Human exposure to a hot environment may result in various heat-related illnesses (HRIs), which range in severity from mild and moderate forms to life-threatening heatstroke. The Hajj is one of the largest annual mass gatherings globally and has historically been associated with HRIs. Hajj attracts over two million Muslim pilgrims from more than 180 countries to the holy city of Makkah, Kingdom of Saudi Arabia. Several modifiable and non-modifiable factors render Hajj pilgrims at increased risk of developing HRIs during Hajj. These include characteristics of the Hajj, its location, population, and rituals, as well as pilgrims’ knowledge of HRIs and their attitude and behavior. Makkah is characterized by a hot desert climate and fluctuating levels of relative humidity. Pilgrims are very diverse ethnically and geographically, with different adaptations to heat. Significant proportions of the Hajj population are elderly, obese, and with low levels of fitness. In addition, many have underlying health conditions and are on multiple medications that can interfere with thermoregulation. Other factors are inherent in the Hajj and its activities, including crowding, physically demanding outdoor rituals, and a high frequency of infection and febrile illness. Pilgrims generally lack awareness of HRIs, and their uptake of preventive measures is variable. In addition, many engage in hazardous behaviors that increase their risk of HRIs. These include performing rituals during the peak sunshine hours with no sun protection and with suboptimal sleep, nutrition, and hydration, while neglecting treatment for their chronic conditions. HRIs preventive plans for Hajj should incorporate measures to address the aforementioned factors to reduce the burden of these illnesses in future Hajj seasons. Lessons from the Hajj can be used to inform policy making and HRIs preventive measures in the general population worldwide.
The pilgrimages of Muslims to Makkah (Hajj and Umrah) is one of the largest religious gatherings in the world which draws millions of people from around 180 countries each year. Heat stress during summer has led to health impacts including morbidity and mortality in the past, which is likely to worsen due to global warming. Here we investigate the impacts of increasing heat stress during the peak summer months over Makkah at present levels of warming as well as under Paris Agreement’s targets of 1.5 degrees C and 2 degrees C global mean temperature increase above pre-industrial levels. This is achieved by using multi member ensemble projections from the half a degree additional warming, prognosis and projected impacts project. We find a substantial increase in the exceedance probabilities of dangerous thresholds (wet-bulb temperature >24.6 degrees C) in 1.5 degrees C and 2 degrees C warmer worlds over the summer months. For the 3 hottest months, August, September and October, even thresholds of extremely dangerous (wet-bulb temperature >29.1 degrees C) health risks may be surpassed. An increase in exceedance probability of dangerous threshold is projected by two and three times in 1.5 degrees C and 2 degrees C warmer worlds respectively for May as compared to the reference climate. September shows the highest increase in the exceedance probability of extremely dangerous threshold which is increased to 4 and 13 times in 1.5 degrees C and 2 degrees C warmer worlds respectively. Based on the indicators of hazard, exposure and vulnerability, we carried out probabilistic risk analysis of life-threatening heat stroke over Makkah. A ten time increase in the heat stroke risk at higher wet-bulb temperatures for each month is projected in 2 degrees C warmer world. If warming was limited to 1.5 degrees C world, the risk would only increase by about five times, or half the risk of 2 degrees C. Our results indicate that substantial heat related risks during Hajj and Umrah happening over peak summer months, as it is the case for Hajj during this decade, will require substantial adaptation measures and would negatively affect the performance of the rite. Stringent mitigation actions to keep the global temperature to 1.5 degrees C can reduce the risks of heat related illnesses and thereby reduce the non-economic loss and damage related to one of the central pillars of a world religion.
