c. 2007 Religion News Service

(UNDATED) Faruq Rahim thought he had a touch of the flu, but wasn’t going to let it stand in the way of his Hajj, the annual Muslim pilgrimage to the holy city of Mecca. Aside from high blood pressure and some back pain, Rahim, a Pakistani immigrant living in Skokie, Ill., was feeling up to the trip.

“He was in good spirits,” said his niece, Sofia Shakir. “But he was sick, he was in pain, but he ignored it.”

Rahim collapsed on the last day of the Hajj. Emergency room doctors found his white blood cells were dangerously low. A regimen of antibiotics, transfusions and dialysis at a Jeddah hospital failed, and on Jan. 10, 2007, Rahim died of sepsis.

He was just 54, and left behind a wife and three daughters. He was flown back to Mecca for burial.

As of Dec. 31, 2006, the final day of last year’s five-day pilgrimage, Saudi Arabian authorities reported 439 deaths from “natural causes” _ sickness, heart attacks and old age. That does not include deaths caused by trauma, falls or car accidents. It also doesn’t count pilgrims, like Rahim, who succumb to disease or sickness after the pilgrimage, some in their home countries.

Stampedes, which have killed almost 2,500 people since 1990, have received the most notoriety, but disease, heart attacks and other “natural causes” kill hundreds of pilgrims every year.

Such deaths could often be prevented with basic precautions, but experts say many pilgrims make the Hajj with little regard to their health and the health of others.

The Hajj, which this year begins Dec. 18, is a health-care challenge by any stretch. Some 2 million global pilgrims descend on Mecca every year for five days, living in tight quarters where coughing and touching can easily spread germs.

Many pilgrims infect people at home with diseases contracted on the trip. The physical stresses of the Hajj, which involves walking a few miles each day and battling large crowds, only compound the epidemiological hazards.

As “custodians” of Mecca’s holy sites, Saudi officials have taken steps to keep sickness and injury to a minimum. This year, Saudis have more than 10,000 doctors, nurses and other healthcare staff working at 300 health centers set up throughout the Hajj circuit. In an unprecedented move, Saudi officials have paid to fly doctors from Turkey, Pakistan and a handful of other Muslim-majority countries to help pilgrims.

“They need all the manpower they can get,” said Nail Al-Jubeir, a spokesman with the Saudi Embassy in Washington, noting that 142,000 pilgrims were treated at Saudi health centers during last year’s Hajj.

The most common cause of hospital admissions during the Hajj, according to a 2006 study by Saudi physicians published in the Lancet medical journal, is respiratory diseases like pneumonia and the flu. Meningitis is also a threat, killing more than 100 people during Hajj-related outbreaks in 2000 and 2001.

Tuberculosis is not uncommon, the study said, and physicians investigating pilgrims should also be on the lookout for “emerging infectious diseases” such as Rift Valley Fever and Ebola virus.

Diarrhea and skin infections are also common, while blood-born diseases like Hepatitis B, C and HIV are also threats towards the end of the Hajj, when men have their heads shaved _ a ritual often performed by barbers using unwashed blades.

Heart attacks are the leading killer, the study said, pointing to the large crowds, physical challenges and the advanced age of many of the pilgrims. When the Hajj (which operates on a lunar calendar year) enters the summer months, temperatures can reach 130 degrees, making heat stroke a concern.

After the 2001 meningitis outbreak, Saudi Arabia required pilgrims to get meningitis vaccinations in their home countries before entering the kingdom. Saudi officials also require pilgrims from countries where yellow fever exists to be vaccinated against that disease.

When the Ebola virus killed 170 Ugandans in 2001, Saudi officials banned pilgrims from Uganda that year. Saudi airports are equipped with thermal cameras to detect pilgrims with unusually high fevers, which could indicate SARS.

The Saudi government and governments of countries sending pilgrims, as well as Hajj tour agencies, have tried to educate the public about what preventing illness.

At the same time, many would-be pilgrims seek advice on Muslim Internet sites. Advice includes wearing facemasks, bringing cough drops and using hand sanitizer. Anyone with heart conditions or other medical problems should get a check-up and tell their doctor they are performing Hajj.

“Whatever you do, never touch your face before washing your hands,” said Brenda Grant, a California Muslim who said she was one of the few people in her group who didn’t get sick when she made the pilgrimage in 1999.

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Few pilgrims, however, pay attention, Al-Jubeir said. Some even bribe health officers for fake vaccination stamps. Many Muslim countries that distribute a limited number of Hajj travel spots often give priority to older Hajj applicants, since they have the least time to make their once-in-a-lifetime pilgrimage.

Still, many pilgrims say that no matter how many precautions one takes, sickness is unavoidable, just containable.

“I’m counting on a getting a virus; I just want to control it,” said Salman Tajauddin of Arlington, Va., who at 34 is making his first Hajj this year. He’s gotten fit through jogging and is packing cough drops, vitamin C and other health items.

“Everyone I talked to, no matter how hard they tried to protect themselves, has come back with something.”

KRE/CM END SARCIBEY