Inam Danish Khan - Army College of Medical Sciences and Base Hospital, New Delhi, India
Syed Bahavuddin Hussaini - Madurai Medical College, Government Rajaji Hospital, Madurai, India
Shazia Khan - Specialist Obstetrics and Gynaecology, INHS Kalyani, Vishakhapatnam, India
Faiz MH Ahmad - Army College of Medical Sciences and Base Hospital, New Delhi, India
Faisal Ahmad Faisal - Specialist Paediatrics, MH Roorkee, India
Muhammad Arif Salim - Hospital Administrator, Assam, India
Razzakur Rehman - Specialist Physiology, Guwahati, India
Syed Asif Hashmi - Army College of Medical Sciences and Base Hospital, New Delhi, India
Bushra Asima - Army Hospital Research and Referral, New Delhi, India
Muhammad Shaikhoo Mustafa - Public Health Consultant, Chennai, India

Introduction: Extreme heat claims more lives than all other weather-related exposures combined. Hajj rituals at Mina, Arafat, and Muzdalifah involve a minimally-clothed, moving assemblage of ۳.۵ million pilgrims who are exposed to a harsh, hot, desert climate during physically challenging outdoor rituals and unsheltered night stays, rendering them prone to heat illness, dehydration, and sunburn. This cross-sectional study assessed the emergency response of the Indian Hajj Medical Mission to overwhelming heat illnesses in Mina and Arafat among Indian pilgrims during Hajj, ۲۰۱۶. Methods: In ۲۰۱۶, ۸۸ patients affected by the heat were brought to central tent-clinics at ۳۶ maktabs in Mina and Arafat that were established by the Indian Hajj Medical Mission. Patients were offered rapid external evaporative cooling (wet towels) and cold intravenous saline infusion on patient couches and wheelchairs. Results: The incidence of heat illness among Indian pilgrims in ۲۰۱۶ was ۰.۶۲/۱۰۰۰. The ratio of males to females was ۱.۸:۱. Mean ages of males and females were ۶۲.۲ ± ۷.۴۳ and ۵۲.۶ ± ۹.۳, respectively. Pre-existing conditions, such as diabetes mellitus and hypertension, were present in ۹۳.۲% of the patients. The most common presentations included hyperthermia, fatigue, and restlessness. Heatstroke presented in five patients and resulted in one fatality. Twenty-eight patients were referred to Saudi hospitals, and ۱۲ of them were institutionalized. Exertion related to the stoning of Satan ritual during late morning and afternoon hours was the leading cause of heat illness. Conclusion: The overwhelming incidence of heat illness among Indian pilgrims in the critical five-day period of the Hajj represents the tip of the iceberg as the Hajj attracts over ۳.۵ million pilgrims from ۲۰۰ countries annually. Heat illness is difficult to manage in the presence of pre-existing comorbidities and mandates clientele education and outreach warning systems to enhance resilience capital amongst Hajj pilgrims, sportspersons, outdoor enthusiasts, and military personnel.

Hajj, Heat Illness, Heat Exhaustion, Heat Stroke, Mass Gathering Medicine