Intended for healthcare professionals

Practice 10 minute consultation

The Hajj

BMJ 2011; 343 doi: (Published 15 September 2011) Cite this as: BMJ 2011;343:d5593
  1. A R Gatrad, consultant paediatrician and honorary professor1,
  2. A Sheikh, professor of primary care research and development2
  1. 1Manor Hospital, Walsall and University of Kentucky, Lexington, KY 40506
  2. 2Centre for Population Health Sciences, The University of Edinburgh, Edinburgh EH8 9DX
  1. Correspondence to: abdul.gatrad{at}
  • Accepted 12 August 2011

A 68 year old Muslim man with diabetes, which is reasonably well controlled on twice daily insulin and who has a history of myocardial infarction 12 months previously, wants advice on his fitness to go on pilgrimage (the Hajj) to Mecca.

What you should cover

Explore his understanding of the Hajj

Hajj is one of the five pillars of Islam that is compulsory for every Muslim, once in a lifetime. Is he aware that those who are physically unable to perform the Hajj because of illness or infirmity are exempt from going?

Does he experience angina?

Ask if he has chest pain at rest or on exertion. More than 40% of deaths during Hajj are related to cardiovascular disease.1

Does he appreciate the possible effects of heat, physical exertion, crowds, and altered routine on his health?

Annually, more than two million people travel to Mecca during Hajj and this results in overcrowding.2 The Hajj rituals might, depending on the time when Hajj falls, need to be undertaken in extreme temperatures that can reach more than 45°C.2 Dehydration and heat stroke are particular risks,3 and they are exacerbated by the strenuous physical exertion associated with performing the various Hajj rites.2 For example, the seven circuit circumambulation around the Ka’ba (the centre point of the Grand Mosque) can—because …

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