|Year : 2016 | Volume
| Issue : 4 | Page : 227-229
Hajj 2016: Safeguarding the faithful - Saudi Arabia takes the long view
Qanta A Ahmed1, Ziad Ahmed Memish2
1 Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, Winthrop University Hospital; Associate Professor of Medicine, State University of New York, Stony Brook, New York, USA
2 Ministry of Health, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
|Date of Web Publication||12-Oct-2016|
Ziad Ahmed Memish
Ministry of Health, College of Medicine, Alfaisal University, P.O. Box 54146, Riyadh 11514
|How to cite this article:|
Ahmed QA, Memish ZA. Hajj 2016: Safeguarding the faithful - Saudi Arabia takes the long view. J Health Spec 2016;4:227-9
During the last two weeks of September, 2016 throughout both the Kingdom and the wider international community, Hajj planners and public health administrators were recovering from, and rightly pleased in succeeding at the intense task of hosting Hajj which is among the world's largest mass gatherings. Each year, Hajj unites millions of Muslims together for worship at Mecca and related religious sites in the Kingdom of Saudi Arabia. The Saudi Government, under the auspicious leadership of the Custodian of the Two Holy Mosques, HM King Salman Al Saud, takes the responsibility of hosting the 'Guests of God' very seriously. While a literal and pragmatic responsibility, to the Kingdom and the Kingdom's ruler, hosting Hajj remains a deeply spiritual and devotional privilege.
Once again, 2016 proved the Kingdom remains up to the monumental task. By the Grace of God, an uneventful Hajj in 2016 is a welcome relief but more importantly tangible testament to the immense preparation, administration and execution of the largest mass gathering of Muslims around the world. The success of Hajj 2016 has to be credited foremost to the pilgrims and their perseverance in performing difficult rituals with patience and precautions. Just as important, credit is due to the Government of Saudi Arabia under the aegis of the Custodian of the Two Holly Mosques. The WHO immediately noted many successes of Hajj 2016 in a major acknowledgement of the Kingdom's efforts though its success this year went largely unnoted in the global media - good news being no news to some, it would seem. 
Successes are not accidental. Successes are the function of intense focus and driven intention - Saudi Arabia's commitment to Hajj is no different. The Saudi Arabian government is involved in every stage of a pilgrim's first intention to make Hajj: In assessing visa eligibilities, in applying national quotas of visas for each of 183 nations from where pilgrims travel, in issuing visa embargos for those who have travelled to Hajj within a 5-year window and in monitoring and enforcing the many requirements of Hajj eligibility including public health and infection control criteria - visas are tied to documented vaccination status and no exceptions are made. 
This year's Hajj was a departure from prior pilgrimages in scale: attendance was the lowest, both in domestic and international attendees, in a decade. A total of 1.8 million attended - almost half the maximum recorded attendance in 2012 of 3.2 million.  This decline in attendance was anticipated and deliberate. Saudi Arabian authorities tightened the ingress of the undocumented, i.e., 'illegal pilgrims' emphatically this year, for both public health and security reasons. Harbouring of or managing illegal pilgrims, was this year charged with hefty fines. Rigorous punishment discouraging the practice was forcibly instituted. Those caught smuggling the undocumented are now subject to deportation, blacklisting and a punitive financial penalty. These moves, while seemingly heavy-handed, are a vital necessity in this important gathering which is both massive and fragile.
Each year, concerns at Hajj focus both on known infectious outbreaks, recognised infections and non-infectious hazards and also emerging infectious disease threats. Hajj 2016 was conducted under the global shadow of intense Zika outbreaks in multiple regions worldwide; , yellow fever , outbreaks remained a concern. Although, not yet documented in the Kingdom of Saudi Arabia, in neighbouring countries such as Singapore, Malaysia and China, yellow fever has been reported for the first time and may pose future hazards to Hajj, particularly if Indonesia is involved. Controlling pilgrim ingress into the Kingdom mitigates the risk of introduction of these agents or developing outbreaks. Islam teaches the Muslim to have duty not only to self and to God but also to the society. In managing Hajj, the Kingdom is placing paramount emphasis on its duty to the global society. Restricting numbers, therefore, become essential. Certainly, the Kingdom is reluctant to impose restrictions for fear of denying a Muslim's God given right to perform Hajj, yet such legislation becomes a vital necessity for safeguarding the Hajj population and the global populations to whom pilgrims return after Hajj.
Other reasons exist for reduced numbers of pilgrims this year - the conflict in Syria has displaced millions of well-to-do Muslims who might otherwise attend. Fragmented families and displaced refugees make Hajj impossible until these families are re-established. Those landlocked in Syria cannot attend Hajj due to the active conflict.
A third factor in the temporary reduced attendance could be the incredible expansion of the physical sites of Hajj. Saudi Arabia has committed $100 billion in both land and infrastructure expansion with much of this on-going work. The new King Abdul Aziz International Airport and the expansion of the Haram Sharif - the Grand Mosque surrounding the Ka'aba - are to be completed by 2017-2018. 'Haramain', a high speed above ground railway linking Mina to Medina, the second holiest city in Islam (often included in Hajj rites) will be completed this year but will be opened to the public after extensive testing in 2017. The Mecca-Metro project connecting a 4-km-long station and two metro stations to the tune of $16.5 billion will be completed by the decade's end, greatly relieving congestion at the focal site of Hajj. Because of these incredible expansion projects both above and below ground, Mecca has been more physically limited than years past, resulting in less space to accommodate usual number of pilgrims. These spatial limitations were certainly in the Hajj planners' focus, further mandating pilgrims numbers more tightly controlled than years prior [Figure 1]. 
Certainly, the Kingdom regrets that not every pilgrim who desired to attend Hajj this year, nor indeed any year, might be able to fulfil what is a heartfelt wish, but the Kingdom is farsighted in its intention. Soon, Umrah visitors will far outstrip current numbers. At present, while approximately 3 million may attend an average Hajj, around 6 million Muslims travel to Mecca both domestically and internationally for Umrah, the minor pilgrimage which can be performed year round. With the above multidimensional expansions fully operational, the Kingdom expects to host more than 15 million international pilgrims by 2020. Certainly ambitious, the expansion underlines the Kingdom's commitment to the Guests of God, all of whom would wish to meet their Maker at Mecca. With the global Muslim community now at 1.6 billion in population and Muslims projected to be a full 25% of all humanity by 2020, demand for religious pilgrimage whether minor in the sense of Umrah, or major as in Hajj, can only be expected to rise. The Kingdom must be saluted for its improvements to the needs of the world's Muslims.
From here, as we look back to almost four cumulative decades of sharing, investigating, revealing and advancing Hajj health for the medical academe, the next steps for Hajj academicians are clearly in our view. It is time to formalise both the study and management of Hajj. We are delighted to announce the Alfaisal University in Saudi Arabia as the world's first facility to offer exactly such a credential - a formal academic degree - in the form of a Master's in Public Health with specific concentration in Hajj Health.
Realising this has been a personal goal (ZM) first articulated in Saudi Arabia's inaugural Mass Gathering Medicine Symposium in Jeddah in 2010 as one of the six central outcomes of Saudi Arabia's vision for Mass Gathering Medicine.  An initial Diploma Programme in Hajj Health was subsequently approved by Saudi Commission for Health Specialties at the Ministry of Health. Soon after, the obvious came to mind - to offer postgraduate education in the field to which Saudi Arabia has made an unparalleled contribution. Al Faisal University realized this mission by offering a Master degree in Public Health with a concentration in Haj Health. This is the world's first such programme and will become a template for other such programmes as together around the world. There has not been a more exciting time to work in the field of Hajj Health.
Building a novel medical academe devoted to Hajj Health ensures we will work collaboratively in coming decades to unfold the mysteries and challenges of Hajj. At the centre of our mission, as we begin enrolling our first Master's Candidates - men and women around the world and within the Kingdom, always one priority is within our focus: The safeguarding of the tens of millions of faithful retracing the very steps that our beloved Prophets Abraham (PBUH) and Mohammed (SAW) took centuries before us. As Muslims from 183 nations tread this hallowed, ancient ground, Saudi Arabia is honoured to shelter them with modern technology, medical advances, vaccine developments and intelligent engineering. May we wish the Faithful God speed.
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