Mass Gatherings: Health
Hajj and the Olympic Games
Dr. Mozammel Haque
In July, the city and communities of London will welcome the world for the Olympic Games. With millions of additional visitors expected in the capital, the event will prove to be an immense logistical challenge for the organisers, public services and the people of London. From transportation to accommodation, health and hospitality, London’s infrastructure will be put to the test.
Mass gatherings and health hazard
Mass gathering have been defined as groups of greater than 1,000 people; however most of the public literature reflects much larger events (25,000). A more inclusive definition is large number of people attending an event that is focused at specific sites for a finite time.”
Dr. Ziad Memish, Professor of King Faisal University, Riyadh, classified Mass gathering into two types: spontaneous and planned which is again divided into Recurrent Events: Different locations (e.g., Olympic, World Cup) and same location (e.g., Hajj, Wimbledon). No doubt, a mass gathering poses unique challenges for maintaining public health.
Hajj, the annual Muslim pilgrimage involving well over two million people required to follow a schedule of movements from one location to another within prescribed times, is perhaps the closes logistical comparison to London’s summer event. Each year the authorities are tasked with the responsibility of moving, catering and looking after millions of pilgrims at the same time, at the same place. There have been success stories, and there have been tragedies.
Before going into the management of the mass gathering during Hajj, let us see first the situation when millions of people will be in London during the Olympics.
Facts & Figures of Olympics
2012 Summer Olympic Games will take place in London, England, the United Kingdom for seventeen days, from 27 July to 12 August, 2012 in which 12,000 athletes, 29 sports, 302 gold medals will participate.
London will become the first city to officially host the modern Olympic Games three times, having previously done so in 1908 and 1948. Organisers estimate that some 8 million tickets would be available for the Olympic Games and 1.5 million tickets for the Paralympic Games. It is estimated that 80% of available Olympic tickets and 63% of Paralympic tickets will be sold. LOCOG aims to raise 375-400 million pounds in ticket sales.
There are criticisms from people in London that the Games will cause chaos, disrupt business and make life more difficult for many people. The organisers of London 2012 are creating 30 miles of Games Lanes for use by the “Olympic family”. The lanes apply to major routes that have two more carriageways and will be used by 4,000 BMWs and 1,500 coaches ferrying around Olympic VIPs, athletes, sponsors and the media. It has created anger about congestion and the preferential treatment of Olympic dignitaries and sponsors over ordinary Londoners. Anyone using the lane without authorisation will be fined heavily.
Facts & Figures of Hajj
Professor Ziad Memish briefly described Hajj, saying Hajj is once in a lifetime obligation. It brings pilgrims from 183 countries. It includes 2 million international pilgrims and one million domestic. Whereas, Umrah is a ‘mini pilgrimage’ which can be done any time of the year. The busiest month is Ramadan and the 3 months before Hajj. Close to 6 million pilgrims arrived from abroad last year for Umrah.
Comparison of Mass Gathering
between Hajj and Olympic
As it was mentioned, Olympic Games is a planned recurrent event at different location, whereas Hajj is also a planned recurrent event, but at the same location. Secondly, Olympic Games take place every four years in different location, whereas Hajj takes place in the same location every year. Thirdly, Olympic Games is sport, whereas Hajj is a religious obligation.
In spite of these differences, there is one common similarity, which is mass gathering and health issue. Let us first see. How the Saudi government planned, managed and running the Mass Gathering during Hajj. Recently, Professor Dr. Ziad Memish, Deputy Public Health Minister of Saudi Arabia, responsible for the Hajj, came to England and delivered a keynote address on “Health Protection during Mass Gatherings: The Hajj Experience” at the Symposium, entitled “Health, Hajj and the Olympics: How Mass Events Medicine Affect Communities” organised by Muslim Council of Britain (MCB) at the London School of Hygiene and Tropical Medicine on 17 May, 2012.
How Saudi Arabia make Mass Gathering
preparedness during Hajj
Professor Memish said, when planning and running Mass Gatherings (MGs), we need to take into account: type of event, duration, size and location, and the effects of hot or cold weather. If the gatherings draw visitors from different nations, regions and cultures the potential for importing infectious disease becomes greater.
Mass Gathering constitutes a unique opportunity to study the public health issues in mobile populations. Speaking about the mass gathering preparedness, Professor Memish mentioned three areas, such as i) Risk assessment: What might happen? ii) Surveillance: How will we know when it happens? And iii) Response: What we will do when it happens?
Speaking about the Preventive Program Framework of Saudi Arabia, Professor. Memish mentioned the Supreme Hajj Committee (At Higher Level); Secondly, The Supervisory Committee for Preventive Medicine Program (At Ministry of Health Level) and Thirdly, The Executive Committee for Preventive Medicine Program (At Makkah Regional Level). The Supreme Hajj Committee consists of HRH Crown Prince and the Minister of Interior.
Professor Memish mentioned of the outbreaks of Meningitogoal Disease related to Hajj (1987-2003); there was large outbreaks in 1974 & 1987 (Serogroup A) and smaller outbreaks in 1992/1993 (mainly Serogroup A from non-Vaccinated); Serogroups W135 outbreak in 2000 and Serogroups W135 outbreak in 2001.
Professor Memish mentioned about “The Jeddah Declaration”, wherein it was resolved: Encouraging research and scientific institutions as well as research funding national and international universities and authorities to include MG health on their priority list; Holding a MG Health Conference periodically every two years and establish “Custodian of the Two Holy Mosques Award for MG Health”
Professor Memish made some concluding remarks. He said, In view of the global public health threats that might originate from MGs, medicine relevant to MGs has become an essential, specialized, and interdisciplinary branch of PH. Agencies outside the realm of public health should be closely involved in MG medicine.
Dr. Memish also mentioned, in the operation and management of an MG, several sectors (e.g. health care, security and public communications) need to know how to interface with public health services and resources quickly and effectively. MGs pose complex challenges that require a broad expertise and a multidisciplinary collective approach.
Ziad Memish obtained his medical degree from the University of Ottawa in 1987. He is Fellow, Royal College of Physicians and Surgeons of Canada and the American College of Physicians. In November, 2007, he was awarded by the Custodian of the Two Holy Mosques King Abdullah bin Abdulaziz al-Saud “The King Abdulaziz Medal from the First Degree” – the highest award on a National level in Saudi Arabia for achievements in the field of infectious diseases and infection control.
Mass Gathering during Olympic Games
As mentioned earlier, this summer, an estimated 10,000 athletes and millions of visitors from all over the world will gather in London for the 2012 Olympic and Paralympic Games. Such mass gatherings present special challenges for public health that need to be prepared for and managed.
8,000 inspirational people will carry the Olympic Flame as it journeys across the UK. The Olympic Flame will travel to 95 per cent of people in the UK, the Isle of Man, Guernsey and Jersey during the 70-day Torch Olympic Torch Relay. It is said that the Olympic Flame stands for peace, unity and friendship. It will be carried by 8,000 truly inspirational Torchbearers and will visit more than 1,000 communities over 70 days.
People are saying that there will be chaos in public transport. Earlier this year, the Network Rail chief executive Sir David Higgins warned that that “bad things will happen” to London’s transport system during the Olympics. The key thing is not to panic, he said. TfL says: “London’s transport network will, at certain times and in certain places, be very busy next summer. People planning to travel in London next summer are advised to visit getaheadofthegames.com to see what steps they can take to avoid transport hotspots and keep themselves, and London, moving."
What plan London has during Olympics
Some of the world’s leading experts in the health and medical issues around global mass gatherings and major sporting events gathered at the London School of Hygiene & Tropical Medicine (LSHTM) to explore relevant issues and engage in a public panel discussion. This panel discussion, jointly organised by Chatham House, the Institute of Global Health Innovation at Imperial College London and LSHTM, held on 18th of May, 2012, examined progress over the past decade in health policies concerning mass gatherings, the development of medical sub-speciality of Mass Gatherings Medicine, and how international collaboration can increase resilience in future.
Participants included senior representatives of the UK Health Protection Agency London 2012, the World Health Organisation (WHO), and the Saudi Ministry of Health.
Dr. Brian McCloskey, London Regional Director and Olympics lead at the Health Protection Agency, UK, said: “In the lead up to the London Olympics we have liaised with public health experts from all over the world, to learn from their experiences with mass gatherings – including previous Olympic Games – in order to provide the best possible protection to the public and Games participants from threats to their health.
“Our risk assessments indicate that there is only a slight increased risk of infectious disease during the Olympics, such as diarrhoea and vomiting, and the reality is that serious outbreaks are relatively rare. Nevertheless, we have worked with public health experts from across the globe to put in place world class systems to monitor and respond rapidly to any outbreaks of infectious diseases or environmental hazards. This builds on existing tested, high quality capacity within the UK public health system.”
Professor David L. Heymann, Professor of Infectious Disease Epidemiology at LSHTM and Head and Senior Research Fellow at the Centre on Global Health Security at Chatham House, said: “Global Mass Gatherings such as at London 2012 present specific challenges, and it is important that the public health risks are recognised and understood. Prevention is both a collective and a personal issue – collective by ensuring that water, sanitation and food are safe, and individual in knowing how to protect against infectious diseases that may be transported by persons who attend or participate in the games.
“Lessons from the Hajj, the world’s largest annual mass gathering, will be shared and have much to teach us about how best to prepare and respond. This is a global issue and it is vital that we collaborate on a global scale to minimise the risks to public health that mass gatherings can pose.”
Olympic Games during Ramadan
As the games fall during the month of Ramadan the occasion will also be a challenge for Muslims choosing to observe the fast – be they visitors or the communities in the UK. The MCB symposium also heard from volunteers and service providers ready to cater for fasting Muslims during the Olympics.
Dr. Muhammad Abdul Bari, former Secretary General of the Muslim Council of Britain, mentioned, London won the Olympic Games bid in 2005 and France was the forerunner. London won the bid for its diversity, youthfulness and of course the legacy.
As a board member of the London Organising Committee of the Olympic Games and Paralympic Games (LOCOG), Dr. Abdul Bari said, from the day one the faith communities, especially the Muslim community, realise that Olympic is happening during the month of Ramadan. “We tried to make sure that the facilities for prayers have been made. Different prayer places, dozens of mosques have been gearing up to massive Iftar gatherings; organised by London city all Muslim organisations.”