i Exploring Preparedness and Adaptive Capacity for Disaster Management during Hajj in Makkah City, Saudi Arabia

Abstract

Although the number of deaths from natural disasters has decreased over the years due to factors such as early warning systems and risk reduction, the losses from such disasters have not reduced and are still unequal across different regions. Kingdom of Saudi Arabia (KSA) is particularly vulnerable to natural and human made disasters, and faces additional risks related to the Hajj, one of the largest religious events in the world. This event is very important in the Islamic faith and millions of people attend it every year, increasing the chances of crowd-related disasters, health complications, and the pressure on the health care systems. Hajj as a mass gathering event with participants from different parts of the world presents numerous public health issues such as infectious diseases transmission and care of the chronically ill in the context of physical and environmental stressors of the pilgrimage. These dynamics call for proper disaster management measures that are suitable for religious mass gatherings given that such events are frequent in Saudi Arabia. The purpose of this study is to examine disaster preparedness and adaptive capacity during Hajj in Makkah City, Saudi Arabia, and to assess the strategies and the knowledge, skills, and preparedness of the healthcare providers for disaster management. It outlines the organisational and contextual factors that determine preparedness and looks at how the sociodemographic factors influence the preparedness of the healthcare providers, administrators and the pilgrims. The bioecological theory of human development underpins the study, integrating the Process-Person-Context-Time (PPCT) model's dimensions of individual characteristics (person), dynamic strategies (process), sociocultural and organisational environments (context), and time factors (time). It will explore the roles and interactions of these elements that help formulate a disaster resilience framework addressing the specific needs of similar large-scale religious gatherings. Employing a mixed-methods case study approach design this study integrates quantitative data from a survey of 161 healthcare providers with qualitative insights from semi-structured interviews of six healthcare providers, five health administrators, and five pilgrims/community members. This data is analysed using SPSS and NVivo software. The results reveal varying knowledge, skills, confidence, and implementation strategies. In terms of knowledge, which included understanding disaster, familiarity with disaster preparedness procedures, and management, 45.3% of participants demonstrated a high level of understanding. Skills, assessed through technical skills, soft skills, and experience in mass gatherings, revealed that 44.1% of healthcare providers possessed high disaster management skills. Confidence in disaster preparedness was notably high, with 54.4% of providers expressing strong confidence in managing disasters during Hajj. Implementation, which encompassed viii viii infrastructure readiness, healthcare facilities and resources, emergency response and coordination, risk assessment and mitigation, and monitoring and evaluation, saw 55% of providers displaying a high level of knowledge in implementing disaster preparedness measures. Challenges identified included language barriers, conflicting stakeholder roles, logistical issues, staff shortages, and extreme heat. However, opportunities for gaining disaster management skills, leadership experience, practical training application, and improved team collaboration enhanced overall preparedness and resilience. The religious aspect of Hajj preparation significantly motivated healthcare providers, many of whom view their work as a form of worship and charity, seeking spiritual rewards through their service. Applying the PPCT model to Hajj disaster preparedness highlighted the roles of individual characteristics, continuous learning, unique ecological challenges, and historical factors, underscoring a comprehensive approach to disaster preparedness. Additionally, insights from the Asia-Pacific Ministerial Conference on Disaster Risk Reduction (APMCDRR) 2022 conference resonated with the study's findings, emphasising the need for a holistic approach to building resilience. This connection emphasizes the need to integrate the global approaches and best practices in disaster risk reduction into the Hajj context. However, there are some areas of knowledge and skills that needed further development; suggesting the need for enhanced training, better coordination between agencies, and a more holistic approach to disaster management in terms of individual and organizational resilience. The study recommends that there should be better training in crowd control, disaster management and cultural sensitivity for the healthcare workers. It underlines the importance of improving the healthcare system in Makkah City and cooperation between different agencies; including the command center and integrated health strategies. Measures that include awareness campaigns for pilgrims, disaster preparedness through early warning systems, emergency plans and drills are also emphasized. Additionally, the study recommends the use of technology in the delivery of healthcare services such as electronic health records and telemedicine; and the alignment of strategies with the PPCT model which includes person-centered training, process improvement, contextualization, and time-sensitive planning and evaluation.