One of the leading causes of mortality and illness at mass gatherings (MGs), which also represent a major public health problem, are non-communicable diseases and injuries. Heatstroke and human stampedes are the most prevalent cause of death at these events. The third paper on MGs in the The Lancet Infectious Diseases Series draws attention to large areas of insufficient knowledge about many non-communicable health risks during MGs, as well as lacking evidence as to which public health interventions function best.

Lead author Robert Steffen from the University of Zurich in Switzerland explains:

“Strategies for government preparedness and those of various international agencies have focused mainly on the risks of communicable diseases because of their potentially huge consequences, and less on documenting the risks introduced by non-communicable diseases.”

The diversity of non-communicable risks that range from drug and alcohol related use to acts of terrorism, pose a wide range of public health challenges to the event organizers as wells as for health systems.

Over the last 3 decades, human stampedes and crush injuries have resulted in over 7,000 deaths and 14,000 casualties, whilst reports state that 2,000 incidents of heatstroke during the 1985 Hajj resulted in over 1,000 deaths within just a few days.

Another important risk are life-threatening cardiovascular events, which more than double during MGs, which are associated with intense emotional stress as for instance at the World Cup in Germany in 2006.

According to the authors, minor traumatic injuries and medical complaints, such as cuts, sprains and headaches are the leading causes of illness and require onsite medical care facilities. They note that events that take place in developing countries also present other increased risks of injury and illness, such as warm weather conditions, density and mood of the crowd and young, old, or female visitors.

Steffen and his team discovered several efficient interventions, for instance by providing advice about the dangers of heat and air-conditioned environments to lower incidences of heat-related illness, and to introduce effective crowd control with real-time crowd tracking and structural changes to lower the risk of stampedes. However, they point out that there is insufficient evidence for the effectiveness of existing guidelines and recommendations, which contain several intervention strategies like models for the prediction of onsite emergency medical care.

The researchers argue, that:

“Until appropriate models are developed and successfully tested, most of the medical requirements will still be based on historical data that are specific to each event.”

They conclude:

“No one-size-fits-all solution exists for the mitigation of risks from non-communicable diseases at MGs. However, new rigorous research into the factors that increase the risks and best practices in the mitigation of those risks would contribute greatly to further understanding the complex dynamics of MGs.”

Written by Petra Rattue