetables and fruits thoroughly before eating, especially those that won’t be cooked.
Don’t drink tap water.
Avoid unpasteurised milk or foods made from unpasteurised milk.
Avoid foods that have an unusual odour or a spoiled taste.
Avoid buying food from street vendors.
Keep away from uncovered food which is exposed to insects and pollution.
Skin Problems
Skin problems may be aggravated by the climate. It is vitally important to bring the condition under control as best as possible prior to the journey, as scratching of the skin should be avoided whilst in the state of Ihram. Medications and creams can be used to prevent itching.
Heat Rash
Due to the intensity of the heat, a heat rash may appear on people who have sensitive skin. It occurs when the skin’s sweat glands are blocked which causes inflammation as sweat cannot reach the surface of the skin leading to a rash. The skin can become reddened and itchy and can prove quite a nuisance. If a rash does develop, calamine lotion can be used to soothe the skin and loose-fitting clothing should be worn.
Dry Skin
Pilgrims may suffer from dry skin on various parts of the body. Dry skin can lead to cracked heels which may be exacerbated by walking around on the hard, dry marble in the Haramain. To prevent and treat this condition, moisturise frequently.
Similarly, dry eyes may also become an issue. If you are prone to this problem, make use of sunglasses and consult your optician before your depart.
Friction Burn
Another fairly common skin ailment is inner thigh chafing which is often experienced by men whilst in Ihram. Sweating and rubbing of the thighs while walking can lead to friction burn, especially affecting those who are overweight. To prevent this, men are advised to apply Vaseline or another non-scented moisturiser to the area whilst in Ihram.
Sleep Deprivation
As a result of travel, worship and the rites of Umrah and Hajj, it will prove difficult to sleep for more than 4 hours at a time. Sleep deprivation causes irritability, excessive drowsiness and yawning, which can interfere with balance, coordination, and decision-making abilities.
You will almost certainly experience some sleep deprivation and tiredness during your journey, so you must try to formulate a decent sleeping routine, ensuring you don’t omit any Hajj rites or compromise on your worship.
Marble Floors
Marble floor in Masjid al-Haram
Marble flooring is used extensively around the Haramain. This can become very slippery when wet, which may cause serious injury to your elbows, wrists, hips and back in the event of a fall. To minimise the risk of falling, leather socks or two pairs of regular socks may be worn.
Additionally, the sun’s glare often reflects off the white marble, potentially causing problems for those with sensitive eyes. To prevent this, sunglasses can be worn around the Haramain. Sunglasses are permissible to wear in the state of Ihram.
Crowds
Huge crowds during Hajj
Although crowd control has improved over recent years and rituals have become streamlined to allow for a continuous flow of pilgrims, overcrowding remains a hazard. It has been the cause of a number of deadly incidents, the most recent being the Mina stampede of 2015 which claimed the lives of over 2,000 pilgrims. Here are a few tips if you find yourself in a crowd:
Avoid peak times – Some Hajj rituals, such as Rami al-Jamarat, can be performed throughout the day. It is advisable to complete these rituals at times when there isn’t as much of a crowd as there normally would be during peak times.
Take a break – If you’re performing a ritual such as Tawaf or Sa’i or walking between Hajj sites and you feel the crowd is getting too much for you, it is perfectly acceptable to take a break and find a less crowded area.
Be aware – Just as you would if you were driving a car, be completely mindful of what’s going on around you. You may well collide with people or even wheelchairs during rituals if you’re not as careful as you should be.
Take care of your belongings – Thieves tend to steal wallets and other items from pilgrims in crowded areas. Stay vigilant and ensure your belongings are adequately secure.
Never push – In crowded places, some pushing and shoving is inevitable. Remember there will be many pilgrims from countries where pushing and shoving in crowded places is a norm. Try your best not to push and perform your rites in a cool and collected manner. Don’t harm anybody and remain calm if others are pushing.
Go with the flow – In a crowd, go with the flow rather than against the flow, remaining within the block of people heading in the direction that you wish to go. Avoid walking in the opposing direction of people as this will inevitably lead to collisions.
Company – Avoid walking alone, especially if you’re a woman. It’s nice to have that bit of support, especially if you’re someone that struggles with crowds.
Help others – If you notice someone around you becoming anxious about the crowds, try to give them space and reassure them.
Be patient – Crowding and long queues are inevitable, so you must remain patient and try not to get frustrated.
Road Traffic Accidents
As pilgrims walk long distances close to or through busy roads, road traffic accidents are a major cause of injury and death. To avoid being injured in a road traffic accident, take care when crossing roads, follow road safety rules and always wear a seat belt when travelling in a vehicle.
Infectious Disease from Shaving
After performing Hajj or Umrah, the vast majority of men elect to have their heads shaved entirely (Halq). Unlicensed barbers often use non-sterile blades, sometimes on more than one person, leading to a risk of spreading infectious diseases such as hepatitis and HIV. Some of these barbers also exercise a lack of care, resulting in cuts and bleeding during shaving. To protect yourself against infections associated with shaving, follow these tips:
Go to a licensed barber, rather than an unlicensed street barber.
Make sure single-use disposable blades are used.
Ask the barber to thoroughly wash his hands with water and soap before shaving.
Use your own equipment to shave your head or ask the barber to do it for you.
Never share your grooming equipment with others to use.
Guidelines for Pilgrims with Chronic Illnesses
Pilgrims suffering from chronic illnesses such as diabetes, heart problems, high blood pressure, arthritis, asthma etc. should ensure that they control their illnesses to the best of their ability prior to departure and during the journey. If the symptoms are not regulated during the course of the journey, the entire Hajj or Umrah may not only be ruined for the pilgrim, but for others in the group as well. A doctor must be consulted at least 3 months before departure to provide advice about medication and to bring any illnesses under control. We have provided advice regarding some common chronic illnesses although these should be discussed in more detail with qualified medical professionals.
General tips for those with chronic illnesses:
Consult your doctor at least 3 months before your journey to assess your health situation and bring your symptoms under control.
Closely follow the instructions of your doctor.
Take your medication with you, ensuring they are stored properly.
Take your medicines when required, as instructed by your doctor.
Designate persons in your group to help you with your illness – inform them of your health issues, medication, what to do in an emergency and who to contact etc.
Seek medical attention immediately if an emergency arises.
Rest sufficiently.
Ensure you wear your wrist strap or information card which displays your details, illness and treatment.
Avoid strenuous effort and make use of facilities such as wheelchairs.
Diabetes
People with diabetes are at a greater risk of falling ill, particularly due to the increase in physical exertion in addition to the illness itself. Diabetics are more likely to be prone to infections, dehydration, heat-related illnesses as well as developing problems relating to their condition such as low or high blood glucose levels and foot problems. In order to prevent and manage these problems, you should:
Be aware of symptoms of low blood glucose levels and how it should be treated and managed.
Check your blood glucose levels regularly.
Carry glucose tablets and sweets.
Prevent foot problems by wearing protective and comfortable footwear that have been sufficiently “worn in” i.e. they are not brand new.
Drink plenty of fluids to avoid dehydration.
Use an umbrella for the sun and always carry water.
Eat regular meals.
Take medication regularly.
Store insulin in a cool bag, away from direct sunlight.
High Blood Pressure / Hypertension
High blood pressure is a chronic condition characterised by symptoms such as headache, fatigue, vision problems, chest pain and irregular heartbeat. If left uncontrolled, it can lead potentially lead to having a stroke or a heart attack. In order to prevent and manage these problems, you should:
Take medication regularly.
Reduce the amount of salt you eat.
Maintain a generally healthy diet.
If you’re a smoker, make an effort to stop smoking well before you go on Hajj or Umrah.
If you live a sedentary lifestyle, make an effort to start exercising and prepare yourself physically for your journey.
Try to lose weight if you’re overweight.
Arthritis
Arthritis is a common problem caused by wear and tear of the joints, affecting people of all ages, particularly the elderly. Symptoms include pain, tenderness and stiffness in the joints, inflammation in and around the joints as well as restricted movement of the joints. To manage these symptoms, you should:
Try to lose weight if you’re overweight.
Exercise to strengthen muscles around the affected joint (consult a physiotherapist).
Use non-steroidal anti-inflammatory drugs (NSAIDs).
Asthma
Sufferers of asthma usually experience an increase in symptoms during Hajj or Umrah due to overcrowding and coming into contact with people who are coughing, pollution from vehicles, as well as a sudden change in temperature. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. To manage these symptoms, you should:
Take medication regularly whether they are tablets or the use of inhalers.
Avoid drinking cold water or juices; cold fluids may cause an asthma attack.
Avoid crowded places if possible.
Distance yourself from people who are showing symptoms of respiratory infections such as coughing and sneezing.
Wear a facemask as and when needed, especially in crowded places.
Back Problems
For those who suffer with back problems, it is important to remedy this condition to the best of your ability prior to departure. Back pain may be a genuine source of discomfort during Hajj or Umrah, especially due to excessive walking and sitting for prolonged periods in the Haramain. To alleviate the symptoms of back pain before departing, you should:
Remain as active as possible although don’t lift, pull or push anything heavy just before departure.
Take exercise classes or do exercises that help to strengthen your core muscles and improve your posture.
Undertake manual therapy such as physiotherapy or chiropractic.
Take anti-inflammatory agents.
Sit upright and avoid slouching.
Take care when lifting luggage, ensuring the knees are bent and the back is straight.
Use luggage with wheels that can be pulled rather than having to be lifted.
Medical Facilities in Saudi Arabia
Healthcare in Arafat
There is an abundance of hospitals, clinics and infirmaries in the Kingdom of Saudi Arabia, staffed by thousands of health workers. Basic healthcare facilities are free of charge for pilgrims. Wheelchair facilities are also provided to those who have difficulty walking.
As of 2010, the Ministry of Health disclosed that there were 24 Health Ministry hospitals – 7 hospitals in Makkah, 10 in Madinah, 4 in Mina and 3 in Arafat, with a total capacity of 4,005 beds.
There were also 144 health centres in and around Makkah and in Madinah. Of these, 127 health centres were in Makkah and the holy sites – 31 centres in Makkah, 46 in Arafat, 28 in Mina, 6 in Muzdalifah and 16 centres at the Jamarat Bridge. Additionally, 10 health centres were present in the vicinity of Masjid al-Haram and 12 pharmacies were assigned in Mina to provide medical services to pilgrims.
Over-the-Counter Drugs
Over-the-counter medication can also be purchased from local pharmacies
Pilgrims are encouraged to bring a reasonable supply of over-the-counter drugs for common ailments, as well as first aid supplies to deal with issues such as muscular pain, stomach problems, cuts, nausea, headaches, etc.
The following is a list of items which may be used for common ailments experienced by pilgrims:
Cold & flu relief medication.
Pain relief tablets.
Travel sickness tablets.
Moisturising cream for dry skin.
Cream/balm/lotion for skin irritation and cracked/dry skin on heels.
Lip balm.
Throat lozenges/spray and cough syrups for coughs and sore throats.
Vitamin C supplements.
Diarrhoea tablets e.g. Imodium for an upset stomach.
Vaseline.
Plasters/blister plasters/bandages for cuts, burns and blisters.
Sun block to minimise the risk of heat exhaustion and heatstroke.
Muscle pain ointments/creams for muscular/joint aches and pains.
Oral rehydration salts to treat dehydration especially due to diarrhoea.
Although many of these items will be available in local pharmacies, bringing your own medication will save you the trouble of having to make the trip to the pharmacy. Ensure you take these and other medications you may need to Mina, Arafat and Muzdalifah during your Hajj.
