Hajj and Umrah health guide: vaccines, heat and your regular medicines

Hajj and Umrah are among the most important journeys in a Muslim’s life. They also involve long days of walking, intense heat, huge crowds and a demanding physical routine, often for people who are older or who live with long-term conditions. A little health preparation beforehand helps you focus on your worship and return home safe and well.

This guide explains the vaccines required and recommended for pilgrims travelling from the UK, how to cope with the heat and crowds, and how to look after your regular medicines.

Start early: when to get advice

Speak to your pharmacist or GP at least six to eight weeks before you travel, and ideally as soon as you’ve booked. Some vaccines need time to take effect, and you’ll need your proof of vaccination before you can get your visa or enter Saudi Arabia. If you have a long-term condition, a check-up in good time lets you plan your medicines and discuss whether the journey is right for you.

Take along:

• Your list of medicines, including supplements and over-the-counter products
• Your vaccination history
• Details of your travel dates and group arrangements
• Any recent hospital letters about your health

Vaccines for pilgrims

Meningitis ACWY: required

The Saudi authorities require all pilgrims to have been vaccinated against meningococcal meningitis (the ACWY vaccine) and to carry proof of vaccination. Outbreaks of meningitis have been linked to Hajj in the past, because infection can spread easily where people are in close contact.

The vaccine must have been given within a set time before you arrive, and the certificate must be valid for the period required by the Saudi Ministry of Health. Because requirements are updated each season, check the latest rules before you book your vaccination, and make sure your certificate records the vaccine type and date.

This vaccine is not usually available free on the NHS for adult pilgrims, so you will normally have to pay for it. Many pharmacies can give it and provide a certificate, so ask your pharmacist.

Seasonal flu and COVID-19

Respiratory infections spread very easily among large crowds, and many pilgrims come home with a cough, sore throat or chest infection, sometimes called “Hajj cough”. Flu vaccination is strongly recommended for all pilgrims, and COVID-19 vaccination is recommended where you are eligible. If you’re in a clinical risk group, you may also be offered the vaccines on the NHS.

Pneumococcal vaccine

If you’re 65 or over, or have a long-term condition such as lung disease, heart disease, diabetes, kidney disease or a weakened immune system, you may be eligible for the pneumococcal vaccine on the NHS. Ask your GP or pharmacist.

Hepatitis B

At Hajj, men shave or trim their heads at the end of the pilgrimage, and unclean blades can spread blood-borne viruses such as hepatitis B and C. Hepatitis B vaccination is often advised. Whatever your vaccination status, always insist on a fresh, single-use blade, preferably from a licensed barber, and never share razors.

Hepatitis A and typhoid

Both are spread by contaminated food and water and are commonly recommended for travellers to the region, particularly if you’ll be eating food from street vendors or large catering operations. They are available on the NHS in England for travel.

Routine vaccines and others

Check your routine vaccinations are up to date, including MMR, and tetanus, diphtheria and polio. The Saudi authorities have also set polio vaccination requirements for pilgrims travelling from countries affected by polio, and a yellow fever certificate may be needed if you’re arriving from, or have travelled through, a country with risk of yellow fever. Check the requirements for your whole route, including any stopovers.

Malaria isn’t a risk in Makkah and Madinah, so tablets are not normally needed for the pilgrimage itself.

Coping with the heat

Heat is one of the biggest dangers to pilgrims, particularly when Hajj falls in the hottest months. Temperatures can be very high, and long periods outdoors, physical exertion and crowds make heat illness more likely, even in people who are fit and healthy.

Know the warning signs

Heat exhaustion: heavy sweating, pale and clammy skin, headache, dizziness, nausea, muscle cramps, fast breathing or pulse, and feeling very tired or thirsty. Move to a cool place, rest, sip water, and cool the body with wet cloths or a cool shower.

Heatstroke is a medical emergency. Signs include a very high temperature, hot and dry skin (or heavy sweating), confusion, fits, collapse or loss of consciousness. Get urgent medical help immediately, and cool the person down as quickly as possible while waiting.

How to protect yourself

• Drink regularly, before you feel thirsty, and carry water at all times. Pale urine is a sign you’re drinking enough

   

• Use an umbrella for shade, and wear light, loose clothing within the rules of ihram

   

• Use sunscreen, applied regularly. Pilgrims in ihram should choose an unscented product

   

• Rest in the shade or in air-conditioned places, and plan the most strenuous rituals for cooler times of day where possible

   

• Cool yourself down with a damp cloth, a cooling towel or a water spray

   

• Don’t overexert yourself. Pace yourself, and take breaks, especially if you’re older or have a medical condition

   

• Know where to find medical help in your group and along the route

Looking after yourself in the crowds

• Stay with your group, and agree a meeting place in case you get separated. Keep your hotel and group contact details on you, for example on a wristband or card

   

• Wear comfortable, supportive footwear, and break it in before you go. Foot problems are very common, so check your feet daily and treat blisters early

   

• Prevent chafing. In the heat, friction between the thighs can cause painful skin irritation. Keep skin clean and dry, and consider an anti-chafing balm or powder (unscented while in ihram)

   

• Take care to avoid falls and crush injuries. Stay calm, move with the flow of the crowd, and avoid pushing

   

• Improve your fitness beforehand. Gentle, regular walking in the weeks before you go helps your body cope with the distances

   

• Move around on long flights, drink water and consider compression socks to lower the risk of blood clots, particularly if you’re older, have had a clot before, or are pregnant

Preventing infections

• Wash your hands often with soap and water, particularly before eating and after coughing, sneezing or going to the toilet. Use an unscented alcohol hand gel when soap isn’t available

   

• Cover your nose and mouth when coughing and sneezing, use disposable tissues, and bin them

   

• Consider wearing a face mask in crowded places, and change it when damp

   

• Don’t share personal items such as towels, razors, toothbrushes and drinking bottles

   

• Eat freshly cooked food served hot, and avoid food that has been left out in the heat. Drink bottled or sealed water

   

• Seek medical help early if you develop a fever, a persistent cough or breathing problems

MERS-CoV and camels

Middle East respiratory syndrome (MERS) is a viral illness linked to camels, and cases have occurred in Saudi Arabia. The risk to most pilgrims is low, but avoid contact with camels, don’t drink raw camel milk or urine, and avoid undercooked camel meat. This is particularly important if you have diabetes, kidney failure, chronic lung disease or a weakened immune system.

Your regular medicines

If you take medicines regularly, planning ahead is essential.

• Take enough for the whole trip, plus extra in case of delays. Carry them in your hand luggage, never in the hold

   

• Keep medicines in their original packaging, with the pharmacy label, and carry a copy of your prescription or a letter from your GP listing your conditions and medicines

   

• Check the rules for your medicines. Saudi Arabia restricts some medicines that are routinely prescribed in the UK, including some strong painkillers, sleeping tablets and medicines for anxiety or ADHD. Check the Saudi Food and Drug Authority guidance and your airline’s rules before you travel, and get a doctor’s letter if needed

   

• Protect medicines from the heat. Many medicines should be stored below 25°C. Insulin and other medicines that need refrigeration should be kept in a cool bag, and never left in direct sun or in a hot vehicle

   

• Plan around time differences and routines. Ask your pharmacist how to adjust the timing of your doses if you’re crossing time zones, or if your daily routine will be different
• Take extra care if you have diabetes. Long walks, heat and irregular meals can cause low blood sugar. Carry fast-acting sugar and snacks, check your levels regularly, and keep your diabetes supplies in hand luggage

   

• If you have asthma or COPD, carry your inhalers and use them as prescribed, as heat, dust and crowds can trigger symptoms

   

• If you have a heart condition, speak to your doctor about whether the physical demands are safe, and carry your medicines, such as a GTN spray, with you

   

• Pack a small first aid kit: pain relief such as paracetamol, plasters and blister dressings, oral rehydration sachets, antiseptic cream, sunscreen, insect repellent, and any medicines you know you tend to need

   

Be careful not to buy medicines abroad unless you’re sure of the source, as poor-quality or counterfeit medicines can be a problem.

Delaying periods

Some women ask about delaying their period during the pilgrimage. If you wish to do so, speak to your pharmacist or GP well in advance. Medicines that can do this are not suitable for everyone, usually need to be started several days before the expected period, and can have side effects, including an increased risk of blood clots in some women. Never use someone else’s medicine, and never start a new one without advice.

Who should think carefully about travelling?

The pilgrimage is physically demanding. If you are older, pregnant, or have a serious long-term condition such as heart disease, lung disease, kidney disease or diabetes, speak to your GP before booking. Saudi authorities have in the past advised that some groups, such as those with serious chronic illnesses, pregnant women and young children, consider postponing, so check the latest guidance. If you decide to go, ask about arrangements for wheelchairs, mobility support and medical care within your group.

Insurance and healthcare

Saudi Arabia has modern hospitals and healthcare facilities, but they are under heavy pressure during Hajj. Make sure you have comprehensive travel insurance that covers medical treatment, repatriation and religious pilgrimages, as some policies exclude them. Carry your policy details, and know how to contact your group leader and medical team.

Your Hajj and Umrah checklist

• Book a health appointment six to eight weeks before you travel

   

• Get your meningitis ACWY vaccine and certificate

   

• Have your flu and COVID-19 vaccines, and ask about pneumococcal, hepatitis B, hepatitis A and typhoid

   

• Check entry requirements, including any polio and yellow fever certificate rules

   

• Plan your regular medicines: enough for the trip, in hand luggage, in original packaging, with a doctor’s letter

   

• Check whether any of your medicines are restricted in Saudi Arabia

   

• Pack unscented sunscreen, hand gel, anti-chafing balm, an umbrella, comfortable shoes and a first aid kit

   

• Practise walking in the weeks before you travel

   

• Arrange travel insurance that covers pilgrimage

   

• Keep vaccination certificates with your passport