Al Muftareshoon Revisited, Hajj season 1425 H

Living on the street during hajj is a major social and health problem that recurs annually. Several problems can occur to the Muftaresheen. In addition to hindering access of emergency vehicles, and interfering with the movement of both pedestrians and vehicles, the accumulation of waste on the streets, let alone their uncivilized sight, they are more likely to suffer from accidents and diseases. This study was conducted to investigate the demographic characteristics of the Muftaresheen in Mina, their behavior, social and health problems, and the reasons for their stay on the street.

A cross sectional study was conducted using Quota sampling technique. A questionnaire was designed and divided into 2 parts, the first for "Individual Hajjis" traveling alone, and the second for "Group Hajjis". Any male hajji who was considered as Muftaresh was interviewed. In case of groups of Hajjis traveling together, only one of them was interviewed. Data was collected from the 8th to 13th of Dhul-Hijjah, 1425 H.

The first part of the study involved 527 single hajjis, primarily located on the pedestrian road (74.4%). Most of them were domestic (91.5%), with 57.9% from Makkah region. Their mean age was 35.2 years (SD 9.8), most were married 74.7%, and from Arab countries 62%. Saudis constituted 2.7%. Almost half of the muftaresheen had an educational level of secondary school and above 45%. The mean monthly income of domestic muftaresheen was 1347.5 Saudi Riyals (SD 878.8). Regarding medical history, 4.2% had chronic diseases. Hajjis who had Hajj permission constituted only 16% of the sample and 11.4% had paid Hamlas for obtaining hajj permission. During their stay in Makkah, 22.8% had accommodation and only 21 (4%) had paid Hamla for residency in Mina. Of the sample, 54.3% were performing hajj as Muftaresheen with other people. Among those who had performed hajj previously, 81% were Muftaresheen during the last hajj. Only 47.6% had received Meningitis vaccine.

Of the total single hajjis, 12.3% had fallen sick, of who 70.8% had respiratory infection. 1.5% had been involved in accidents during their stay in Mina; of those 62.5% were stepped on by pedestrians, 25% were involved in accidents with vehicles, and 12.5% was stepped upon by moving crowd.

The total number of group hajjis was 1824, with a mean of 6.4 hajjis in each group. Out of who 11% were females, 2.2% were children, 4.6% were aged over 60, 84.6% were domestic, 26.6% had hajj permission, 51.7% had received meningitis vaccine, 5.4% had fallen sick, of who 67.3% had respiratory infection. 0.6% had been involved in accidents during their stay in Mina.

Several reasons were given for living in the street in Mina, particularly expensive Hamlas or expensive Mina residency (75.5%).

Restaurants were the main source of food (57.3%). General public toilets were mainly used (96.2%). Regarding waste disposal, 84.8% stated that they disposed of waste in the large municipal street bins. 7.2% left it in plastic bags on the street, and 3% just threw it on the street.

Almost 86.5% got a chance to sleep in their places, mean sleeping hours in the last 24 hours was 4.3 hours (SD 2.1), 32.2% could not sleep well due to different reasons, noise was stated as the major cause (23.5%). Saudi authorities asked 10% to leave their places once: 8.8% were asked to leave 2 to 5 times, and 1% were asked to leave more than 5 times.

A large number (63.6%) stated that they had faced no problems as muftaresheen. The main problems stated were crowdedness 7.8%, difficulty obtaining food 4.6%, difficulty finding toilets 3.8%, fighting with other hajjis for the place 4%, and people stepping over them 1%.

Seventy six percent were satisfied with performing hajj as Muftaresheen. Among those planning to perform hajj next season, 53.3% stated that they will repeat hajj as Muftaresheen, the main reasons cited for this decision were low cost 76.3%, and easy to perform hajj rituals 18%. Factors influencing this decision were mainly satisfaction with staying as muftaresh this hajj season (OR 15.10, 95% CI 7.24 €” 31.49; adjusted OR 18.52, 95% CI 8.55-40.00; and being muftaresh during previous hajj season (OR 4.87, 95% CI 9.24 €” 25.59; adjusted OR 5.85, 95% CI 2.23-15.38). Reasons cited for future plan of not staying in the street among hajjis who plan to perform hajj in future seasons were mainly that hamlas are better 80.1%, more privacy 10.8%, and avoiding accidents 6.0%.

Hajjis spend around 4 days during hajj in Mina The Saudi government has provided well-equipped camps for hajjis attached to organized Hamlas during their stay in Mina. The Muftaresheen, however, reside on the streets of Mina, where they sleep, eat, and carry out their daily activities, hence were given their name They mainly reside on the pedestrian road, around Jamarat, around Al-Kaif mosque, around Mina general hospital and along the bridges.

Muftaresheen are at higher risk than other hajjis, where the environment is unsafe for women, children and the elderly. They are at greater risk of road traffic accidents, or people trampling over them in areas where large groups of people move. Their risk of infection is also higher as a result of the crowdedness, eating from exposed food sold by street vendors, and low vaccination coverage. They also face a number of other problems concerning sleeping, privacy, weather changes, crowdedness and fights over their location.

A previous study conducted by the Field Epidemiology Training Program on the Muftaresheen in 1420 H involving 412 Hajjis,[1] showed that 62% were domestic and about 95% were non-Saudis. The proportion of domestic Muftaresheen has therefore increased from 62% in 1420 H to 84.6% in this study.

Meningococcal meningitis is a major health risk, especially during hajj[2], however, this study showed that almost half of the Muftaresheen had not received the meningococcal vaccine The proportion of vaccinated hajjis among Muftaresheen fell from 81% in 1420 H,[1] to 51.7% in the current study.

In the previous study of 1420 H, the main reason reported for staying on the street was financial, and almost one third were not comfortable with performing Hajj this way.' Similarly, in this study the main reason stated for living on the street was expensive Hamlas or high cost of residence in Mina.

This study has demonstrated that the Muftaresheen phenomenon is continuous and repeated annually, such that 80.9% of those who had performed hajj previously had been Muftaresheen, and 53.3% of the Muftaresheen during this hajj season decided to be so again in future.

It seems that this phenomenon cannot be stopped, it can, however, be reduced, as suggested by the Muftaresheen themselves, by decreasing the cost of residence in Mina, providing free camps and decreasing the cost of Hamlas.