No consensus is available on the definition of a “Mass Gathering”. Traditionally,
a mass gathering event was defined as a group of more than 1,000 persons assembled
at a particular location for a specific purpose and for a defined period of time.
Nevertheless, most of the published literature reports larger events accounting for
more than 25,000 participants.1,2 This definition is however limiting as it only considers
the size of the crowd, which is but one descriptor of a varied gathering of human
beings at a mass gathering event.3 Some authors define mass gatherings from a health
prospective, considering a mass gathering event as a situation during which a large
gathering of people occurs and results in limited access to patients, causing delayed
public safety response to medical emergencies.2 The World Health Organization (WHO)
definition also takes a broader view of mass gatherings to include the public health
dimensions and defines mass gatherings as events attended by a sufficient number of
people to potentially strain the public health resources of the community, city, or
nation hosting the event.1
Mass gatherings can be either planned or spontaneous and recurrent or sporadic.4 Planned
mass gatherings may include sporting, social, cultural, religious, and political events.
Examples include: music festivals, the Olympic Games, and the Hajj.1 Spontaneous mass
gatherings by their nature are more difficult to plan for and may include events,
such as funerals of religious and political figures.1,4 Mass gatherings may also include
the gatherings of displaced populations due to natural disasters, conflicts, and wars.4
Mass gatherings can pose several significant public health challenges to the health
and security authorities both within the host country and abroad.1,4 They place additional
pressures on health systems, which must operate for the duration of the mass gatherings
stretched to surge capacity. They also require intersectoral approaches to risk mitigation
and coordination and cooperation across multiple disciplines, agencies, sectors, and
ministries. Risk communication is complex, especially for mass gatherings with international
dimensions involving different languages and cultures. These factors in addition to
the introduction of infectious and non-infectious public health threats to local,
national, or international population during or after the events and the risk of deliberate
action against mass gatherings, increase the likelihood of emergencies resulting in
a significant number of casualties.4
On the other hand, mass gathering events can be a great prospect for a lasting health
legacy through intense periods of exceptional focus and funding for sustainable improvements
in health infrastructure and capacity, enhanced collaborations and synergies between
stakeholders nationally and internationally, and major opportunities to obtain consensus
for developing optimum recommendations for global health security.4,5 The wealth of
knowledge and expertise generated from mass gatherings can drive best health promotion,
education, and risk mitigation strategies and optimize the planning and delivery of
effective health services during future mass gathering events. To minimize the negative
impact and to capitalize on the potential benefits of hosting a mass gathering, effective
planning and handling of health risks associated with the mass gathering are crucial.
“Mass Gatherings Medicine” is an area of medicine that deals with health aspects during
mass gatherings including the health effects and risks of mass gatherings and strategies
for effective health services delivery during these events. The concept of mass gatherings
medicine and the practice of medicine in mass gatherings are not new, with numerous
literature published in the last decades addressing the issue of medical care in mass
gatherings.3 However, it was only at the 2010 “Global Forum on Mass Gathering Medicine”,
hosted by Saudi Arabia and organized by the Saudi Ministry of Health and “The Lancet
Infectious Diseases”, where the Jeddah declaration was adopted, which proposed the
formalization and establishment of the new discipline of mass gatherings medicine.5
Therefore, moving the complex public health issues surrounding mass gatherings into
an official scientific discipline that include several specialties. The formal discipline
of mass gatherings medicine was launched at the World Health Assembly of Ministers
of Health in Geneva in May 2014.5
However, the term mass gatherings “health” rather than “medicine”, maybe be more appropriate
for this newly recognized discipline, since ensuring the wellbeing of people at mass
gatherings requires a far greater range of activities than encompassed by the traditional
concept of medicine.6 Mass gatherings health deals with the diverse health risks associated
with mass gatherings including transmission of infectious disease, non-communicable
disease, trauma and injuries (occupational or otherwise), environmental effects (such
as, heat-related illnesses, dehydration, hypothermia), illnesses related to the use
of drugs and alcohol and deliberate acts, such as terrorist attacks.4 Mass gatherings
health is an emerging field with many areas of knowledge gaps that need to be explored
and studied. Mass gatherings health research should be encouraged to advance the collective
understanding in all areas of the discipline, as well as in formulating evidence-based,
robust and effective public health policies, and interventions in the planning and
management of mass gatherings. In addition, mass gatherings health as a discipline
should be promoted, including its introduction into training and educational programs,
to empower the next generation of experts in mass gatherings health. This is particularly
important in Saudi Arabia given the crucial role the Kingdom played in the inception
and formalization of this discipline and the country’s yearly hosting of the Hajj
and Umrah global mass gatherings.