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Pilgrimage (hajj) 3 min read.

Hajj: The Sacred Journey to Mecca

Hajj literally means, “to continuously strive to reach one’s goal.” The Hajj , or Pilgrimage to Mecca, is a once-in-a-lifetime obligation for those who have the physical and financial ability to undertake the journey.

The Spiritual Significance

The Hajj is essentially a re-enactment of the rituals of the great prophets and teachers of faith. Pilgrims symbolically relive the experience of exile and atonement undergone by Adam and Eve after they were expelled from Heaven, wandered the earth, met again and sought forgiveness in the valley of Mecca. They also retrace the frantic footsteps of the wife of Abraham, Hagar, as she ran between the hills of Safa and Marwa searching for water for her thirsty baby (which according to Muslim tradition, God answered with the well of Zam Zam). Lastly, the pilgrims also commemorate the willingness of Abraham to sacrifice his son for the sake of God. God later substituted a ram in place of his son.

Performing the rituals of Hajj provides a reminder of how the great prophets and teachers of faith established a deep and personal relationship with God. As the pilgrim makes his supplications to God, he realizes that He is asking of the same God that answered the prayers of those before him. These reminders are an important part of strengthening one’s faith, trust and dependence in God.

A Journey of Deep Spiritual Transformation and Inner Peace

The faithful hope that the Hajj will bring about a deep spiritual transformation, one that will make him or her a better person. If such a change from within does not occur, then the Hajj was merely a physical and material exercise devoid of any spiritual significance. As all great religions teach, we are more than mere physical creatures in that we possess an essence beyond the material world. Indeed, this is why all great religions have a tradition of pilgrimage. In the Islamic tradition, Hajj encapsulates this spiritual journey toward this essence. Hajj teaches one to show sincerity and humilty in one’s relationship with God. The result of a successful Hajj is a rich inner peace, which is manifested outwardly in the values of justice, honesty, respect, generosity, kindness, forgiveness, mercy and empathy.

Explore the Spiritual Significance of Hajj

These are the articles and videos covered in this section:

Hajj: The Journey of a Lifetime “Pilgrimage is a central duty of Islam and brings together Muslims from all races, colors and statuses for one of life’s most moving and spiritual experiences….”

Universal Lessons of Hajj The result of a successful Hajj is a rich inner peace, which is manifested outwardly in the values of justice, honesty, respect, generosity, kindness, forgiveness, mercy and empathy to others.

Origin and Significance of Hajj Like the prayer, Fasting and Almsgiving, Hajj shapes the life of a Muslim and prepares him to live in submission to God’s will.

Hajj and the Neglected Legacy of a Great Woman “Eid al-Adha is a great and unique occasion of joy and celebration. Ironically, this joy and celebration revolve around sacrifice. It would probably make sense to only those who understand that the joy of giving that touches others’ lives is far greater and deeper than the joy of receiving.” Dr. Mohammad Omar Farooq

Hajj: One Year Later “The Hajj was the most powerful and emotional spiritual experience I have ever had……” Hesham A. Hassaballa, M.D

Festival of The Sacrifice Eid-ul-Adha or the Festival of Sacrifice, is a representation of two significant Islamic events: the culmination of the Hajj and the sacrifice that God commanded to Prophet Abraham of his beloved son.

Why are Millions Going to Mecca?

877-Why-Islam presents a brief talk given by Mubinul Kathrada at an interfaith luncheon hosted by Zubaida Foundation.

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• Ask About Islam

What Makes Hajj a Lifetime Journey?

Short Answer: 

• Hajj is, in many ways, the central event of the year, perhaps of a whole lifetime. It is the act in which the unity of Muslims is most fully expressed.

One indication that a pilgrimage has been accepted, it is said, is when a pilgrim abandons his/her sinful ways, exchanges his/her idle companions for righteous company and friends, then forsakes frivolity and heedlessness in favor of seriousness and vigilance.

………….

Salam  Dear Brother,

Thank you for your question and for contacting Ask About Islam.

I appreciate your question, for many people do wonder about Hajj (pilgrimage). What exactly is it? What is the pilgrimage of Muslims, to the Ka`bah in Makkah?

" title="Advertise and Market to Muslims" target="_blank">Ads by Muslim Ad Network

Is it a religious rite, a trade fair, a political gathering or… all in one? How can such a journey, known as one of the five pillars of Islam, be a manner of worship?

The Islamic Concept of Worship

Worship, according to Islam, is a means for purifying both man’s soul and practical life. The basis of worship is the fact that human beings are creatures and thus bondservants of God, their Creator, and their Lord, to Whom they are destined to return.

Thus, man’s turning towards God, in intimate communion and reverence – in the spirit of devotion and humble submission – is termed worship.

Actually, worship is an indispensable part of all religions, including the idolatrous ones. It is motivated, however, in each religion by different objectives. It assumes different forms and is performed under a different set of rules.

In some religions, worship is a means to develop in man the attitude of asceticism and isolation from life. In these religions, worship seeks to develop a mentality, which eliminates the enjoyment of the pleasures of this world.

Instead, in Islam, the concept of worship is related primarily to its fundamental view. It is that the true foundations of a good [enjoyable] life are the soundness of belief and thinking, purity of soul and righteousness of action.

The real purpose of Islam in declaring that worship embraces the totality of the life of Man is to make the religious faith play a practical and effective role in shaping human life. It should also develop in man an attitude of dignified patience and fortitude in the face of hardships and difficulties.

It should create in him/her the urge to strive for the prevalence of good and removal of evil. Accordingly, there are principal means in Islam that strengthen the person’s connection with God, one of which is Hajj.

The Journey to Makkah

Once during his/her lifetime, every Muslim who is physically and financially in a position to do so is expected to journey to Makkah . This is where God’s final revelation to mankind was first disclosed.

You are not obliged to go if you are not of sound mind, if you do not possess the necessary financial resources, or are under a certain age. Also, if you are a woman who has no male relative to go with – as a chaperone and protector.

A basic purpose of the pilgrimage is to heighten the pilgrim’s devotion to God and His revealed will, but the practice has other benefits as well. It is, for example, a reminder of human equality.

Before reaching Makkah, pilgrims remove their normal attire, which carries the marks of social status, and put on two simple sheet-like garments. Thus everyone, on approaching Islam’s earthly focus, wears the same thing. The distinction of rank and hierarchy is removed, and the prince and pauper stand before God in their equal humanity.

The pilgrimage also provides a useful service for enhancing international relations. It brings together people from many countries, demonstrating thereby that they share a loyalty that transcends their loyalty to their own nationalities and ethnic origins. Pilgrims pick up information about other lands and peoples and return home with a better understanding of one another.

Purposes of Hajj

The purposes for which God has enjoined Hajj are many, among which are the following:

• It is the largest annual convention of faith, where Muslims meet to know one another, study their common affairs and promote their general welfare.
• It is also the greatest regular peace conference known in the history of mankind. In the course of Hajj , peace is the dominant theme. It is peace with God, with one’s soul and with one another. It is even peace with animals, birds, and insects. To disturb the peace of anyone or any creature, in any way or form, is strictly prohibited.
• It is a wholesome demonstration of the universality of Islam, where brotherhood and equality of Muslims are fulfilled. From every corner of the globe, Muslims begin the journey, from all paths of life, trades, and classes, to assemble at Makkah in response to the divine call. They dress in the same simple way, observe the same regulations and utter the same supplications at the same time, in the same way, for the very same end. There is no royalty, but loyalty – of all – to God. There is no aristocracy, but humility and devotion.
• Hajj confirms the commitment of Muslims towards God and their readiness to abandon their material interests, for the sake of His service.
• It is also to commemorate the divine rituals, observed by Abraham and Ishmael (peace be upon them), who are known to have built the Ka`bah for the practicing of monotheism and worshiping of God – the One and Only – on earth.
• It is a reminder of the grand assembly on the Day of Judgment, when people will stand equal before God, waiting for their final destiny, when no superiority of race or wealth can be claimed.

A Self-discipline Program

A major purpose of Hajj , is to achieve self-discipline and maintain strong morals. Every single step and rite during the journey should direct the pilgrim towards such goals. The following examples can clarify how such simple steps can assist in the process of elevating the soul and purifying it.

The Purity of Intention and Means

The pilgrim should meet his expenses by lawful means, for God would never accept otherwise. He/she should have his/her hands free of any worrisome and distracting business concerns.

His/her attention should be devoted exclusively to God, while his/her heart is directed in tranquility to the remembrance of God. In fact, devoting one’s heart can never be a hundred percent pure except if it is no longer occupied by material concerns, especially money.

This would definitely be more applicable when the person gets rid of any unlawful money, no matter how he/she needs it, for the sake of God. This is where sincere devotion shows.

Forsaking Evil Conduct

The pilgrim should renounce indecency, immorality and wrangling, as spoken of in the Quran. Indecency is a general term, covering all nonsense and foul behavior.

In fact, wrangling, excessive quarreling and argument, causing ill will, distract from the noble purpose of Hajj are incompatible with good Muslim character. One should, therefore, refrain from complaining about each other and even about animals as well.

One should take things gently; sheltering others and taking care of them along the way to the holy sanctuary. Good conduct is essential in Hajj . It goes – sometimes – as far as putting up with painful things, rather than trying to repel them.

Being Accepted

In fact, his/her heart might be the person’s true indicator. If it is no longer attached, unduly to worldly matters and has enjoyed the agonies of the journey without longing for material pleasures, then the pilgrim might have achieved his/her goal. He/she – then – has attained a heart longing for God and renouncing fake materialism of this world.

Worth mentioning also is that Hajj is, in many ways, the central event of the year, perhaps of a whole lifetime. It is the act in which the unity of Muslims is most fully expressed.

This is in the sense that it is an example of all kinds of travel. It is also a market for exchanging news and ideas, brought from all over the Muslim world. Last, but not least, it symbolizes the unity of so many hearts seeking the pleasure of God.

Well then, I hope the above gives you a satisfactory answer. Please keep in touch.

(From Ask About Islam archives)

Please continue feeding your curiosity, and find more info in the following links:

10 Common Questions About Hajj

Stoning Satan in Hajj: Beyond Symbolism

Hajj and Good Manners

Privacy Overview

The Stages of Hajj, the Islamic Pilgrimage to Mecca (Makkah)

• Hajj and Eid Al Adha
• Important Principles
• Prayer Salat
• Prophets of Islam
• Ramadan and Eid Al Fitr
• M.Ed., Loyola University–Maryland
• B.S., Child Development, Oregon State University

Hajj, the religious pilgrimage performed in ritual stages in and around the holy city of Mecca (Makka), is required of Muslims at least once during their lifetimes. It is the largest annual gathering of human beings on earth, with approximately three million people gathering each year for three to five days between the eighth and 12th of Dhul-Hijjah, the last month of the Muslim calendar. The pilgrimage has been occurring annually since 630 CE​ when the prophet Muhammad led his followers from Medina to Mecca. 

Fast Facts: Hajj

• Description: A three- to five-day pilgrimage involving several rituals in honor of the Islamic prophet Muhammad, and events pertaining to Muhammad and his ancestor Abraham (Ibrahim). 
• Key Participants: Nearly three million Muslims from all over the world. 
• Start Date: The eighth day of the lunar month of Dhul-Hijjah (the Gregorian date changes every year).
• End Date: The 12th day of Dhul-Hijjah. 
• Location: Mecca and several nearby locations.

Significance of the Hajj

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The great pilgrimage called the Hajj (Arabic for "pilgrimage") is significant for a number of reasons. First and probably most important, it is a time when approximately three million or more Muslims come together, mixing across lines of ethnicity, nationality, sect, and gender. Second, the pilgrimage was initiated by the Prophet Muhammad himself, who is said to have been sent with 1,400 of his followers on the pilgrimage to celebrate one of the founding myths of the Abrahamic religions. Third, one of the stops—the Plains of Arafat—is where Muhammad gave his farewell sermon.

Preparation for the Hajj

Wael Abutalib / EyeEm / Getty Images 

In the modern pilgrimage, the  Hajj  pilgrims begin arriving by air, sea, and land during the days and weeks prior to the pilgrimage period. They usually arrive into Jeddah, Saudi Arabia, the major port city closest to Mecca (about 45 miles away). From there they travel with their Hajj group to Mecca; many if not most travelers come with an official package group. As they approach Mecca, they stop at one of the designated areas to shower and  change clothing , entering into a state of devotion and purity (Ihram) for the pilgrimage. Men must wear two lengths of white cloth without seams (one wrapped around their shoulders and a second one around their waists). Women can wear regular clothing as long as it is clean and modest, with veils covering their heads but not their faces.

For the next three days, participants must not smoke, swear, shave, cut their nails, or have sex. Fighting and arguments are banned, and participants are prohibited from hunting or killing anything. All must avoid scented cologne, perfume, makeup, and soaps.

They then begin reciting an invocation:

Here I am, Oh God, at Your command! Here I am at Your command! You are without associate! Here I am at Your command! To You are all praise, grace and dominion! You are without associate!

The sound of this chant (said in Arabic) echoes over the land as the pilgrims begin arriving in Mecca by the thousands for the sacred rites.

Day 1 of the Pilgrimage (8th of Dhul-Hijjah)

Andrew Marcus/Getty Images

On the first official day of the pilgrimage, the millions of pilgrims perform the first rituals associated with the Hajj in the Masjid al-Haram (Sacred Mosque) complex, rituals that will be repeated throughout the journey. First is a "tawaf," in which pilgrims walk around the Ka'aba ("the Cube"), a stone shrine said to have been built by Abraham (Ibrahim in Arabic) and his son Ishmael (Ismail) some 4,000 years ago. The Ka'aba has four walls and a roof and in one corner on the outside wall is the Black Stone of Mecca, where Ibrahim laid out Ismail to be sacrificed. The Ka'aba is covered with a black silk cloth decorated with verses from the Quran in gold-embroidered Arabic calligraphy: The cloth is replaced every year on Day 2 of the Hajj. For the tawaf, pilgrims walk counterclockwise seven times around the shrine. If a pilgrim is near enough to the Ka'aba, he or she can touch the Black Stone, and if not, they raise their hands in a salute palm first facing the stone. Official sources estimate that over 10,000 people walked around the Ka'aba every hour during the Hajj in 2018.

Next, the pilgrims perform the Say'a, running seven times between the two hills Safa and Marwah, commemorating Hagar's (Hajira's) search for water for her son Ismail. Today the hills are contained within the Masjid al-Haram complex, and the ritual takes place along a long, beautiful air-conditioned gallery with marble floors; a moving walkway is provided for those who cannot walk.

Pilgrims then travel by foot or take a shuttle bus from Mecca to Mina, a small village east of the city. There they spend the day and night in one of the 160,000 tents supplied by the Saudi government to accommodate 50 pilgrims each. The tents are Teflon-coated fiberglass and air-conditioned, and they house men and women separately. People pray, read the Quran , hear lectures, and rest up for the next day.

Day 2 of the Pilgrimage (9th of Dhul-Hijjah)

Reza/Getty Images

On the second day of the pilgrimage, the pilgrims leave Mina just after dawn to travel to the Plain of Arafat for the culminating experience of the Hajj. On what is known as the " Day of Arafat ,” the pilgrims perform the Wuquf, a rite in which they spend the entire day standing (or sitting) near Mount Arafat (the "Mount of Mercy"), asking Allah for forgiveness and making supplications. A cooling mist sprays the pilgrims from specially built towers, providing a bit of respite from the heat. The Plain of Arafat is where Muhammad gave his farewell sermon in 632, and the Wuquf honors that occurrence. Muslims around the world who are not at the pilgrimage join them in spirit by fasting for the day.

After sunset on the Day of Arafat, the pilgrims leave and travel to a nearby open plain called Muzdalifah, roughly halfway between Arafat and Mina. There they spend the night sleeping on the ground under the stars, praying and collecting small stone pebbles to be used the following day.

Day 3 of the Pilgrimage (10th of Dhul-Hijjah)

Abid Katib/Getty Images 

On the third day, the pilgrims move before sunrise, this time back to Mina. Here they perform the Ramy ceremony, during which they throw the stone pebbles they collected on the previous day at three pillars that represent the temptations of Satan. The three pillars are Jamrat al-‘Aqaba (at the narrow pass of al-‘Aqaba, and the largest), Jamrat al-Wusta (the middle one), and Jamrat al-Sughra (the small one). The pillars are set separately in large depressions, and participants walk down a corridor to throw the pebbles.

When throwing the stones, the pilgrims recall the story of Satan’s attempt to dissuade Ibrahim from following God’s command to sacrifice his son. The stones represent Ibrahim's rejection of Satan and the firmness of his faith. This is by far the most dangerous of the rituals during Hajj, tense and emotional, with thousands of peoples throwing pebbles and not uncommon stampedes taking place, so sick or elderly people do not typically attend, but rather wait until evening or send another to throw pebbles for them.

After casting the pebbles, most pilgrims slaughter an animal (often a sheep or a goat) and give away the meat to the poor. Alternatively, pilgrims can purchase a sacrifice voucher from a qualified person who will sacrifice a lamb for each pilgrim or a camel for every seventh. This is a symbolic act known as the Eid al-Adha (Festival of Sacrifice ) that shows their willingness to part with something precious to them, as a remembrance of Ibrahim who was prepared to sacrifice his son at God’s command.​ After the sacrifice, people are released from their prohibitions and most cut their hair or shave for the next day's events.

Throughout the world, Muslims celebrate Eid al-Adha on this day. This is the second of the two major holidays in Islam each year.

The Closing Days of the Pilgrimage

Abid Katib/Getty Images

Over the next two to three days, the pilgrims return to Mecca and perform the tawaf and the sayee, and drink from the ancient spring known as Zamzam, said to have been created by the child Ismail, which continues to flow today. Today the water is brought from the well of Zamzam, purified, cooled, and pumped into the Mosque via a tap. There are no other requirements for performance, people are free to shop in the malls, or take tours, except that a final act before leaving Saudi Arabia is to perform a final tawaf.

Pilgrims from outside Saudi Arabia are required to leave the country by the 10th of  Muharram , about one month after the completion of the pilgrimage.

After Hajj, pilgrims often return home with renewed faith and are given honorific titles of Hajji.

Foundation Myth of the Hajj

According to legend, Allah sent Muhammad to perform the Hajj in remembrance of the Quranic version of the biblical story of Abraham, Hagar, and Ishmael.

Abraham is the patriarch of the three great Abrahamic religions of the Western world: Islam, Judaism , and Christianity. As told in the book of Genesis in the Torah, Abraham's first wife, Sarah, could not conceive, and she arranged for Abraham to sleep with their Egyptian slave girl and Pharaoh's daughter Hagar, in order for him to have sons. Hagar had a boy, named Ishmael; after that, God made it possible for Sarah to conceive and she had a boy named Isaac. Ishmael, called Ismail in Quranic records, is the ancestor of the Prophet Muhammad. 

The version in Genesis says that Sarah had Hagar and Ishmael thrown out of Abraham's house, and they wandered the desert. The versions provided by the Quran and Muslim scholars are similar, except that Abraham (Ibrahim) takes his wife Hagar (Hajira or Hajar) and Ishmael (Ismail) into the desert, where he leaves them, returning to Canaan. Left in the desert, Hajira desperately seeks water for her son, running between the two hills called Safa and Marwa. She collapses and prays to Allah for deliverance. Ismail strikes his foot in the ground and finds the spring (later called Zamzam), and they are saved and found the city of Mecca. 

Ibrahim returned to Hajira and Ismail and, rejoicing that they survived the ordeal, Ishmael and Ibrahim build a shrine (the Ka'aba) at that place. The Quran says that Abraham must sacrifice his son; Islamic scholars say that son is Ismail (Genesis says that son was Sarah's son Isaac). The devil tempts Ibrahim three times, telling him that he should not sacrifice his son, but Ibrahim persists. Before he can kill his son, Allah intervenes and an unspecified "great sacrifice" is made instead.

Annual Dates of the PIlgrimage

The Hajj always takes place between the eighth and 12th day of Dhul-HIjjah ("The Month of the Pilgrimage" in Arabic), which is the last month in the Muslim lunar calendar. Matching Gregorian dates are not precisely predictable from year to year.

The Muslim calendar (or Hijiri Calendar) is used to determine the dates of religious events and observances, and the timing of the months is based on astronomical observation—Islamic astronomers and mathematicians are famous for their brilliance. Any new month can only begin when a waxing crescent moon is seen shortly after sunset. Lunar calendars are 11 days shorter than solar ones, so each festival starts 11 days earlier in the year than the previous year. The date of the Hajj, which falls in the last lunar month, is not determined until an authoritative body—in this case, Saudi Arabia's High Judicial Court—can see the waxing crescent moon in the sky shortly after sunset on the 29th day of the previous month. If the sky is obscured by clouds or other astronomical forces the new month must begin a day later. 

For financial and business uses and rather than relying on visual sightings, Saudi Arabia bases its calendar on a calculated astronomical moon. The Tabular Islamic calendar is 354 days long, broken into 12 months with predetermined lengths and adjustments for leap years. But the precise starting day of the Hajj is still not determined until eight days before the Hajj is set to begin.

Estimated Gregorian dates for the next few years have been calculated by several sources, but they don't coincide and the dates are tentative.

Modern Changes in the Pilgrimage

Jasmin Merdan/Getty Images

In 1950, only 100,000 people attended the Hajj; people were discouraged from taking photographs and cameras were even confiscated. Then, as now, the Hajj is a requirement, it is the fifth pillar of Islam, and it is required that each individual Muslim do so, if he or she is healthy and wealthy enough to make the pilgrimage during their adulthood. However, with the advance of modern freeways and charted air flights, more and more people make the journey more than once.

In addition to a complicated logistical structure that involves visas and crowd control, security details, GPS units, and security cameras, the Saudi government has created Mecca as a global marketplace, and the Sacred Mosque has expanded to become a place where tens of thousands of people can perform tawaf at once.

Participants in the 2018 Hajj were nearly equal numbers of men and women; people commonly bring their children, and their cell phones, and many blog or live stream the events as they experience them. Pilgrims still need to walk if they can, they still sleep outside at Mina, and they still stand or sit in the Plain of Arafat: but modern distractions have replaced some of the hardships of the early Hajj.

• Amanullah, Shahed. " Hajj 2.0: Technology's Impact on the Muslim Pilgrimage ." Georgetown Journal of International Affairs 10.2 (2009): 75–82. Print.
• Clingingsmith, David, Asim Ijaz Khwaja, and Michael Kremer. " Estimating the Impact of the Hajj: Religion and Tolerance in Islam's Global Gathering. " Quarterly Journal of Economics 124.3 (2009): 1133–70. Print.
• Din, Abdul Kadir Haji. " Economic Implications of Moslem Pilgrimage from Malaysia ." Contemporary Southeast Asia 4.1 (1982): 58–75. Print.
• Gatrad, Abdul Rashid, and Aziz Sheikh. " Hajj: Journey of a Lifetime ." BMJ: British Medical Journal 330.7483 (2005): 133–37. Print.
• Ladjal, Tarek, et al. "Asian Hajj Routes: The Reflection of History and Geography." Middle-East Journal of Scientific Research 14.12 (2013): 1691–99. Print.
• Ryad, Umar. " On His Donkey to the Mountain of Ἁrafāt: Dr. Van Der Hoog and His Hajj Journey to Mecca ." The Hajj and Europe in the Age of Empire . Ed. Umar Ryad. Brill, 2017. 185–216. Print.
• Williams, Jennifer. " Hajj, the Islamic Pilgrimage to Mecca, Explained for Non-Muslims ." Vox Culture . August 20, 2018. Web.
• The Architecture and History of the Kaaba
• Meaning and Significance of the Day of Arafat
• What Is the Significance of the First 10 Days of Dhul Hijjah?
• The Major Holidays Celebrated by Muslims
• Makkah Visitors Guide
• The Specific Dates for the Day of Arafat from 2017 to 2025
• Lesson Plans for Eid al Adha, an Islamic Celebration
• Prophet Ibrahim (Abraham)
• Biography of the Prophet Muhammad's Later Life
• Overview of the Islamic Calendar
• When Is the Hajj Held?
• All About Ramadan, Islam's Holy Month
• Why and When Do Muslim Girls Wear the Hijab?
• What Is the Ka'aba in Mecca?
• What happens after one performs Hajj?

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Hajj: journey of a lifetime

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• Peer review

This article has a correction. Please see:

• Hajj: journey of a lifetime - August 18, 2005
• Abdul Rashid Gatrad ( sec.gatrad{at}walsallhospitals.nhs.uk ) , consultant paediatrician 1 ,
• Aziz Sheikh , professor of primary care research and development 2
• 1 Manor Hospital, Walsall WS2 9PS
• 2 Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh
• Correspondence to: A R Gatrad
• Accepted 22 November 2004

Introduction

Journeying to Mecca for Hajj (pilgrimage) is no ordinary undertaking for many Muslims (boxes 1 and 2; fig 1 ). Hajj represents the culmination of years of spiritual preparation and planning. Once they have completed the pilgrimage, pilgrims are given the honorific title Hajji (pilgrim).

Holy Ka'bah, Mecca, Saudi Arabia

Hajj commemorates the patriarch Abraham's readiness to sacrifice his son Ishmael in biblical times. Performing Hajj is one of the five pillars of Islam and is therefore obligatory for all adult Muslims who can afford to undertake the journey and are in good health. Hajj lasts for five days, and, as the Islamic calendar is lunar, the precise Gregorian calendar dates of the Hajj season will vary each year. Muslims travel to Mecca at other times to perform a lesser pilgrimage called Umrah.

Mecca's resident population of about 200 000 swells to well over two million during the Hajj season. This rapid increase in numbers poses many challenges, including ensuring adequate food, water, and sanitary facilities in Mecca and the neighbouring deserts of Mina and Arafat, which pilgrims must visit as part of the Hajj ritual.

Although the journey is incumbent on a Muslim only once in a lifetime, many Muslims, particularly those living in the West, will journey more often. For example, more than 20 000 Britons do the Hajj each year, and the current annual figure for Umrah stands at almost 29 000. 3 In view of the very large numbers of people from disparate regions and the hostile climate of the Arabian desert, the chances of disease, particularly in elderly and infirm people, are high.

In this paper, we briefly describe the main rites of the Hajj before focusing on particular health risks associated with it and measures that may be taken to minimise them. Our main aim is to offer practical advice to healthcare professionals providing care to people intending to travel on Hajj.

We drew on materials identified from searches of Medline, internet searches of Islamic websites, fatwa banks, and our personal libraries. To supplement these sources, we drew on our personal experiences of having travelled to Saudi Arabia on both Hajj and Umrah, running Hajj preparatory courses, and issuing medical advice to people intending to travel on Hajj and Umrah.

Summary points

Hajj, the journey to the Sacred Mosque in Mecca, is a once in a lifetime obligation for all adult Muslims who are physically and financially able

Each year, more than two million people globally, including 1% of the British Muslim community, take part in the Hajj

If the pilgrim is unprepared, the health risks associated with the Hajj are considerable; most important are the risks of heat exhaustion, heatstroke, and infectious diseases

All pilgrims must be vaccinated against meningococcal disease; a “Hajj travel consultation” is thus mandatory, offering the ideal opportunity for health promotional advice

The rites of Hajj

Many prospective pilgrims fail to appreciate that Hajj is physically demanding. It is the most complex of the Islamic rituals and involves, among other things, walking long distances and camping in desert tents, often with only the most basic sanitation. 4 Central in these activities is the pilgrim's presence on the desert plain of Arafat, from noon until sundown. Here, dressed in the simplest possible garb made up of two pieces of unstitched cloth for men (Ihram), with women wearing their usual clothing with a headscarf, pilgrims will spend much of the day standing in humility and prayer, performing a dress rehearsal for the final standing before God on Judgment Day.

Box 1: The Sacred Mosque (Ka'bah)

“A curious object, that Ka'bah! There it stands at this hour, in the black cloth-covering the Sultan sends it yearly; ‘twenty-seven cubits high'; with circuit, with double circuit of pillars, with festoon-rows of lamps and quaint ornaments: the lamps will be lighted again this night—to glitter again under the stars. An authentic fragment of the oldest Past. It is the Qiblah (direction of prayer) of all Muslims: from Delhi all onwards to Morocco, the eyes of innumerable praying men are turned towards it, five times, this day and all days: one of the notablest centres in the Habitation of Men.”—Thomas Carlyle 1

Box 2: Journeying home

“And when, as a pilgrim, he stands before the Ka'bah in Mecca (after circling it seven times), the centrality already prefigured by his orientation when he prayed far off is made actual. Clothed only in two pieces of plain, unsewn cloth, he has left behind him the characteristics which identified him in the world, his race, his nationality, his status; he is no longer so-and-so from such-and-such a place, but simply a pilgrim.

“Beneath his bare feet, like mother-of-pearl, is the pale marble of this amphitheatre at the centre of the world, and although he is commanded to lower his eyes when praying elsewhere, he is now permitted to raise them and look upon the Ka'bah, which is the earthly shadow of the Pole or Pivot around which circle the starry heavens. Although Paradise may still seem far distant, he has already come home.”—Gai Eaton 2

Box 3: Next please!

“In the next few days, prostration from (heat) exposure passed at a rapid clip through the hotel. Striking down groups of four or five, it moved from room to room and floor to floor. Soon the hotel began to resemble an infirmary, with dozens of guests in various stages of illness strewn around the lobby every night. Guides were not spared.

“Every day the temperature climbed by one or two degrees. At midnight the mercury remained above one hundred Fahrenheit.”—Michael Wolfe 6

Because of the large numbers of people, performing even the simplest rites can take an extraordinary length of time. A religious dispensation exists for those in poor health, and many will make use of this allowance after consultation with their doctor 5 ; some will, however, travel against medical advice, often in the hope of dying in the Holy Land. For Muslims living in the West, the decision of whether or not to travel on health grounds is often more complex, as most health professionals are unaware of what the Hajj entails or its associated health risks and, therefore, typically find it difficult to offer an informed opinion.

Minimising risks to health

Problems of sun and heat.

Travelling to Mecca in advance of the Hajj is sensible, particularly for people unaccustomed to the oppressive climate of the Arabian desert (box 3). Pilgrims need to be made aware that acclimatisation to very high temperatures—which occurs through a gradual increase in sweat production, thereby facilitating cooling through increased water evaporation—can take between one and two weeks. 7

Sunburn is an important hazard, particularly for light skinned people. An appropriate strength sun block will minimise the risks of burning, with its associated risk of malignant tumours. Sun exposure must be kept to a minimum as discussed below.

Even when Hajj occurs during winter, the average temperature is over 30°C during the day and 20°C at night. Heat exhaustion and heatstroke are common and can be fatal, as evidenced by one study that reported more than 1700 fatalities in a single Hajj season, most of which were judged to be heat related. 8 The Saudi authorities, in their role as the pilgrims' hosts, undertake valuable health promotional work, distributing leaflets and issuing radio and television warnings of the dangers of excessive sun exposure. The number of people who still die of heat is evidence that the message needs to be reiterated at every possible opportunity.

During the Hajj, men are prohibited from directly covering their heads (with a hat or scarf, for example), thereby increasing the risk of heat exposure. The usefulness of a good quality umbrella, preferably white in colour, to deflect the sun “away,” cannot be overemphasised ( fig 2 ). Such simple measures could be life saving if the pilgrim was to lose his or her bearing in the desert, as is easily and not infrequently done. Box 4 summarises other important precautions.

Umbrellas (preferably white) provide useful shade

Heat exhaustion typically occurs in people who are not acclimatised and undertake strenuous exercise. Water depletion or a combination of salt and water depletion due to excessive sweating is the underlying cause. Up to 5 litres of water and up to 20 g of salt a day may be lost. Most cases are relatively mild, with symptoms of weakness, lightheadedness, and muscle cramps that will respond to a combination of rest, cooling, and fluid and salt replacement. Without adequate treatment, however, heatstroke may occur. 9 10 Although salt tablets may be taken, they can cause vomiting and gastrointestinal upset, so we suggest that a quarter of a level teaspoon of salt (approximately 1 g) is added to a pint, or two level teaspoons to a gallon (approximately 5 l), of drinking water during travel; this concentration is below the taste threshold. 11

Box 4: Precautionary measures to minimise the risk of heat exhaustion and heatstroke

Avoid spending long periods in the sun, particularly when it is at its zenith

Travel by night whenever possible (which may also avoid stampedes)

Keep your head covered during the day (with an umbrella if necessary)

Consume large volumes of fluid throughout the day

Always keep a canister of fluid in your possession

Increase dietary salt intake or use salt tablets

Avoid travelling in “open top” buses

Heatstroke is a medical emergency (box 5) and can occur within 20 minutes of severe exertion. 12 Skin is hot to the touch, and there is a notable absence of sweating. Young children, elderly people, and people with diabetes are most at risk. The extreme rise in body temperature makes prompt and appropriate treatment imperative. Patients should be moved into the shade, stripped, cooled with a combination of fanning and spraying the body with tepid water, and, if conscious, given fluid replacement, while expert medical attention is urgently sought.

Since the early 1980s, cooling units have been installed along the pilgrim route. Emergency services will often suspend patients in a hammock-like bed and spray them liberally with an air-water mixture. The water is warm and cools the body through evaporation, simultaneously preventing further dehydration. These simple devices are significantly quicker in reducing body temperature than the usual method of placing patients in an ice bath, possibly because vasoconstriction and shivering are not induced—responses that ultimately cause the body temperature to rise. 13

Most pilgrims travel on foot, so good quality footwear is important, although in our experience it is often overlooked. During the day, the desert sand typically becomes burning hot. Care needs to be taken to avoid walking barefoot because of the serious risk of burns to the foot. This is particularly important for people with diabetic neuropathy, as very extensive damage may quickly occur, often compounded by the problems of poor wound healing and the increased risk of infection. Footwear must be removed before prayers, and people who have not been on Hajj are often unaware of the ease with which footwear can become confused with another pilgrim's and thus be inadvertently taken. Pilgrims may be forced to walk barefoot in an attempt to reclaim their footwear, with potentially devastating consequences. Thus pilgrims should be advised to carry footwear in a bag at all times.

Box 5: Symptoms suggesting heat exhaustion and heatstroke

Fatigue, weakness, and leg cramps

Headache, nausea, and vomiting

Syncope and coma

Infectious diseases

An outbreak of group A meningococcal meningitis occurred among British Muslim pilgrims after the 1987 Hajj. Eighteen primary cases occurred among pilgrims and 15 subsequent cases among their direct and indirect contacts. 14 15 Similarly, outbreaks of W135 meningococcal disease occurred among British pilgrims in 2000 and 2001. The Saudi authorities now insist that all pilgrims are vaccinated with two doses of ACWY Vax (three months apart) with conjugate meningitis vaccination. 16 Immunity is thought to last for approximately three years. A medical certificate confirming vaccination is now required before visas will be issued.

Vaccination against hepatitis A and malaria prophylaxis, together with advice on measures to minimise the risk of exposure, are important. We recommend vaccination against hepatitis B (see below). In addition to checking tetanus and polio status, typhoid and diphtheria vaccination should be considered. Many people decide to travel on from the Hajj, particularly to Africa and the Indian sub-continent, so taking details of travel plans is important. Pilgrims need to be reminded of the importance of seeking medical attention for any unexpected symptoms, such as fever, diarrhoea, or jaundice, or a high fever on their return. A persistent cough is also significant because of the reported high incidence of pneumonia (particularly tuberculous) among pilgrims. 17 18

One of the rites of the Hajj is for men to have the head shaved (although trimming the hair is also acceptable). Most will have their heads shaved, often in makeshift centres run by opportunistic “barbers.” A razor blade is commonly used, and it may be used on several scalps before being ultimately discarded. The risks of important bloodborne infections such as HIV and hepatitis B and C are obvious, especially considering that many pilgrims will come from regions where such infections are now endemic. Pilgrims need to be aware of these dangers and should insist on the use of a new blade. Physical relationships are prohibited during Hajj, even between husband and wife, so the risks of acquiring sexually transmitted diseases are minimal.

Minor injuries are relatively common, particularly to the toes; these typically result from inadvertently being stamped on while circumambulating the Ka'bah barefoot. More serious injuries, some of which prove to be fatal, occur each year during stampedes in Mina as pilgrims undertake the stoning rite ( fig 3 ). Pilgrims should be advised to avoid peak times, and old and infirm people should be advised to consider appointing a proxy for the performance of this rite. Major trauma and death from road traffic crashes is a further important cause of injury in pilgrims. 19

The stoning rite in Mina

Chronic disorders

Travellers with chronic medical conditions should take sufficient supplies of their usual drugs and also carry a written record of these, giving their generic names, in case further supplies are needed. A letter documenting medical problems and drugs will allow rapid assessment should an illness occur and will also be of help through customs.

Diabetes Diabetes is common among South Asian Muslims and often leads to health problems during the Hajj. During travel, insulin should not be put in the luggage hold of an aircraft as it may freeze. Insulin should be refrigerated, but not in the freezer compartment, during the stay in Saudi Arabia.

If any illness occurs, diabetic control will need careful monitoring and insulin may be temporarily needed in people with type 2 diabetes. Although problems of hyperglycaemia and hypoglycaemia can occur, the second of these is more common as a result of increased physical activity. 20 Food intake may therefore have to be increased before exertion. Hypoglycaemia may also occur if the insulin in Saudi Arabia is different from that of the patient's country of origin, so anyone accompanying a person with diabetes should be aware of the symptoms of hypoglycaemia.

We are aware of an education programme that includes classes on factors relating to diabetes, along with more practical matters concerning the Hajj. 21 During these classes advice on footwear, insulin storage, food, drug doses, and immunisations are discussed. Such innovative projects could be further promoted by the Department of Health working collaboratively with, for example, the Muslim Council of Britain.

Box 6: Considerations in the “Hajj travel consultation”

Fitness to perform the Hajj

Heat exhaustion and heatstroke

Foot burns and sunburn

General travel advice

Emergency numbers: ambulance 997; police 999

General advice

Menstruation is considered a state of ritual impurity, so menstruating women are not permitted to perform the Hajj. This often causes a great deal of concern, which is perfectly understandable if one remembers the importance of the journey and the time, effort, and money that may have been invested. Delaying menstrual bleeding, by using the combined contraceptive pill or daily progesterone, for example, is perfectly acceptable; many women consult their general practitioners or family planning clinics for this reason in the run up to the Hajj season.

Contact lenses are also often problematic, particularly in arid conditions where sand can be blown into the eyes. Ocular lubricants (such as hypromellose 1% eye drops) should be used liberally to stop lenses adhering to the cornea. Temporarily using spectacles may be another option.

Although several makeshift dispensaries are erected during the Hajj season, these are often difficult to access, largely on account of the human mass. Pilgrims should ensure that they take small supplies of common remedies, such as analgesics and clove oil for dental pain. A simple travel pack containing adhesive dressings, an insect repellent, antiseptic cream, and water sterilisation tablets is also useful.

The “Hajj travel consultation”

All potential pilgrims must now be protected against meningococcal disease, and this opportunity to review patients can be used to impart other advice (box 6). Several known risks are associated with pilgrimage to Mecca and can mar the entire experience. That said, most of these problems should, with sensible precautions, now be preventable. However, in patients who have returned from pilgrimage doctors should be vigilant for signs of diseases such as meningitis, tuberculosis, hydatid disease, malaria, and hepatitis. Fever, rash, jaundice, pyoderma, foot ulcers, diarrhoea, or vomiting should alert a healthcare professional to the possibility of an infection having been acquired during Hajj.

Acknowledgments

We acknowledge the source of the material for this article as follows: Sheikh A, Gatrad A. Caring for Muslim patients . Oxford: Radcliffe Medical Press, 2000; Sheikh A, Gatrad A, Hansan H. Caring for Muslim patients . 2nd ed, in preparation. Oxford: Radcliffe Publishing. Reproduced with the permission of the copyright holder. We thank the Islamic Foundation, Leicester, for providing the photographs and M Walji from the World Federation of Khoja Shia Ithna-Asheri Muslim communities for advice.

Contributors AS and ARG jointly conceived the idea of this paper. AS took the lead in drafting the manuscript, and ARG contributed to subsequent drafts. ARG is the guarantor

Funding None

Competing interests This review is adapted from a chapter in our book Caring for Muslim Patients. Radcliffe Medical Press, 2000.

• Muslim Council of Britain
• Clarke CRA ,
• Al Ghamdi SM ,
• Fathaldin OA ,
• Al-Rashed RS
• Ghaznawi HI ,
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• Al-Sugair N ,
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Hajj: The Journey of a Lifetime

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Yan's Hajj: The Journey of a Lifetime Paperback – Picture Book, April 17, 2018

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• Reading age 5 - 8 years
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• Publisher ‏ : ‎ The Islamic Foundation (April 17, 2018)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 32 pages
• ISBN-10 ‏ : ‎ 0860376230
• ISBN-13 ‏ : ‎ 978-0860376231
• Reading age ‏ : ‎ 5 - 8 years
• Item Weight ‏ : ‎ 2.31 pounds
• Dimensions ‏ : ‎ 8.6 x 0.2 x 8.5 inches
• #300 in Children's Muslim Fiction
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About the author

Fawzia gilani-williams.

Dr. Fawzia Gilani-Williams is the Cluster Lead Librarian for Bloom Education, UAE and serves as a research fellow for the Eid Stories Institute for Literary Studies and Peace Research in the UK. Born and raised in England, Fawzia earned a Ph.D in the field of English Language and Literature from the University of Worcester. Her Master's degree is from the University of Birmingham, UK. She is an internationally experienced principal, teacher and researcher. Fawzia’s areas of specialization include elementary education, Islamic children’s literature, and creative writing. Her research interests are child identity and empowerment, character development, and Islamic critical theory. She has written a number of ‘mirror books’ and ‘window books’ to promote intercultural literacy, emotional development and social flourishing. She is the author of the Islamic fairy tale series produced by Kube, UK. Her titles include Cinderella, Snow White, Sleeping Beauty, and Rapunzel which together underscore moral power, quiet heroism and multicultural cognizance. Fawzia’s book, Yaffa and Fatima Shalom Salaam, illustrated by Chiara Fedele was awarded a silver medal by the Sydney Taylor Book Award.

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In this heart-warming tale about helping others, Yan’s trip to perform Hajj turns into a journey that lasts a lifetime. Yan is a big-hearted young man determined to perform Hajj, the pilgrimage to Makkah. But first, he must work hard on his farm and fill up his money bag for the journey. Despite the trials he faces on each unsuccessful trip to the Kaaba, Yan’s helpful nature, compassion, and generosity enable him to succeed in the end. Fawzia Gilani-Williams was born in England where she graduated as a teacher. She serves as an international educational consultant with a PhD in children’s literature and character development. She is a Global Representative for the International Positive Education Network and works for the Abu Dhabi Education Council in the UAE. Sophie Burrows is a children’s illustrator based in England.

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Hajj - The Journey of a Lifetime (part 2 of 2): The Rites of Abraham

Description: one fifth of humankind shares a single aspiration: to complete, at least once in a lifetime, the spiritual journey called the hajj.  part two: the procession from arafah until the last of the rites, and a hajj accepted by the almighty..

• By Nimah Ismail Nawwab (edited by M. Abdulsalam)
• Published on 27 Dec 2006
• Last modified on 17 Dec 2007
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Just after sunset, the mass of pilgrims proceeds to Muzdalifah, an open plain about halfway between Arafat and Mina.  There they first pray and then collect a fixed number of chickpea-sized pebbles to use on the following days.

Throwing the pebbles is symbolic of humans’ attempt to cast away evil and vice, not once but seven times - the number seven symbolizing infinity.

Following the casting of the pebbles, most pilgrims sacrifice a goat, sheep or some other animal.  They give the meat to the poor after, in some cases, keeping a small portion for themselves.

This rite is associated with Abraham’s readiness to sacrifice his son in accordance with God’s wish.  It symbolizes the Muslim’s willingness to part with what is precious to him, and reminds us of the spirit of Islam, in which submission to God’s will plays a leading role.  This act also reminds the pilgrim to share worldly goods with those who are less fortunate, and serves as an offer of thanksgiving to God.

As the pilgrims have, at this stage, finished a major part of the hajj , they are now allowed to shed their ihram and put on everyday clothes.  On this day Muslims around the world share the happiness the pilgrims feel and join them by performing identical, individual sacrifices in a worldwide celebration of ‘Eid al-Adha, “the Festival of Sacrifice.”  Men either shave their heads or clip their hair, and women cut off a symbolic lock, to mark their partial deconsecration.  This is done as a symbol of humility.  All proscriptions, save the one of conjugal relations, are now lifted.

Thomas Abercrombie, a convert to Islam and a writer and photographer for National Geographic Magazine, performed the hajj in the 1970’s and described the sense of unity and harmony pilgrims feel during the circling:

“Seven times we circled the shrine repeating the ritual devotions in Arabic: ‘Lord God, from such a distant land I have come unto Thee....  Grant me shelter under Thy throne.’  Caught up in the whirling scene, lifted by the poetry of the prayers, we orbited God’s house in accord with the atoms, in harmony with the planets.”

While making their circuits pilgrims may kiss or touch the Black Stone.  This oval stone, first mounted in a silver frame late in the seventh century, has a special place in the hearts of Muslims as, according to some hadeeth, it is the sole remnant of the original structure built by Abraham and Ishmael.  But perhaps the single most important reason for kissing the stone is that the Prophet did so.

No devotional significance whatsoever is attached to the stone, for it is not, nor has ever been, an object of worship.  The second caliph, Umar ibn al-Khattab, made this crystal clear when, on kissing the stone himself in emulation of the Prophet, he proclaimed:

“I know that you are but a stone, incapable of doing good or harm.  Had I not seen the Messenger of God kiss you - may God’s blessing and peace be upon him - I would not kiss you.”

After completing the tawaf , pilgrims pray, preferably at the Station of Abraham, the site where Abraham stood while he built the Kaaba.  Then they drink of the water of Zamzam.

Another, and sometimes final, rite is the sa’y , or “exerting.”  This is a reenactment of a memorable episode in the life of Hagar, who was taken into what the Quran calls the “uncultivable valley” of Mecca, with her infant son Ishmael, to settle there.

The sa’y commemorates Hagar’s frantic search for water to quench Ishmael’s thirst.  She ran back and forth seven times between two rocky hillocks, al-Safa and al-Marwah , until she found the sacred water known as Zamzam.  This water, which sprang forth miraculously under Ishmael’s tiny feet, is springs from the same well from which pilgrims drink today

These rites performed, the pilgrims are completely deconsecrated: They may resume all normal activities.  They now return to Mina, where they stay up to the 12th or 13th day of Dhu al-Hijjah.  There they throw their remaining pebbles at each of the pillars in the manner practiced or approved by the Prophet.  They then take leave of the friends they have made during the Hajj .  Before leaving Mecca, however, pilgrims make a final tawaf round the Kaaba to bid farewell to the Holy City.

Usually pilgrims either precede or follow the hajj , “the greater pilgrimage,” with the umrah , “the lesser pilgrimage,” which is sanctioned by the Quran and was performed by the Prophet.  The umrah , unlike the hajj , takes place only in Mecca itself and can be performed at any time of the year.  The ihram , talbiyah and the restrictions required by the state of consecration are equally essential in the umrah , which also shares three other rituals with the hajj : the tawaf , sa’y and shaving or clipping the hair.  The observance of the umrah by pilgrims and visitors symbolizes veneration for the unique sanctity of Mecca.

In this city, loved by Muslims for centuries, people still feel the effect of the Prophet’s life.  Muhammad Asad, an Austrian Jew who converted to Islam in 1926 and made five pilgrimages between 1927 and 1932, comments on this aspect of the city:

“Even after thirteen centuries [the Prophet’s] spiritual presence is almost as alive here as it was then.  It was only because of him that the scattered group of villages once called Yathrib became a city and has been loved by all Muslims down to this day as no city anywhere else in the world has ever been loved.  It has not even a name of its own: for more than thirteen hundred years it has been called Madinat an-Nabi , ‘the City of the Prophet.’  For more than thirteen hundred years, so much love has converged here that all shapes and movements have acquired a kind of family resemblance, and all differences of appearance find a tonal transition into a common harmony.”

As pilgrims of diverse races and tongues return to their homes, they carry with them cherished memories of Abraham, Ishmael, Hagar, and Muhammad.  They will always remember that universal concourse, where poor and rich, black and white, young and old, met on equal footing.

They return with a sense of awe and serenity: awe for their experience at Arafat, when they felt closest to God as they stood on the site where the Prophet delivered his sermon during his first and last pilgrimage; serenity for having shed their sins on that plain, and being thus relieved of such a heavy burden.  They also return with a better understanding of the conditions of their brothers in Islam.  Thus is born a spirit of caring for others and an understanding of their own rich heritage that will last throughout their lives.

The pilgrims go back radiant with hope and joy, for they have fulfilled God’s ancient injunction to humankind to undertake the pilgrimage.  Above all, they return with a prayer on their lips: May it please God, they pray, to find their hajj acceptable, and may what the Prophet said be true of their own individual journey:

“There is no reward for a pious pilgrimage but Paradise.” ( Al-Tirmidhi )

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Preparations Begin For Annual Haj Pilgrimage, First-Time Travelers Begin Their Training For Haj Journey

W ith the annual Haj to the Muslim holy cities of Mecca and Medina set to be held between June 14 and 19 approximately, community groups and government organisations that facilitate the pilgrimage have started training those who have been selected for the journey.

The pilgrimage is one of the obligatory duties of a Muslim and this year, 1.75 lakh will undertake the journey from India, a majority of whom will be first-time air travelers with no knowledge of immigration procedures. Community groups are stepping in to prepare the pilgrims for the trip, which will be a once-in-a-lifetime experience for most. According to those who are following the progress, there have been communications between the Indian and Saudi Arabian governments on the possibility of increasing the quota community groups in Mumbai want the quota of 2.25 lakh.

Empowering Pilgrims: Training Workshops Prepare Haj Travelers For International Journey

Trainers from the Haj Committee of India and the Maharashtra State Haj Committees, which are government organisations that facilitate the pilgrimage, started a three-day workshop from Friday in central Mumbai. The Sunni Dawate Islami, a community group, will be holding similar camps. At these workshops, pilgrims learn about the dos and don’ts of international travel. They are informed about items prohibited in the luggage, documents needed for travel, immigration procedures, and travel etiquette.

“Between 80 to 90% of them are travelling abroad for the first time. In case of those travelling through the Haj Committees, this percentage is higher. Many of them are senior citizens who may not be familiar with immigration procedures,” said Shams Chowdhury of the Haj Pilgrims Social Welfare Group, which organises such workshops.

“Besides the pilgrims are also India’s ambassadors and how they conduct the journey has a bearing on the country’s image,” Shams said, adding that pilgrims from Indonesia, which is the country with the largest Muslim population in the world sends the biggest contingent of pilgrims, are reputed to the best behaved because of the training they receive before they embark on the journey.

Training and Guidance for Haj Pilgrims: Etiquette, Crowd Behavior And Practical Tips

Pilgrims are taught about crowd behaviour at choke points during the journey and not to argue or shout at immigration officials and fellow travellers. Many of them also get advice on how to use toilet facilities on the aircraft and at the pilgrimage sites.

The Haj Committee of India has also released a series of videos with information and instructions for the pilgrimage. The fee for a Haj Committee-assisted is s estimated to be between Rs3.2 and Rs3.3 lakh.

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• v.330(7483); 2005 Jan 15

Hajj: journey of a lifetime

Abdul rashid gatrad.

1 Manor Hospital, Walsall WS2 9PS

Aziz Sheikh

2 Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh

Introduction

Journeying to Mecca for Hajj (pilgrimage) is no ordinary undertaking for many Muslims (boxes 1 and 2; fig 1 ). Hajj represents the culmination of years of spiritual preparation and planning. Once they have completed the pilgrimage, pilgrims are given the honorific title Hajji (pilgrim).

Holy Ka'bah, Mecca, Saudi Arabia

Hajj commemorates the patriarch Abraham's readiness to sacrifice his son Ishmael in biblical times. Performing Hajj is one of the five pillars of Islam and is therefore obligatory for all adult Muslims who can afford to undertake the journey and are in good health. Hajj lasts for five days, and, as the Islamic calendar is lunar, the precise Gregorian calendar dates of the Hajj season will vary each year. Muslims travel to Mecca at other times to perform a lesser pilgrimage called Umrah.

Mecca's resident population of about 200 000 swells to well over two million during the Hajj season. This rapid increase in numbers poses many challenges, including ensuring adequate food, water, and sanitary facilities in Mecca and the neighbouring deserts of Mina and Arafat, which pilgrims must visit as part of the Hajj ritual.

Although the journey is incumbent on a Muslim only once in a lifetime, many Muslims, particularly those living in the West, will journey more often. For example, more than 20 000 Britons do the Hajj each year, and the current annual figure for Umrah stands at almost 29 000. 3 In view of the very large numbers of people from disparate regions and the hostile climate of the Arabian desert, the chances of disease, particularly in elderly and infirm people, are high.

In this paper, we briefly describe the main rites of the Hajj before focusing on particular health risks associated with it and measures that may be taken to minimise them. Our main aim is to offer practical advice to healthcare professionals providing care to people intending to travel on Hajj.

We drew on materials identified from searches of Medline, internet searches of Islamic websites, fatwa banks, and our personal libraries. To supplement these sources, we drew on our personal experiences of having travelled to Saudi Arabia on both Hajj and Umrah, running Hajj preparatory courses, and issuing medical advice to people intending to travel on Hajj and Umrah.

Summary points

Hajj, the journey to the Sacred Mosque in Mecca, is a once in a lifetime obligation for all adult Muslims who are physically and financially able

Each year, more than two million people globally, including 1% of the British Muslim community, take part in the Hajj

If the pilgrim is unprepared, the health risks associated with the Hajj are considerable; most important are the risks of heat exhaustion, heatstroke, and infectious diseases

All pilgrims must be vaccinated against meningococcal disease; a “Hajj travel consultation” is thus mandatory, offering the ideal opportunity for health promotional advice

The rites of Hajj

Many prospective pilgrims fail to appreciate that Hajj is physically demanding. It is the most complex of the Islamic rituals and involves, among other things, walking long distances and camping in desert tents, often with only the most basic sanitation. 4 Central in these activities is the pilgrim's presence on the desert plain of Arafat, from noon until sundown. Here, dressed in the simplest possible garb made up of two pieces of unstitched cloth for men (Ihram), with women wearing their usual clothing with a headscarf, pilgrims will spend much of the day standing in humility and prayer, performing a dress rehearsal for the final standing before God on Judgment Day.

Box 1: The Sacred Mosque (Ka'bah)

“A curious object, that Ka'bah! There it stands at this hour, in the black cloth-covering the Sultan sends it yearly; `twenty-seven cubits high'; with circuit, with double circuit of pillars, with festoon-rows of lamps and quaint ornaments: the lamps will be lighted again this night—to glitter again under the stars. An authentic fragment of the oldest Past. It is the Qiblah (direction of prayer) of all Muslims: from Delhi all onwards to Morocco, the eyes of innumerable praying men are turned towards it, five times, this day and all days: one of the notablest centres in the Habitation of Men.”—Thomas Carlyle 1

Box 2: Journeying home

“And when, as a pilgrim, he stands before the Ka'bah in Mecca (after circling it seven times), the centrality already prefigured by his orientation when he prayed far off is made actual. Clothed only in two pieces of plain, unsewn cloth, he has left behind him the characteristics which identified him in the world, his race, his nationality, his status; he is no longer so-and-so from such-and-such a place, but simply a pilgrim.

“Beneath his bare feet, like mother-of-pearl, is the pale marble of this amphitheatre at the centre of the world, and although he is commanded to lower his eyes when praying elsewhere, he is now permitted to raise them and look upon the Ka'bah, which is the earthly shadow of the Pole or Pivot around which circle the starry heavens. Although Paradise may still seem far distant, he has already come home.”—Gai Eaton 2

Box 3: Next please!

“In the next few days, prostration from (heat) exposure passed at a rapid clip through the hotel. Striking down groups of four or five, it moved from room to room and floor to floor. Soon the hotel began to resemble an infirmary, with dozens of guests in various stages of illness strewn around the lobby every night. Guides were not spared.

“Every day the temperature climbed by one or two degrees. At midnight the mercury remained above one hundred Fahrenheit.”—Michael Wolfe 6

Because of the large numbers of people, performing even the simplest rites can take an extraordinary length of time. A religious dispensation exists for those in poor health, and many will make use of this allowance after consultation with their doctor 5 ; some will, however, travel against medical advice, often in the hope of dying in the Holy Land. For Muslims living in the West, the decision of whether or not to travel on health grounds is often more complex, as most health professionals are unaware of what the Hajj entails or its associated health risks and, therefore, typically find it difficult to offer an informed opinion.

Minimising risks to health

Problems of sun and heat.

Travelling to Mecca in advance of the Hajj is sensible, particularly for people unaccustomed to the oppressive climate of the Arabian desert (box 3). Pilgrims need to be made aware that acclimatisation to very high temperatures—which occurs through a gradual increase in sweat production, thereby facilitating cooling through increased water evaporation—can take between one and two weeks. 7

Sunburn is an important hazard, particularly for light skinned people. An appropriate strength sun block will minimise the risks of burning, with its associated risk of malignant tumours. Sun exposure must be kept to a minimum as discussed below.

Even when Hajj occurs during winter, the average temperature is over 30°C during the day and 20°C at night. Heat exhaustion and heatstroke are common and can be fatal, as evidenced by one study that reported more than 1700 fatalities in a single Hajj season, most of which were judged to be heat related. 8 The Saudi authorities, in their role as the pilgrims' hosts, undertake valuable health promotional work, distributing leaflets and issuing radio and television warnings of the dangers of excessive sun exposure. The number of people who still die of heat is evidence that the message needs to be reiterated at every possible opportunity.

During the Hajj, men are prohibited from directly covering their heads (with a hat or scarf, for example), thereby increasing the risk of heat exposure. The usefulness of a good quality umbrella, preferably white in colour, to deflect the sun “away,” cannot be overemphasised ( fig 2 ). Such simple measures could be life saving if the pilgrim was to lose his or her bearing in the desert, as is easily and not infrequently done. Box 4 summarises other important precautions.

Umbrellas (preferably white) provide useful shade

Heat exhaustion typically occurs in people who are not acclimatised and undertake strenuous exercise. Water depletion or a combination of salt and water depletion due to excessive sweating is the underlying cause. Up to 5 litres of water and up to 20 g of salt a day may be lost. Most cases are relatively mild, with symptoms of weakness, lightheadedness, and muscle cramps that will respond to a combination of rest, cooling, and fluid and salt replacement. Without adequate treatment, however, heatstroke may occur. 9 , 10 Although salt tablets may be taken, they can cause vomiting and gastrointestinal upset, so we suggest that a quarter of a level teaspoon of salt (approximately 1 g) is added to a pint, or two level teaspoons to a gallon (approximately 5 l), of drinking water during travel; this concentration is below the taste threshold. 11

Box 4: Precautionary measures to minimise the risk of heat exhaustion and heatstroke

• Avoid spending long periods in the sun, particularly when it is at its zenith
• Travel by night whenever possible (which may also avoid stampedes)
• Keep your head covered during the day (with an umbrella if necessary)
• Consume large volumes of fluid throughout the day
• Always keep a canister of fluid in your possession
• Increase dietary salt intake or use salt tablets
• Avoid travelling in “open top” buses

Heatstroke is a medical emergency (box 5) and can occur within 20 minutes of severe exertion. 12 Skin is hot to the touch, and there is a notable absence of sweating. Young children, elderly people, and people with diabetes are most at risk. The extreme rise in body temperature makes prompt and appropriate treatment imperative. Patients should be moved into the shade, stripped, cooled with a combination of fanning and spraying the body with tepid water, and, if conscious, given fluid replacement, while expert medical attention is urgently sought.

Since the early 1980s, cooling units have been installed along the pilgrim route. Emergency services will often suspend patients in a hammock-like bed and spray them liberally with an air-water mixture. The water is warm and cools the body through evaporation, simultaneously preventing further dehydration. These simple devices are significantly quicker in reducing body temperature than the usual method of placing patients in an ice bath, possibly because vasoconstriction and shivering are not induced—responses that ultimately cause the body temperature to rise. 13

Most pilgrims travel on foot, so good quality footwear is important, although in our experience it is often overlooked. During the day, the desert sand typically becomes burning hot. Care needs to be taken to avoid walking barefoot because of the serious risk of burns to the foot. This is particularly important for people with diabetic neuropathy, as very extensive damage may quickly occur, often compounded by the problems of poor wound healing and the increased risk of infection. Footwear must be removed before prayers, and people who have not been on Hajj are often unaware of the ease with which footwear can become confused with another pilgrim's and thus be inadvertently taken. Pilgrims may be forced to walk barefoot in an attempt to reclaim their footwear, with potentially devastating consequences. Thus pilgrims should be advised to carry footwear in a bag at all times.

Box 5: Symptoms suggesting heat exhaustion and heatstroke

• Fatigue, weakness, and leg cramps
• Headache, nausea, and vomiting
• Syncope and coma
• Infectious diseases

An outbreak of group A meningococcal meningitis occurred among British Muslim pilgrims after the 1987 Hajj. Eighteen primary cases occurred among pilgrims and 15 subsequent cases among their direct and indirect contacts. 14 , 15 Similarly, outbreaks of W135 meningococcal disease occurred among British pilgrims in 2000 and 2001. The Saudi authorities now insist that all pilgrims are vaccinated with two doses of ACWY Vax (three months apart) with conjugate meningitis vaccination. 16 Immunity is thought to last for approximately three years. A medical certificate confirming vaccination is now required before visas will be issued.

Vaccination against hepatitis A and malaria prophylaxis, together with advice on measures to minimise the risk of exposure, are important. We recommend vaccination against hepatitis B (see below). In addition to checking tetanus and polio status, typhoid and diphtheria vaccination should be considered. Many people decide to travel on from the Hajj, particularly to Africa and the Indian sub-continent, so taking details of travel plans is important. Pilgrims need to be reminded of the importance of seeking medical attention for any unexpected symptoms, such as fever, diarrhoea, or jaundice, or a high fever on their return. A persistent cough is also significant because of the reported high incidence of pneumonia (particularly tuberculous) among pilgrims. 17 , 18

One of the rites of the Hajj is for men to have the head shaved (although trimming the hair is also acceptable). Most will have their heads shaved, often in makeshift centres run by opportunistic “barbers.” A razor blade is commonly used, and it may be used on several scalps before being ultimately discarded. The risks of important bloodborne infections such as HIV and hepatitis B and C are obvious, especially considering that many pilgrims will come from regions where such infections are now endemic. Pilgrims need to be aware of these dangers and should insist on the use of a new blade. Physical relationships are prohibited during Hajj, even between husband and wife, so the risks of acquiring sexually transmitted diseases are minimal.

Minor injuries are relatively common, particularly to the toes; these typically result from inadvertently being stamped on while circumambulating the Ka'bah barefoot. More serious injuries, some of which prove to be fatal, occur each year during stampedes in Mina as pilgrims undertake the stoning rite ( fig 3 ). Pilgrims should be advised to avoid peak times, and old and infirm people should be advised to consider appointing a proxy for the performance of this rite. Major trauma and death from road traffic crashes is a further important cause of injury in pilgrims. 19

The stoning rite in Mina

Chronic disorders

Travellers with chronic medical conditions should take sufficient supplies of their usual drugs and also carry a written record of these, giving their generic names, in case further supplies are needed. A letter documenting medical problems and drugs will allow rapid assessment should an illness occur and will also be of help through customs.

Diabetes is common among South Asian Muslims and often leads to health problems during the Hajj. During travel, insulin should not be put in the luggage hold of an aircraft as it may freeze. Insulin should be refrigerated, but not in the freezer compartment, during the stay in Saudi Arabia.

If any illness occurs, diabetic control will need careful monitoring and insulin may be temporarily needed in people with type 2 diabetes. Although problems of hyperglycaemia and hypoglycaemia can occur, the second of these is more common as a result of increased physical activity. 20 Food intake may therefore have to be increased before exertion. Hypoglycaemia may also occur if the insulin in Saudi Arabia is different from that of the patient's country of origin, so anyone accompanying a person with diabetes should be aware of the symptoms of hypoglycaemia.

We are aware of an education programme that includes classes on factors relating to diabetes, along with more practical matters concerning the Hajj. 21 During these classes advice on footwear, insulin storage, food, drug doses, and immunisations are discussed. Such innovative projects could be further promoted by the Department of Health working collaboratively with, for example, the Muslim Council of Britain.

Box 6: Considerations in the “Hajj travel consultation”

• Fitness to perform the Hajj
• Heat exhaustion and heatstroke
• Foot burns and sunburn
• General travel advice
• Emergency numbers: ambulance 997; police 999

General advice

Menstruation is considered a state of ritual impurity, so menstruating women are not permitted to perform the Hajj. This often causes a great deal of concern, which is perfectly understandable if one remembers the importance of the journey and the time, effort, and money that may have been invested. Delaying menstrual bleeding, by using the combined contraceptive pill or daily progesterone, for example, is perfectly acceptable; many women consult their general practitioners or family planning clinics for this reason in the run up to the Hajj season.

Contact lenses are also often problematic, particularly in arid conditions where sand can be blown into the eyes. Ocular lubricants (such as hypromellose 1% eye drops) should be used liberally to stop lenses adhering to the cornea. Temporarily using spectacles may be another option.

Although several makeshift dispensaries are erected during the Hajj season, these are often difficult to access, largely on account of the human mass. Pilgrims should ensure that they take small supplies of common remedies, such as analgesics and clove oil for dental pain. A simple travel pack containing adhesive dressings, an insect repellent, antiseptic cream, and water sterilisation tablets is also useful.

The “Hajj travel consultation”

All potential pilgrims must now be protected against meningococcal disease, and this opportunity to review patients can be used to impart other advice (box 6). Several known risks are associated with pilgrimage to Mecca and can mar the entire experience. That said, most of these problems should, with sensible precautions, now be preventable. However, in patients who have returned from pilgrimage doctors should be vigilant for signs of diseases such as meningitis, tuberculosis, hydatid disease, malaria, and hepatitis. Fever, rash, jaundice, pyoderma, foot ulcers, diarrhoea, or vomiting should alert a healthcare professional to the possibility of an infection having been acquired during Hajj.

We acknowledge the source of the material for this article as follows: Sheikh A, Gatrad A. Caring for Muslim patients . Oxford: Radcliffe Medical Press, 2000; Sheikh A, Gatrad A, Hansan H. Caring for Muslim patients . 2nd ed, in preparation. Oxford: Radcliffe Publishing. Reproduced with the permission of the copyright holder. We thank the Islamic Foundation, Leicester, for providing the photographs and M Walji from the World Federation of Khoja Shia Ithna-Asheri Muslim communities for advice.

Contributors: AS and ARG jointly conceived the idea of this paper. AS took the lead in drafting the manuscript, and ARG contributed to subsequent drafts. ARG is the guarantor.

Funding: None.

Competing interests: This review is adapted from a chapter in our book Caring for Muslim Patients . Radcliffe Medical Press, 2000.

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According to the Gulf News, Saudi Arabia has issued the final date for the upcoming Islamic Hajj pilgrimage.

The Kingdom announced that the registration process for this year’s Islamic Hajj pilgrimage will run until the 7th of the Islamic lunar month of Dhul Hajjah, which corresponds to June 13, 2024.

Official channels guarantee your opportunity to embark on the Hajj pilgrimage while protecting your rights. #Makkah_and_Madinah_Eagerly_Await_You pic.twitter.com/Ai9ccjrJaF — Ministry of Hajj and Umrah (@MoHU_En) April 25, 2024

According to the Ministry of Hajj and Umrah of Saudi Arabia, this registration is available to first-time pilgrims subject to available places.

In February 2024, Saudi Arabia opened the e-registration process for its citizens and Muslim expatriates who wish to perform the Hajj pilgrimage due this year in June. Meanwhile, the kingdom reportedly started issuing Hajj permits for domestic pilgrims on Wednesday.

The New Nusuk App allows pilgrims to plan a holistic spiritual journey seamlessly, offering ease and convenience. #Makkah_and_Madinah_Eagerly_Await_You pic.twitter.com/cFZaLmKmv7 — Ministry of Hajj and Umrah (@MoHU_En) April 25, 2024

Eligible pilgrims and Hajj workers are also required to get vaccinations. These include one dose of the updated vaccine against COVID-19 (for people aged above 18 years), an anti-seasonal influenza vaccine, as well as an inoculation against meningitis.

The Ministry of Hajj has also launched four pilgrimage packages. Their prices range from SR4,099 to SR13,265 depending on the accommodation level. The ministry also confirmed that pilgrims can pay the prices of these packages in three installments.

In the first installment, 20 percent of the overall cost was asked to be paid until the first day of the holy month of Ramadan which started on March 11, 2024. The second installment asked for the payment of 40 percent and the deadline was set on the 20th of Ramadan, which corresponded to March 31, 2024. The third and final installment has to be paid by the 20th of the Islamic month of Shawwal, which corresponds to April 29, 2024.

Hajj is an obligatory Islamic duty that must be carried out by Muslims who can afford it physically and financially at least once in a lifetime.

Last year, some 1.8 million pilgrims from around the world performed the Islamic pilgrimage of Hajj, marking the return to pre-pandemic levels.

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Cover image source : Twitter

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The journey of a lifetime

Sharing a note I sent to our Atlassian employees earlier today

Co-Founder and Co-CEO

It’s been 23 years since Mike and I started Atlassian, fresh out of university. We got to work on the heels of the dot com bust and unbeknownst to us, we were kickstarting the Australian tech industry. We started what is now known as ‘Product Led Growth’ by selling business software online with no salespeople, and 23 years later, we continue to innovate by leading the world as the largest company committed to remote work with Team Anywhere.

Today, rockets don’t launch into orbit without Atlassian’s software 🚀. From helping to land the Mars Rover, to ensuring cars roll off the production line and Domino’s pizzas are delivered on time, to life-saving medical procedures being tracked and managed in hospitals, our solutions are woven into the fabric of teamwork worldwide. We’re unleashing the potential of teams in every corner of the world (and beyond!).

And while there is never a perfect time to make this change, I take comfort in my decision knowing Atlassian is so well placed for the future. We have a world-class cloud platform and the best team we’ve ever had. Our new Point A products are gaining real traction, AI is providing new and exciting opportunities, and we have over 300,000 cloud customers consolidating around Atlassian.

There are very few companies in the world that can play (and win) in the huge markets we do, with the incredible opportunities at our feet. The future has never looked brighter ✨.

Beyond the outward impact, it’s Atlassian’s soul that brings me the most joy. People say there’s something special about this place – something hard to put your finger on. Atlassians really, truly, deeply care about each other and for doing the right thing for one another, for our customers, and for the planet.

As for me, I’m looking forward to spending some time with my young family, improving the world via philanthropy with Skip Foundation and Pledge 1%, investing with Skip Capital, as well as mentoring other tech CEOs.

My last day as co-CEO will be Aug 31, 2024, and after that, I will remain a board member and a special advisor.

Finally, while there will be plenty of time for long thank yous and goodbyes over the next four months, I can’t let this opportunity go by without recognising and thanking my co-founder Mike. Mike, it’s hard to put into words the gratitude I feel, and my love for all we have created together. You really are George Bernard Shaw’s Unreasonable Man, and the world and I are better as a result 🙏.

– Scott 💙

Advice, stories, and expertise about work life today.