SHAH ALAM - Under the updated Saudi framework for haj, all prospective pilgrims applying from 2026 onwards must satisfy stricter medical criteria prior to visa issuance, introducing a more explicit health-based screening mechanism into pilgrimage management.
The move reflects growing concerns over the risks associated with haj, which involves prolonged physical exertion, extreme heat exposure and massive crowd density over several days. These conditions significantly increase health risks, particularly among elderly pilgrims and those with chronic illnesses.
For Malaysia, the policy carries wider implications because many pilgrims only receive haj allocations in their 50s or later, placing a large portion of applicants within higher-risk health categories.
Tabung Haji (TH) has clarified that medical screening is not new, but health criteria are now being tightened and standardised in line with Saudi requirements. Malaysian pilgrims will continue to undergo health assessments administered by the Health Ministry before receiving haj offers.
TH is also expected to continue operating medical clinics in Makkah and Madinah, although greater reliance may be placed on Saudi Arabia’s healthcare system for advanced treatment and critical care cases.
Medical experts say the stricter requirements have exposed a deeper issue: while many Malaysians spend years preparing financially for haj, far fewer prepare physically and mentally for the demands of the pilgrimage itself.
They added that the tightening of Saudi Arabia’s medical requirements reflects a broader shift in how haj readiness is increasingly being understood.
While financial capability remains essential, physical endurance, chronic disease control, nutrition, hydration and mental resilience are now equally important in ensuring pilgrims can complete the journey safely.
Former Health director-general Tan Sri Dr Noor Hisham Abdullah said many Malaysians still underestimate the realities pilgrims face in the Holy Land.
“Although some personal preparation is often undertaken, it may not fully reflect the realities on the ground, particularly for first-time pilgrims facing extreme heat, dense crowds and the overall physical intensity of the pilgrimage.
“Proper preparation must go beyond finances and include physical resilience, medical readiness and mental preparedness,” he said in an interview with Sinar Daily.
Dr Noor Hisham explained greater attention is now being placed on ensuring that pilgrims are medically fit enough to complete the pilgrimage safely.
He stressed that pilgrims who fulfil both financial and health requirements should ultimately be prioritised so they can undertake haj safely and meaningfully.
Universiti Kebangsaan Malaysia Public Health Medicine Specialist and Citra Studies Centre dean, Professor Dr Sharifa Ezat Wan Puteh said infectious diseases and harsh environmental conditions remain among the biggest health concerns during haj.
“Some may not fully appreciate the level of physical exertion involved or the potential exposure to infectious diseases such as SARS, MERS-CoV, tuberculosis and cholera.
“With pilgrims from many countries gathering in close proximity while sharing accommodation, food and facilities, it is important for individuals to ensure that their physical condition is at an optimal level before travelling.
“They should also prepare all necessary medications and remain consistent with their treatment throughout the pilgrimage,” she told Sinar Daily.
Sharifa Ezat warned that chronic illnesses such as diabetes, hypertension and heart disease may worsen under the physical strain of Hajj, especially amid heatwaves, dehydration and fatigue.
She emphasised that preparation should begin early, with a focus on building stamina through walking, jogging and cardiovascular exercise.
“Weight management, quitting smoking, proper footwear and sufficient rest can also help pilgrims better cope with the journey,” she added.
Meanwhile, Sri Kota Specialist Medical Centre (SKSMC) medical officer Dr Muhammad Munir Mohd Fuze said many pilgrims still leave physical preparation only weeks before departure.
“Physical readiness is often overlooked compared to spiritual or financial preparation, despite studies showing that Hajj involves significant physical exertion, including prolonged walking and extended outdoor exposure.
“Temperatures in Mecca can exceed 45°C, making heat exposure and dehydration major concerns, particularly for elderly pilgrims and those with chronic diseases,” he said in an interview with Sinar Daily.
According to Dr Munir, preparation should ideally begin six to 12 months before departure, especially for individuals with chronic illnesses or lower fitness levels.
He also noted that obesity, poor stamina and uncontrolled chronic illnesses could significantly increase the physical strain experienced during Hajj, while elderly pilgrims face higher risks of falls, heat-related illnesses and slower recovery.
Beyond fitness and disease management, nutrition has also emerged as an important component of haj preparation.
SKSMC dietitian Izzatul Hareesa said nutritional preparation should begin gradually at least two to three months before departure rather than through drastic last-minute dieting or sudden lifestyle changes.
She explained that sudden attempts to lose weight or adopt restrictive eating patterns shortly before departure are often ineffective and may leave the body weaker, more fatigued and less able to cope with the physical demands of Hajj.
“The body needs time to adapt to healthier eating habits, improved hydration routines and progressive physical conditioning so that energy levels, digestion and recovery become more stable.
“Prospective pilgrims should prioritise balanced meals that support endurance, energy and recovery in the heat and crowded conditions of haj.
“Their diet should include complex carbohydrates for sustained energy, lean proteins for muscle maintenance and fruits and vegetables for hydration, fibre and overall health,” she said in an interview with Sinar Daily.
Saudi Arabia’s Ministry of haj and umrah has introduced new mandatory health requirements for haj visas beginning from the 1447H/2026 season.
Under the new regulations, pilgrims must be free from infectious diseases and serious or uncontrolled chronic illnesses, while also being physically capable of performing haj rituals independently.
Those with certain medical conditions will be considered ineligible. These include:
- Chronic kidney failure
- Heart failure or severe heart disease
- Chronic lung and liver disease
- Neurological or mental conditions affecting cognitive or motor function
- Dementia or severe frailty among elderly individuals
- High-risk pregnancies
- Active infectious diseases
- Cancer patients undergoing treatment
The growing discussion surrounding Saudi Arabia’s stricter health requirements reflects a broader shift in how haj readiness is increasingly being understood.
While financial capability remains essential, medical experts are now stressing that physical endurance, chronic disease management, nutrition, hydration and mental resilience are equally important components of a safe and meaningful pilgrimage.
For many health professionals, the message is increasingly clear: preparing for haj should not begin only when a departure date arrives, but years earlier through healthier lifestyles, consistent fitness and long-term medical readiness.