Volume 18, Issue 2 (5-2026)
jorar 2026, 18(2): 81-90 |
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Rahmani F, Ghomian Z, Mohammadi Behnoush M, Jobaneh M. Healthcare Challenges and Solutions During the Arbaeen Pilgrimage: Perspectives of Nurses and EMS Personnel. jorar 2026; 18 (2) :81-90
URL: http://jorar.ir/article-1-1081-en.html
URL: http://jorar.ir/article-1-1081-en.html
Associate Professor, Safety Promotion and Injury Prevention Research Center, Research Institute for Health Sciences and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: (114 Views)
INTRODUCTION:The Arbaeen pilgrimage is one of the world’s largest annual religious mass gatherings, attracting millions. It presents major challenges to healthcare delivery, medical supply chains, and welfare services due to extreme crowd density, high temperatures, long walking distances, and limited infrastructure. This study explores these challenges and potential solutions from the perspectives of nurses and Emergency Medical Services (EMS) personnel.
METHODS: This qualitative study used inductive content analysis. Semi-structured interviews were conducted with 18 nurses and EMS personnel using purposive sampling until data saturation was reached.
FINDINGS: The findings identified key challenges, including shortages of human resources (particularly female nurses) and equipment, inadequate accommodation and welfare facilities, limited specialized care for vulnerable groups, sociocultural and communication barriers, healthcare worker exhaustion, crowd congestion, inefficient resource management, and limited patient transfer capacity.
CONCLUSION: Improving healthcare services during the Arbaeen pilgrimage requires targeted interventions. Key strategies include increasing female nurse recruitment, establishing dedicated Mokebs for women and children, deploying mobile clinics and ICUs, integrating Arabic interpreters, implementing electronic health records, strengthening coordination, utilizing intelligent crowd management, and deploying motorcycle ambulances in high-density areas. These measures can enhance care quality, decision-making, and patient referral processes.
METHODS: This qualitative study used inductive content analysis. Semi-structured interviews were conducted with 18 nurses and EMS personnel using purposive sampling until data saturation was reached.
FINDINGS: The findings identified key challenges, including shortages of human resources (particularly female nurses) and equipment, inadequate accommodation and welfare facilities, limited specialized care for vulnerable groups, sociocultural and communication barriers, healthcare worker exhaustion, crowd congestion, inefficient resource management, and limited patient transfer capacity.
CONCLUSION: Improving healthcare services during the Arbaeen pilgrimage requires targeted interventions. Key strategies include increasing female nurse recruitment, establishing dedicated Mokebs for women and children, deploying mobile clinics and ICUs, integrating Arabic interpreters, implementing electronic health records, strengthening coordination, utilizing intelligent crowd management, and deploying motorcycle ambulances in high-density areas. These measures can enhance care quality, decision-making, and patient referral processes.
Keywords: Arbaeen pilgrimage, healthcare delivery, nurses, emergency medical services, qualitative study, challenges.
Article Type: Research article |
Subject:
Healthcare and rehabilitation in disasters
References
1. Amerzadeh M, Tabatabaee SS. A qualitative study on operational challenges of Iranian affiliated mobile health clinics in Iraq during Arbaeen. Sci Rep. 2025;15(1):38935. [DOI:10.1038/s41598-025-22820-7]
2. Moulaei K, Dinari F, Mashoof E, Haghdoost AA. The impact of Arbaeen long-walk on the health of pilgrims: a qualitative study. Health Sci Rep. 2026;9(3):e71938. [DOI:10.1002/hsr2.71938]
3. Al-Ansari F, Al Ansari M, Hill-Cawthorne GA, Abdulzahra MS, Al-Ansari MB, Al-Ansari B, et al. Arbaeen public health concerns: a pilot cross-sectional survey. Travel Med Infect Dis. 2020;35:101546. [DOI:10.1016/j. tmaid.2019.101546]
4. Shafi S, Azhar E, Al-Abri S, Sharma A, Merali N, Al-Tawfiq JA, et al. Infectious disease threats at the Arba'een: a neglected but one of the largest annually recurring mass gathering religious events. Int J Infect Dis. 2022;123:210–1. [DOI:10.1016/j.ijid.2022.09.010]
5. Nouri M, Mohammadinia L, Sharifi-Sedeh M, Darabi S, Movahedi A. Volunteer dental services in field hospitals during the Arbaeen pilgrimage: an analysis of patient demographics and treatment outcomes. Mass Gather Med J. 2024;1(1). [DOI:10.5812/mgmj-156652]
6. Azizi H, Davtalab Esmaeili E, Naghili B, Ghanbarzadeh Javid S, Sarbazi E, Abbasi F. Risk factors for diarrheal diseases among pilgrims during Arba'een mass gathering: a case-control study. BMC Infect Dis. 2024; 24(1):1063. [DOI:10.1186/s12879-024-09962-1]
7. Salehi SZ. Heatstroke during Arbaeen walking and its prevention: a review study. Mass Gather Med J. 2024;1(2):e148850. [DOI:10.69107/mgmj-148850]
8. Peyravi MR, Ahmadi Marzaleh M, Najafi H. An overview of health-related challenges in a mass gathering. Trauma Mon. 2020;25(2):78–82. [DOI:10.30491/TM.2020.213574.1022]
9. Mohammadinia L, Abadi ES. Barriers and challenges for healthcare professionals in the context of the Arbaeen pilgrimage. Mass Gather Med J. 2025;2(2). [DOI:10.69107/mgmj-161999]
10. Karampourian A, Ghomian Z, Khorasani-Zavareh D. Exploring challenges of health system preparedness for communicable diseases in Arbaeen mass gathering: a qualitative study. F1000Res. 2018;7:1448. [DOI:10.12688/f1000research.15290.1]
11. Moulaei K, Bastaminejad S, Haghdoost A. Health challenges and facilitators of Arbaeen pilgrimage: a scoping review. BMC Public Health. 2024;24(1):132. [DOI:10.1186/s12889-024-17640-9]
12. Ghabish AM. Exploring Healthcare Services and Emergency Response during the Pilgrimage to Imam Hussein: A Qualitative Study. Mass Gather Med J. 2024;1(2):e159867. [DOI:10.69107/mgmj-159867]
13. Lami F, Hameed I, Arbaji A. Assessment of temporary community-based health care facilities during Arbaeenia mass gathering at Karbala, Iraq: a cross-sectional survey study. JMIR Public Health Surveill. 2019;5(4):e10905. [DOI:10.2196/10905]
14. Almehmadi M, Alqahtani JS. Healthcare research in mass religious gatherings and emergency management: a comprehensive narrative review. Healthcare (Basel). 2023;11(2):244. [DOI:10.3390/healthcare11020244]
15. Kheradmand JA, Khankeh H, Borujeni SM, Nasiri A, Shahrestanki YA, Ghanbari V, et al. Analysis of healthcare services in 2019 Arbaeen march: a qualitative study. Health Emerg Disasters Q. 2024;9(2):125–36. [DOI:10.32598/hdq.9.2.524.1]
16. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12. [DOI:10.1016/j.nedt.2003.10.001]
17. Lincoln YS, Guba EG. Criteria for assessing naturalistic inquiries as reports. In: Proceedings of the Annual Meeting of the American Educational Research Association; 1988 Apr 5–9; New Orleans (LA), USA.
18. Hashemian AH, Direkvand-Moghadam A. Reproductive and health challenges of women pilgrims during the Arbaeen pilgrimage: a qualitative study. Adv Hum Resour Dev Manag. 2025; 1(1) [DOI:10.55578/hrdm.2512.007]
19. Gorjian Z, Moradbeygi K, Taheri N, Shakouri F. Mass gathering nursing in action: nurses' lived experiences of clinical care delivery to Arbaeen pilgrims. Res Sq [Preprint]. 2025. [DOI:10.21203/rs.3.rs-81738 10/v1]
20. Memish ZA, Steffen R, White P, Dar O, Azhar EI, Sharma A, et al. Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events. Lancet. 2019;393(10185):2073–84. [DOI:10.1016/ S0140-6736(19)30501-X]
21. Ziaei T, Kiani Z, Simbar M, Heydari M, Soltani A. Medical Challenges for Women and Ways or Strategies to Deal with Them During the Arbaeen Pilgrimage: A Qualitative Study Utilizing Content Analysis Approach. Mass Gather Med J. 2025;2(2):e165013. [DOI:10.69107/mgmj-165013]
22. Zibasokhan Sh, Sharififar S, Azizi M, Teymouri F, Azarmi S. Challenges and promotion strategies of temporary medical centers in mass gatherings: a qualitative study. Iran J War Public Health. 2017;17(3):325–33. [DOI:10.58209/ijwph.17.3.325]
23. Yezli S, Yassin Y, Mushi A, Almuzaini Y, Khan A. Pattern of utilization, disease presentation, and medication prescribing and dispensing at primary healthcare centers during the Hajj mass gathering. BMC Health Serv Res. 2022;22(1):143. [DOI:10.1186/s12913-022-07507-3]
24. Yezli S, Yassin Y, Mushi A, Balkhi B, Stergachis A, Khan A. Medication handling and storage among pilgrims during the Hajj mass gathering. Healthcare (Basel). 2021;9(6):626. [DOI:10.3390/healthcare9060626]
25. Samarkandi OA, Alamri F, Aljishi H, Alabdullatif L, Alsaleh GS, Alfelali M, et al. Medication adherence among pilgrims with chronic diseases at Hajj 2024. Med Sci Monit.2025;31:e948979. [DOI:10.12659/MSM.948979]
26. Marzban A, Golzarhamid S, Nouri M. Health Challenges of the Elderly During the Arbaeen Pilgrimage: A Review of Physical, Psychological, Hygienic, Sociocultural and Managerial Dimensions. Mass Gather Med J. 2025;2(2):e165600. [DOI:10.69107/mgmj-165600]
27. Obaid KB, Ajil ZW, Musihb ZS, Athbi HA, Al-Juboori AK, Mahmood FM. Patterns of diseases among children's pilgrims during Arba’een of Imam Hussein in holy Kerbala city. International Journal of Psychosocial Rehabilitation. 2020;24(09):3955-60.
28. Gore M, Patwardhan A. Sanitation and menstrual health challenges among Pandharpur women pilgrims: an exploratory study with recommendations. J Prim Care Community Health. 2025;16:21501319251359136. [DOI:10.1177/21501319251359136]
29. Marzban A, Nouri M, Golzar S. Challenges and safety solutions for pregnant women in mass gatherings. Mass Gather Med J. 2025;2(2):e166202. [DOI:10.69107/mgmj-164604]
30. Paredath MS, Alasmari FA, Mayinkanakath MS. Nurses’ experiences of multicultural and multilanguage barriers to patient safety and quality care during the Hajj season. Evid Based Nurs Res. 2023;5(1):24–31. [DOI:10.47104/ebnrojs3.v5i1.261]
31. Al-Yateem N, Hijazi H, Saifan AR, Ahmad A, Masa'Deh R, Alrimawi I, et al. Language barriers in healthcare: a qualitative study of non-Arab healthcare practitioners caring for Arabic patients in the UAE. BMJ Open. 2023;13(12):e076326. [DOI:10.1136/bmjopen-2023-076326]
32. Rayan A, Sisan M, Baker O. Stress, workplace violence, and burnout in nurses during Hajj season. J Nurs Res. 2019;27(3):e26. [DOI:10.1097/jnr.0000000000000291]
33. Alotaibi S, Alshammiri SZ, Alharbi AG, Alsarhan AK, Almutairi RS, Almutairi NM, et al. Impact of stress among nursing workers during Hajj season compared to normal working days in Saudi Arabia. Rev Diabet Stud. 2024;249–58.
34. Alaska YA, Aldawas AD, Aljerian NA, Memish ZA, Suner S. The impact of crowd control measures on the occurrence of stampedes during Mass Gatherings: The Hajj experience. Travel medicine and infectious disease. 2017;15:67-70. [DOI:10.1016/j.tmaid.2016.09.002]
35. Rahmani F, Ghomian Z. Towards Safer Mass Gatherings Using Social Media: A Crowd Management Perspective. Mass Gather Med J. 2025;2(1):e161865. [DOI:10.69107/mgmj-161865]
36. Meites E, Brown JF. Ambulance need at mass gatherings. Prehosp Disaster Med. 2010;25(6):511–4. [DOI:10.1017/S1049023X00008682]
37. Bistaraki A, McKeown E, Kyratsis Y. Interagency planning and collaboration in mass gatherings: lessons from the London 2012 Olympics. Public Health. 2019; 166:19–24. [DOI:10.1016/j.puhe.2018.09.031]
38. Tian Y, Shen Z, Zhao Y, Zhou T, Li Q, Zhang M, et al. Design of an emergency medical information system for mass gatherings. Heliyon. 2024;10(20):e39061. [DOI:10.1016/j.heliyon.2024.e39061]
39. Tahernejad A, Safarpour H, Shabanikiya H, Pirani D. The Role of Mobile Electronic Health Records in Facilitating the Provision of Health Services in Mass Gatherings. Mass Gather Med J. 2025;2(2):e164252. [DOI:10.69107/ mgmj-164252]
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