Authors: Usama Basit / Editor: Liz Herrieven / Codes: SLO8, SLO9 / Published: 21/03/2023

Ramadan is about to start and we thought it would be a good idea to think about how it might impact Muslim Emergency Department (ED) staff and patients.

Islam is a religion that is based on 5 principles or ‘Pillars’:

  • To believe in the oneness of Allah – Kalma Shahadat;
  • To pay alms, or charitable contributions to those less fortunate (Zakat),
  • To pray five times a day (Salat),
  • To fast in the month of Ramadan, and
  • To perform Hajj, the annual pilgrimage to Makkah, the holiest place on earth for Muslims, at least once in their lifetime for all Muslims who can afford the trip.

The month of Ramadan is a part of the Islamic lunar calendar – it is the 9th month, and like all lunar months, starts when the new moon is first spotted, which signifies the eve of the new month has begun – the month starts that evening, and the fast starts in the morning. Each lunar month lasts 28-30 days, depending on the lunar cycle. This is why dates according to the lunar calendar are estimated, but may be off by 1-2 days, and are only confirmed once the moon for each month is first sighted.

Muslims fast from sunrise to sunset – you can eat and drink until the first call to prayer for the early morning Fajr prayers. This ‘pre-fast’ meal is called ‘Sehri’ or ‘Suhoor’, the ‘breaking-fast’ meal at sunset is called ‘Iftar’ or ‘Iftari’.

The focus may seem to be on eating and drinking (or lack of) but it is a time of prayer and reflection. It teaches you humility and patience and puts you in the shoes of others who do not have a choice to fast but go hungry or thirsty due to being less fortunate than you – it invokes gratitude for your blessings, as well as the urge to help others who are less fortunate.

During the fast, it is not just food and drink that is prohibited. You are also not allowed to indulge in sexual intercourse and you need to control your anger – raising your voice, being angry, lying, stealing or performing any acts of violence are forbidden. And obviously, Muslims cannot eat or drink anything during the fasting hours. Yes, that includes water and your favourite caffeinated beverage. It also includes smoking and any medication that you may need to take – but usually regular medications can be modulated to be taken prior to Suhoor or after Iftar. If, however, you need to take medication at a time when fasting may prohibit you from doing so, you are allowed to not fast for medical or health reasons. You don’t have to fast if you are unwell and require e.g IV fluids etc (that would be cheating!). You can also choose not to fast if you are on your period, and it is not mandatory to fast prior to puberty. You are exempt from fasting if you are pregnant, breast-feeding, undergoing or recovering from surgery and if you are travelling. If you are unable to fast due to these reasons, you are supposed to make up the fasts at a later date.

When it comes to your Muslim patients, who may be fasting, headaches may be a problem. Advice to drink plenty of water at Suhoor and Iftar can help. Patients may be more prone to dehydration, and the sequelae of slightly lower blood pressure. It’s also worth considering timings of medications when prescribing to fasting patients.

Ramadan is not just a time for prayer and contemplation, it is a time to improve yourself and to cleanse yourself physically and mentally from all the constant human and personal struggles – to teach you about community and thinking about your brothers and sisters around you, to look at your neighbour and your fellow human beings, and contemplate their struggles and try to help them out. It teaches you to improve yourself, and if everyone works towards improving themselves, then as a community and indeed the world, we can improve in leaps and bounds. It is a time to get together, to celebrate the blessings of life, and not just the food and water but everything we have been given in this life.

Ramadan is also an opportunity for non-Muslims to inquire about the practises and beliefs that are involved in day-to-day fasting. If you are curious, ask politely. It is always a welcome situation when a colleague or a friend is inquisitive in a non-judgemental, genuinely curious way.

Muslims shouldn’t need special allowances during working hours to carry out their fasts – yes it is maybe more difficult than a regular work day if you can’t have your usual caffeine fix, or can’t take a break to have a drink of water – but by and large we are usually able to meet our work-related commitments. But some compassion, understanding and flexibility may be required. For example – I have had shifts where handovers have coincided with ‘Iftar’ – breaking fast after a long 10-12 hours shift – and a kind colleague has taken my bleep for a few minutes to allow me to scoff down some food and water! Depending on the shift or work-day pattern, a colleague may need a few minutes to start their fast and eat something quickly for their ‘Suhoor’ meal – (one of my colleagues made sure I had a break at that time and they covered me so I could do that in peace). Try to be aware of our restrictions – I have been offered water to drink during shift, and when I clarified I am fasting I was told ‘Well water does not have any energy, just plain water should be allowed, surely?’. Comments like ‘Oh that sounds brutal/cruel’ or ‘It must be so difficult for you’ may make you think you are showing sympathy but it can feel as though our beliefs are not being respected. We are not being forced to do this, we want to do this and questioning that or suggesting someone’s religious beliefs are ‘backward’ or ‘outdated’ or ‘do not make sense’ is not appropriate or kind. You can absolutely eat in front of us – don’t worry we will not blame you! But it is not appropriate to schedule a work-related group meal activity during fasting hours. That would exclude any fasting colleagues and would be potentially discriminatory. You don’t need to have fasted to be able to join us for ‘Iftar’. In fact, joining us for ‘Iftar’ is a welcome and great idea – I mean, who wants to eat alone right?

Yes – we can have headaches, be a bit grumpy, or get annoyed easily – we need to work and improve ourselves if that is the case but a little understanding of what is going on in the background is most appreciated. Equally, never assume someone is fasting if they have a ‘Muslim-sounding’ name, or they wear a head covering. They may be menstruating, or not fasting for medical reasons, or might not be Muslim! This is a personal religious obligation and not something that someone may wish to advertise. If you know someone is fasting or is Muslim, wishing them Ramadan Mubarak or Ramadan Kareem is definitely appropriate and more than welcome. If you can make some allowances for them to step away for a few minutes to complete their prayer obligations that would be a very welcome relief and would enable them to focus more on their work commitments. If it cannot be helped, of course that is understandable.

Once Ramadan ends, and the next lunar month starts, the eve of that day is a cause for celebration – it means you have completed your obligations for the month of Ramadan and can partake in the celebrations marking the end of the month – called ‘Eid-ul-Fitr’ – a 3 day holiday where Muslims like to indulge in food and drink and gatherings at home and in local mosques and meet with family and friends. If possible and the work rota allows, planning ahead for these times so Muslims can have that day or days off would be amazing. An understanding of how the lunar calendar works is necessary though, and the fact that these occasions can only be celebrated once the moon is sighted makes it difficult. If the workplace allows, a bit of flexibility around those times would also be quite welcome – who doesn’t want to celebrate with their families and friends?

The author is aware some people may have different beliefs or strong feelings about some of the things shared here. This piece is not intended to offend anyone’s or any community’s sensitivities. It is a general overview for awareness and information, and the author is happy to be educated about any different opinions regarding any of the above content.