- Hajj and Umra pilgrimages to Saudi Arabia present health risks due to exertion, increased temperatures, intense crowding, and exposure to international travelers. Influenza, pneumonia, and respiratory infections are the most common causes of hospitalization, making vaccination and respiratory precautions very high priorities.
- Travelers should be fit and ensure preexisting medical conditions are well controlled prior to travel.
- Routine vaccinations (influenza, measles, mumps, rubella, polio [adequate primary series and 1 adult dose], tetanus, diphtheria, pertussis, and chickenpox) and hepatitis A, hepatitis B, typhoid, and pneumococcal should be up to date.
- Required vaccinations include meningococcal for pilgrims and Hajj/Umra workers, polio for travelers arriving from certain polio-risk countries, and yellow fever for travelers arriving from (or having transited for > 12 hours through) yellow fever risk countries.
Hajj is the annual pilgrimage to Islam's holiest sites in Saudi Arabia. All those who are physically and financially capable are obliged to perform Hajj once in their lifetime. The Hajj moves backward by 10 days each year of the Gregorian calendar. Umra is optional and can be performed at any time of the year. Each year, approximately 3 million pilgrims participate in the Hajj. In 2019, Hajj 1440H will take place approximately August 9-14.
Useful web sites for additional information about the Hajj include https://www.saudiembassy.net/hajj-requirements, www.haj.gov.sa/, and https://www.moh.gov.sa/en/Hajj/HealthGuidelines/HealthGuidelinesDuringHajj/Pages/HealthRequirements.aspx.
Intense crowding during Hajj can increase the transmission of respiratory and intestinal infections, which have caused major outbreaks in the past (e.g., cholera, meningitis, and influenza). A severe respiratory illness (called MERS-CoV) that has been occurring in Saudi Arabia since 2012 has not spread to pilgrims during any pilgrimage year. No vaccines are available. Influenza and other respiratory viruses are common and travelers going to or returning from Saudi Arabia should seek immediate medical attention for severe respiratory symptoms.
All routine vaccinations (including measles, mumps, rubella, polio [adequate primary series and 1 adult dose], tetanus, diphtheria, pertussis, and chickenpox) and hepatitis A, hepatitis B, typhoid, and pneumococcal should be up to date.
The Saudi Arabian Ministry of Health requires certain vaccinations; proof of vaccination must be submitted at the time of visa application:
- Meningococcal vaccine: Required for all travelers older than 2 years arriving for the purpose of Hajj or Umra pilgrimage or seasonal work in Hajj/Umra zones. The certificate must have been issued not more than 3 to 5 years previously (depending on vaccine used) and not less than 10 days before arrival to Saudi Arabia. An antibiotic may be given to certain travelers upon arrival if deemed necessary by port-of-entry officials.
- Polio vaccine: All travelers, regardless of age, coming from Afghanistan, Burma, Democratic Republic of the Congo, Mozambique, Niger, Nigeria, Pakistan, Papua New Guinea, Somalia, Syria, or Yemen must show proof of polio vaccination given between 4 weeks and 1 year prior to arrival; some travelers will also receive a dose of oral polio vaccine (OPV) when entering Saudi Arabia.
- Yellow fever vaccine: A yellow fever certificate of vaccination is required of all travelers arriving from or transiting for more than 12 hours through countries or areas known to be infected with or at risk for transmission of yellow fever. The certificate must have been issued not less than 10 days before arrival to Saudi Arabia. (In the absence of such a certificate, the person will be placed under strict surveillance for 6 days from the date of vaccination or the last date of potential exposure to infection, whichever is earlier.)
- Influenza vaccine: Recommended for all pilgrims, particularly for those at increased risk for severe complications, such as pregnant women, the elderly (older than 65 years), children younger than 5 years, and persons with chronic medical conditions. Required for domestic pilgrims and health care workers.
Preexisting health status and medical conditions
The traveler should visit his or her health care provider and discuss the health risks of the Hajj. Some chronic conditions may make a person more susceptible to infection. Exertion and heat will put extra strain on the heart, lungs, and kidneys, and travelers should be as fit as possible and correct their weight to the extent possible before undertaking Hajj. Persons with preexisting medical conditions who decide to travel should consult their health care provider, ensure that their conditions are well controlled, obtain and carry an adequate supply of medication, and be sure to carry a doctor's covering letter and prescriptions for all medications. This is especially important if the medicines include prescription opiates. Travelers should keep medicines in their original labeled containers for ease of identification at customs.
Travel and health insurance
Although health care at the holy sites is free, pilgrims are advised to carry adequate travel and health insurance and to identify an in-country medical provider. The availability of emergency evacuation is questionable.
Travel Medical Kit
Pilgrims should assemble and carry a travel medical kit containing these items:
- Routine medications appropriate to each traveler
- First aid items
- Azithromycin and loperamide for self-medication for travelers' diarrhea
- Sunscreen (at least SPF 30 and fragrant-free)
See Packing Personal Medications and Supplies for additional recommendations.
Travel, Accommodations, and Communications
Pilgrims generally fly into Jeddah and travel overland to Mecca. There may be delays of many hours on arrival at Jeddah as well, due to full airplanes and crowded airports. All luggage should have fixed labels on the outside and inside, showing the pilgrim's name, nationality, passport number, air carrier, and flight number. Onward travel to Riyadh or other Saudi Arabian cities other than the vicinities of Jeddah, Mecca (Makkah), or Medina is usually not permitted during the Hajj. Upon arrival, pilgrims must surrender their passports to the United Agents Office for completion of all travel formalities to Mecca and Medina. All pilgrims are then issued an identification card and wristband that they should carry at all times. Passports are returned only immediately prior to departure while at the airport. Travelers must carry vaccination certificates with them for inspection by the Saudi Arabian Authority at ports of entry.
Conditions in Mecca range from luxury hotels with transportation in air-conditioned buses to hostel accommodations in blocks without elevators to rented rooms. At Mina and Arafat, accommodation is in tents set up by the Tawafa Establishment. Overnight at Muzdalifah is under the open sky.
Communications facilities to contact family in other countries are available in all parts of Saudi Arabia.
Health and Safety Precautions
Some required rituals are physically demanding. Daily distances to be covered between sites range from 8 to 19 km (5 to 12 mi). Pilgrims may travel via prebooked bus, commercial taxi, or on foot, but any of these methods will be slow and take hours.
Food: During the stages of Hajj, facilities for preparing and storing food are simple and without refrigeration. Eat freshly cooked food and avoid street vendors.
Crowds, crush, stampede, and trauma: Congestion is severe. Pilgrims have been crushed during stampedes. Since 1994, 7 stampedes have killed more than 1,700 pilgrims. In September 2015, more than 700 pilgrims were killed in a stampede near Mina. The most common causes of trauma are from accidents on roads crowded with vehicles and pedestrians and from inexpert slaughter of animals.
The Saudi authorities forbid the taking of photographs (still or video, including mobile telephone photographs) at the Holy Mosque at Mecca or at the Prophet's Mosque at Medina. This restriction also includes the courtyards surrounding these holy sites. Any violation is likely to lead to the confiscation of one's camera.
In summer, temperatures above 40-50°C (104-122°F), lack of shade, bare heads, and dehydration readily lead to heat exhaustion and heat stroke, especially in children and those who are not acclimatized, unless precautions are taken. Standing barefoot on marble paving may cause burns on the soles. At certain points, men must stand with head and arms uncovered.
Respiratory, intestinal, and skin infections are common. Influenza is the most commonly acquired respiratory infection, whereas pneumonia is the most common cause of hospital admission. Tuberculosis infection is also a risk. Travelers' diarrhea is common. Risks exists for hepatitis A and typhoid fever. Heat, sweat, and crowding promote bacterial and fungal skin infections, including boils.
- Arrive a few days early to acclimatize.
- Eat freshly cooked food and avoid street vendors.
- Avoid consumption of raw camel milk, camel urine, or improperly cooked meat.
- Observe hand-hygiene (frequent, thorough handwashing) measures, especially after using the bathroom and before preparing food or eating.
- Drink plenty of drinking water, either bottled or supplied by the Tawafa Establishment.
- Avoid the heat of the day, seek shade, and, whenever possible, travel the stages of Hajj after sunset. In the sun, use sunscreen on exposed skin, use the umbrella for shade, and wear socks (not forbidden) if standing barefoot on very hot stone, but beware of slipping.
- Saudi Arabian authorities recommend wearing a simple surgical face mask to reduce the risk of respiratory infection, but the mask may prove uncomfortable in the heat, and its value is unproven.
- Observe good respiratory-hygiene (cough and sneeze etiquette) measures.
- Avoid contact with persons who appear ill.
- Do not use unauthorized barbers.
- Keep the skin as cool, clean, and dry as possible; seek treatment for any new skin infection.
- Consider hiring a professional proxy for animal slaughter.
- Women and children should stay close to their male companions, especially at crowded points.
- Use a wheelchair if elderly or infirm: All sites are accessible.
- Use of fragrance and smoking tobacco are forbidden.
- Take all regular medications.
- In the event of travelers' diarrhea, start self-treatment and drink more fluids.