Hajj and Umrah

The Ministry of Health of Saudi Arabia issue their requirements and recommendations for Hajj and Umrah annually Hajj and Umrah

On 9 April 2022 the Saudi Ministry of Hajj and Umrah announced that one million international and domestic pilgrims will be given permission to perform Hajj 1443H [1]. Each country will be allocated a quota of pilgrims allowed to perform Hajj 1443H.

Details of the requirements and recommendations for Hajj 1443, including required and recommended vaccinations, COVID-19 and general health advice are available from the Saudi Ministry of Health [2]: Health Requirements and Recommendations for Travellers to Saudi Arabia for Hajj and Umrah – 1443H (2022).

Before making plans, pilgrims should check:

It is important to note that travel restrictions can change at short notice.

Key Messages

Hajj, the annual pilgrimage to Makkah (Mecca), in the Kingdom of Saudi Arabia (KSA) is one of the largest gatherings of its kind in the world.
Performing the rituals of the Hajj and Umrah is demanding and often involves walking long distances in hot weather. Pilgrims must ensure that they are as physically fit as possible. For Hajj 1443H (2022), the KSA Ministry of Health states that pilgrims must be aged less than 65 years.
Pilgrims are usually required to have vaccinations prior to attending Hajj/Umrah; these can change yearly. Those required and recommended for Hajj 1443H are listed below. See also our KSA Country Information page.
Pilgrims should be advised of the importance of checking the British Foreign, Commonwealth & Development Office (FCDO) and Ministry of Hajj and Umrah websites for up to date travel advisories.
Pilgrims should be advised to practise good hand hygiene and to avoid activities that promote exchange of respiratory secretions, such as sharing drinks and eating utensils.
The KSA Ministry of Health (MoH) recommends that, as a precautionary measure, pregnant women and young children should postpone the performance of the Hajj and Umrah [3].
Influenza is easily transmitted in crowded conditions. Pilgrims in clinical risk groups for influenza should receive influenza vaccine annually from their usual healthcare provider, when available, as this may still confer some protection for their pilgrimage. Influenza vaccine for those not in clinical risk groups would need to be accessed from a private clinic or pharmacy service.

Overview

Due to the large crowds, mass gatherings such as Hajj and Umrah are associated with unique health risks [4]. Each year, in early summer, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) issues the requirements and recommendations for entry visas relevant to pilgrims and seasonal workers who intend to visit KSA during forthcoming Hajj and Umrah season [2]. Requirements and recommendations may differ from year to year.

Hajj, the annual pilgrimage to Makkah (Mecca) in KSA occurs between the 8th and 12th day of the twelfth month of the Islamic calendar and is one of the largest mass gatherings in the world. Approximate dates for the 2022 Hajj are 7-12 July.

Usually approximately three million Muslims from around the world gather in Makkah for Hajj each year. All adult, able bodied Muslims are required to undertake Hajj at least once in their lifetime if they can afford to do so [4]. On 9 April 2022, the Ministry of Hajj and Umrah announced that permission to perform Hajj 1443H (2022) would be restricted to one million international and domestic pilgrims, with each country being allocated a quota of pilgrims allowed to enter KSA [1].

Umrah is a shorter, non-compulsory pilgrimage for Muslims, which is performed as part of the Hajj ritual, but can also be undertaken at any time.

UK residents and British nationals resident in Saudi Arabia can find information on how to register to apply to perform Hajj and Umrah – 1443H (2022) through the official Ministry of Hajj and Umrah app ‘Eatmarna’.

A comprehensive guide for applying to perform Umrah, including information for those applying from outside of Saudi Arabia, has been produced by the Ministry of Hajj and Umrah; the Council of British Hajjis’ also provide regular Umrah updates.

The Foreign, Commonwealth and Development Office (FCDO) official social media channels @ukinsaudiarabia also provide information and guidance [5].

Health advice for KSA can be found on our Saudi Arabia Country Information page. The information on the country page should be tailored to individual pilgrims and seasonal workers.

Pre-pilgrimage preparation

Pilgrims should also seek advice about the health risks for any travel that may be undertaken either before or following Hajj or Umrah. Information on health risks for other destinations throughout the world can be found on the Country Information pages.

In the context of COVID-19, a mass gathering could amplify the transmission of the virus and potentially disrupt the host country's response capacity. All travellers to KSA are required to comply with local preventive regulations and procedures required by the KSA authorities [2] to reduce the risk of transmission or the potential strain on health services. These include:

  • restrictions on number and control of crowd movement
  • physical distancing
  • respiratory/cough etiquette
  • hand hygiene practices

Further information is available via the Tawakkalna app.

Pilgrims should ensure they are up to date with all routine immunisations, and ideally see their healthcare provider at least four to six weeks prior to performing Hajj for advice on vaccinations, malaria chemoprophylaxis (if appropriate for travel before or after the pilgrimage), food and water precautions, risks from insect bites, heat exhaustion and injury prevention.

Performing the rituals of Hajj is demanding and involves walking great distances usually in hot weather. Pilgrims should ensure that they are physically fit before travelling, and pilgrims with pre-existing medical conditions should discuss the suitability of travel with their doctor. If on prescribed medications, they should ensure they have a sufficient supply to cover their time abroad with some extra in case of delays, and carry a copy of their prescription.

MoH KSA advises that pilgrims consider their physical ability and health conditions before considering attending Hajj and Umrah.

In some situations, deferment of Hajj should be considered when the risks to the pilgrim are assessed to be high. MoH KSA recommends that pregnant women and young children (pre-puberty) postpone the performance of the Hajj and Umrah rituals for their own safety [3].

Women who anticipate their periods occurring during the Hajj may wish to delay menstruation, which is possible to achieve using hormonal treatment [3]. Women should discuss this with their healthcare provider.

Pilgrims should identify in-country healthcare resources in advance of their trip, and ensure they have adequate health insurance should they fall ill. Sharia compliant health insurance is available.

Pilgrims should also pack a first aid kit to help them manage common issues such as cuts and grazes, headaches and travellers’ diarrhoea.

Vaccination

Pilgrims should be up-to-date with immunisations routinely administered in the United Kingdom (UK) [6] including measles, mumps and rubella (MMR). Information on specific health risks, including recommended vaccinations, for pilgrims in KSA can be found on our Country Information page.

Required vaccinations

COVID-19

MoH KSA states that in order to perform Hajj pilgrims must have proof that they have:

  • received COVID-19 vaccinations approved by the Saudi Ministry of Health; see Ministry of Health Approved Vaccines.
  • a negative COVID-19 test result, taken within 72 hours of the time of departure to Saudi Arabia [2].
Residents and visitors will be required to complete a Registration Immunisation Form before travel, through the Muqeem Portal [5].

Meningococcal disease

All travellers aged over one year, arriving for Umrah, Hajj or for seasonal work in Hajj zones, are required to submit a valid vaccination certificate with a quadrivalent (ACWY) meningococcal vaccine received at least 10 days prior to the planned arrival to Hajj and Umrah areas [2].

This vaccine is also recommended for personal protection against groups A, C, W and Y meningococcal disease (see also recommended vaccines).

Vaccination with ONE of the following vaccines is acceptable:

  • Quadrivalent (ACWY) polysaccharide vaccine within the last three years.
  • Quadrivalent (ACWY) conjugate vaccine within the last five years.

If vaccine type is not indicated on the certificate, it will be considered valid for three years [2].

Details of the vaccine name and type (i.e. conjugate vaccine) should be recorded in a patient held vaccine record showing the individual’s full name. It is advisable that the proof of vaccination record is issued by the individual's doctor, nurse or pharmacist and should accurately reflect the details of the vaccine administered and be authenticated with the healthcare provider's official stamp.

If an individual is in possession of an International Certificate of Vaccination or Prophylaxis (ICVP) booklet, meningococcal ACWY vaccine can be recorded in the ‘Other Vaccinations’ pages.

MoH KSA states they may administer prophylactic antibiotics to some travellers arriving from countries with or at risk of frequent meningitis epidemics or outbreaks [2].

Polio

MoH KSA states that travellers from countries reporting cases of wild poliovirus type 1 (WPV1) or circulating vaccine-derived poliovirus type 1 (cVDPV1) are required to submit a polio vaccination certificate with at least one dose of bivalent oral polio vaccine (bOPV) or inactivated polio vaccine (IPV) within the previous 12 months and not less than four weeks prior to arrival. Travellers from countries reporting cases of circulating vaccine derived poliovirus type 2 (cVDPV2) are required to submit a polio vaccination certificate with at least one dose of IPV within the previous 12 months and at least four weeks prior to arrival. If IPV is not available, it is accepted to submit a polio vaccination certificate with at least one dose of oral polio vaccine (OPV) within the previous six months and not less than four weeks prior to arrival [2].

See Appendix 1: Tables 1 and 2 in Health Requirements and Recommendations for Travellers to Saudi Arabia for Hajj and Umrah – 1443H (2022) for country details.

Yellow fever

All travellers above nine months of age visiting KSA for Hajj and Umrah arriving from countries or areas at risk for transmission of yellow fever (YF) as stated in the WHO International Travel and Health guidelines, must present a valid International Certificate of Vaccination or Prophylaxis documenting YF vaccination [2, 7].

There is no risk of YF in the UK. Therefore, this YF certificate requirement will only apply to UK pilgrims if they are travelling to KSA via a YF risk country and not if they are travelling directly to KSA from the UK.

Recommended vaccinations

General vaccination advice for KSA can be found on our Country Information page.

All pilgrims should ensure that they are up-to-date with routine immunisations including measles, mumps and rubella (MMR) and diphtheria-tetanus-polio vaccine.

The following vaccine-preventable diseases have particular relevance to Hajj and Umrah pilgrims.

Hepatitis B

Hepatitis B virus is found in body fluids and can be transmitted either through the skin (percutaneously) or by sexual contact. Percutaneous transmission can occur through the use of contaminated medical, dental, or other instruments; all pilgrims should consider receiving hepatitis B vaccine prior to travel.

One of the Hajj rites for men is head shaving. The KSA authorities provide licensed barbers with a new blade for each pilgrim. However, unlicensed barbers may not conform to this [8]. Pilgrims should avoid shaving with a previously used blade, as this could result in transmission of hepatitis B and other blood borne infections such as hepatitis C or HIV for which there are no vaccines. Pilgrims can consider taking with them a disposable razor for personal use during this rite.

Meningococcal disease

Meningococcal disease may result in meningitis (infection of the lining of the brain) or septicaemia (blood poisoning) or a combination of both. Less common manifestations of meningococcal disease include myocarditis (inflammation of the heart), pericarditis (inflammation of the sac that surrounds the heart), arthritis, pharyngitis (sore throat) or conjunctivitis (pink eye) [9]. Large outbreaks of meningococcal disease, including meningitis and septicaemia, have occurred during previous Hajj pilgrimages and spread to other countries by returning pilgrims [8].

A conjugated meningococcal ACWY vaccine is the preferred vaccine for all travellers because it not only protects against serious infection but also prevents vaccinated individuals from carrying the meningococcal bacteria and bringing it back with them.

UK Health Security Agency (UKHSA) recommends conjugated meningococcal ACWY vaccine as the preferred vaccine in all instances. Full details of meningococcal vaccines and schedules can be found in Immunisation against infectious disease (the Green Book) [10] and the manufacturers Summary of Product Characteristics [11].

The UK’s Joint Committee on Vaccination and Immunisation reviewed information on length of protection following ACWY conjugate vaccine and advised that for travellers at continued risk, boosting every five years would be a sensible approach until data becomes available [12]. These vaccines do not protect against all the causes of meningitis and septicaemia; any pilgrim who becomes unwell after returning from the Hajj or Umrah should contact their GP, NHS 111 or local hospital.

In addition to vaccination, pilgrims should be advised to practice good hand hygiene and to avoid activities that promote exchange of respiratory secretions, such as sharing drinks and eating utensils [13, 14].

Rabies

There is a risk of rabies in KSA. Pilgrims should be advised of the importance of avoiding contact with wild or domestic animals and to seek urgent emergency medical treatment if any potential exposure (animal bite, lick or scratch) occurs.

Pre-exposure vaccination can be considered. However, rabies vaccination prior to travel does not eliminate the need for post-exposure medical evaluation and additional doses of rabies vaccine. A three-dose course of pre-exposure rabies vaccine simplifies post exposure rabies treatment and removes need, for most travellers, for post exposure rabies immunoglobulin, which is in short supply worldwide.

Influenza

Influenza is transmitted via the respiratory route and through contact (direct or indirect) with surfaces on which the virus has been deposited by sneezing or coughing. It is easily transmitted in crowded conditions.

Certain groups are considered at particular risk of complications from influenza. MoH KSA recommends that travellers arriving for Hajj, Umrah or for seasonal work in Hajj areas are vaccinated against influenza (2).

In the UK, influenza vaccine is available free for those in clinical risk groups and eligible pilgrims should receive influenza vaccine annually from their usual healthcare provider [15]. Those who do not fall into any of these risk categories can still pay and be vaccinated at some high street pharmacies, other retailers, or private travel clinics, but a vaccine may not be available in the UK summer months. New winter season influenza vaccine for the northern hemisphere is usually available in the UK from late August-September at the earliest; pilgrims planning to undertake Hajj the following year should ensure they are vaccinated during the flu season before as this may still confer some protection. Southern Hemisphere influenza vaccine is not usually available in the UK.

Viral respiratory infection (known as Hajj cough) experienced by many pilgrims at the Hajj, can range from a mild inconvenience to a severe illness, and can interfere with performing the rites. Advice about influenza prevention can be found in our factsheet on influenza.

Other health risks

COVID-19

Guidance on travel abroad from England during coronavirus (COVID-19) is available from the Department for Transport.

All individuals, but particularly those who are at high risk and previously considered clinically extremely vulnerable to severe COVID-19 disease, should follow current UK recommendations to reduce their risk of infection and consider postponing pilgrimage.

All pilgrims should be prepared to follow the advice of local authorities regarding COVID-19-related measures. Be ready to comply with local isolation, social distancing, or quarantine requirements, and to rely on the local health system.

There are also general principles travellers can follow to help prevent the spread of respiratory viruses, including [16]:

  • Ensure you are up to date with the COVID-19 vaccination course and boosters, as recommended in the UK vaccination programme.
  • Wash your hands more often – with soap and water for at least 20 seconds or use a hand sanitiser when you get back to your accommodation, when you blow your nose, sneeze or cough, eat or handle food.
  • Wear a face mask in crowded places.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Avoid close contact with people who have symptoms.
  • Cover your cough or sneeze with a tissue, then throw the tissue in a bin and wash your hands.
  • Clean and disinfect frequently touched objects and surfaces in your accommodation.
  • Open windows/doors to let fresh air in when sharing a space with others.

Middle East respiratory syndrome coronavirus (MERS-CoV)

Middle East respiratory syndrome coronavirus (MERS-CoV) can cause severe illness and death [17]. It was first identified in KSA in 2012; most cases to date have occurred in the Arabian Peninsula and in particular in KSA [18]. UKHSA remains vigilant and closely monitors developments in the Middle East and in the rest of the world where new cases have emerged, and continues to liaise with international colleagues to assess whether UKHSA recommendations (see below) need to change [16].

MoH KSA recommends all pilgrims to comply with the following advice:

  • Wash hands with soap and water or a disinfectant, especially after coughing and sneezing, after using toilets, before handling and consuming food, and after touching animals.
  • Use disposable tissues when coughing or sneezing and dispose of used tissues in a wastebasket.
  • Wear a face mask in crowded places.
  • Avoid close contact with people who appear ill and avoid sharing their personal belongings.
  • Avoid contact with camels in farms, markets or barns.
  • Avoid drinking raw milk or eating raw meat or animal products that have not been thoroughly cooked [2].

UKHSA advises that travellers, or UK citizens living in the Middle East follow the advice of local health authorities. People who are acutely ill with an infectious disease are advised not to perform Hajj but to seek local health advice immediately [16].

Pilgrims who develop symptoms (e.g. fever, cough or increasing breathlessness) should seek medical advice locally prior to travel back to the UK.

Should British pilgrims travel back to the UK following Hajj and become unwell within 14 days of their return, they should seek advice by calling their GP or NHS 111 and mention which countries they have visited, so that appropriate measures and testing can be undertaken.

UKHSA provides further guidance for travellers to, and returning from the Middle East, alongside more detailed information for health professionals.

Travellers’ diarrhoea

Diarrhoeal illnesses are transmitted by the consumption of contaminated food or water. Dehydration can occur with diarrhoea and is of particular risk in hot weather. Babies, infants, the elderly and those with chronic medical conditions are more vulnerable to dehydration.

MoH KSA advises all pilgrims to take personal, food and water hygiene precautions:

  • Wash hands before and after eating and after going to the toilet.
  • Thoroughly clean and wash fresh vegetables and fruit.
  • Cook food thoroughly and store at safe temperatures.
  • Keep raw and cooked foods separated [2].

Pilgrims should also take with them oral rehydration therapy and self-treatment for diarrhoea. An antimotility agent, such as loperamide, can be carried. Information on treatment options can be found in our travellers’ diarrhoea factsheet.

Vector-borne diseases

Malaria is not present in Medina or Makkah [Mecca] (or in the cities of Jeddah, Riyadh and Ta’if or areas of Asir province above 2,000m), but malaria is a risk in the south-western provinces of Saudi Arabia (including Asir province below 2,000m). Pilgrims planning further travel before or after Hajj or Umrah to malaria risk areas in KSA or Asia, Africa and Latin America, should seek advice about malaria prevention.

Pilgrims are advised to take necessary measures to avoid mosquito bites during the day and evening which include wearing protective clothing (preferably light-coloured) that covers as much of the body as possible; using physical barriers such as window screens and closed doors; and applying insect repellent to skin or clothing. This will help protect against vector-borne diseases, such as dengue.

Zika

Zika virus has not been detected in KSA [18, 19]. However, the presence of the vector mosquito (Aedes aegypti) has been recorded in KSA [20]. MoH KSA requires that aircrafts, ships, and other means of transportation coming from countries affected with the Zika virus and/or dengue fever to submit a certificate indicating that disinfection measures have been undertaken [7].

Other health considerations

Accidents and injuries

Minor injuries are relatively common, particularly to the feet. More serious injuries can occur as a result of stampedes as pilgrims undertake the stoning rite or other mass activities.

Pilgrims are advised to avoid peak times. Elderly and infirm people, who have decided to make their pilgrimage, may wish to consider appointing a proxy for the performance of this rite. All pilgrims to Hajj and Umrah should have adequate health insurance.

Environmental hazards (cold, heat and sun)

Daytime temperatures in KSA, even during the winter months, can reach over 30°C. Associated risks include sunburn, dehydration, heat exhaustion and heat stroke. MoH KSA recommends all pilgrims, especially older individuals, to avoid direct sun exposure while performing rituals and to drink enough fluids. Medicines with the potential to exacerbate dehydration (e.g. diuretics) or interfere with heat exchange may need adjustment by treating physicians [21].

If possible, travel to Makkah (Mecca) before the start of Hajj should be considered to allow a period of heat acclimatisation. Pilgrims should drink plenty of clean water (preferably bottled or boiled and cooled) to avoid dehydration.

Sun protection factor (SPF) of 30 or above, with four or five star UVA protection, should be applied liberally to exposed skin every two to three hours. Male pilgrims are not allowed to cover their heads, but an umbrella will provide shade from the sun.

Desert sand can reach very high temperatures; good quality footwear should be worn to avoid burning the feet. Footwear must be removed during times of prayer, to avoid losing them; pilgrims are advised to carry their shoes in a bag.

During the winter months the weather can be very cold overnight. If staying in basic accommodation, pilgrims should ensure they take appropriate bedding with them such as blankets and sleeping bags.

Food and water advice

The authorities in KSA do not permit entry Hajj and Umrah travellers to bring food into KSA except in properly canned or sealed containers [2, 21]. All pilgrims are advised to take personal, food and water hygiene precautions.

Physical fitness

Performing the rituals of Hajj is demanding and involves walking great distances usually in hot weather. Pilgrims should ensure that they are physically fit.

Illness abroad or on return from Hajj or Umrah

If you develop symptoms of new continuous cough, high temperature or a loss of, or change in your normal sense of taste or smell (anosmia) while abroad, or during travel, you should immediately [22]:

  • Stay indoors and avoid contact with other people.
  • Call your health provider and/or insurance company to discuss what you should do.
  • Follow local public health guidance, if available.
  • If you become unwell at an airport, bus or train station before or during a long trip, seek medical advice and do not start or continue your journey.
  • If you test positive for COVID-19 while abroad you will need to follow local public health advice regarding self-isolation. You should expect to self-isolate in the country you are in, so you may need to stay longer than planned. Plan ahead for any possible delays to your return home.
  • Once you have fully recovered, check with your local health provider if you are fit to travel, before any onward travel.

Advice after travel

Travellers must check current rules regarding travel to the UK as they may change at short notice. See GOV.UK information on entering the UK and the Foreign, Commonwealth & Development Office travel advice for up to date information.

  1. Ministry of Hajj and Umrah. One million pilgrims to perform Hajj in 1443H/2022. 9 April 2022 [Accessed 9 June 2022]
  2. Ministry of Hajj and Umrah. Health Requirements and Recommendations for Travelers to Saudi Arabia for Hajj and Umrah – 1443H (2022). May 2022. [Accessed 8 June 2022]
  3. Ministry of Health, Kingdom of Saudi Arabia. Hajj 1439H Health Guidelines. Woman and Children during Hajj. [Accessed 9 June 2022]
  4. Aldossari M, Aljoudi A & Celantano D. Health issues at the Hajj pilgrimage: a literature review. [Accessed 9 June 2022]
  5. Foreign, Commonwealth and Development Office: Foreign travel advice. Saudi Arabia. [Accessed 9 June 2022]
  6. UK Health Security Agency. UK immunisation schedule Ch 11. Immunisation against infectious disease. Update 17 March 2022. [Accessed 9 June 2022]
  7. European Centre for Disease Prevention and Control. Public health risks related to communicable diseases during the hajj 2019, Saudi Arabia, 9–14 August 2019 1 July 2019. [Accessed 9 June 2022]
  8. Memish Z. The Hajj: communicable and non-communicable health hazards and current guidance for pilgrims. September 2010;15:39 [Accessed 9 June 2022]
  9. Harrison LH, Granoff DM, Pollard A. Meningococcal Capsular Group A, C, W, and Y Conjugate Vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards K eds. 7th ed. Philadelphia: Elsevier; 2018. p619
  10. UK Health Security Agency. Meningococcal, Ch. 22. Immunisation against infectious disease. Last updated 17 May 2022. [Accessed 9 June 2022]
  11. electronic medicines compendium
  12. Joint Committee on Vaccination and Immunisation. Draft minutes of meeting 1 February 2017. [Accessed 9 June 2022]
  13. Government of Canada. CATMAT statement: meningococcal disease and international travel. Volume 41-5, May 7, 2015: Visiting friends and relatives [Accessed 9 June 2022]
  14. World Health Organization. Meningococcal meningitis, Defeating meningitis by 2030: Development of the roadmap. [Accessed 9 June 2022]
  15. UK Health Security Agency. Influenza, Ch. 19. Immunisation against infectious disease. Updated 29 October 2020. [Accessed 9 June 2022]
  16. World Health Organization. Fact sheet Middle East Respiratory Syndrome Coronavirus (MERS-CoV) 11 March 2019 [Accessed 9 June 2022]
  17. World Health Organization. Epidemic and pandemic-prone diseases MERS situation update, April 2019. [Accessed 9 June 2022]
  18. UK Health Security Agency. Risk Assessment of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Updated 23 September 2021 [Accessed 9 June 2022]
  19. Public Health England/UK Health Security Agency. Zika virus: country specific risk, 19 July 2019. [Accessed 9 June 2022]
  20. World Health Organization Regional Office for the Eastern Mediterranean. Zika virus. Number of countries affected. 2018. [Accessed 9 June 2022]
  21. Saudi Press Agency. Ministry of Hajj and Umrah: Increasing operational capacity of the Grand Mosque during Ramadan. 5 April 2021. [Accessed 9 June 2022]
  22. UK Health Security Agency. Coronavirus (COVID-19): guidance. Updated 4 April 2022. [Accessed 9 June 2022]

First Published :   25 Apr 2022
Last Updated :   28 Jun 2022

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