To fully appreciate the physical dimensions of the Hajj let us consider the Hajj as a dynamic system. On arrival you are going to be wearing the Ihram clothes and once in Makkah you have to go for Tawaf or the circumambulation the Ka'bah seven times and then perform the Sa'i; the act of jogging seven times between the hills of Safa and Marwah, a distance of 500 meters, i.e., a total distance of 3.5 kilometers. On Arafat day all Hujjaj must assemble on the Mount of Mercy from morning until sunset.
After sunset a mass exodus of Hujjaj starts from Arafat, mainly on foot, towards Muzdalifah, an open plain, where they spend a night under the open sky. In the morning they head towards Mina, where they spend three days in camps. Two rites are performed during this period stoning the devil and sacrificing an animal. Each day the pilgrim throws 21 pebbles at three stone monuments which symbolize the devil. Each adult male is expected to sacrifice a healthy animal, preferably a sheep. Approximately one million animals are slaughtered during these three days. The final rite of the Hajj requires the return of Hujjaj to Makkah for a farewell circumambulation around the Ka'bah.
From this brief description of the movements it can be seen that all the rites of the Hajj entail strenuous physical effort. However, if the physical exertion is increased beyond its natural limits, especially in hot weather, one may suffer from various heat-induced illnesses; this is particularly true for those with chronic diseases.
Overcrowding is another major problem since the area is limited and the numbers are increasing annually. Accommodation is difficult to find and is very expensive. Many Muslims prefer to sleep on the pavements. Lack of sleep and the resulting physical exhaustion both predispose to heat illnesses.
RESPIRATORY TRACT INFECTION
People from all over the world bring with them all kinds of infections, and the unavoidable closeness of the hundreds of thousands of Hujjaj facilitates easy spread of those illnesses. Fatigue, and lack of sleep from the physically demanding regimen of Hajj rites as well as the over-enthusiastic exertions in salah and devotions, lower one's immunity and resistance, thereby making one more vulnerable to disease. Acute respiratory infection is very common. Epidemics of flu-like illnesses are also very common.
The key point here is that nearly all-upper respiratory tract ijifections (URI) are viral. They will resolve spontaneously, and require no antibiotic treatment. Patients should seek care only if they experience symptoms consistent with complications of URI such as prolonged illness with purulent nasal secretion, fever, and facial pain; isolated sore throat with fever; shortening of breath; productive cough with fever or shortening of breath, or the subjective feeling of a severe illness. Try symptomatic measures to minimize the symptoms of sore throat or flu, as follows:
Drink lots of clear fluids (water, juice, Sprite).
Take acetaminophen or paracetamol to reduce pain and fever. For a cough try an over-the-counter cough suppressant. For sore throat: gargle with salt water; suck on ice cubes or lozenges; drink hot water with lemon and honey. Wash your hands often. Flu is spread through the air by coughing or sneezing. It may also spread by hand contact.
Not all types of heat illnesses are mentioned here to avoid confusion or unnecessary details. It should be made clear, however, that heat can present major challenges to persons making Hajj, and that they should take such illnesses seriously.
Commonly caused by dehydration and loss of body salts. It is manifested by weakness, headache, dizziness, nausea, vomitting, and diarrhea. An increased body temperature and pulse rate may be present. The treatment of heat exhaustion is by resting, getting out of the heat/sun, sponging the body with water and fanning it, and aggressively replacing fluids and salts. If not taken seriously, this can progress to heat stroke. Patients diagnosed as suffering from heat exhaustion should be admitted to hospital where they are covered with large sheets of wet gauze and fans used to aid cooling. IV-fluid should be administered and a fluid balance chart kept monitoring urine output. Nearly all patients recover and are discharged within 24 hours. Patients must be transferred immediately to the nearest health care center.
In this condition the body loses its ability to regulate temperature and the body temperature soars, often to above 106 degrees. Sweating may or may not be present. The hallmarks of heat stroke are physical collapse and mental deterioration ranging from confusion to coma. This is a medical emergency and must be treated aggressively with rapid cooling and IV-fluids if available. If not, death or permanent damage to the kidneys, heart, or liver may result. Emergency treatment can consist of cooling in whatever water is available or removing clothing and wetting/fanning the body. If able to drink, give the victim water, or oral rehydration formula.
All patients diagnosed as suffering from heat stroke should be cooled on the specially designed Makkah Body Cooling Unit (BCU). This achieves rapid reduction of the body temperature by evaporation from the warm skin; the skin temperature is kept at 30-32 C (84-90 F) to enhance vasodilatation and increase the heat flow.
PREVENTING HEAT ILLNESS
Even marginal dehydration interferes with the body’s ability to regulate temperature. It also makes a mild diarrheal illness more likely to become serious. In hot climates you should always consume enough water so that you must urinate every two to three hours. If your urine becomes dark yellow it means that you are getting dehydrated or that you are getting jaundiced! Here are some preventive measures that help you reduce the burden of heat:
* Don’t be exposed to direct sunlight but rather use an umbrella or other protective gadget
* Don’t leave your kids is unventilated vehicles
* Drink plenty of water, even if you are not thirsty (preferably Zam-zam water)
* Keep a close watch on children to be sure they do the same
Reduce physical activities by:
* Not walking for long periods. Rather ride any available vehicle
* Trying to avoid crowded places as much as you can and not rush when performing rites
* In case of weakness (e.g. chronically-ill patient) and if you can’t handle the crowd during stoning, it is permissible for you to go to Mina at the end of the night to stone the Jamra before the arrival of the crowd
* Taking enough time for rest and sleep as needed