Introduction

Journeying to Mecca for Hajj (pilgrimage) is no ordinary undertaking for many Muslims (boxes 1 and 2; fig 1). Hajj represents the culmination of years of spiritual preparation and planning. Once they have completed the pilgrimage, pilgrims are given the honorific title Hajji (pilgrim).

Holy Ka'bah, Mecca, Saudi Arabia

Hajj commemorates the patriarch Abraham's readiness to sacrifice his son Ishmael in biblical times. Performing Hajj is one of the five pillars of Islam and is therefore obligatory for all adult Muslims who can afford to undertake the journey and are in good health. Hajj lasts for five days, and, as the Islamic calendar is lunar, the precise Gregorian calendar dates of the Hajj season will vary each year. Muslims travel to Mecca at other times to perform a lesser pilgrimage called Umrah.

Mecca's resident population of about 200 000 swells to well over two million during the Hajj season. This rapid increase in numbers poses many challenges, including ensuring adequate food, water, and sanitary facilities in Mecca and the neighbouring deserts of Mina and Arafat, which pilgrims must visit as part of the Hajj ritual.

Although the journey is incumbent on a Muslim only once in a lifetime, many Muslims, particularly those living in the West, will journey more often. For example, more than 20 000 Britons do the Hajj each year, and the current annual figure for Umrah stands at almost 29 000.3 In view of the very large numbers of people from disparate regions and the hostile climate of the Arabian desert, the chances of disease, particularly in elderly and infirm people, are high.

In this paper, we briefly describe the main rites of the Hajj before focusing on particular health risks associated with it and measures that may be taken to minimise them. Our main aim …