The Hajj or Haj is the Pilgrimage to Mecca (or, "Makkah") and is the fifth of the "Five Pillars of Islam". Every able-bodied Muslim who can afford to do so is obliged to make the pilgrimage to Mecca at least once in a lifetime. Later this month about three million Muslims will gather for this major pilgrimage. But two doctors in this week's BMJ warn that the Hajj carries considerable health risks if the pilgrim is unprepared.
Heat exhaustion and heat stroke are important hazards, write Abdul Rashid Gatrad and Aziz Sheikh. Even when Hajj occurs during winter, the average temperature is over 30°C during the day and 20°C at night.
"Men are particularly at risk, as they are prohibited from directly covering their heads during Hajj," says Professor Gatrad of Manor Hospital, Walsall. He recommends simple measures, such as use of an umbrella, preferably white in colour, to deflect the sun away.
"The risk of infectious diseases is also important," says Professor Sheikh of the University of Edinburgh. "Outbreaks of meningococcal meningitis occurred among British pilgrims in 1987, 2000, and 2001, and the Saudi authorities now insist that all pilgrims must be vaccinated."
Pilgrims also need to be aware of the risks of important bloodborne infections such as HIV and hepatitis B and C, especially as one of the rites of Hajj is for men to have their head shaved.
"With sensible precautions, most of these problems should be preventable," say the authors. The need for vaccination means that a "Hajj travel consultation" is now mandatory, and is an ideal opportunity for health professionals to offer general health advice.
In patients who have returned from Hajj, doctors should be vigilant for signs of diseases such as meningitis, tuberculosis, malaria, and hepatitis, they conclude.
Contact:
Abdul Rashid Gatrad, Consultant Paediatrician, Manor Hospital, Walsall, UK
Tel: +44 (0)1922 656 558
Email: [email protected]
He went in for a colonoscopy. The hospital charged $19,000 for two.