Health Guidelines For Hajj And Umrah
The performance of Hajj is obligatory on all adult Muslims who have the means to make the trip to the Holy City of Makkah. Umrah is regarded as a minor pilgrimage with only part of the required rituals performed. Whosoever enters the Mi’qaat (boundary of the Holy Land) has to perform Umrah, which includes Tawaaf (seven circuits around the Holy Kabah) and Sa’i (seven times between Mount Safa and Mount Murwa).
Good health makes it easier not only to enjoy Hajj and Umrah in the pleasure of Allah Subahanahu Wata’ala but also to make maximum use of the opportunity to make as much ibadah as possible.
Health plays a major role in fulfilling the requirements of Hajj and Umrah as Hajj and Umrah can be physically demanding depending on circumstances prevailing at the time.
The following is a guideline and must be accompanied by your own Doctor’s advice pertaining to your own health needs.
The more physically fit you are, the easier it would become to perform the many rituals associated with Hajj. If you have decided to perform a walking Hajj, then it would be very important for you to be as fit as possible. This will require walking as much as possible, starting about 6 to 8 weeks before departure, walking greater and greater distances as the time of departure arrives.
A brisk walk for about an hour three times a week would be sufficient to prepare for a walking Hajj. During Hajj and Umrah, the footwear for men is specified in that the high arch on the top of the foot needs to be exposed. The sandles or slippers that are used need to be broken-in well before Hajj and Umrah. Using your new sandles well before departure helps to make the feet accustomed to the footwear. Women may wear any comfortable footwear. Total distance to walk – approximately 10 – 12 kilometres to Arafat and 10 – 12 Kilometres back to Makkah.
Men are not allowed to cover their heads during Hajj and Umrah. Furthermore, in the case of Hajj, men may have shaven their heads recently from the performance of Umrah. It would therefore be advisable to expose the head to the sun whilst exercising before departure so that the head (scalp and face) and neck can become accustomed to the sun. This can also be done in Saudi Arabia before Hajj starts.
The sooner exercise is started, the better. For those who can, brisk walking, stationary cycling, swimming, etc. would be excellent forms of exercise. Even if one is not performing a walking Hajj, these exercises will help tremendously.
Tawaf – approximately 200 metres to 2 kilometers depending on the crowd present and where it is performed, e.g., 1st floor of the Haram.
Sai (Safa – Marwa) – approximately 3.5 kilometers.
Rasulallah Sallallahu Alaihi Wasallum often spoke of the importance of physical fitness in general.
Physical fitness is therefore very important.
CLIMATE IN SAUDI ARABIA
Jeddah is on the coast of the Red Sea and therefore enjoys a slightly humid climate in summer. It becomes less humid in winter.
Makkah is about 70 kilometers inland. It has an escarpment around it. One of the most famous sources of drinking water is from the Holy well of Zam Zam . There is very little vegetation in and around Makkah due to the low rainfall. The Great Arabian Desert is all around Makkah. The climate is dry. Temperatures are extremely high, usually in the forty degree Celsius range and sometimes going into the fifties in summer.
Medina is situated about 500 kilometers north and is about 150 kilometers from the coast. It is a large oasis with the Great Arabian Desert all around it. Because of the numerous wells providing excellent water, it has date orchards spreading out on to the outskirts of the city. The climate is dry and hot, the temperatures not reaching as high as in Makkah. In winter, it can become cool to cold especially around Tahadjud and Fajr times.
Water obtained from bore holes is brought to the hotels in tankers. Water is stored in huge tanks on the top of hotels.
Drinking water has to be bought in the form of bottled water. However, Zam Zam is available freely in Makkah and in Medina. Since this is an opportunity to drink as much Zam Zam water as possible, plastic containers easily obtainable can be filled with Zam Zam water and brought to the room.
Because of the hot weather conditions, it becomes necessary to drink water in abundance. Less urine is passed due to the hot conditions. The body conserves water by concentrating the urine. It is not good to pass very concentrated urine for a variety of reasons. Drink enough water so that the urine is clear. Passing clear urine indicates good hydration.
Drinking brackish water can causes a sore throat, stomach cramps and a cough from the irritation in the throat. The sore throat can be confused with a throat infection. Zam Zam water is abundantly available in both the Haramain. Zam Zam water is also available from taps outside the Haram Shareef. Plastic containers may be purchased outside the Haram Shareef, either empty or full of Zam Zam water. Zam Zam water that is available in storage containers in the Harram Shareef is cooled in cooling chambers. Ice is not added to the Zam Zam water. Every group of Zam Zam water containers in the Haram has one container that does not have cooled water. Arabic writing on the container would indicate which container has Zam Zam water that is not cooled.
Although the authorities provide disposable cups for drinking Zam Zam in the Haram, people unfamiliar with this practice often mix the used cups with the unused ones resulting in confusion. If one is unsure, rinse out the cup well before use. It is through the sharing of cups that infections can spread from one pilgrim to another. People come from all parts of the world with different hygienic control. What one may find offensive may be quite normal for another. The important thing to do is to avoid picking up infections from this source.
The Hajj authorities in Saudi Arabia do an excellent job of keeping the Zam Zam water area and containers as clean as possible. Clean drinking cups are always available. Despite hundreds of thousands of people going through the Harram, the authorities keep the facilities exceptionally clean.
Drink adequate amounts of fluids especially water throughout your stay.
CONTROL OF EXISTING HEALTH PROBLEMS
It is very important for anyone who takes regular medications to have enough supplies available for use during their stay in the Holy land.
Medications are available from Pharmacies. Please take a prescription from your doctor with you in case your medication gets misplaced or runs out. The names of the medications may be different and can be confusing. It is far better to take adequate supplies of your own medications. Make sure that you continue to take your medication regularly.
Arthritis needs to be controlled well before departure. Your Doctor is the best person to ask for guidance on medication. Please do not take advise from people who are not properly qualified. The treatment of the arthritis would involve decreasing the inflammation in and around the joints that are affected. Once the inflammation has settled, then light exercises to strengthen the muscles around the affected joint would help tremendously. Again be guided by a Doctor with the help of a Physiotherapist.
Start treatment well before departure.
People who suffer from arthritis of the weight-bearing joints should lose weight if they are overweight. Less weight would result in a decrease in load bearing on the joints.
Control arthritis well before departure.
Care of the back
Most people would travel with heavy suitcases when going overseas. Going to Makkah is no exception. In most cases, it will be found that most of the clothes taken will not be used. Travel light.
Back strain is a common problem. Most people suffer some back pain during their lifetime. Back strains take time to heal sometimes up to a month. Prolapsed discs take longer to heal. Therefore, it is strongly recommended that every precaution be taken not to strain the back unnecessarily.
If it were necessary to buy new luggage, then it would be better to spend a little more and acquire bags with wheels. These can be pulled along without being carried.
Proper lifting of heavy articles involves not bending the back but bending the knees and lifting with a straight back. It will be better to allow others who are not going to Hajj to do the lifting, e.g., relatives who are not going, hotel staff, porters, etc.
If a back problem already exists, extra care needs to be taken not only in lifting but also in sitting in awkward positions or on very low chairs, bending and twisting awkwardly, etc.
Remember, back strains take up to a month to heal. If a disc becomes prolapsed, this would take longer to heal, sometimes requiring operations.
1. Travel light.
2. Lift luggage correctly.
3. Find others who are not performing Hajj or Umrah to lift the luggage if possible.
Fungal Infections of the feet
Fungal infections of the feet present as either a dry scaly very itchy rash or little fluid-filled blisters between the toes or under the feet or around the heel. Fungal infections thrive in moist conditions, as between the toes or under the feet after bathing and after wudhu. The fungi cannot grow without moisture. It is therefore a good habit to dry the feet and the areas between the toes with a paper towel or tissue and to wear open sandals were possible so the feet may dry out. Fungal infections are contagious.
If a fungal infection is present, this must be attended to especially if diabetes is present. Fungal infections of the feet resulting in cracks or maceration of the skin can get secondarily infected with other bacteria causing a spreading cellulites. This can take up to a week or two to resolve with antibiotics and leg elevation.
Fungal infections can be treated with an anti-fungal agent until cured. Please consult a Doctor or Pharmacist for the most appropriate one to use.
As a prophylaxis and also as treatment in some cases, a cheap anti-fungal in the form of a generic anti-fungal can be useful. More expensive preparations, which are cosmetically better, are available and may be in a spray or powder form. The spray and powder form can be used inside shoes and sandles where the fungus may still be present.
Treatment must start well before departure so that the infection can be treated adequately.
Only prophylactic treatment may then be needed. Treat fungal infections well before departure to prevent complications.
Tea ordered from a take-away place may have sugar added to it.
Fruit juices that are made in take-away places have large amounts of sugar added to them to make the juice taste sweet. It is not wise to assume that the fruit juice that is available has not had sugar added to it. Please read labels of fruit juice containers to make sure whether sugar is added or not.
Diabetics must make sure that no sugar is added. Fruit juices are plentiful and extremely tempting.
Please make sure that diabetic control is at its optimum. Together with a Doctor’s help optimal diabetic control should start at least two months before departure to make sure that control is good and the correct medication is taken. Take your glucose monitor (glucometer) with you and enough strips to last you for the duration of your stay. Test your glucose level regularly and write down the results. This becomes important if a Doctor needs to be consulted.
A proper diabetic diet is very important. Some people would have their food included in their accommodation package. The hotels provide food for many people who do not have special dietary requirements. Diabetics should make their own arrangements where possible, e.g., use brown bread which can be bought easily instead of the tempting white-flour rolls or bread that may be on offer, or the abundant white rice that may be prepared.
Diabetics must take extra care of their feet. Treat scratches and even tiny cuts and fungal infections promptly with an antibiotic cream like Bactroban until they heal.
Apply extra moisturiser to keep the skin supple and elastic. Urea-based moisturizers are the best.
Care of nails on feet is also important. Remember that open sandals will be worn for the duration of Hajj. Nails should be well trimmed and not “catch” on clothes.
When walking, allow enough space in front so that feet are not trampled. If a fidgety or panicky person is in front of you, move to another place.
Complications from wounds can easily arise in diabetics resulting in unnecessary pain and discomfort and a possibility of missing Hajj.
Following a diabetic diet is very important always but especially before and during Hajj. Correct medication and good control must be maintained throughout your stay. Take your glucose monitor with you with enough test strips to last you for the duration of your stay.
High Blood Pressure
High blood pressure must be well controlled. Start at least three months before departure. Visit your Doctor regularly so that if a change in medication is necessary, it can be introduced and established before your departure. It is not enough to have your blood pressure checked at a Pharmacy or a nursing sister. Your whole body would need to be checked.
Have your blood pressure checked regularly whilst you are there.
Those who suffer from gout must make sure that they continue their preventative medication. They should also take with them a supply of medicines that usually helps them during an attack of gout. Gout usually affects the feet causing swelling and severe pain.
Those who suffer from asthma must ensure that their asthma is well controlled with preventative medications. Good control must be achieved before departure. Adequate supplies of medications must be taken, especially preventative medications, broncho-dilator inhalers and tablets.
If well controlled, asthma should not pose a problem during Hajj and Umrah.
Both Makkah and Medinah have a dry climate. There is very little pollen in the air. Due to the dry climate, house dust mite population is also low. Cockroach allergy may cause a problem for those who are allergic to cockroach droppings. Those with hyper-reactive airways sensitive to other pollutants should ensure that they control their asthma well. Asthmatics must seek medical attention as soon as their normal medication stops helping them.
Good asthma control is essential for a hassle-free Hajj and Umrah.
Itchy conditions of the skin
People who suffer from skin conditions which cause intense itching, e.g., eczema, lichen planus, psoriasis, etc., are advised to visit their doctor to bring their condition under control to their best ability well before departure. Medications, both tablets and creams can be taken to stop the itching for the duration of the state of Ihraam.
Moisturizers must be used liberally throughout the stay in the Holy land, especially during Hajj. Make sure that the moisturizers do not contain perfumes as perfumes are not allowed whilst in the state of Ihraam.
Moisturizers have different strengths of oil in them. This affects their ability to moisturize. The more the oil content, the more the ability to moisturize. If a moisturizer is not moisturizing adequately, then a “stronger” one is necessary.
Going from weak to strong, the following is a guide:
Aqueous cream – Cream E45 – Vaseline – Nutraderm – Nutraderm Plus – Heal balm.
For itchy conditions of the skin, moisturize, moisturize, moisturize.
There is nothing worse than having pain during Hajj. It can take all your energy and concentration away. A toothache is one such condition that can cause intense pain. To find a dentist during the Hajj period will be very difficult. A dental check is essential well before departure to make sure that all the teeth and gums are normal. If you are unfortunate enough to suffer a toothache whilst you are there, a course of a broad spectrum antibiotic will help the pain until you can have it attended to after Hajj, Insha-Allah.
Have a dental check before departure to make sure that your teeth and gums are all in order.
People who have an eye problem, e.g., glaucoma, must make sure that they take enough medication with them.
Those people who need reading glasses and those that cannot see well without glasses should take a spare set of spectacles with them. If your glasses break for some reason or is lost, it will not be possible to find another suitable pair.
The white marble around the Haramain shine brilliantly in sunshine. It can be over-whelming. Sun glasses can be used for those with sensitive eyes.
PROBLEMS THAT MAY ARISE
The Prevention of Infections
In situations where there are crowds of people, infections are bound to spread. Germs spread by droplets from our mouth as we speak or when we cough or sneeze especially if phlegm is present, or by direct contact as in kissing or sharing a cup, spoon, fork, etc.
Germs also spread via the faecal-oral route, as in the case of diarrhoea or gastro-enteritis and hepatitis A. Protect children, as they are the ones who come closest to us. Cover your mouth before you cough so as not to spread the infection further. The unhygienic act of spitting phlegm onto the pavement is a sure way of spreading germs! Signs that show that spitting on floors is prohibited are stuck on walls in all Muassasah’s offices. Large open bins are situated in strategic places for those that want to spit. Rather there than on the floor.
Thorough washing of hands with soap helps tremendously in preventing the spread of infections.
Avoid close contact with people who are ill. Visit them by all means but keep your distance. Spend as little time as possible with the ill person.
Use a mask if necessary.
If you are ill and are fortunate enough to have a visitor, protect your visitor by staying a fair distance away. Avoid close contact and tell visitors that the illness may be contagious.
People who are ill should try not to mix with people who are well. In this way, the illness can be contained.
If you suffer from any condition which results in decreased immunity, e.g., following chemo-therapy, please use a mask. Avoid people who are ill. Avoid crowded conditions.
If you need an antibiotic, please consult a Doctor there to get the most appropriate antibiotic at the correct dose.
Diarrhoea and vomiting
If one has diarrhoea, one must drink extra fluids, preferably oral re-hydrating fluids, like hydrol or rehidrate, which are easily available there. Try not to take any medication to stop the diarrhoea unless one is having very frequent diarrhoea (more than 6 times in 12 hours for an adult is a reasonable guide). In this case, one may take either lomotil or Imodium or their generic equivalents as directed in the package insert. These are easily available in Saudi Arabia. Diarrhoea is a method by which the body is trying to get rid of the germs. By stopping it, one may be helping the germs to stay in the body causing one to become more ill. Stomach cramps can occur. Anti-spasmodic agents such as buscopan can be used for pain relief. If there is appetite loss, the forced intake of food may cause the person to become more ill. If an appetite is present, one may eat food, but take in carbohydrates, fruit and vegetables only. Avoid protein foods such as meat, chicken, fish, eggs, dairy products and fried and fatty foods for the first 48 hours. Then, a normal diet may be resumed.
The fruit bought may have insecticides or pesticides sprayed on them. Thorough washing of the fruit before eating must be done to minimize infection. Peel the fruit to be safer. Fruit that need to be peeled are safer e.g., oranges, mandarins, bananas, etc.
When diarrhoea and vomiting are present, drink extra fluids preferably with electrolytes.
Due to a change in the diet and the hot weather resulting in water depletion, constipation can be a real problem. Constipation may result in haemorrhoids and fissures. These may result in bleeding. Constipation, haemorrhoids and fissures can be very distressing. It can affect normal activities resulting in loss of valuable time in Makkah and Medinah.
Maintaining a high fibre diet, e.g., a high fibre breakfast cereal, wholemeal bread, dried fruit like prunes and apricots, drinking adequate amounts of water can avoid constipation.
To avoid constipation, eat a high fibre diet and drink adequate amounts of liquids.
Because of the harsh, dry conditions that can be encountered, dryness of the skin can become a problem.
Saudi Arabia, being in the Northern Hemisphere has its winter when the southern hemisphere is having its summer. Hence, those people travelling from the southern hemisphere are confronted by a big change in the external environment.
Going from a humid climate to dry conditions will have a major effect on the skin. The skin will not have the time necessary to acclimatise. Cracking of the skin is common. If this happens on the feet, it can cause deep fissures resulting in pain and discomfort with the possibility of infection developing. This is especially important for diabetics.
A good moisturizer applied two or three times a day starting as soon as possible after arrival in Saudi Arabia will help the skin retain moisture and slowly acclimatise. The moisturizer need not be expensive. A good heel balm would be ideal. To allow the feet to retain the moisture in the skin, it may be necessary to wear a pair of socks to avoid the evaporation of water. Extra care should be paid to the feet, as performing Hajj with painful feet would add an unnecessary burden. A suitable heel balm will also help to smoothen out the thick skin around the heels.
Good care must be taken of the skin, especially the skin on the feet.
Scafing or scuffing of the inner thigh and scrotum
As men are not allowed to wear underwear, inflammation of the skin on the inner side of the thigh and scrotum can occur especially if the person is over-weight. The sweat and the rubbing of the thighs and scrotum during walking can cause a very painful rash and excoriation of the skin in this area.
To prevent this condition, men are advised to use vaseline or any other non-perfumed moisturiser liberally to the inner side of the thighs frequently throughout the state of Ihraam. If this problem does occur, a mild steroid cream will help in soothing the area until healing takes place, Insha-Allah.
Prevention is better than cure.
Swelling of feet
Due to the intense heat, it is not uncommon for the feet to swell. In healthy people, this is transient and is due to the dilatation of blood vessels in the lower limbs from the heat. As the body acclimatises to the hot conditions, the swelling should subside, Insha Allah. If one suffers from any illness, especially heart disease, diabetes or high blood pressure, then one should seek the advice of a Doctor. Acclimatisation usually takes about 5 to 7 days. Those that spend a short time in Saudi Arabia before Hajj may find their feet swollen during Hajj. Not much can be done about this as the body needs time to adjust.
It would help to elevate the legs at every opportunity so that the dependent fluid in the feet can go back into the circulation.
Most medicines that we find here are obtainable in Saudi Arabia. Take adequate and extra amounts of the usual medicines that you need in case departure from Saudi Arabia is for some reason delayed. These would include medications for High blood pressure, Diabetes, Heart Disease, Glaucoma, raised cholesterol, etc. Besides the usual medicines taken, one may take small quantities of a pain killer such as panado or suncodin and whatever else one may feel is needed. Codiene-containing preparations are not available in Saudi Arabia as codeine is addictive. Pharmacies in Saudi Arabia do not require prescriptions for medications that usually require control here. This is done to make medication easily accessible to the millions of people that come there without the need to look for a doctor. The pharmacists are usually very helpful and will give you whatever you need. Take a presctription of your medications from your Doctor to make it easier for the Pharmacist there. Do not hesitate to take the advise of a Doctor or a Pharmacist who may be traveling with you.
The Holy Mosques in Makkah and Medina have extensive marble floors inside and outside. When the smooth marble is wet, as after rain or after washing, it becomes very slippery. Walking on slippery floors must be done with extra care as slipping and falling hard onto the marble can cause some serious injury to the back, hips, elbows and wrists.
Fractures usually result from these falls.
Take extra care when walking on wet marble floors in and around the Haramain.
THE FIVE DAYS OF HAJJ
We must not lose sight of the primary aim of our journey and that is to perform Hajj. We can become engrossed in daily activities in Makkah and Medinah without realising the closeness of Hajj. The whole purpose of our journey is to perform Hajj. We must therefore be physically and spiritually ready to undertake the Pilgrimage.
If you are ill, get adequate treatment so that you can recover well before Hajj actually starts. If you are not ill, make sure that you look after yourself so that you do not become ill, e.g., avoid coming too close to people who are ill, dress adequately so that you do not get cold or wet if it rains. exercise your body to keep well in peak condition. Take special care of your skin and your feet. Try out your footwear to make sure they fit. Walk with them for a few days or all the time to “break” them in and allow your feet to become accustomed to the footwear.
Have a positive attitude during this time. You are a guest of Allah Ta’ala. Look forward to going out of Makkah to show Allah Ta’ala that you would prove to Him that you are worthy of returning to Makkah for Tawaful Ziyarah, that you reject Shaitaan with enthusiasm and contempt and not return to the ways of Shaitaan. It would be more productive to go out there and perform the rituals with enthusiasm. A positive attitude towards helping other pilgrims in whichever way possible can help you to have a very fulfilling Hajj, Insha-Allah. Please help out in which ever way you can and don’t expect things to be done for you by others.
Spend ALL your time in Ibadaat. The time in Mina is mainly for reflection, on your life so far and on Allah Ta’ala, on Zikr and reading appropriate parts of the Quran.
The Day of Arafat is the most important day of Hajj. Use it to the maximum. You may not get another chance. Take full advantage of standing outside during Waquf to tell Allah Ta’ala how Great He is and to thank Him for all that He has done for you and your family and friends.
Ask Him for whatever your needs are with humility and confidence. If you have prepared well, standing in the hot sun for two to three hours would not be a difficult task Insha Allah.
Please remember to take your medications on time. If you are on a diet, stay strictly on the diet. This is not the time to get sick because you did not take your medication or follow your diet. Besides compromising your own Hajj, you may inconvenience other Hajees.
Do not over eat. Eat small meals, take adequate liquids
Do not rush to stone the Shaitaan. This must be done deliberately with a lot of emotion. Wait for a suitable opportunity. Stand at a safe spot and observe the scene. Do not rush into the crowd. Insha-Allah, a suitable opportunity will present itself. Women should be protected from the pushing. There can be a lot of pushing. Please do not push as it worsens the situation. If you lose your footwear and if it is very crowded with people pushing and shoving, leave your footwear. Do not try looking for your footwear in the crowd. A little push can throw you to the ground. People can get trampled in this rush.
If an injury is sustained on the feet, treat it well with an antiseptic such as savlon regularly and apply Mercurochrome or a suitable antiseptic cream if the wound is deeper until medical help is available. Do not ignore it as Hajj is yet incomplete. There is still Tawaful Ziyarah to be done sometimes under very trying conditions. There is no need to rush. Insha-Allah, there will be plenty of time to complete Hajj.
Pharmacies are available at Mina during Hajj.
Yellow Fever Immunisation is recommended only for people traveling through Africa. South Africa is not regarded as a yellow fever endemic area. Therefore, South Africans traveling straight to Saudi Arabia need not take yellow fever immunization. However, some airlines travelling from South Africa to Saudi Arabia make an unscheduled stop in Central Africa, usually Nairobi. If this happens, then Yellow Fever Immunisation becomes necessary. Therefore, it would be advisable to take the Yellow Fever Immunisation. This vaccine lasts 10 years.
Menningo-coccal meningitis vaccine (4 strain – A,C,W135,L- only) is also recommended and required by the Saudi authorities as this infection can be picked up from fellow travelers. This is compulsory for everyone above 2 years old.
This vaccine lasts for 3 years.
Menningo-coccal meningitis can be carried by people who have been vaccinated. To prevent pilgrims from taking the germ home where it can infect other people, all pilgrims are required to take one dose of CIPROBAY 500mg before departure (GENERIC AVAILABLE). This can be obtained from a pharmacy. The tablets are purchased in packs of ten tablets.
Hepatitis A is an infection of the liver resulting in jaundice. It is transmitted via the faecal-oral route by infected food from infected food handlers. The incubation period is 2 to 3 weeks from the time of contact. It can be a serious illness. Hepatitis A vaccine can be taken at least two weeks before departure. Immunity derived from this vaccine can last up to two years. If a booster vaccine is taken after six months, the immunity to hepatitis A will last 10 years. This vaccine is optional.
It is recommended that the Influenza vaccine be taken by all pilgrims before departure for Hajj. Influenza spreads very fast in the crowded situations. This is most important for the elderly, and for people who have chronic illnesses like asthma, diabetes, etc.
Immunisations can have side effects. For this reason, it is better to take the injections well before departure. This will allow for good immunity to develop as well as for the injection site to heal.
Adequate preparations to keep your health in good condition will, Insha Allah make the performance of Hajj a spiritually uplifting and memorable experience. Invoking Allah Ta’ala’s help, in duas, in keeping illness and injury away and in protection from ill-health cannot be over-emphasised.
Author: Dr. Farouk Haffejee
Courtesy: www.everymuslim.co.za ?