HEALTH GUIDELINES FOR HAJJ AND UMRAH

The performance of Haj is obligatory on all adult Muslims who have the means to make the trip to the Holy City of Makkah. Umrah is regarded as a minor pilgrimage with only part of the required rituals performed. Whosoever enters the Mi'qaat (boundary of the Holy Land) has to perform Umrah which includes seven circuits around the Holy Kabah.

One must be in good health, not only to enjoy Haj and Umrah but also to make maximum use of the opportunity to make as much ibadat as possible, that is, extra Salaahs and extra Nafl Tawaafs. We are guests of Allah Subahanahu Wata'ala whilst we are in Makkah and guests of Rasulullah Salallahu Alaihi Wassalum whilst we are in Madinah. We must , therefore show enthusiasm whilst we are there and perform Ibadat enthusiastically.

Physical fitness:

The more physically fit one is, the easier it would become to perform the many rituals associated with a complete Haj. If one has decided to perform a walking Haj, then it would be very important for one to be as fit as possible. This will require one to walk as much as one can, starting about 4 to 6 weeks before departure, walking greater and greater distances as the time of departure arrives.

One should be able to walk briskly for about an hour continuously, taking a few hills into one's walk. During Haj, one will not be walking in one's designer walking shoes but in thongs or a slipper which is not sewn or which does not cover the high arch on the top of one's foot in the case of men. These can be quite uncomfortable. For this reason, one should practice one's walking in similar footwear so that one's feet can get used to the slippers and form calluses where they are required. Men are not allowed to cover their heads during Haj. Furthermore, the heads of men would have been shaved recently from the performance of Umrah. It would therefore become necessary for one to expose one's head to the sun whilst exercising so that one's head may become used to the sun.

The sooner exercise is started, the better. If one is young and can jog, then this will do fine. Even if one is not performing a walking Haj, the exercise will help tremendously. Rasulallah Sallallahu Alaihi Wasallum often spoke of the importance of physical fitness in general.

Climate in South Africa:

KwaZulu Natal coast enjoys a sub-tropical climate which is humid. The humidity is worse in summer. The body becomes acclimatised to the humid conditions and the skin adapts to this humidity.

The Cape Peninsula has a Mediterranean type climate where the humidity is not as intense as it is in the KwaZulu Natal area. It is a drier climate although it can become humid in summer.

The south-eastern areas of South Africa enjoy a temperate climate with the humidity decreasing as one moves further south.

The inland areas of South Africa are drier with the humidity decreasing as one goes further into the centre. Therefore, in the Gauteng area, the humidity is quite low even in summer. In the drier climate, the body adjusts to the drier conditions and the skin adapts.

Climate in Saudi Arabia:

Jeddah is on the coast of the Red Sea and therefore enjoys a slightly humid climate in summer. It becomes less humid in winter.

Makkah is about 70 kilometres inland. It has an escarpment around it. The only natural source of drinking water is from the well of Zam Zam and the well of Abu Dawwod. The rest of the water from bore holes and wells is brackish, unfit for human consumption. Because of the escarpment, the climate is dry and harsh. There is very little vegetation in and around Makkah due to the low rainfall. The Great Arabian Desert is all around Makkah. The climate is dry. Temperatures are extremely high, usually in the forty degree Celsius range and sometimes going into the fifties. It becomes so hot that even the buildings do not get a chance to cool down overnight. Even in winter, it is hot!

It is sometimes referred to as the hottest place on earth!

Medinah is situated about 500 kilometres north and is about 100 kilometres from the coast. It is a large oasis with the Great Arabian Desert all around it. Because of the numerous wells providing excellent drinking water, it has date orchards spreading out on to the outskirts of the city. The climate is dry and hot, the temperatures not reaching as high as in Makkah. In winter, it can become cool to cold especially around Tahadjud and Fajr times.

Since the climate of Medinah is less hot and dry than that of Makkah, spending 8-10 days in Medinah before coming to Makkah helps to allow our bodies to acclimatise.

Drinking Water:

Tap water is not safe to drink anywhere in Saudi Arabia. Drinking water has to be bought in the form of bottled water. However, Zam Zam is available freely in Makkah and in Medinah. Since this is an opportunity to drink as much Zam Zam water as possible, one can fill containers with Zam Zam water and bring it to one's room. One can make tea and coffee with the Zam Zam water. Zam Zam water is only for drinking. Please respect it.

Because of the hot weather conditions, it becomes necessary to drink water in abundance. Less urine is passed due to the hot conditions. The body conserves water by concentrating the urine. It is not good to pass very concentrated urine for a variety of reasons. Drink enough water so that the urine is clear. Passing clear urine indicates good hydration.

Ice that is available to cool the Zam Zam water is not always of good quality. Unscrupulous people may make the ice with only brackish water or mix the brackish water with drinking water to save on costs. This results in the brackish water contaminating bottled water or Zam Zam water. Drinking Brackish water causes a sore throat, abdominal pains and a cough from the irritation in the throat. People may use antibiotics thinking that the cause of the sore throat is an infection. It is better to drink Zam Zam water directly from the well in the Haram Shareef or taking the water from the numerous taps available outside the Harram Shareef. Zam Zam water that is available in storage containers in the Harram Shareef are cooled by adding ice. This ice may not always be of good quality.

Although the authorities provide disposable cups for drinking Zam Zam in the Haram, people unfamiliar with this practice often mix the used cups with the unused ones resulting in confusion. If one is unsure, rinse out the cup well before use. It is through the sharing of cups that infections can spread from one pilgrim to another. People come from all parts of the world with different hygienic control. What one may find offensive may be quite normal for another. The important thing to do is to avoid picking up infections from this source.

Please make sure that drinking water is safe.Drink adequate amounts of fluids especially water throughout your stay.

Arthritis:

Those people who suffer from arthritis of their hips or knees or ankles should lose weight if they are overweight. They must have treatment for their arthritis long before the departure date so that the inflammation has time to settle. Your Doctor is the best person to ask for guidance on medication. Please do not take advise from people who are not properly qualified. Once the inflammation has settled, then light exercises to strengthen the muscles around the affected joint would help tremendously. Again be guided by a Doctor with the help of a Physiotherapist.

Care of the back

Most people would travel with heavy suitcases when going overseas. Going to Makkah is no exception. In most cases, it will be found that most of the clothes taken will not be used, but they were taken just in case they were needed. It is not necessary to travel with heavy luggage but if it is necessary, then care must be taken to lift the bags correctly. Back strain is a common problem that occurs. Bags have to be taken out of the house and into the trunk of a car. At the airport, they must be taken out of the trunk and hopefully put onto a trolley to be wheeled to the departure counter. If no trolleys are available, these bags will need to be carried. The same process occurs on arrival, the difference being that now the bags will have to be carried into the place of accomodation,e.g., a hotel.

If it is necessary to buy new luggage, then it would be better to spend a little more and acquire bags with wheels. These can be pulled along without being carried.

Proper lifting of heavy articles involves not bending the back but bending the knees and lifting with a straight back. It will be better to allow others who are not going to Haj to do the lifting, e.g., relatives who are not going, hotel staff, etc.

If a back problem already exists, extra care needs to be taken not only in lifting but also in sitting in awkward positions or on very low chairs, bending down and twisting awkwardly, etc.

A back injury or aggravation of a back injury takes two to three weeks to settle. Sustaining a back injury on the way to the Holy Land or in the Holy Land may compromise your Umrah and Haj. Please be extra careful.

Constipation:

Due to a change in the diet and the hot weather resulting in water depletion, constipation can be a real problem. Constipation may result in haemorrhoids and bleeding both of which can be very distressing. It can affect normal activities resulting in loss of valuable time in Makkah and Medinah.

Maitaining a high fibre diet, like a bran or wheat cereal, wholemeal bread, dried fruit, not eating an abundance of fried or fatty foods, drinking adequate amounts of water can avoid constipation.

Asthma:

Asthma suffers must ensure that their asthma is well controlled with preventative medications. They must ensure that they take an adequate supply of their medications with them including preventative medication, broncho-dilator inhalers and tablets.

If well controlled, asthma does not pose a problem during Haj and Umrah.

Both Makkah and Medinah have a dry climate. There is no pollen in the air. Due to the dry climate, house dust mite population is also less. Those with hyper-reactive airways sensitive to other pollutants should ensure that they control their asthma well.

Skin Care:

Because of the harsh, dry conditions that can be encountered, it would help to prepare one's self. Saudi Arabia, being in the Northern Hemisphere has it's winter when we have our summer. Hence, our bodies are confronted by a big change in the external environment.

If one lives in a humid climate, the dry conditions will have a major effect on one's skin. One's skin will not have the time necessary to acclimatise. Cracking of the skin is common. If this happens on the feet, it can cause deep fissures resulting in pain and discomfort with the possibility of infection developing. This is especially important for diabetics.

A good moisturiser applied two or three times a day starting as soon as possible after arrival in Saudi Arabia will help the skin retain moisture and slowly acclimatise. The moisturiser need not be expensive. Aqueous Cream or vaseline which is cheap, applied frequently will do. To allow the feet to retain the moisture in the skin, it may be necessary to wear a pair of socks to avoid the evaporation of water. Extra care should be paid to the feet, as performing Haj with painful feet would add an unnecessary burden. A suitable heel balm will also help to smoothen out the thick skin around the heels.

If one lives in a drier part of South Africa, it will still be necessary for one to apply a moisturiser as the dryness in Saudi Arabia far exceeds the dryness here.

Swelling of feet:

Due to the intense heat, it is not uncommon for the feet to swell. In healthy people, this is transient. As the body acclimatises to the hot conditions, the swelling should subside. If one suffers from any illness, especially heart disease, diabetes or high blood pressure, then one should seek the advise of a Doctor. Acclimatisation usually takes about 7 to 10 days. Those that spend a short time in Saudi Arabia before Haj may find their feet swollen during Haj. Not much can be done about this as the body needs time to adjust.

It would help to elevate the legs at every opportunity so that the dependent fluid in the feet can go back into the circulation. Avoid standing for long periods. Walking would help settle the swelling.

Fungal Infections of the feet:

Fungal infections of the feet present as either a dry scaly very itchy rash or little fluid-filled blisters between the toes or under the feet or around the heel. Fungal infections thrive in moist conditions, as between the toes or under the feet after wudhu. The fungi cannot grow without moisture. It is therefore a good habit to dry the feet and the areas between the toes and to wear open sandals were possible so the feet may dry out.

If a fungal infection is present, this must be attended to especially if diabetes is present. Fungal infections of the feet resulting is cracks or maceration of the skin can get secondarily infected with other bacteria causing a spreading cellulitis. This can take up to a week to resolve with antibiotics and leg elevation. This is something that one does not need during Umrah or Haj!

Fungal infections can be treated with an anti-fungal agent until cured. Please consult a Doctor for the most appropriate one to use. As a prophylaxis and also as treatment in some cases, a cheap anti-fungal in the form of Whitfield's Ointment (Fungistatin ointment) can be useful. More expensive preparations which are cosmetically better are available and may be used not only on the feet but also inside shoes and sandles where the fungus may still be present.

Treatment must start well before departure so that the infection can be treated adequately.

Only prophylactic treatment may then be needed. However, due to the dry, hot conditions in Saudi Arabia, the custom of wearing open sandals and the lack of moist carpets in the Mosques, fungal infections are not very common.

Diabetics:

Tea ordered from a take-away place may have sugar added to it.

Fruit juices that are made in take-away places have large amount of sugar added to them to make the juice taste nice. It is not wise to assume that the fruit juice that is available has not had sugar added to it. Diabetics must make sure that no sugar is added. Fruit juices are plentiful and extremely tempting. Please remember that Mango juice contains a large amount of natural sugar and must be avoided.

Please make sure that diabetic control is at its optimum. Together with a Doctor's help optimal diabetic control should start at least two months before departure to make sure that control is good and the correct medication is taken.

A proper diabetic diet is very important. Most people would have their food included in their accommodation package. The hotels provide food for many people who do not have special dietary requirements. Diabetics should make their own arrangements where possible, e.g., use brown bread which can be bought easily instead of the tempting white flour rolls or bread that may be on offer, or the abundant white rice that may be prepared.

Diabetics must take extra care of their feet. Treat scratches and even tiny cuts promptly until they heal.

Apply extra moisturiser to keep the skin supple and elastic.

Care of nails on feet are also important. Remember that open sandals will be worn for the duration of Haj. Nails should be well trimmed and not "catch" on clothes.

When walking, allow enough space in front so that feet are not trampled. If a fidgety or panicky person is in front of you, move to another place.

Complications from wounds can easily arise in diabetics resulting in unnecessary pain and discomfort and a possibility of missing Haj.

High Blood Pressure:

Blood pressure must be well controlled. Start at least three months before departure. Visit your Doctor regularly so that if a change in medication is necessary, it can be introduced and established before your departure. It is not enough to have your blood pressure checked at a Pharmacy or a nursing sister. Your whole body would need to be checked.

If you are on diuretics ("water tablets"), you may need to reduce the dosage or stop whilst you are there. Please do not do this on your own. You must consult a Doctor there and be guided by your blood pressure and your fluid level there.

Gout:

Those who suffer from gout must make sure that they continue their preventative medication. They should also take with them a supply of medicines that usually helps them during an attack of gout. Gout usually effects the feet causing swelling and severe pain.

Diarrhoea and vomiting:

In situations where there are crowds of people, infections are bound to spread. Remember, germs spread by droplets from our mouth as we speak or when we cough especially if phlegm is present, or by direct contact as in kissing or sharing a cup, spoon, fork, etc. Protect children, as they are the ones who come closest to us. The unhygienic act of spitting phlegm onto the pavement that is so commonly seen in Makkah and Medinah is a sure way of spreading germs!

Thorough washing of hands with soap helps tremendously in preventing the spread of infections.

Avoid close contact with people who are ill. Visit them by all means but keep your distance.

If you are ill and are fortunate enough to have a visitor, protect your visitor by staying a fair distance away. Avoid close contact and tell visitors that the illness may be contagious. That will definitely work in keeping visitors at bay.

People who are ill should try not to mix with people who are well. In this way, the illness can be contained.

If one has diarrhoea, one must drink extra fluids, preferably oral re-hydrating fluids, like hydrol or rehidrate, which are easily available there. Try not to take anything to stop the diarrhoea unless one is having very frequent diarrhoea (more than 6 times in 12 hours is a reasonable guide). In this case, one may take medication to stop the diarrhoea as directed on the package insert. These are easily available there. Diarrhoea is a method by which the body is trying to get rid of the germs. By stopping it, one may be helping the germs to stay in the body causing one to become more ill. If there is appetite loss, the forced intake of food will cause the person to become more ill. If an appetite is present, one may eat food, but take in carbohydrates, fruit and vegetables only. Avoid protein foods such as meat, chicken, fish, eggs, dairy products and fried and fatty foods until a normal motion is passed. Then, a normal diet may be resumed.

Food bought from outside stalls and fruit bought from side-street vendors carry the risk of infection. The fruit may also have insecticides or pesticides sprayed on them. Thorough washing of the fruit before eating must be done to minimise infection.

Scafing of thigh area

As men are not allowed to wear any underwear, scafing of the skin on the inner side of the thigh can occur especially if the person is over-weight. The sweat and the rubbing of the thighs together during walking causes the problem.

To prevent this, men are advised to use vaseline or any other non-perfumed moisturiser liberally to the inner side of the thighs frequently throughout the the state of Ihraam.

Itchy conditions of skin

People who suffer from skin conditions which can cause intense itching , e.g., eczema or psoriasis, etc., are advised to visit their Doctor and bring their condition under control to the best of their ability BEFORE departure. Medications, both tablets and creams can be taken to stop the itching for the duration of the state of Ihraam. In the state of Ihraam, scratching of the skin or scalp is not allowed. Moisturisers must be used liberally throughout the stay in the Holy land, especially during Haj.

Medicines:

Most medicines that we find here are obtainable in Saudi Arabia. They are also cheaper there than here. It is not necessary to take large amounts of medicines to Saudi Arabia. Take adequate and extra amounts of the usual medicines in case departure from Saudi Arabia is for some reason delayed. Besides the usual medicines taken, one may take small quantities of a pain killer such as panado and whatever else one may feel is needed.

All codiene containing pain killers are banned in Saudi Arabia, e.g., Suncodin, Stopayne, Stilpane, etc. All tranquilisers and sedatives and sleeping tablets are also banned. If you are on any of these medications, please take a letter from your Doctor to confirm that you are on these medications.

Pharmacies in Saudi Arabia do not require Prescriptions for medications that usually require control here. This is done to make medication easily accessible to the millions of people that come there without the need to look for a doctor. The pharmacists are usually very helpful and will give you whatever you need. Do not hesitate to take the advise of a Doctor who may be travelling with you.

It is possible to delay menses for a period by taking appropriate contraceptive pills or hormone tablets. It is far better to adjust the menses slowly starting a few months before departure so that the period may not need to be delayed. If the dates of departure and the length of stay in Medinah and arrival in Makkah for Umrah are known well in advanced, your Doctor will be able to slowly adjust your cycles so that menses would come at an appropriate time, naturally. However, if not enough time is available, then menses can be adjusted using hormones. Please consult your Family Doctor on the best method for you.

The Five Days of Haj:

We must not lose sight of the primary aim of our journey and that is to perform Haj. We can become engrossed in daily activities in Makkah and Medinah without realising the closeness of Haj. When the 1st day of Dhul Haj is known, it is time to prepare for Haj - not on the 7th of Dhul Haj. The whole purpose of our journey is to perform Haj. We must therefore be physically and spiritually ready to undertake the Pilgrimage. Look at your state of health very carefully.

If you are ill, get adequate treatment so that you can recover well before Haj actually starts. If you are not ill, make sure that you look after yourself so that you do not become ill, e.g., avoid coming too close to people who are ill, dress adequately so that you do not get cold or wet if it rains. Rest your body as well as exercise your body to keep in peak condition. Take special care of your skin and your feet. Try out your footwear to make sure they fit. Walk with them for a few days or all the time to "break " them in and allow your feet to become accustomed to the footwear.

Have a positive attitude during this time. You are a guest of Allah Ta'ala. Look forward to going out of Makkah to show Allah Ta'ala that you would prove to Him that you are worthy of returning to Makkah for Tawaful Ziyarah, that you reject Shaitaan with enthusiasm and contempt and not return to the ways of Shaitaan. It would be more productive to go out there and perform the rituals with enthusiasm.

Having taken special care of yourself, you should be fit and ready for Haj on the 7th of Dhul Haj. Have a good sleep on the 7th day of Dhul Haj so that your body is well rested Once Haj starts, you may not be able to sleep well for a few days.

During Haj:

Spend ALL your time in Ibadaat. The time in Mina is mainly for reflection, on your life so far and on Allah Ta'ala, on Zikr and reading appropriate parts of the Quran. Not much physical effort is required except in getting to Mina. You will, Insha Allah have enough time to rest.

The Day of Arafat is the most important day of Haj. Use it to the maximum. You may not get another chance. Take full advantage of standing outside during Waquf to tell Allah Ta'ala how Great He is and to thank Him for all that He has done for you and your family and friends.

Ask Him for whatever your needs are with humility and confidence. If you have prepared well, standing in the hot sun for two hours would not be a difficult task Insha Allah.

Please remember to take your medications on time. If you are on a diet, stay strictly on the diet. This is not the time to get sick because you did not take your medication or follow your diet. Besides compromising your own Haj, you may inconvenience other Hajees.

Do not over eat. Eat small meals, have adequate liquids and keep out of the sun until you are required to stand outside.

The return to Mina from Muzdalifa and the day in Mina can be the most difficult of the whole Haj. This is the day when Shaitaan is rejected by All the Hajees in a short space of time. Do not rush to stone the Shaitaan. This must be done deliberately with a lot of emotion. Wait for a suitable opportunity. Women should be protected from the pushing. There will be a lot of pushing and shoving. Your strength will be required here to keep people off yourself and your partner while concentrating on your task. Be careful other people do not trample on your toes or your feet especially if you are a diabetic. If you lose your footwear and if it is very crowded with people pushing and shoving, leave your footwear and move. Do not try looking for your footwear. A little push can throw you to the ground. People can get trampled in this rush.

If an injury is sustained on the feet, treat it well with an antiseptic such as savlon regularly and apply mercurochrome or a suitable antiseptic cream if the wound is deeper until medical help is available. Do not ignore it as Haj is yet incomplete. There is still Tawaful Ziyarah to be done sometimes under very trying conditions. There is no need to rush. Insha-Allah, there will be plenty of time to complete Haj.

Marble Floors:

The Holy Mosques in Makkah and Medina have extensive marble floors inside and outside. When the smooth marble is wet, as after rain or after washing, it becomes very slippery. Walking on slippery floors must be done with extra care as slipping and falling hard onto the marble can cause some serious injury to the back, elbows and wrists.

Yellow Fever Immunisation is recommended although South Africa is not an endemic area. There is a chance that travel through Africa may be necessary in the hectic atmosphere of return from Saudi Arabia. The infection can be picked up from people who are also performing Umrah or Haj.

Menningo-coccal meningitis vaccine is also recommended and required by the Saudi authorities as this infection can be picked up from fellow travellers especially from the East.

Hepatitis A is an infection that can be transmitted via the faecal-oral route. It can be transmitted by infected food from infected food handlers. The incubation period is 2 to 3 weeks from the time of contact. It can be a serious illness. There is a vaccine available for ACTIVE immunisation which must be taken at least two weeks before departure. Immunity derived from this vaccine can last upto three years although a booster is advised every two years for frequent travellers. If insufficient time is available, PASSIVE immunity can be obtained by having an injection of normal human immunoglobulin. This protection would last upto three months.

Immunisations can have side effects. For this reason, it is better to have the injections well before departure. This will allow for good immunity to develop as well as for the injection site to settle. If multiple immunisations are necessary, they can be spread out well before departure.

For people who are over 60 years old and for those under 60 who have a chronic problem such as diabetes, asthma, chronic bronchitis, emphysema, heart valve problems and cardiac disease, immunisation against the Pneumococcus bacteria is advisable.

In South Africa, the vaccine is called Pneumo 23. The Pneumococcus bacteria is a common germ usually found in our respiratory tract. It can get out of control if our immunity is compromised.

Conclusion:

If one intends performing Haj or Umrah, one needs to make sure that one's general health is good. If you suffer from any illness, please visit your Doctor early so that your condition can be improved to the maximum before you leave.

Adequate preparations will, Insha Allah make the performance of Haj a fruitful and memorable experience. It may bring the intention of performing the perfect Haj that much closer. Invoking Allah Ta'ala's help, in duas, in keeping illness away cannot be over-emphasised. Allah Ta'ala is All-Powerful, All-Knowing.

Islamic Info

Source:  Jamiatul Ulama (Kwazulu-Natal)