From Devotion to Danger

Every year, a large number of Muslims from across the world embark on the haj pilgrimage to Mecca in Saudi Arabia. The mass migration is unparalleled in scale, and pilgrims face various health hazards.

Mecca is viewed as the holiest city for Muslims. And haj is one of the Five Pillars of Islam, making it a mandatory duty for Muslims to perform at least once in their life if they are physically and financially capable.

The 2024 pilgrimage journey has been overshadowed by tragedy, with the death of 900 pilgrims, mostly due to heat exhaustion and related complications.

One of the most devastating incidents occured in 2015 during the ritual of "Rami al-Jamarat" in Mina, near Mecca. This ritual involves pilgrims throwing stones at pillars symbolising the devil. On that day, overcrowding and the movement of large groups of pilgrims in opposite directions led to a deadly crowd crush. More than 2,400 pilgrims lost their lives, making it one of the deadliest disasters in the history of haj or any mass gathering.

Another mass casualty event occurred in 1990, in the Al-Ma’aisem pedestrian tunnel near Mecca, which led to the holy sites. A combination of ventilation failure and an enormous influx of pilgrims caused a suffocating crush inside the tunnel; 1,426 pilgrims died.

There have also been different incidents during the pilgrimage journey throughout the year. In 1994, a stampede near the Jamarat Bridge resulted in the death of around 270 pilgrims. The 1998 pilgrimage saw 118 pilgrims killed in another stampede.

Over the last 50 years, more than 9,000 individuals have died in mass religious gatherings, with more than 5,000 of these happening during the pilgrimage in Saudi Arabia.

Why haj pilgrimage so risky?

With millions of pilgrims converging in a confined area, the potential for overcrowding and crowd-crush accidents is high. This situation is worsened by the high emotion and passion associated with the pilgrimage. Pilgrims perform rituals with intense devotion and enthusiasm, which can sometimes lead to overexertion.

Another factor is the age of the pilgrims. Many are elderly, having saved for years to afford this spiritual journey. Their advanced age makes them particularly vulnerable to the harsh conditions and physical demands of the pilgrimage. The intense heat, prolonged periods of walking, and sheer physical strain of performing the rituals can exacerbate existing health issues and lead to new complications.

The extreme congestion of people also amplifies health risks, particularly from infectious diseases. Communicable diseases such as SARS, avian influenza, and meningococcal disease have posed significant threats during haj in the past.

High temperatures make mass gatherings more dangerous

A study documenting deaths and injuries at mass gatherings up to 2019 shows that, while the 1980s saw most fatalities at sporting events, such events are now rare, while fatalities during religious pilgrimages, particularly in India and Saudi Arabia, are becoming more common.

While most haj fatalities have been due to crowd crushes and stampedes, a new threat has emerged: extreme climate. Saudi Arabia’s climate can be brutal. During this year’s pilgrimage, temperatures soared to 50°C.

Saudi Arabia is warming at a rate 50% higher than the rest of the Northern Hemisphere. The decade from 2010 to 2019 was the warmest on record, with more frequent and severe heatwaves. This rising temperature, combined with higher humidity, makes conditions increasingly unbearable without artificial cooling.

The planning of the pilgrimage journey, directed by the lunar Islamic schedule, implies it moves around 10 to 11 days sooner every year in the Gregorian schedule. This implies haj can happen in various seasons north of a 33-year cycle. Currently, pilgrimage is being held during the summer months, leading to extreme heat risks.

Saudi Arabia has also experienced an increase in extreme rainfall events in recent years, particularly towards the end of summer and into the fall. These torrential downpours and thunderstorms have caused significant flooding in regions such as Mecca and Jeddah.

As climate patterns continue to evolve, the occurrence of such rainfall could align with the haj season, creating additional hazards for pilgrims.

How to mitigate the risk?

Unlike concerts or sporting events, the haj pilgrimage cannot be rescheduled or relocated. Being outdoors is an integral part of haj.

Pilgrims must perform the haj rituals correctly for their pilgrimage to be accepted. According to Islamic teachings, the haj must be conducted with precise adherence to its rituals and timings. Any deviation or omission can render the pilgrimage invalid.

The Saudi Ministry of Health has implemented various measures, including encouraging vaccinations, health checks, and educational campaigns urging pilgrims to stay hydrated, use umbrellas, and avoid prolonged sun exposure.

The ministry deployed thousands of paramedics and set up field hospitals to manage the crisis. Cooling measures such as misting systems and portable water stations were used.

Yet the extreme heat proved overwhelming, indicating more needs to be done. Educational campaigns can do more to raise awareness among (especially non-local) pilgrims and healthcare workers about heat risks and preventive measures.

The introduction of new technologies such as smart bracelets for monitoring pilgrims’ health could further enhance medical responses.