Hajj Tests Faith—and Health

More than 2 million Muslim pilgrims from around the world this week descend on the historical city of Mecca, about 70 kilometres inland from the Red Sea on the western coast of Saudi Arabia.

There, they will converge on the Great Mosque of Mecca to fulfill their religion’s fifth pillar, or duty—the Hajj. This week-long spiritual journey involves a series of rituals, including walking counter-clockwise seven times around the Kaaba, the revered cubical building towards which all Muslims pray.

Hajj is a time of deep reflection, and also tests faith, stamina and patience. It can also be a dangerous venture and hundreds have died over the years in the crush of people and collapsed structures.

Toronto Star reporter Noor Javed is one of the 5,000 Canadian Muslims expected to participate in this year’s rites of Hajj. Javed has spent months preparing for the pilgrimage attending weekly information sessions, visiting a travel health clinic, obtaining a visa and doing some pre-emptive soul-searching.

The first thing that hits you is the sheer number of people.

They are, literally, a sea of pilgrims. Their faces are blurred, their numbers seem limitless with no end in sight. In a matter of days, this wave of pilgrims washes over Mecca, fills up the city, the holy mosque, even the streets leading into the sanctuary.

There is little you can do to mentally prepare for such a crush of people. Personal space does not exist—it can’t be accommodated.

Which is why those on the holiest of Muslim pilgrimage should at least aim to protect their bodies, their health and the health of millions of others, says Dr. Brian Aw, a travel medicine specialist who has been studying Hajj for more than a decade.

“There are moments during the Hajj where there are people literally on top of each other,” says Aw, from his office in a Richmond Hill clinic. “The last thing you want to be worrying about is if the guy next to you just coughed on you,” he says.

“Any scenario, like Hajj or a cruise ship, or even a university dorm where there is a mass grouping of people, allows for the spread of infectious disease,” he adds.

There are obvious differences, however, between those who go for Hajj and those who sign on to enjoy a cruise.

“Hajj is a unique religious setting that is driven not by pleasure, but by obligation,” says Aw.

Many of those who make the journey to Mecca have never had vaccinations. Others don’t have up-to-date shots. And some may be carrying strains of viruses that we no longer see in Canada, he notes.

Hajj made it onto the infectious diseases radar in 2000-’01 after health officials saw a spike in the number of pilgrims with meningitis (the W-135 strain, the form capable of causing an epidemic). The outbreak wasn’t an example of poor vaccination, says Aw, but an example of disease being spread through overcrowding.

Since then, the Saudi government has made the meningitis vaccination mandatory and a requirement for obtaining a Hajj visa. This one requirement has helped control the international spread of the disease.

In 2005, there was a spike in worldwide cases of polio—a disease the World Health Organization had hoped to eradicate by this century.

Aw notes that health officials found the particular strain of polio was the same as that which had spread among unvaccinated members of the Housa tribe, in Nigeria, that same year.

Many of the tribe members travelled to Hajj in 2005, and passed the disease to pilgrims from the Middle East, Asia and Africa. Worldwide numbers for polio went up to 2,000 cases that year, a sharp increase from the hundreds that had been seen in previous years.

WHO has taken the Nigeria outbreak so seriously that it now recommends pilgrims be vaccinated before Hajj. The Saudi government has taken it a step further: “People coming from countries like Pakistan, India, are given an oral polio vaccination at the airport (upon arrival),” says Aw. “Canadians aren’t, since we are considered a polio-free country,”

Aw has encouraged Canadian pilgrims to make every effort to be properly immunized—even taking extra vaccinations as a precaution. Those he’s recommended are hepatitis A, typhoid, and the oral Dukoral vaccine that protects from E.coli bacteria and cholera.

And he’s advising when it comes to eating and drinking: “Boil it, cook it, peel it or forget it.”

But ultimately, Aw says, the “biggest risk factor is your neighbour.” He notes that influenza, whooping cough and pneumonia are common air-borne diseases that can spread.

On top of the risk of contracting an infectious disease during Hajj, the majority of pilgrims return to Canada with either a chronic cough or diarrhea, he said.

Khadija Haffajee, who made the Hajj pilgrimage nearly a decade ago, says that for many, Hajj is a reality check.

“Hajj is a unique situation. Here are all these people with different levels of education, different levels of hygiene,” she says.

“At first, it is a bit shocking. You aren’t here to tell them what to do—but to accept them as they are.”

Aw, who is not Muslim and has not been to Mecca, says his clients have returned from Hajj incredibly moved by their memorable experience

“It is a great event, a big event, but because there are millions of people together, it allows for the propagation of disease,” he says.

“Your goal should be to experience the holy event, and experience it healthy.”

[Editor’s Note: Part 1 of this series can be read here.]