HEALTH QUARANTINE AS PILGRIM RISK CONTROL DURING THE 2026 HAJJ EMBARKATION PHASE
Balai Besar Kekarantinaan Kesehatan (BBKK) Surabaya & Universitas Terbuka
Introduction. The Hajj pilgrimage is among the largest religious mass gatherings globally, in which the embarkation phase serves as the final health risk control point before pilgrims depart for Saudi Arabia, integrating health examination, istithaah assessment, fitness to fly determination, vaccination, environmental sanitation, and catering oversight as a unified safety system. Method. This study applied an integrative literature review with descriptive document analysis using two official 1447 H/2026 Hajj embarkation surveillance documents from the Directorate of Surveillance and Health Quarantine, Ministry of Health of the Republic of Indonesia, supplemented by peer-reviewed literature. Analysis combined descriptive statistics, content analysis, narrative synthesis, and cross-document triangulation. Result & Analysis. All twenty embarkation units reported through SINKARKES at full compliance, covering over five hundred flight groups and more than two hundred thousand registered pilgrims. Most pilgrims carried comorbid conditions, yet the majority were classified as eligible or eligible with accompaniment under the istithaah framework. Illness and hospitalisation were the dominant reasons for deferred and cancelled departures. Vaccination occurred primarily at the region of origin, while environmental sanitation and catering inspections achieved full compliance across all units. Discussion. The embarkation phase functions as a structured pre-event risk control mechanism within the mass gathering health framework, wherein health examination, aggregate surveillance, vaccination verification, and environmental and food safety oversight collectively constitute a comprehensive instrument of pilgrim safety prior to international departure.
Keywords: Embarkasi, Health Quarantine, Istithaah, Mass Gathering Health, Hajj Pilgrims
Al-Tawfiq, J.A., Kattan, R.F. and Memish, Z.A. (2022) “Mass Gatherings and Emerging Infectious Diseases: Monkeypox is the Newest Challenge,” Journal of Epidemiology and Global Health, 12(3), pp. 215–218. Available at: https://doi.org/10.1007/s44197-022-00059-z.
Alhajri, W., Templeton, A. and Moore, A. (2023) “Social norms and risks at mass gatherings: A systematic review,” International Journal of Disaster Risk Reduction, 88, p. 103586. Available at: https://doi.org/10.1016/j.ijdrr.2023.103586.
Alharbi, K.K. et al. (2026) “Disease Burden and Pattern of Healthcare Utilization Among Pilgrims During Hajj 2024: A Cross‑Sectional Analysis,” Annals of Global Health, 92(1), p. 25. Available at: https://doi.org/10.5334/aogh.4956.
Almehmadi, M. and Alqahtani, J.S. (2023) “Healthcare Research in Mass Religious Gatherings and Emergency Management: A Comprehensive Narrative Review,” Healthcare, 11(2), p. 244. Available at: https://doi.org/10.3390/healthcare11020244.
Almuzaini, Y. et al. (2025) “Critical determinants of morbidity and adverse outcomes during the Hajj using the Haddon matrix and the combined model,” Scientific Reports, 15(1), p. 39824. Available at: https://doi.org/10.1038/s41598-025-23504-y.
Alnafisah, R. et al. (2023) “Food Safety Practices during Hajj: On-Site Inspections of Food-Serving Establishments,” Tropical Medicine and Infectious Disease, 8(10), p. 480. Available at: https://doi.org/10.3390/tropicalmed8100480.
Alrukban, M.O. et al. (2025) “Diarrheal Illnesses and Their Association With Hygiene Practices and Food and Water Sources Among Domestic Pilgrims During the 2022 Hajj Season,” Cureus [Preprint]. Available at: https://doi.org/10.7759/cureus.9933.
Alshahrani, N.Z. et al. (2025) “Influenza Vaccination and Morbidity Among Sudanese Hajj Pilgrims During the 2025 Hajj,” Vaccines, 13(11), p. 1134. Available at: https://doi.org/10.3390/vaccines13111134.
Alshammari, S. et al. (2025) “Modeling Infectious Disease Epidemics in Mass Religious Gatherings: A Systematic Review,” ACM Transactions on Modeling and Computer Simulation, 35(3), pp. 1–31. Available at: https://doi.org/10.1145/3716869.
Azizi, H. et al. (2024) “Risk factors for diarrheal diseases among pilgrims during Arba’een mass gathering: a case-control study,” BMC Infectious Diseases, 24(1), p. 1063. Available at: https://doi.org/10.1186/s12879-024-09962-1.
Dalglish, S.L., Khalid, H. and McMahon, S.A. (2021) “Document analysis in health policy research: the READ approach,” Health Policy and Planning, 35(10), pp. 1424–1431. Available at: https://doi.org/10.1093/heapol/czaa064.
Haseeb, A. et al. (2023) “Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic,” Antibiotics, 12(8), p. 1299. Available at: https://doi.org/10.3390/antibiotics12081299.
Hayati, F. et al. (2024) “Food Hygiene and Sanitation at the Jakarta Pondok Gede Hajj Embarkation Dormitory: Food Safety Efforts for the Hajj Pilgrims,” Kesmas National Public Health Journal, 19(3). Available at: https://doi.org/10.21109/kesmas.v19i3.2018.
Khan, A.A. et al. (2025) “Vaccinations for Hajj: Enhancing health and global health security,” Travel Medicine and Infectious Disease, 63, p. 102784. Available at: https://doi.org/10.1016/j.tmaid.2024.102784.
Kolivand, P. et al. (2025) “Hospitalization, mortality, and health service delivery pattern among Iranian Hajj pilgrims by age, sex, and province in 2013–22,” Frontiers in Public Health, 13. Available at: https://doi.org/10.3389/fpubh.2025.1451591.
Mahdi, H.A. et al. (2022) “Syndromic surveillance of respiratory-tract infections and hand hygiene practice among pilgrims attended Hajj in 2021: a cohort study,” BMC Infectious Diseases, 22(1), p. 578. Available at: https://doi.org/10.1186/s12879-022-07559-0.
Msrahi, N. and Turkistani, A. (2025) “Assessment the association between foodborne disease and food safety knowledge and practices among pilgrims during Hajj in Saudi Arabia,” Journal of Health, Population and Nutrition, 44(1), p. 248. Available at: https://doi.org/10.1186/s41043-025-00964-6.
Mushi, A. et al. (2021) “A Longitudinal Study Regarding the Health Profile of the 2017 South African Hajj Pilgrims,” International Journal of Environmental Research and Public Health, 18(7), p. 3607. Available at: https://doi.org/10.3390/ijerph18073607.
Parker, S. et al. (2024) “Sacred journeys and pilgrimages: health risks associated with travels for religious purposes,” Journal of Travel Medicine, 31(8). Available at: https://doi.org/10.1093/jtm/taae122.
Saputra, H. et al. (2025) “Addressing Public Health Challenges of Hajj Pilgrims: A Comprehensive Narrative Review,” Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 8(3), pp. 188–197. Available at: https://doi.org/10.56338/mppki.v8i3.6912.
Sugeng, S. et al. (2024) “Experiences of Indonesian nurses as Hajj health personnel in caring for Hajj pilgrims: A qualitative study,” Belitung Nursing Journal, 10(5), pp. 554–562. Available at: https://doi.org/10.33546/bnj.3494.
Sukhera, J. (2022) “Narrative Reviews: Flexible, Rigorous, and Practical,” Journal of Graduate Medical Education, 14(4), pp. 414–417. Available at: https://doi.org/10.4300/JGME-D-22-00480.1.
Sweileh, W.M. (2022) “Health-related research publications on religious mass gatherings of Muslims: a bibliometric analysis (1980–2020),” Tropical Diseases, Travel Medicine and Vaccines, 8(1), p. 1. Available at: https://doi.org/10.1186/s40794-021-00158-y.
Taheri, M. et al. (2023) “The Association of Acute Watery Diarrhea in Iranian Pilgrims of Iraq with Cholera Cases in Iranians,” Medical Journal of the Islamic Republic of Iran [Preprint]. Available at: https://doi.org/10.47176/mjiri.37.52.
Wicaksana, A.L. and Hertanti, N.S. (2024) “A scoping review of Islamic pilgrimage to Mecca: Mapping the health concerns and proposed solutions,” Public Health Nursing, 41(3), pp. 487–502. Available at: https://doi.org/10.1111/phn.13299.
Yezli, S. et al. (2021) “Gastrointestinal symptoms and knowledge and practice of pilgrims regarding food and water safety during the 2019 Hajj mass gathering,” BMC Public Health, 21(1), p. 1288. Available at: https://doi.org/10.1186/s12889-021-11381-9.
