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More than 2 million Muslims are expected to take part in this year’s Hajj pilgrimage to Makkah — a spiritual journey that forms an integral part of the Islamic faith. The visit, however, can be extremely demanding on the body and mind.

As pilgrims descend on Saudi Arabia for the six-day journey to the holy sites, doctors are encouraging visitors to prioritize their health so that they are able to complete the religious rituals before celebrating Eid later in the week.

Contrary to the rules put in place over the last two years, Saudi Arabia is no longer imposing an age limit on older pilgrims. As a result, the number of Muslims performing Hajj in 2023 is expected to return to, or even surpass, pre-pandemic levels.

Following the World Health Organization’s announcement last May declaring the COVID-19 pandemic over, pilgrims are now free to experience Hajj without complicated travel and quarantine requirements and grueling testing and social distancing restrictions.

That said, Muslims who traveled this year were still required to have received two doses of a COVID-19 vaccine and one booster, as well as vaccinations against seasonal viruses such as influenza and meningitis.

“While the COVID-19 pandemic has been declared over by some governments, the virus is still circulating and there is a risk of it spreading during the Hajj season as it involves a large gathering of people from all over the world,” Dr. Mamdouh Masoud, a general practitioner at Almana Group of Hospitals in Saudi Arabia, told reporters.

According to Dr. Sarla Kumari, an internal medicine physician at the Canadian Specialist Hospital, the spread of respiratory tract infections is common during Hajj due to mass gatherings.

This is followed by gastro-intestinal infections, more specifically diarrhea, as a result of poor hand hygiene, as well as meningitis infections.

“The main pathogen resulting in diarrhea is E. coli, and Saudi Arabia specifically has a high rate of third-generation cephalosporin-resistant E. coli,” said Kumari.

Another is salmonella, which is often the cause of severe diarrhea among pilgrims and requires medical attention and proper rehydration.

“In the last few years the government has set up special clinics and those suffering from these symptoms should attend those clinics which are equipped to handle these kinds of issues effectively,” said Kumari.

Given that Hajj has fallen during the summer months in recent years and will continue to do so for several more, Masoud said it is important for pilgrims to protect themselves from extreme heat by drinking lots of fluids, taking breaks, and staying in the shade as much as possible.

“The hot weather in Saudi Arabia during Hajj seasons can increase the risk of heat-related illnesses, such as heat stroke, heat exhaustion, and dehydration … and these illnesses can be serious,” he said.

Dr. Farhana bin Lootah, an internal medicine consultant at Imperial College London Diabetes Centre in Abu Dhabi, advised pilgrims to regularly apply sunscreen and carry an umbrella to help protect themselves from ultraviolet rays.

“Consuming plenty of fluids is also very important to avoid dehydration, which can potentially escalate into heat exhaustion, a serious health emergency,” she said.

For those with chronic illnesses, however, adhering to general safety measures can go a long way toward keeping them healthy.

Pilgrims with long-term health conditions must remember to carry their prescription medications at all times, along with face masks, a first aid kit, and an umbrella for hotter days, said bin Lootah.

Items like cooling creams, disposable towels and comfortable footwear can also help make the trip more comfortable.

Masoud said pilgrims remain at risk of developing health problems, not least from contagious infections.

“The most common health problems we see during this period include respiratory infections, heat-related illnesses, dehydration, cardiovascular disease, and trauma,” he said.

Whether walking around the Holy Kaaba in Makkah, performing the circumambulation seven times between the Safa or Marwa, or traveling between Mina and Arafat or Makkah and Madinah, Hajj requires a person to be physically strong and somewhat fit.

Masoud said pilgrims must be aware of their own medical history and should take precautions, such as staying hydrated, taking medications on time, using face masks, avoiding crowded places, and refraining from strenuous activity, particularly in hot weather, in order to reduce the risk of illness.

“Preparations for Hajj have been underway for a long time, and pilgrims are treated with the utmost caution to their safety,” bin Lootah said.

However, for patients with heart disease, it might be advisable to wear masks when in crowds to avoid any kind of respiratory diseases commonly found in densely populated areas.

For those with diabetes, bin Lootah added, it is essential to bring along a glucose meter to check blood sugar levels throughout the trip.

“Again, my general advice to pilgrims would be to maintain good hygiene and to wash your hands before handling any food or water, and using sanitizer when permitted,” she said.

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