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Background: The problems associated with exposure to excessive heat are a key health concern throughout the world, and are likely to become increasingly important as Earth's climate warms. Heat exposure is particularly problematic when large groups of people gather, but there is relatively little literature on the subject. Islam requires all adherents who are able to undertake a pilgrimage to Mecca (Saudi Arabia), known as the Hajj. This can result in huge numbers of pilgrims travelling to Mecca in the summer months, during which the temperatures can be very high, and to undertake physically demanding activities.

Objective: The aim of this study was to identify the perception level of heat-related health issues and the coping behaviors adopted by pilgrims in the face of excessive heat exposure.

Methods: A cross-sectional study was conducted in Mecca, Saudi Arabia among male Arab pilgrims performing Hajj of the Islamic calendar year 1436 (Summer 2015). Sample was divided into two strata: domestic pilgrims and international Arabs. A total of 14 camps were selected randomly, seven from each stratum. A total of 412 participants completed the questionnaire.

Results: Mean age was 43.48 (SD = 13.42) years. Majority of pilgrims had never performed Hajj before (68.2%). Almost 89.5% among pilgrims more than 40 years of age had more water intake compared to only 76.5% for people under 40 years. Only 7.3% of educated people used to go out at noon time, and almost two-fold of pilgrims with lower educational level did so (15.4%). Approximately 51.8% among those who were aware of Mecca's weather used cotton clothes, compared to 36.0% among pilgrims unaware of Mecca's weather.

Conclusion: This study reveals the extent of pilgrims' understanding of, and abilities to cope with, excessive heat and also suggests coping strategies and options for improved understanding of heat-related health issues world-wide.