Hajj is a 5-day Muslim pilgrimage to Mecca to celebrate Abraham's readiness to sacrifice Ishmael. Its yearly date is unfixed. Pilgrims renew their faith shoulder-to-shoulder, as a sacred duty, with 2 million Muslims from all over the world. 20,000 travel from the UK, and another 29,000 also make a lesser pilgrimage to Mecca called Umrah. Hajj is physically taxing (but often exhilarating) involving walking and camping in the desert with basic sanitation. Hajj is not required for those in poor health, and your role may be to advise on poor health to enable religious dispensation.
- Meningococcal vaccination is mandatory (2 doses ACWY-Vax conjugate meningitis vaccination, 3 months apart). Immunity is thought to last 3 years. Hepatitis A, and malaria prophylaxis are important. Consider also polio, typhoid and diphtheria vaccines and hepatitis B vaccines.
- Women should not menstruate during Hajj. Menstrual delay by norethisterone or contraceptive pill may be requested.
- Sun stroke and heat exhaustion are major hazards. Advise acclimatization (so arrive 1 week before Hajj to enable sweating), 5L fluid with half teaspoonful salt/L intake daily; keep fluid bottle with one. Take an umbrella (preferably white) as sun shade. Avoid travel in middle of day and on open top buses. Use liberal sun block if fair skinned.
- Much walking is needed so advise comfortable shoes and carrying a shoe bag to carry them in when removed for prayers (so as not to lose them). Sand is so hot that bare foot walking may cause sole burns.
- Male head-shaving by shared razor blades risks blood-borne infections. Advise using new razor blades (hair trimming may be acceptable).
- Take an adequate supply of medications and a list of them in generic names. Also take simple analgesics.
- Most injuries are to feet. Being crushed by crowds will be best avoided by avoiding the most popular times (eg travel at night).
- Post-Hajj diagnoses to consider: meningitis, hepatitis, hydatid, TB, malaria.
Rashid A 2005 BMJ 350 133
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