EMS Communication Challenges During the Hajj Pilgrimage

Introduction and Research Question

The Hajj pilgrimage is the largest annual gathering in the world, attracting millions of Muslims each year. As the global Muslim community grows to well over one billion, the number of pilgrims to Makkah — sometimes spelled Mecca — continues to increase as well. The sheer volume of people presents significant challenges for EMS staff. The population of Makkah province is currently seven million people, a figure that rises sharply during Hajj season (Arab News, 2012). In 2012, more than 3.5 million men and women attended, and those numbers are expected to climb to as many as ten million by the year 2020 (D'Alessandro, Edd & Al Mubarek, 2013). This mass gathering creates a range of concerns for EMS professionals, from acute injuries related to crowd surges to the spread of infectious diseases to cardiac arrests. Effective communication is critical to the success of all EMS efforts at the annual Hajj pilgrimage.

As the number of pilgrims increases each year and as local infrastructure shifts in response, EMS professionals face ongoing challenges related to communication. These challenges can be loosely grouped into five categories: language and cultural barriers, inter-agency communication constraints, intra-agency communication constraints, technology challenges, and challenges related to public relations, public education, and the media. Each category presents particular opportunities for the EMS community, for primary stakeholders in Saudi Arabia, and for all participating organizations worldwide. Although some communication-related problems seem overwhelming given the sheer number of participants or the involvement of multiple organizations and government agencies, such challenges can be overcome through concerted, collaborative effort and cooperation.

Research Question: What are the communication challenges faced by the Saudi Emergency Medical Services during the Hajj season in Makkah, and in what ways can these problems be solved?

Background and Literature Review

For fourteen centuries, religious pilgrims have visited Makkah and Madinah in what is now the Kingdom of Saudi Arabia to "perform rituals based on those conducted by the Prophet Muhammad during his last visit to the city" (Royal Embassy of Saudi Arabia, Washington DC, 2016). Every year for five days during the month of Dhu al-Hijja, Muslims from around the world make the pilgrimage to Makkah to fulfill a religious obligation that is one of the five essential pillars of Islam. The tradition extends to the time of Ishmael, son of Abraham (Ibrahim), who built a monument at a spring known as the Kaaba (Fetini, 2009). That same site has been a place of pilgrimage for more than 2,000 years, but since the Prophet Muhammad first led a group of pilgrims there in 630 CE, the Kaaba has become central to the Muslim faith. Today, the Kaaba is marked by an enormous black cube that Muslims believe to be the "center of the world," situated literally at the center of the vast mosque complex Masjid al-Haram (Fetini, 2009). When pilgrims visit Makkah and enter the mosque complex, they circle the Kaaba seven times in a counter-clockwise direction — a ritual that serves several spiritual functions including seeking forgiveness, guaranteeing a place in heaven, and fulfilling a duty considered essential to the practice of Islam (Fetini, 2009). All persons fit of mind and body are considered obligated to perform the Hajj at least once in their lifetime. In addition to encircling the Kaaba, the pilgrim also visits Arafat, Mina, and Muzdalifah, all holy sites that form part of the overall pilgrimage. A large number of pilgrims also journey to Madinah, the site of the tomb of Muhammad. The movement of people between and within these sacred sites creates tremendous crowd-related risks, particularly given that more than two million people per year now complete the Hajj (Fetini, 2009).

Dhu al-Hijja is the last month of the Muslim lunar calendar and is considered the time when "God's spirit is closest to earth" (Fetini, 2009). Unfortunately for many pilgrims, the Hajj has also proven fatal. During the 2015 Hajj event, well over two thousand pilgrims died in a stampede ("Saudi Arabia Hajj disaster death toll rises," 2015). Mismanagement of the event and its crowds has been partially blamed for recurring tragedies, as people die each year and several years have witnessed death tolls in the hundreds or thousands ("Timeline of tragedies during hajj pilgrimage in Mecca," 2015). Short of completely redesigning the site or staggering visits, crowd management and disaster management must be improved using evidence-based practice. Communication is one of the most critical areas for improvement, both to minimize risks and to enhance the efficacy of emergency response services.

Notably, for eight consecutive years from 2006 to 2015, no major disaster occurred at the Hajj. If the management of the event was different in some meaningful way during those years, authorities need to understand how to best prevent future tragedies. One important tool is mathematical modeling to ascertain crowd movements and determine risks (Benedictus, 2015). Hajj naturally presents the most severe risk due to crowd density exceeding six people per square meter — a density at which "bodies are jammed together so tightly that they can no longer choose where they go and they begin to behave like a fluid" (Benedictus, 2015). Prior disasters have often involved crowd stampedes and the crushing of people. However, ancillary disasters have also occurred, including hotel collapses, injuries from the symbolic stoning of the devil in 2003, a tent fire in 1997, and in 1979, "hundreds of gunmen opposed to the Saudi government barricaded themselves inside the Grand Mosque," taking many pilgrims hostage and resulting in hundreds of deaths and injuries ("Timeline of Tragedies during Hajj Pilgrimage in Mecca," 2015).

The Hajj is not unique in experiencing mass-gathering disasters. As Benedictus (2015) notes, crush incidents in which more than ten people die as a result of being trampled during a stampede at a mass event occur once every four months somewhere in the world. Yet much can still be done to improve communications and reduce both injuries and fatalities at this holy event.

References

Alanazi, A. F. (2012). Emergency medical services in Saudi Arabia: A study on the significance of paramedics and their experiences on barriers as inhibitors of their efficiency. International Journal of Applied Medical Research, 2(1), 34–37.

Arab News (2012). Riyadh most populous Saudi city, Makkah most populous province.

Aymen, A. (2016). An interview with the Hajj season EMS system general director.

Benedictus, L. (2015). Hajj crush. The Guardian.

Brdesee, H., Corbitt, B., & Pittayachawan, S. (2013). Barriers and motivations affecting information systems usage by Hajj-Umrah religious tourism operators in Saudi Arabia. Australasian Journal of Information Systems, 18(1).

D'Alessandro, K., Edd, W. L., & Al Mubarak, H. (2013). Muslim mass pilgrimage poses logistical and planning challenges. Journal of Emergency Medical Services.

Dees, L. (2007). Culturally competent care in the emergency medical services. Texas EMS Magazine. July/August 2007.

Eltahir, A. H. (2000). Development of health services in Hajj seasons. Journal of Family and Community Medicine, 7(1), 13–14.

Fetini, A. (2009). The Hajj. Time. November 25, 2009.

Gowa, M. A., et al. (2015). Health issues confronting Muslims on Hajj. International Journal of Endorsing Health Science Research, 3(2), 16–17.

Grow, R. W., Sztajnkrycer, M. D., & Moore, B. R. (2007). Language barriers as a reported cause of prehospital care delay in Minnesota. Prehospital Emergency Care, 12(1), 76–79.

Imran, M., Castillo, C., Diaz, F., & Vieweg, S. (2015). Processing social media messages in mass emergency: A survey. ACM Computing Surveys, 47(4), Article 67.

Memish, A. Z. (2013). Hajj and public health significance of mass gatherings. East Mediterranean Health Journal, 19(2), 5–6.

Oliveira, M. (2013). Multicultural environments and their challenges to crisis communication. International Journal of Business Communication. doi: 10.1177/0021943613487070.

Royal Embassy of Saudi Arabia, Washington DC (2016). Hajj.

Saudi Arabia Hajj disaster death toll rises (2015). Al Jazeera America.

Technical Response Planning (2012). Public relations planning for emergency management.

Timeline of tragedies during Hajj pilgrimage in Mecca (2015). The Guardian.

Turkestani, A., et al. (2013). Using health educators to improve knowledge of healthy behaviour among Hajj 1432 (2011) pilgrims. Eastern Mediterranean Health Journal, 19(2).

United States Department of Justice (2006). Communications interoperability.