2006 Hajj stampede

The number of fatalities reached 363, 203 of whom were identified within the first two days. Among deaths were 118 males and 85 females.[7]

Casualties include multiple nationalities, with Chinese, Moroccans, Afghans, Ethiopians, Bangladeshis, Algerians, Saudis, Jordanians, Yemenis, Iraqis, Iranians, Syrians, Turks, Sudanese, Maldivians, Egyptians, Indians, Omanis, Pakistanis, Nigerians, Palestinians and nationals from Germany, Belgium, Chad and Ghana.[7]

"The bodies were piled up. I couldn't count them - they were too many," said Suad Abu Hamada.[8]
"Everybody was pushing from behind to get through and suddenly police blocked the entrance and people started falling on each other", said Mohammed al-Farra.[9]

The Saudi government had invested in improving crowd flow[13] at Jamaraat Bridge, by widening it to eight lanes.[14]

Plans for the bridge to be demolished and rebuilt as a four-storey structure with air-conditioning were approved in 2005.[2][10] This work went ahead immediately after the January 2006 Hajj[10] and was completed prior to the 2009 Hajj.[15]

These infrastructure improvements were not accompanied by adequate signage telling pilgrims which direction to travel, a problem given that most Hajjis have never visited before.[16]

There have been repeated calls to restrict the numbers allowed to attend the Hajj and, in particular, 'illegal' pilgrims. 'Illegal' pilgrims are those who do not hold a Hajj permit, Mecca residence permit or a Hajj work permit.[17] There were reports of up to one million illegal pilgrims in 2006.[2]

Crackdowns on such pilgrims have become an increasing feature of security arrangements.[12][18][17]

Calls continued to be made for better disaster planning long after the 2006 crush, with suggestions to make pilgrims aware of that the stoning ritual can take place at various times[14] as well as training on basic preventive measures for infectious diseases and outbreaks[19] and how to stay safe in large crowds.[20]

By 2009, large bags had been banned during the stoning rituals.[15]

Because of heavy congestion, shared accommodation, air pollution, compromised hygiene and heat, the transmission of infectious diseases is high.[21][22]

Due to climate change, the Middle East has had a rising surface temperature since the 1970s. Pilgrims are expected to spend between 20–30 hours outside during the 5-6-day rituals in an average heat of 43 °C (highest 50 °C).[23][12] The expected extreme heat and humidity is going to exceed the danger threshold by 20% between the years 2045 and 2053 creating an even more challenging Hajj.[24][12]

Due to population growth, economic growth and advancement in transport attendance between 2000 and 2010 increased by 46%.[20] Global travel directly amplifies the risk of disease transmission.[25]

• All visitors from both yellow fever and/or polio-affected countries must present valid certificates and/or vaccination evidence upon entry to Saudi Arabia.[21]
• All visitors must have proof of vaccination against meningitis.[21]
• The Saudi Arabia Ministry of Health recommends travellers to have the influenza, pertussis and measles vaccinations.[21]

• 50% of pilgrims suffer with diabetes.[26]
• 64% of admissions into intensive care are for cardiovascular diseases.[27]
• 46-66% of deaths during the Hajj are from cardiovascular diseases.[27]