Tomorrow (11 October) marks a day of mourning and sadness to many Muslims across the world. It is Ashoura – a day which not only has sad connotations for many Muslims but also sees increasing numbers of people making potentially dangerous cuts to their body.
Ashoura means the tenth day of the Islamic month of Muharam. It commemorates the brutal death of Imam Hussain (Muslim prophet’s grandson) in a fierce battle over 1000 years ago. Imam Hussain, his family and his followers were murdered.
This event is observed mainly within the Shiite Muslim community in different ways. The range of responses varies from donating to those in need to, at the extreme end of the scale, Shiite Muslims showing their repentance through self-inflicting injuries using knives, spiked or bladed chains and other sharp tools.
This practice is well known as Zanjeer Zani. It is most common in Pakistan, Iran, Iraq, Bahrain, Oman, and to a lesser extent, in Afghanistan, Egypt, Lebanon and Syria. However, there have been reports of this practice emerging in Europe and the UK.
While many Islamic scholars are publicly opposing Zangeer Zani it is impossible to control or ban this deeply rooted cultural practice. Hence a harm reduction approach is best to minimise the risks associated with this ritual.
The main public health risk is Blood Borne Viruses (BBV) and other bacterial skin infections.
Unfortunately, the risks are not well documented and there is nothing published in the literature. The ministries of health of those countries where this practice is common and the WHO-EMRO region have no protocols or guidelines in place in response to this annual practice.
Although I fully acknowledge the challenges in the EMRO region, I would like to call upon clinicians and public health professionals in the UK to raise awareness, encourage testing for BBV and promote contact tracing and Hepatitis B vaccination as interim measures to reduce the risks associated with this ceremony.
Dr Bayad Nozad, FFPH with special interest in Blood Borne Viruses