Health Challenges of the Elderly During the Arbaeen Pilgrimage: A Review of Physical, Psychological, Hygienic, Sociocultural and Managerial Dimensions

Abstract

Context: The Arbaeen pilgrimage is one of the largest religious mass gatherings in the world, attracting millions of participants annually, including a significant number of elderly individuals. While their participation reflects deep spiritual commitment, it also exposes them to a wide range of health risks due to physical exertion, environmental stressors, and limited access to age-appropriate services. Understanding these challenges is essential for improving health outcomes and ensuring safe participation. Evidence Acquisition: This study employed a narrative review methodology. Scientific literature published between 2010 and 2025 was retrieved from databases including PubMed, Scopus, Google Scholar, Scientific Information Database (SID), and Magiran. Keywords such as “elderly”, “Arbaeen pilgrimage”, “health in mass gatherings”, and “geriatric care” were used. After screening and applying inclusion criteria, 42 relevant studies were selected and analyzed across five thematic domains: Physical, psychological, hygienic, managerial, and sociocultural. Results: Findings revealed that elderly pilgrims face multifaceted health challenges. Physically, they experience fatigue, chronic disease exacerbation, and injury risks. Psychologically, anxiety, cognitive decline, and sleep disruption are prevalent. Hygienic and nutritional issues include poor sanitation, dehydration, and inadequate dietary options. Managerial challenges involve insufficient infrastructure, emergency response gaps, and lack of trained volunteers. Sociocultural barriers such as language differences and limited social support further compound vulnerability. Conclusions: Elderly participation in the Arbaeen pilgrimage, while spiritually meaningful, requires targeted health interventions. Multilevel strategies — including infrastructure improvements, preventive care, volunteer training, and international coordination — are essential to safeguard their well-being. Addressing these challenges is both a public health priority and a humanitarian obligation.