Heat-related illnesses in Saudi Arabia: Prevention, early recognition, and public health strategies

Abstract Saudi Arabia's extreme desert climate, with temperatures often exceeding 45°C and humidity levels reaching 90%, creates significant public health challenges related to heat-related illnesses (HRIs). During Hajj 2024, temperatures reached 52°C, resulting in over 1,300 deaths across several days, primarily among unregistered pilgrims. This narrative review examines the epidemiology of HRIs in Saudi Arabia through analysis of published literature, government health reports, and clinical data from 2010–2024. PubMed, Google Scholar, and Saudi Ministry of Health reports were searched using keywords including heat-related illness, heat stroke, Saudi Arabia, Hajj, and occupational heat exposure. Current prevention strategies and public health interventions were evaluated, focusing on vulnerable populations including elderly individuals, outdoor workers, and pilgrims. Heat-related illnesses encompass a spectrum of conditions ranging from mild heat exhaustion to life-threatening heat stroke, with mortality rates increasing substantially during extreme heat events. During the 2016 Hajj season, approximately 29% and 67.7% of hospital admissions were due to heat stroke and heat exhaustion respectively, with 6.3% mortality for heat stroke cases. Construction workers in southeastern Saudi Arabia frequently experience wet-bulb globe temperature readings exceeding 31–33°C, with 78% of outdoor work days exceeding occupational exposure limits. The elderly, outdoor workers, pilgrims, and individuals with chronic comorbidities represent particularly vulnerable populations. Meteorological data spanning four decades shows average dry and wet bulb temperatures in Mecca have escalated by 0.4°C and 0.2°C per decade respectively, with strong correlations to heat illness incidence. Recent mitigation measures have achieved substantial reductions in heat illness incidence during mass gatherings despite intensifying heat conditions. However, challenges remain including current midday work bans proving insufficient during peak morning heat exposure, and critical gaps in protective coverage for marginalized populations highlighted by the 2024 Hajj experience. Recommendations include strengthening heat-health surveillance systems, expanding cooling center networks, improving occupational safety regulations to address morning peak exposures, implementing comprehensive heat action plans at national and regional levels, and addressing health equity gaps for unregistered pilgrims and migrant workers. The evidence from Saudi Arabia's experience managing HRIs during mass gatherings provides valuable insights for other countries facing similar climate challenges.