Environmental and Social Factors Influencing Heat Exhaustion Among Arbaeen Pilgrims: A Narrative Review

Abstract

Context: Heat exhaustion is a significant concern among Arbaeen pilgrims due to extreme environmental conditions, prolonged physical exertion, and limited access to medical resources. The combination of high temperatures, humidity, crowd density, and cultural practices increases the risk of heat-related illnesses. Despite existing mitigation strategies, challenges persist in effectively managing heat stress during the pilgrimage. The present study aimed to examine the environmental and social factors contributing to heat exhaustion among Arbaeen pilgrims, identify gaps in current mitigation strategies, and propose evidence-based interventions to improve health outcomes during future pilgrimages. Methods: A narrative review was conducted using literature from PubMed, Scopus, Web of Science, and Google Scholar, alongside reports from health organizations and government agencies. Inclusion criteria focused on studies examining heat stress in mass gatherings, particularly religious pilgrimages. Findings were categorized into environmental factors (temperature, humidity, hydration, and clothing) and social factors (crowd density, cultural behaviors, healthcare accessibility). Comparative analysis with the Hajj and other mass gatherings provided additional insights. Results: Extreme temperatures (> 40°C) and high humidity significantly impair thermoregulation. Limited hydration and inappropriate clothing choices exacerbate heat stress. Crowd congestion and restricted airflow intensify environmental discomfort. Cultural attitudes toward medical intervention delay treatment-seeking behaviors. Inadequate medical infrastructure reduces response effectiveness. Comparison with the Hajj pilgrimage highlights potential strategies for heat mitigation, including structured crowd management, hydration stations, and mobile clinics. Conclusions: Managing heat exhaustion among Arbaeen pilgrims requires a multidisciplinary approach, integrating urban planning, healthcare accessibility, and culturally sensitive educational campaigns. Key recommendations include hydration stations, mobile medical units, shaded rest zones, and multilingual health awareness programs. Future research should explore data-driven monitoring systems and innovative cooling technologies to further enhance pilgrimage safety.