This article was first published in the Lancet.

Despite recent efforts to improve the sites of the Hajj pilgrimage

Despite recent efforts to improve the sites of the Hajj pilgrimage in Mecca, some experts say that risks remain for visitors because of gaps in education and planning. Chris McCall reports.

More than 2 million people will visit Islam’s holiest sites in and around Mecca for 5 days from Sept 9–10, for a Hajj pilgrimage in which public health and safety will be a prime concern. Zika virus is the latest of many infectious diseases that the Saudi Arabian hosts are guarding against, but crowd safety has proved a much harder problem to tackle.

During last year’s Hajj hundreds of pilgrims were crushed or suffocated to death in a stampede near the site of stoning of the devil ritual in Mina, a key part of the Hajj. Officially, Saudi Arabia has said that 769 people died. Figures pieced together from various countries around the world suggest the death toll was considerably higher, and likely to be more than 2000. It was the latest of many such incidents despite a series of measures implemented by the Saudi Arabian authorities to enable the key sites in and around Mecca to accommodate increased numbers of pilgrims.

Saudi Arabia is under considerable pressure to make sure something similar does not occur this year. “This is an enormous amount of people to cater for”, said Rodger Shanahan, an analyst on Middle Eastern affairs with Australia’s Lowy Institute. “They are going to be ultra keen to have this one go off without a hitch.”

Last year’s stampede was the latest of many such incidents that have killed pilgrims over the past few decades. Many have occurred at or near the site of the stoning of the devil ritual. However, the entire Hajj pilgrimage is arduous, especially for the elderly or infirm. The 5-day rituals may involve sleeping in the open. They involve going without food for a period while circumambulating on foot the Ka’aba, the cubic structure at the centre of the grand mosque in Mecca.

The date of the Hajj is set according to a lunar calendar, which means that in relation to the Gregorian calendar in general use, its date moves forward by a few days each year. There are times when the Hajj takes place in cooler periods of the year, but the current date is getting close to the hottest period of the year in Saudi Arabia. The Council of British Hajjis (CBHUK) is one charity that has taken action to try to help pilgrims. It regularly provides a health stand in Mecca during the Hajj.

CBHUK chief executive Rashid Mogradia says he believes the Saudi authorities have genuinely made an effort to improve public safety, for example, by building a multistorey bridge a few years ago at the site of the stoning of the devil ritual, so there is less risk of a crush.

Saudi Arabian authorities were criticised last year for suggesting some pilgrims contributed to the disaster by not following instructions. However, Mogradia says many pilgrims do indeed come badly prepared. One of his charity’s main areas of work is in educating prospective pilgrims on what to expect, both in terms of the rites they must perform and the health risks they might face. He hopes this approach will eventually be copied around the world. “Every country should be responsible for educating their pilgrims not just on the religious rites of the Hajj but the health impacts”, he said. “We hope that the model that we are using here in the UK is replicated around the world. Over 50% do not come educated on the rites of Hajj, let alone health and safety.”

In the past, pilgrims have worn inadequate footwear, not followed instructions, or taken shortcuts. “If a person behind accidentally puts his foot on part of your footwear, the people behind you won’t know what is going on. Before you know it, it can escalate into something that is very challenging. Once you are entangled in that situation it is very difficult to get out and that leads to suffocation. Before you know it, people are trampling over people”, Mogradia said.

Saudi Arabia has taken a lot of steps to try to control the Hajj, very aware that it provides a perfect location for infectious disease to spread. Special Hajj visas are handed out by country. Vaccination certificates are required. Saudi Arabia has also asked the infirm to consider postponing Hajj, but many old and infirm people feel an urgency about undertaking the Hajj while they still can.

Shanahan says that although the Saudi authorities have been quite successful in dealing with the threat of infectious disease during the Hajj, public safety has proved a much thornier problem to tackle. This situation is partly because of the Saudi system. Saudi Arabia does not do the same kind of open public inquiries into disasters that other countries do, he says. Furthermore, getting promoted through the ranks based on merit and experience is not always easy in Saudi Arabia. This kind of system makes it hard to do the kind of situational planning that is used for good crowd control in other countries, where possible scenarios are worked through before they happen.

This situation leaves open the possibility of yet more such tragedies in the future. “With that many people in that confined space, it doesn’t take much to go wrong. There are lots of potentially vulnerable people there”, says Shanahan.