Skip to main content
SpringerLink
Log in

Health Issues of Mass Gatherings in the Middle East

  • Reference work entry
  • First Online:
Handbook of Healthcare in the Arab World

Abstract

The Middle East is host to some of the world’s most crowded mass gatherings (MGs) including Hajj and Arbaeen pilgrimages. These MGs can strain the health system of the host countries and at the same time can pose significant threat to global health security through the spread of infectious agents with epidemic potential. Large intercontinental outbreaks of meningococcal disease in recent past are a testament to this fact. A range of viral and bacterial infections of the upper and lower respiratory tract can occur during Hajj and Arbaeen, and the risk of diarrhea, a common travel morbidity, increases significantly at Arbaeen and to a smaller extent at Hajj. Stampedes with high fatalities have occurred in those gatherings. The risk of health hazards can be minimized by following host country’s guidance that include stringent compliance with vaccination recommendations, food and water safety practices, adhering hygienic principles, maintaining hydration, risk awareness and avoidance of high-risk behaviors such as walking against the traffic in a crowded place or drinking raw camel milk.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 1,599.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,799.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abdullah S, Sharkas G, Sabri N, Iblan I, Abdallat M, Jriesat S, Hijawi B, Khanfar R, Al-Nsour M (2013) Mass gathering in Aqaba, Jordan, during Eid AI Adha, 2010. East Mediterr Health J 19(Suppl 2):S29–S33

    Article  PubMed  Google Scholar 

  • Abubakar I, Gautret P, Brunette GW, Blumberg L, Johnson D, Poumerol G, Memish ZA, Barbeschi M, Khan AS (2012) Global perspectives for prevention of infectious diseases associated with mass gatherings. LancetI Infect Dis 12:66–74

    Article  Google Scholar 

  • Ahmed QA, Arabi YM, Memish ZA (2006) Health risks at the Hajj. Lancet 367:1008–1015

    Article  PubMed  PubMed Central  Google Scholar 

  • Al-Harthi AS, Al-Harbi M (2001) Accidental injuries during muslim pilgrimage. Saudi Med J 22:523–525

    CAS  PubMed  Google Scholar 

  • Al-Lami F, Al-Fatlawi A, Bloland P, Nawwar A, Jetheer A, Hantoosh H, Radhi F, Mohan B, Abbas M, Kamil A, Khayatt I, Baqir H (2013) Pattern of morbidity and mortality in Karbala hospitals during Ashura mass gathering at Karbala, Iraq, 2010. East Mediterr Health J 19(Suppl 2):S13–S18

    Article  PubMed  Google Scholar 

  • Al-Tawfiq JA, Memish ZA (2014) Mass gathering medicine: 2014 Hajj and Umra preparation as a leading example. Int J Infect Dis 27:26–31

    Article  PubMed  PubMed Central  Google Scholar 

  • Al Shimemeri A (2012) Cardiovascular disease in Hajj pilgrims. J Saudi Heart Assoc 24:123–127

    Article  PubMed  PubMed Central  Google Scholar 

  • Alaska YA, Aldawas AD, Aljerian NA, Memish ZA, Suner S (2017) The impact of crowd control measures on the occurrence of stampedes during mass gatherings: the Hajj experience. Travel Med Infect Dis 15:67–70

    Article  PubMed  Google Scholar 

  • Alfelali M, Barasheed O, Alshehri J, Bokhary H, Alsaedi S, Alhamzi A, Aljohani N, Driscoll T, Rashid H (2014) Foot injuries among Hajj pilgrims with and without diabetes mellitus: implications for infection management. Infect Disord Drug Targets 14:140–147

    Article  CAS  PubMed  Google Scholar 

  • Algeffari M (2019) Diabetes and Hajj pilgrims: a narrative review of literature. J Pak Med Assoc 69:879–884

    PubMed  Google Scholar 

  • Almalki M, Fitzgerald G, Clark M (2011) Health care system in Saudi Arabia: an overview. East Mediterr Health J 17:784–793

    Article  CAS  PubMed  Google Scholar 

  • Almasri M, Ahmed QA, Turkestani A, Memish ZA (2019) Hajj abattoirs in Makkah: risk of zoonotic infections among occupational workers. Vet Med Sci 5:428–434

    Article  PubMed  PubMed Central  Google Scholar 

  • Almekhlafi MA, Alhazmi MA, Alsulami SS, Almorsy SA (2017) Incidence and impact of stroke during Hajj. Results of 2015 Hajj stroke registry. Neurosciences (Riyadh) 22:181–185

    Article  Google Scholar 

  • AlNsour M, Fleischauer A (2013) Public health considerations for mass gatherings in the Middle East and North Africa (MENA) region. East Mediterr Health J 19(Suppl 2):S42–S47

    Google Scholar 

  • Alqahtani AS, Rashid H, Heywood AE (2015) Vaccinations against respiratory tract infections at Hajj. Clin Microbiol Infect 21:115–127

    Article  CAS  PubMed  Google Scholar 

  • Alqahtani AS, Yamazaki K, Alqahtani WH, Tashani M, Heywood AE, Booy R, Wiley KE, Rashid H (2017) Australian Hajj pilgrims' perception about mass casualty incidents versus emerging infections at Hajj. Travel Med Infect Dis 15:81–83

    Article  PubMed  Google Scholar 

  • ANON (2019) Iraq stampede kills 31 at Ashura commemorations in Karbala. BBC News, 10 September 2019, 11

    Google Scholar 

  • Arabi Y, Al Shimemeri A (2006) Critical care medicine in Saudi Arabia. East Mediterr Health J 12:225–230

    CAS  PubMed  Google Scholar 

  • Bala MO, Chehab MA, Selim NAA (2017) Qatar steps up to Global Health security: a reflection on the joint external evaluation, 2016. Glob Health Res Policy 2:30

    Article  PubMed  PubMed Central  Google Scholar 

  • Barasheed O, Rashid H, Alfelali M, Tashani M, Azeem M, Bokhary H, Kalantan N, Samkari J, Heron L, Kok J, Taylor J, EL Bashir H, Memish ZA, Haworth E, Holmes EC, Dwyer DE, Asghar A, Booy R (2014) Viral respiratory infections among Hajj pilgrims in 2013. Virol Sin 29:364–371

    Article  PubMed  PubMed Central  Google Scholar 

  • Benkouiten S, Charrel R, Belhouchat K, Drali T, Nougairede A, Salez N, Memish ZA, Al Masri M, Fournier P-E, Raoult D (2014) Respiratory viruses and bacteria among pilgrims during the 2013 Hajj. Emerg Infect Dis 20:1821–1827

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Benkouiten S, Charrel R, Belhouchat K, Drali T, Salez N, Nougairede A, Zandotti C, Memish ZA, Al Masri M, Gaillard C (2013a) Circulation of respiratory viruses among pilgrims during the 2012 Hajj pilgrimage. Clin Infect Dis 57:992–1000

    Article  PubMed  Google Scholar 

  • Benkouiten S, Charrel R, Belhouchat K, Drali T, Salez N, Nougairede A, Zandotti C, Memish ZA, Al Masri M, Gaillard C, Parola P, Brouqui P, Gautret P (2013b) Circulation of respiratory viruses among pilgrims during the 2012 Hajj pilgrimage. Clin Infect Dis 57:992–1000

    Article  PubMed  Google Scholar 

  • Bieh K, Elganainy A, Yezli S, Malik M, Jokhdar HA, Asiri A, Alotaibi B (2019) Health risk assessment at mass gatherings: a report of the camel festival in Saudi Arabia. East Mediterr Health J 25:647–655

    Article  PubMed  Google Scholar 

  • Boker AM (2016) Clinical exposure and organization of the critical care rotation during the Hajj periods in 1434-1435; perspectives of Arabian Saudi Anesthesiology program residents. Middle East J Anaesthesiol 23:639–645

    PubMed  Google Scholar 

  • Elrewihby WH, Hasan NF, Fikry W, Wafa E (2018) Acute kidney injury in hospitalized patients during Muslim pilgrimage (Hajj: 1432). Saudi J Kidney Dis Transpl 29:1128–1132

    Article  PubMed  Google Scholar 

  • Gatrad AR, Sheikh A (2005) Hajj: journey of a lifetime. BMJ 330:133–137

    Article  PubMed  PubMed Central  Google Scholar 

  • Gautret P (2018) Influenza risk at Muslim pilgrimages in Iraq and Saudi Arabia. Travel Med Infect Dis 21:1–2

    Article  PubMed  Google Scholar 

  • Gautret P, Benkouiten S, Sridhar S, Al-Tawfiq JA, Memish ZA (2015) Diarrhea at the Hajj and Umrah. Travel Med Infect Dis 13:159–166

    Article  PubMed  Google Scholar 

  • Ghasemian R, Babamahmoodi F, Ahangarkani F (2016) Hepatitis A is a health Hazard for Iranian pilgrims who go to Holly Karbala: a preliminary report. Hepat Mon 16:e38138

    Article  PubMed  PubMed Central  Google Scholar 

  • Haddad N, Ammar W, Khoury A, Cox A, Ghosn N (2017) Lebanon’s experience in surveillance of communicable diseases during a mass gathering: sixth francophone games, 2009. East Mediterr Health J 23:119–125

    Article  PubMed  Google Scholar 

  • Hankir A, Chariwala Z, Siddique U, Carrick FR, Zaman R (2019) Hajj and the mental health of Muslim pilgrims: a review. Psychiatr Danub 31:290–293

    PubMed  Google Scholar 

  • Kalimuddin S, Seow CJ, Barkham T, Deepak RN, Li L, Tan TT (2010) Hidden health risks of the Hajj–a report of two cases of brucellosis contracted by pilgrims during the Hajj. Scand J Infect Dis 42:228–230

    Article  PubMed  Google Scholar 

  • Karampourian A, Ghomian Z, Khorasani-Zavareh D (2018) Exploring challenges of health system preparedness for communicable diseases in Arbaeen mass gathering: a qualitative study. F1000Res 7:1448

    Article  PubMed  PubMed Central  Google Scholar 

  • Khan AA, Noji EK (2016) Hajj stampede disaster, 2015: reflections from the frontlines. Am J Disaster Med 11:59–68

    Article  PubMed  Google Scholar 

  • Lami F, Asi W, Khistawi A, Jawad I (2019a) Syndromic surveillance of communicable diseases in mobile clinics during the Arbaeenia mass gathering in Wassit Governorate, Iraq, in 2014: cross-sectional study. JMIR Public Health Surveill 5:e10920

    Article  PubMed  PubMed Central  Google Scholar 

  • Lami F, Hameed I, Arbaji A (2019b) Assessment of temporary community-based health care facilities during Arbaeenia mass gathering at Karbala, Iraq: cross-sectional survey study. JMIR Public Health Surveill 5:e10905

    Article  PubMed  PubMed Central  Google Scholar 

  • Lami F, Hameed I, Jewad AW, Khader Y, Amiri M (2019c) Real-time surveillance of infectious diseases and other health conditions during Iraq’s Arbaeenia mass gathering: cross-sectional study. JMIR Public Health Surveill 5:e14510

    Article  PubMed  PubMed Central  Google Scholar 

  • Lami F, Jewad AW, Hassan A, Kadhim H, Alharis S (2019d) Noncommunicable disease emergencies during Arbaeenia mass gathering at public hospitals in Karbala, Najaf, and Babel Governorates, Iraq, 2014: cross-sectional study. JMIR Public Health Surveill 5:e10890

    Article  PubMed  PubMed Central  Google Scholar 

  • Madani TA, Ghabrah TM, Al-Hedaithy MA, Alhazmi MA, Alazraqi TA, Albarrak AM, Ishaq AH (2006) Causes of hospitalization of pilgrims during the Hajj period of the Islamic year 1423 (2003). Ann Saudi Med 26:346

    Article  PubMed  PubMed Central  Google Scholar 

  • Masood K, Gazzaz ZJ, Ismail K, Dhafar KO, Kamal A (2007) Pattern of psychiatry morbidity during Hajj period at Al-Noor specialist hospital. Int J Psychiatry Med 37:163–172

    Article  PubMed  Google Scholar 

  • Matzarakis A, Frohlich D (2015) Sport events and climate for visitors–the case of FIFA world cup in Qatar 2022. Int J Biometeorol 59:481–486

    Article  PubMed  Google Scholar 

  • Memish Z, Al Hakeem R, Al Neel O, Danis K, Jasir A, Eibach D (2013) Laboratory-confirmed invasive meningococcal disease: effect of the Hajj vaccination policy, Saudi Arabia, 1995 to 2011. Euro Surveill:18

    Google Scholar 

  • Memish ZA (2018) Health of the Hajj. Science 361:533

    Article  CAS  PubMed  Google Scholar 

  • Memish ZA, Ahmed QA (2002) Mecca bound: the challenges ahead. J Travel Med 9:202–210

    Article  PubMed  Google Scholar 

  • Memish ZA, Steffen R, White P, Dar O, Azhar EI, Sharma A, Zumla A (2019) Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events. Lancet 393:2073–2084

    Article  PubMed  PubMed Central  Google Scholar 

  • Memish ZA, Stephens GM, Steffen R, Ahmed QA (2012) Emergence of medicine for mass gatherings: lessons from the Hajj. Lancet Infect Dis 12:56–65

    Article  PubMed  Google Scholar 

  • Mimesh SA, Al-Khenaizan S, Memish ZA (2008) Dermatologic challenges of pilgrimage. Clin Dermatol 26:52–61

    Article  PubMed  Google Scholar 

  • Mirza TA, Fillimban A, Maimini O, Khiyat EY, Dhafar KO, Farooq MU, Gazzaz ZJ (2011) Predictors of asthma severity during the pilgrimage to Mecca (Hajj). Pol Arch Med Wewn 121:327–331

    PubMed  Google Scholar 

  • Rafiq SM, Rashid H, Haworth E, Booy R (2009) Hazards of hepatitis at the Hajj. Travel Med Infect Dis 7:239–246

    Article  PubMed  Google Scholar 

  • Sadeghi S, Heidari A, Fazli H, Rezaei M, Sheikhzadeh J (2015) The Most frequent causes of hospitalization of Iranian Pilgrims in Iraq during a 5-MONTH period in 2012, and their outcome. Iran Red Crescent Med J 17:e12862

    Article  PubMed  PubMed Central  Google Scholar 

  • Samdani AJ (2004) Spectrum of skin disorders presenting to king Abdul Aziz hospital during Hajj season-2000. J Ayub Med Coll Abbottabad 16:10–13

    PubMed  Google Scholar 

  • Shafi S, Booy R, Haworth E, Rashid H, Memish ZA (2008) Hajj: health lessons for mass gatherings. J Infect Public Health 1:27–32

    Article  PubMed  Google Scholar 

  • Sridhar S, Benkouiten S, Belhouchat K, Drali T, Memish ZA, Parola P, Brouqui P, Gautret P (2015) Foot ailments during Hajj: a short report. J Epidemiol Glob Health 5:291–294

    Article  PubMed  PubMed Central  Google Scholar 

  • WHO (2016) What is WHO’s role in mass gatherings? World Health Organization. [Online]. Available: https://www.who.int/features/qa/mass-gatherings/en/. Accessed 1 Nov 2019

  • Wilder-Smith A, Chow A, Goh KT (2010) Emergence and disappearance of W135 meningococcal disease. Epidemiol Infect 138:976–978

    Article  CAS  PubMed  Google Scholar 

  • Worth RF (2005) 950 Die in stampede on Baghdad bridge. New York Times, September 01, 2005

    Google Scholar 

  • Yavarian J, Shafiei Jandaghi NZ, Naseri M, Hemmati P, Dadras M, Gouya MM, Mokhtari Azad T (2018) Influenza virus but not MERS coronavirus circulation in Iran, 2013–2016: comparison between pilgrims and general population. Travel Med Infect Dis 21:51–55

    Article  PubMed  Google Scholar 

  • Yezli S, Yassin Y, Awam A, Attar A, Al-Jahdali E, Alotaibi B (2017) Umrah. An opportunity for mass gatherings health research. Saudi Med J 38:868–871

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhang Y, Shi F, Yu Z, Yang A, Zeng M, Wang J, Yin H, Zhang B, Ma X (2019) A cross-sectional study on factors associated with hypertension and genetic polymorphisms of renin-angiotensin-aldosterone system in Chinese hui pilgrims to Hajj. BMC Public Health 19:1223

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Zumla A, Memish ZA (2019) Risk of antibiotic resistant meningococcal infections in Hajj pilgrims. BMJ 366:l5260

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Saudi Food and Drug Authority, Riyadh, Saudi Arabia

    Amani Salem Alqahtani

  2. Armed Forced Hospitals Southern Region, Khamis Mushayt, Saudi Arabia

    Amal Mohammed Alshahrani

  3. National Centre for Immunisation Research and Surveillance (NCIRS), The Children’s Hospital at Westmead, Westmead, NSW, Australia

    Harunor Rashid

  4. The Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    Harunor Rashid

Authors
  1. Amani Salem Alqahtani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amal Mohammed Alshahrani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harunor Rashid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Harunor Rashid .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada

    Ismail Laher

Section Editor information

  1. Kids Research, National Centre for Immunisation Research and Surveillance (NCIRS), Sydney Children's Hospitals Network, Westmead, NSW, Australia

    Harunor Rashid

  2. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

    Ziad A. Memish MD, FRCPC, FACP

  3. Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital (“PMAH”), Ministry of Health, Riyadh, Saudi Arabia

    Ziad A. Memish MD, FRCPC, FACP

  4. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Ziad A. Memish MD, FRCPC, FACP

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Alqahtani, A.S., Alshahrani, A.M., Rashid, H. (2021). Health Issues of Mass Gatherings in the Middle East. In: Laher, I. (eds) Handbook of Healthcare in the Arab World. Springer, Cham. https://doi.org/10.1007/978-3-030-36811-1_46

Download citation

Publish with us

Policies and ethics

Search

Navigation