Saudi Arabia: Hajj/Umrah Pilgrimage

The Hajj and Umrah are religious pilgrimages to Mecca, Saudi Arabia. Islamic religious doctrine dictates that every able-bodied adult Muslim who can afford to do so is required to make Hajj at least once in his or her lifetime. Hajj takes place from the 8th through the 12th day of Dhul Hijah, the last month of the Islamic year. Because the Islamic calendar is lunar, the timing of Hajj varies with respect to the Gregorian calendar, occurring about 11 days earlier the following year (for example, it was held September 22–27 in 2015 and September 10–14 in 2016). Umrah is called the “minor pilgrimage,” can be completed at any time of the year, and is not compulsory.
More than 2 million Muslims from over183 countries make Hajj each year (approximately 2.8 million in 2010); more than 11,000 pilgrims travel from the United States. The Kingdom of Saudi Arabia (KSA) continues to undertake engineering efforts to allow for an even greater number of pilgrims. Most international pilgrims fly into Jeddah or Medina and take a bus to Mecca. Pilgrims travel by foot or by bus approximately 5 miles (8 km) to the tent city of Mina, the largest temporary city in the world, where most pilgrims are housed in air-conditioned tents.
At dawn on the 9th day of Dhul Hijah, pilgrims begin a nearly 9 mile (14.4 km) walk, bus ride, or train ride to the plain of Arafat, passing Muzdalifah along the way (Map 4-02). Though the route features mist sprinklers to mitigate the oppressive daytime temperatures (which can reach 122°F [50°C]), the risk of heat-related illnesses during this part of the journey is still high. Ambulances and medical stations along the route are available for medical assistance. Hajj climaxes on the Plain of Arafat, a few miles east of Mecca. Pilgrims spend the day in supplication, praying and reading the Quran. The presence on Arafat, even if only for a few moments, on the ninth day of Dhul Hijah is an absolute rite of Hajj. If the pilgrim fails to reach the Plain of Arafat on that day, the Hajj is invalid and will have to be repeated. After sunset, pilgrims begin the 5.5 mile (9 km) journey back to Muzdalifah, where most sleep in the open air. Dust, inadequate and overcrowded washing and sanitation facilities, and the possibility of getting separated or lost are some potential problems pilgrims face.
At sunrise on the 10th day of Dhul Hijah, pilgrims collect small pebbles at Muzdalifah and carry them to Mina. This day’s ritual is called the Stoning of the Devil at Jamaraat. During this ritual, pilgrims throw 7 tiny pebbles (specifically, no larger than a chickpea) at the largest of 3 white pillars. The crowded conditions at this site pose potential hazards; multiple deadly crowd crush disasters have occurred at and around Mina.
Traditionally after Jamaraat, pilgrims sacrifice an animal. Pilgrims have the option to purchase a “sacrifice voucher” in Mecca and have this sacrifice performed by proxy. Centralized, licensed abattoirs perform the sacrifice on behalf of the pilgrim, limiting the exposure of pilgrims to potential zoonotic diseases. However, some pilgrims may visit farms where they either sacrifice an animal themselves or have it done by an appointed representative. The World Health Organization recommends travelers visiting farms or other areas where animals are present practice general hygiene measures, including regular handwashing before and after touching animals and avoiding contact with sick animals. Travelers should avoid the consumption of raw or undercooked animal products (including milk and meat).
After returning to Mecca, pilgrims go immediately to the Grand Mosque, which contains the Ka’aba, and perform a tawaf, which involves circling the Ka’aba 7 times counterclockwise. Because of the vast number of people (each floor of the 3-level mosque has a capacity of 750,000 people), performing a tawafcan take hours. In addition to tawaf, pilgrims may perform sa’i, walking (and running during certain parts) 7 times between the hills of Safa and Marwah, and then drinking water from the Well of Zamzam. This route is enclosed by the Grand Mosque and can be traversed via air-conditioned tunnels, with separate sections for walkers, runners, and disabled pilgrims. Pilgrims then return to Mina and pelt all three columns at the Jamaraat on the 11th and 12th of the month, with the option of repeating it on the 13th.
After performing a final tawaf, pilgrims leave Mecca, ending Hajj. Although it is not required as part of Hajj, many pilgrims extend their trips to travel to Medina. In Medina, pilgrims visit the Mosque of the Prophet, which contains the tomb of Mohammed. Physicians should query patients about their itineraries to ensure they have adequate medication and supplies for the length of their trip.

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