Between two and three million pilgrims are expected to tour the holy places of Mecca and Medina during the next three days to perform the Hajj, a religious pilgrimage that every Muslim should undertake at least once in his/her lifetime. This represents an enormous organizational challenge including the provision of health care.
The Hajj dates back to the 7th Century and the Kingdom of Saudi Arabia has accumulated centuries of experience in hosting waves of pilgrims from all over the world. Preparations for each Hajj begin with lessons learned at the end of the previous pilgrimage season.
Pilgrims supported by a vast health service
Last year alone more than 372 000 people were assisted at Ministry of Health facilities during the Hajj. All health services are provided free of charge, even complicated and costly interventions such as open-heart surgeries. Traditionally, cardiovascular diseases, heat exhaustation and dehydration, burns, food poisoning as well as kidney problems are leading causes of medical interventions during the Hajj.
This year 22 500 health workers from across the Kingdom arrived to staff 25 hospitals with 5250 beds and 141 health centres at 4 main pilgrimage areas. The Emergency Hospital of Mena is built exclusively to serve pilgrims, as it is located between holy sites of Mecca and Arafat, where every pilgrim is supposed to begin the pilgrimage. Closed the rest of the year, the Mena hospital has 190 beds and sees between 10 000 and 12 000 patients daily during the Hajj. New equipment is being introduced this year. Ninety-five small ambulances, described as ‘mobile Intensive Care Units (ICU)’, each with a doctor, nurse and latest state-of-art technology, will be positioned in crowded areas as to rapidly treat or transfer patients in need, bringing total number of ambulances to 175.
Building on knowledge and experience of mass gatherings
For the fourth consecutive year, WHO has been invited by the Saudi Ministry of Health to observe and to provide any required technical assistance during the Hajj. One result of this collaboration – and of KSA’s vast experience in dealing with large gatherings of people for religious, sporting, cultural or other events – called mass gatherings by WHO – is that WHO this year designated the Kingdom’s Centre for Mass Gathering Medicine as a WHO Collaborating Centre. Together, WHO and KSA are learning from and building on the Kingdom’s experience in mass gatherings for the benefit of other countries.
Health education activities have also been stepped up with introduction of a toll-free line where medical doctors respond to calls. Brochures with health information in 10 languages are distributed to arriving pilgrims and to media.
The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) that so far has affected 138 people and caused 60 deaths globally, with the majority of cases being reported in Saudi Arabia, has prompted health authorities to strengthen the surveillance and health education for incoming pilgrims. In addition to the existing laboratory facility in Jeddah and Medina, a new laboratory unit has been installed at Mena Alwadi Hospital in order to rapidly conduct tests for suspected cases.
The Saudi National Scientific Committee for Infectious Diseases recommended that persons older than 65, children, pregnant women and those with underlying conditions should postpone the pilgrimage due to the MERS-CoV risk. According to KSA health authorities, random checks of pilgrims are performed at the arrival at the airports.
Countries outside of the affected region should maintain a high level of vigilance, especially those with large numbers of travellers or guest workers returning from the Middle East. Surveillance should be enhanced in these countries according to WHO guidelines along with infection control procedures in health care facilities. WHO continues to request that Member States report all confirmed and probable cases along with information about their exposures, testing, and clinical course to inform the most effective international preparedness and response. WHO strongly recommends detailed case investigations for every case, case-control studies for index cases and intensive follow-up of contacts with serological testing to improve knowledge of the critical features of MERS-CoV infection.