Deployed national healthcare services in Hajj mass gathering settings: emergency department experience of Makkah Diyanet Hospital during the 2025 Hajj period.

Abstract

Background: Clinical and operational data from independent national Hajj health missions are extremely limited. This study aimed to analyze the demographic and clinical characteristics, presentation patterns, and clinical outcomes of patients presenting to the emergency department of the Makkah Diyanet Turkey Hospital during the 2025 Hajj season.

Methods: A retrospective, cross-sectional, analytical study was conducted at a hospital serving 84,942 Turkish pilgrims between April and July 2025. Diagnoses were coded using the International Classification of Diseases, 10th Revision (ICD-10). Referral, admission, and mortality data were analyzed, and independent risk factors were identified through multivariable logistic regression.

Results: A total of 9,902 pilgrims (11.7%) presented to the emergency department with 13,360 visits. The mean age was 61.3 ± 11.5 years, and 54.1% of the patients were male. The most common diagnosis was respiratory diseases (49.4%). The overall referral rate was 2.76% on a patient basis (n = 273/9,902) and 2.04% on a visit basis (n = 273/13,360). While cardiovascular diseases constituted 7.1% of presentations, they represented 22.3% of referrals; neurological diseases constituted 0.2% of presentations but accounted for 13.6% of referrals. Advanced age was the strongest independent risk factor for referral, increasing approximately 14-fold in the ≥ 75 age group (adjusted odds ratio [aOR]: 13.64; 95% confidence interval [CI]: 6.22-29.93). The revisit rate was 23.0%, with a 3.7-fold higher referral risk in this group. The transition of the service model from secondary to primary care was associated with a 44% increase in referral risk (relative risk [RR]: 1.44; p = 0.009). The overall mortality rate was 34 per 100,000.

Conclusions: This study is among the first to report the emergency service utilization rate (11.7%) of a national Hajj health mission. Although respiratory diseases dominated presentations, critical disease burden and mortality were driven by cardiovascular and neurological emergencies. Among referred patients, trauma-related referrals were 2.7-fold higher in females than males (21.5% vs. 7.9%), supporting gender-specific injury prevention. These findings support age-based risk stratification, strengthening advanced life support capacity, planned coordination with the host country's healthcare system during service model transitions, and resource planning based on approximately 12,000 emergency department presentations per 100,000 pilgrims.