Exploring challenges of health system preparedness for communicable diseases in Arbaeen mass gathering: a qualitative study

Abstract

Background: Infectious diseases are common problems in mass gatherings, especially when there is a lack of health system preparedness. Since Iran is one of the most important countries on the walking path of Arbaeen and has a vital role in providing health services to pilgrims, the experiences of health challenges by participants is of key importance. The aim of this study is to explore stakeholders’ experiences on the health system's preparedness and challenges, and to provide suggestions for preventing infectious diseases during the Arbaeen mass gathering. Methods: A qualitative research method was used with a conventional content analysis approach. The number of participants was 17, including 13 executive managers and 4 health policymakers who entered the study among participants. Semi-structured interviews were used to generate the data. Interviews were analyzed by means of content analysis after face-to-face interviews. Results: Data analysis resulted in the extraction of four main themes and 11 sub-themes. Health infrastructure defects in Iraq has three sub-themes (health abandonment in Iraq, the weaknesses in health culture and problems related to the health system); poor control of the causative factors of infectious diseases has three sub-themes (the underlying factors of the prevalence of contagious diseases, health system response to communicable diseases and ignoring the risks of the Arbaeen ceremony); the low perception of risk in pilgrims has three sub-themes (lack of awareness in pilgrims, fatalism in pilgrims and unhygienic belief in pilgrims); and the ineffectiveness of health education has two sub-themes (training shortage in the targeted group and educational content problems) that shows participant’s experiences of the health system's challenges for coping with infectious diseases during the Arbaeen ceremony. Conclusion: Pilgrim-based training, planning and controlling other challenges may change these threats to opportunities and improve the health of participants of the mass gathering of Arbaeen in the region.

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

“…The Arbaeen is one of the largest, during which pilgrims from Iraqi provinces visit the holy shrine in Karbala, and poses major public health challenges. 114 In West Africa, each year up to 5 million Muslim pilgrims from the Mouride community in Senegal, and from neighbouring countries, assemble in the holy city of Touba in Senegal for the Grand Magal religious pilgrimage, 115 the largest religious mass gathering in West Africa. This pilgrimage attracts individuals from outside Africa and has the potential for globalisation of local endemic infectious diseases.…”

Health Risks, Preventive Behaviours and Respiratory Illnesses at the 2019 Arbaeen: Implications for COVID-19 and Other Pandemics

“…Arbaeen participants may believe their health risks are limited because of the religious focus of the walk [ 11 ]. For example, during the COVID-19 pandemic in 2020, the Arbaeen event did occur, though with fewer numbers.…”

Challenges of Health Services during Arbaeen Pilgrimage in 2019

“…Arbaeen pilgrimage is one of the world's largest religious gatherings held in Iraq on the occasion of the 40 th day of Imam Hussein martyrdom (the third Imam of Shiites). This event begins about 10-14 days before Arbaeen (the 20 th day of Safar, the second month of the Islamic Calendar) and continues until the end of Arbaeen, and the pilgrims walk from Najaf to Karbala during this period (2,3). People from various countries take part in the Arbaeen pilgrimage; however, the majority of them are from Iraq, Iran, Afghanistan, Pakistan, and the Persian Gulf (4).…”

“…The gathering of many people from multiple households in a particular place increases the risk of respiratory diseases (7). Among the common problems in Arbaeen mass gathering, we can refer to the lack of an appropriate transportation system, inadequate health system, lack of access to safe water, infectious diseases, overcrowding, as well as the lack of medicines and medical equipment (3,(8)(9)(10). Moreover, water-and food-borne diseases, along with skin and respiratory illnesses, such as the flu, are the most common diseases (11).…”