Integrating Palliative Care into Mass-Gathering Health Planning: The Case of the Hajj and Umrah

The annual five-day Hajj and continuous Umrah pilgrimages to Mecca, Saudi Arabia are the largest annual mass gatherings that bring millions of pilgrims from over 180 nations. The Hajj health care systems is well developed and model for mass gatherings medicine whereas palliative care in Saudi Arabia is evolving. Two thirds of pilgrims for both religious events originate from resource poor countries. Two thirds of Hajj pilgrims are likely to be elderly and slightly of lower age for Umrah. Pilgrimage venues are confined geographical areas under conditions of high physical and logistical intensity as well climatic, atmospheric, environmental challenges. The demographic profile of pilgrims, with a large proportion being older adults among whom chronic illnesses predominate, and the majority originating from resource poor countries suggests a significant but under-recognized need for palliative care. Societal norms and individual perspectives surrounding death and illness at Hajj and Umrah may be different from that during the non-pilgrimage period. Some pilgrims including those with terminal illness may view death at pilgrimage as God’s will and thus socially desirable. While chronic diseases have recently surfaced in mass-gathering medicine inclusion of palliative care is overdue. Symptom relief, psychosocial support, anticipatory care planning, and dignified end-of-life care- are all relevant in a mass gathering perspective. This paper highlights the need to integrate palliative care into Hajj health-system planning. Hajj and Umrah are well studied prototypes offering perspectives for other large religious mass gatherings, like the Hindu religious pilgrimage Kumbh Mela. Lessons from addition of palliative care at the Hajj would be a primer of similar plans for other mass gatherings.