To Fast or Not to Fast—That Is the Coronavirus Question for Ramadan

With Ramadan services sharply curtailed due to the pandemic, many Muslims are wondering if the required fasting might also pose a health risk.

Muslims buy food before breaking their Ramadan fast in Quetta, Pakistan, on May 12, 2019.
Muslims buy food before breaking their Ramadan fast in Quetta, Pakistan, on May 12, 2019. BANARAS KHAN/AFP via Getty Images

Among the many challenges pious Muslims face during the COVID-19 pandemic is how to commemorate Ramadan, the monthlong religious holiday that begins this week. Fearful that religious gatherings could increase infections, many governments and religious authorities in Muslim-majority countries have sharply curtailed Ramadan services and communal feasts. But this year, the biggest controversy surrounds the practice of Ramadan fasting—one of the five pillars of Islam considered absolutely essential for any Muslim who follows their faith.

Unlike public feasts and gatherings, fasting itself poses no risk of transmitting the disease. But it has brought up a different question: Is the required total abstinence from food and liquids, including water, from sunrise to sunset each day during Ramadan a health risk—and a stress on the immune system—best avoided with the coronavirus going around? Or is it safe, even for people with medical conditions or weakened immune systems?

From Morocco to Indonesia, governments have already placed restrictions on Ramadan festivities, including banning public prayers and iftar, the traditional communal breaking of the fast each evening during Ramadan. In Egypt—famous for its chaotic and raucous Ramadan celebrations every night from sunset to sunrise—the government has imposed a curfew from 8 p.m. to 6 a.m. and is expected to announce new curfew hours for Ramadan this week. The Saudis have indefinitely closed Mecca, Islam’s holiest city, to pilgrims from around the world. In normal years, several million Muslim worshippers travel there during the month of Ramadan to do special penance. In most Muslim-majority countries, governments have closed all mosques for public gatherings.

The biggest controversy is over Ramadan fasting, and whether it might be a health risk with the coronavirus going around.

Muslim authorities have answered the fasting question with fatwas. Al-Azhar University in Cairo, considered the top theological authority for Sunni Muslims, issued a statement reminding all Muslims that they must fast this year—no exceptions allowed. “Not fasting during Ramadan due to coronavirus is not permissible, and fasting is a duty and a must for Muslims,” Al-Azhar said in its statement. In the United Arab Emirates, the grand mufti of Dubai’s Islamic Affairs and Charitable Activities Department said fasting may be forgone only by those who are already ill. “Nothing can excuse one from not fasting, except for ailing people who are on medication and whose health condition may be complicated by fasting,” said the mufti, Ali Ahmad Mashael. Citing the Quran, he said the only exceptions are for those who are sick or traveling.

There is little difference between Shiite and Sunni opinion on fasting in times of the coronavirus. Ayatollah Bashir Hussein al-Najafi, a Shiite cleric in Iraq, issued a fatwa saying that fasting strengthens the immune system and could actually prevent believers from contracting the coronavirus. As evidence, Najafi quoted a hadith from the Prophet Mohammad advising fasting to “remain healthy.”

The reality of Ramadan fasting, however, can look very different. Each year, hospital emergency rooms in the Persian Gulf States are crowded with Ramadan patients, mainly with acute gastroenteritis, or stomach flu.Each year, hospital emergency rooms in the Persian Gulf States are crowded with Ramadan patients, mainly with acute gastroenteritis. It turns out that many Muslims eat even more during Ramadan than the rest of the year. Depending on temperatures—Ramadan sometimes falls in the summer, when days are both hotter and longer—hospitals also see cases of dehydration, exhaustion, and stroke.

A brave few have publicly questioned if fasting is for everyone. In societies that are among the most religious in the world and where Islam is often the state religion, publicly challenging Quranic rules continues to be controversial at best. At worst, it can lead to criminal prosecution based on laws against blasphemy or insulting religion—crimes that can be punished by death in countries such as Iran, Pakistan, and Saudi Arabia. That can make criticizing fasting tricky and potentially even dangerous—especially since it is considered one of the holiest duties in Islam.

One of the few who have spoken out in public this year is Noureddine Boukrouh, the former head of the secular Party of Algerian Renewal, who wrote on his Facebook page that “Muslims need to suspend fasting this year because emptying the body … increases the spread of the virus and will increase the risk of a wider outbreak.” It didn’t take long for him to be criticized for delving into a religious issue.

However, opinions might slowly be changing. Even before the COVID-19 pandemic, less pious Muslims—including a rising share of people who say they are not religious at all—sometimes resent Ramadan’s strict rules. In most Arab countries, for example, bars and entertainment venues are closed during Ramadan. Eating in public is frowned on or even illegal—even for non-Muslim minorities. Sex is forbidden until sunset. Frustrations are particularly common among younger Muslims.In recent years, medical science has discovered and studied the benefits of fasting, some form of which is common to many of the world’s religions. They may choose to eat and drink but often do so in private because of social (or legal) constraints.

Muslim medical opinion will be slower to change. In the eyes of some Muslim scholars today, secular science is associated with a morally contaminated West and therefore must be rejected at all cost. This view is often compounded by the attitude that the coronavirus and other natural dangers are not up to man to control but to God. That attitude, however, has not kept Abbas Tabrizian, an Iranian cleric, from claiming he can cure the virus by applying violet essential oil to the anus. Some call him a doctor of so-called Islamic medicine.

So is Ramadan fasting healthful or not? In recent years, medical science has discovered and studied the benefits of fasting, some form of which is common to many of the world’s religions. Intermittent fasting—the kind practiced during Ramadan—can lower cholesterol levels, reduce high blood pressure, and help prevent cardiovascular disease, according to a growing body of medical research. Even some chronic illnesses respond to medically supervised fasting, including arthritis, asthma, and depression.

Muslims around the world have found ways to substitute for traditional Ramadan celebrations, from e-Ramadan services to holding the iftar feast on Zoom. Improving current fasting habits so they are healthy for everyone will be more difficult. The good news is that most authorities aren’t forcing coronavirus patients to fast.

Geneive Abdo is a visiting fellow at the Brookings Doha Center. Twitter: @AbdoGeneive

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