Journal of Infection and Public Health (2008) 1, 57—61 EDITORIAL Hajj medicine for the Guests of God: A public health frontier revisited Qanta A. Ahmed a , Ziad A. Memish b,* a Department of Medicine, Division of Pulmonary Disease, Critical Care Medicine, Sleep Medicine and Allergy, Medical University of South Carolina, Charleston, SC, USA b Gulf Cooperation Council (States) Center for Infection Control, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia Millions of Muslims perform the annual pilgrimage to Makkah, termed Hajj, a religious ritual which has been central to Islam for over 1400 years. A piv- otal pillar to Islamic belief, Hajj is required of all Muslims of adequate health and sufficient means only once in their lifetimes. The modern Hajj reg- ularly draws populations of 2.5 million or greater. Pilgrims by the hundreds of thousands arrive from all over the globe, gathering to spend several days in intense supplication localized at specific small sites in and around Makkah, a city in the Hijaz area of Saudi Arabia. Unless one has attended Hajj, whether as a wor- shiper or support staff, it’s scale is difficult to comprehend. Most people will at most have experi- enced being part of a crowd at a stadium or perhaps an opening ceremony such as the Olympics - mass gatherings measured in the tens of thousands. At Hajj during peak times, arrivals exceed 50,000 per day (2004 estimates). An independent Hajj termi- nal newly renovated in Jeddah now accommodates 80,000 at any one time. This rate of ingress goes on for days- the equivalent of an entire Shea sta- dium arriving daily for the entire Hajj season, all of whom make their initial rites in the same mosque, * Corresponding author at: King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Kingdom of Saudi Arabia. Tel.: +966 1 2520088x43720; fax: +966 1 2520437. E-mail address: zmemish@uottawa.ca (Z.A. Memish). the Al Haram, in Makkah. The Al Haram Mosque, a 36 hectare complex which surrounds the Ka’bah, the focal point to Hajj (Fig. 1), holds 750,000 pil- grims on. Because of this remarkable scale, and its annual occurrence, preparations for the public health safety and security of this event are extraordinarily challenging, encompassing an intensely collabora- tive task. Multiple domestic agencies must work together to prepare for Hajj within a matter of months. While most mass gatherings of this scale have the greater part of a decade to prepare, Saudi Arabia must ready itself for the massive influx. Within a mere eleven month lead time demand- ing precision, organization and the deployment of a ‘surge’ workforce and massive, semi-permanent infrastructure. Such efforts require inter-Ministry collaboration. Saudi authorities, including the Ministry of Health, the Ministry of Hajj, the Ministry of Interior, the Saudi Red Crescent and other government health sectors including the Saudi Arabian National Guard Health Affairs, the Ministry of Defence and Aviation, and the Security forces come together with a com- mon focus of public health security. Together, these domestic agencies in the host nation must shoulder the lion’s share of logistics, funding, infrastructure requirements and immigration control, an endeav- our in which the Saudi Authorities have invested over USD $25 Billion to date. Collectively these 1876-0341/$ — see front matter doi:10.1016/j.jiph.2008.11.001