Factors Influencing the Health of Participants in Religious Mass Gathering Ceremonies in Iraq: A Systematic Review

In the last decade, the number of religious mass gathering ceremonies, which take place in Iraq, has increased considerably. Millions of participants visit the country annually from across the world to reach Karbala on foot or by other vehicles for participation in a religious ritual called Arbaeen, which lasts about 20 days. Unlike the Hajj mass gathering, another important annual religious mass gathering event of Muslims, an evidence-based review of scientific literature about influential factors on the health of participants in these ceremonies in Iraq has not been done.

Using PRISMA guidelines and searching PubMed, Scopus, ISI_Web of Science, Cochrane Library, ProQuest, and Google Scholar databases, original English language studies focused on participants' health in religious ceremonies of Iraq until October 2021 were selected. The methodological quality of the studies and the risk of bias were checked using the Joanna Briggs Institute (JBI) checklists.In addition, the data from the Iraqi Ministry of Health and other organizations, including WHO and CDC, about Iraq's health condition and other resources were used to describe the related findings better and make health recommendations for the participants.

Thirty-two studies passed our criteria and were included for analysis. There was not any clinical trial. All of them were observational (cross-sectional) or qualitative (interview) research; the majority had low to moderate quality scores. Considering the limitations, the leading health risks of participants in religious ceremonies in Iraq include road accidents, insufficiency of Iraq's health system, cardiovascular disease, respiratory tract (including Covid-19) infections, unhealthy food and drink, gastrointestinal infections (including hepatitis),  and zoonotic infections(leishmaniasis). 

Regarding the grandeur of Iraqi-related mass gatherings, preparation must begin before the events. Pre-participation examination, vaccination of high-risk individuals, and training of pilgrims and authorities on the health hazards are critical.