Ghusl for Deceased Persons with COVID-19

There have been several fataawa in the last few days from various scholars regarding ghusl of those who have died from Covid-19.

Some have said it is permissible with conditions. Others have said that it is exempt due to the dangers associated and the sparsity/ lack of familiarity with personal protective equipment (PPE).

In our professional opinion the differing views are not necessarily contradictory. Following discussions with Medical specialists, Islamic scholars and the National Burial Council, we have summarised how it is possible to achieve a balance between the normative obligation of ghusl and the safety / logistical issues specific to COVID-19 and what to do when this is not possible.

Clickable image to download PDF guidelines below:

  1. British Islamic Medical Association (BIMA) guidance on the performance of ghusl for deceased persons with suspected or confirmed COVID-19

2. Pathway to follow preparing deceased during COVID-19 pandemic

British Islamic Medical Association
[email protected]

Coronavirus self-care

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Stay at Home: Managing Stress & Wellbeing During the Covid-19 (Coronavirus) Pandemic

It is understandable to be worried: Everyone reacts differently to stressful situations.

The Covid-19 pandemic has led to increasing anxiety, stress and fears of uncertainty. It is normal to feel like this. In these difficult times, you should make sure to be in tune with your emotions and mental well-being. If you are feeling overwhelmed, remember to turn to Allah.

The Messenger of Allah ﷺ said, “If anyone constantly seeks pardon (from Allah), Allah will appoint for him a way out of every distress and a relief from every anxiety, and will provide sustenance for him from where he expects not.” [Abu Dawud].

Stress can manifest in different ways 1 

  • Racing heart, feeling tense and anxious.
  • Feelings of sadness, increased irritability and overwhelmedness.
  • Changes in sleeping patterns and habits.
  • Loss of appetite or change in eating habits.
  • Difficulty in concentration or lack of interest.

Tips on Limiting Stress While Social Distancing and Staying Indoors:

  1. You don’t have to be mentaly isolated when in physical isolation. Reach out to friends & ​family and create those human connections. Loneliness can worsen anxiety. 
      • Try video calls instead of emails, phone calls instead of messages. Why not have a virtual catch up over coffee!
      • Remember to check in and call the most vulnerable and the elderly.
  2. Separate spaces. Keep an appointed space for work, a space for sleeping, and a space for​ relaxation & ibadah, even if they all end up needing to be in the same room. This will help you focus and be more productive 2
  3. Fresh air & sunshine. Go out for a walk in your garden if you have one. If you don’t then open​ your windows and let the daylight in. Reflect on the beauty of Allah’s creation all around you.
  4. Exercise. Keeping healthy is not only a Sunnah but also triggers feelings of positivity. It is even​ more important now as our physical health is adversely affected by reduced social contact. Try some simple exercises at home. You could try skipping, push-ups, lunges or sit-ups. There are many useful online exercise videos, and many more being posted due to Covid-19.
  5. Limit your consumption of media. It seems like every media outlet is reporting on the​ pandemic, however try to limit your time watching and following the news. Try to focus on credible sources of information from the NHS 3, WHO 4, or the government 5
    • Do not spread misinformation. It is our duty to verify any information we spread
  6. Maintain a routine. Waking up at the same time will help you feel less tired and more refreshed,​ allowing you to concentrate better through the day. Get ready as you would normally, shower, get dressed and be ready for the day ahead. A personal routine helps to lessen anxiety.
  7. Maintain a healthy diet & stay hydrated. Be inspired by the Prophet’s dates, turnip, olives, black seed & honey. Don’t over eat and drink plenty of fluids (ZamZam if available).
    • The Prophet ﷺ said, “Use the Black Seed for indeed, it is a cure for all diseases except death.” [Bukhari]
    • “Honey is a remedy for every illness and the Quran is a remedy for all illness of the mind, therefore I recommend to you both remedies, the Quran and honey.” [Sahih Bukhari]
  8. Be God Conscious and remember Muraqabah. Spend time engaged in meditation/​mindfulness 6 (sitting in a quiet place, clearing your mind and reflecting on Allah), engage in frequent dhikr and Qur’an recitations. Designate a calm and tranquil place in your home where you engage in these activities. Make sure you disconnect from your phone at this time and try to establish a daily routine incorporating Muraqabah into your day alongside prayers. 
  9. Make time to do things you enjoy. We all have things we enjoy doing and it’s important to put​ aside time to do these. As we need to stay at home, why not try things you always put off because you didn’t have the time.
    • If you have children set aside some time to talk to them and keep them busy with fun activities or hobbies which may keep you occupied as well.

How to relieve symptoms of anxiety and stress

  • Be aware of your stress levels. Recognising the symptoms of stress & anxiety early makes​ them easier to manage. Identify the triggers that cause you to feel stressed.
  • Breathe. Focus on your breathing. Focus on the natural rhythm. Focus only on this.​
  • Listening to the Quran 7 . This can be very relaxing, there are many Qari to choose from. You​ could even try to improve your recitation by copying them, taking an ayah at a time.
  • Notice the good around you. It can sometimes be difficult when there is so much stress and​ uncertainty around you. Find something good around you, focus on it and squeeze the goodness out of it. Keep a look out for all that is good.
  • Be more independent and take a step back. Try to remove yourself from the current stressors​ and look at life as a bigger picture: What has been good? What have you achieved? Who are the positive people around you? What are you grateful for?
  • Write down what is worrying you. Problems can be easier to manage when written down.​
  • Create a ‘worry time’. Allocate time in the day or evening to think about what worries you. If you​ come across things during the day, try not to think about them until your ‘worry time’. You could even try and make this time a time you make du’a to Allah and talk to Him about your worries. 
  • Speak to family or friends. Identify at least one person who you feel comfortable talking to.​

Islamic Guidance on Dealing with Stress

At times of hardship, we are advised to turn to Allah. Whilst you can make dua in your native language for whatever you may wish, there are Prophetic and Quranic supplications that you may want to incorporate into your routine. 

اللُّهمَّ إِنِّي أَعْوذُ بِكَ مِنَ الهَمِّ وَ الْحُزْنِ، والعًجْزِ والكَسَلِ والبُخْلِ والجُبْنِ، وضَلْعِ الدَّیْنِ وغَلَبَةِ الرِّجال

” O Allah, I seek refuge in You from worry and grief, from incapacity and laziness, from cowardice and miserliness, from being heavily in debt and from being overpowered by men .” [Al-Bukhari]

It is narrated that the Prophet (peace be upon him) said: “There is no one who says in the morning of every day and the evening of every night, three times but nothing will harm him.” [Tirmidhi]

بِسْمِ اللهَِّ الَّذِي لاَ یَضُرُّ مَعَ اسْمِهِ شَىْءٌ فِي الأَرْضِ وَلاَ فِي السَّمَاءِ وَهُوَ السَّمِیعُ الْعَلِیمُ

“In the name of Allah with Whose Name nothing on earth or in heaven harms and He is the All-Hearing the All-Knowing and is then harmed by anything .”

رَبَّنَا وَلاَ تُحَمِّلْنَا مَا لاَ طَاقَةَ لَنَا بِهِ وَاعْفُ عَنَّا وَاغْفِرْ لَنَا وَارْحَمْنَا أَنتَ مَوْلاَنَا فَانصُرْنَا عَلَى الْقَوْمِ الْكَافِرِینَ

“ Our Lord, and burden us not with that which we have no ability to bear. And pardon us, and forgive us, and have mercy upon us. You are our protector, so give us victory over the disbelieving people. ” [Qur’an,2:286]

This is the du’a of Prophet Yunus, mentioned in Surah Anbiya, Verse 87. From this dua, we are reminded that we should be patient in all of our affairs and constantly beseech Allah. The Prophet (peace be upon him) said regarding this du’a: “Every person in a state of distress who has used this supplication has had God remove his distress” [Tirmidhi].

لا إِلَهَٰ إِلَّا أَنتَ سُبْحَانَكَ إِنِّي كُنتُ مِنَ الظَّالِمین

“ There is no God but You, glory be to You, I was one of the wrongdoers .”

Seeking Allah’s protection from illness, the Prophet صلى الله عليه وسلم would say:

اللَّهُمَّ إِنِّى أَعُوذُ بِكَ مِنَ الْبَرَصِ وَالْجُنُونِ وَالْجُذَا مِ وَمِنْ سَیِّئِ الأَ سْقَامِ

Anas reported: The Prophet, peace and blessings be upon him, would say, “ O Allah, I seek refuge in you from leprosy, madness, degenerative diseases, and evil sicknesses .” [Sunan Abi Dawud, Hadith: 1549]

Tips for Mosque to Ensure the Well-Being of the Community:

  1. Consider arranging daily talks or events via audio or video links. Some masjids have daily talks​​ during the day & Quranic recitation in the evenings.
    • This may help those who relied on the mosque for their well-being and sense of community to feel engaged and uplifted.
  2. Consider setting up volunteer groups to support the vulnerable and elderly, particularly those​​ with health conditions, mobility restrictions or those in isolation: 
    • These groups could help obtain groceries or supplies if needed, or provide emotional support.
  3. Engage potential volunteers. Many members of the community might have more spare time​ and will benefit from being involved in community work, even if it’s online.
  4. Signpost people to local services. Some may be struggling financially8. Some may need mental​ health support. 

When and How to seek Medical Attention:

If you are still struggling despite self help measures9 then call your GP, local mental services10 or one of the helplines:

  1. Muslim Youth Helpline, www.myh.org.uk , tel: 0808 808 2008
  2. Muslim Counsellor And Psychotherapist Network, www.mcapn.co.uk, email: [email protected]
  3. www.sakoon.co.uk , email: [email protected], tel: 07943 561 561
  4. https://muslimcommunityhelpline.org.uk/ , tel: 0208 908 6715
  5. www.inspiritedminds.org.uk

There is wisdom behind the challenges we are currently facing, these are truly extraordinary times. There is a reason why you have been chosen to face these challenges. Use it as an opportunity to work on strengthening your connection with Allah. Every opportunity is a blessing. 

 

British Islamic Medical Association

Tuesday 24 March 2020

[email protected]

An open letter to the Muslim community.


As Muslim Healthcare Professionals we have all been worried by the gap between the concerns around #COVID19 and the corresponding actions in our community.

We have put this open letter together to simply and clearly highlight the clinical urgency and seriousness of the situation, on the continuation of congregational activities in Muslim institutions in light of the pandemic.

Some will think the letter is going too far, others will think it does not go far enough – This is why we have chosen the form of words as we have.

If you agree that we must all act promptly to reduce the impact of this disease then please sign here to show your support http://bit.ly/COVID19LetterBIMA  

Please share with your friends and colleagues and help us in reducing the impact of this disease in our communities.

The Letter


We, the undersigned, are frontline Muslim health professionals writing to inform our community about the harms of ongoing congregational activities during the coronavirus (COVID-19) pandemic, which continue to have a significant impact on societies across the world.

Today the Prime Minister announced that we all should be taking measures to avoid social contact, and the Chief Scientific Advisor has advised us to avoid gatherings “big or small”.

We seem to be on a similar trajectory as that of Italy which has suffered a dramatic spread of the coronavirus, where in just 3 weeks more than 2,100 Italian lives have been lost so far.

There are genuine fears the impact could be similar, if not worse, here in the UK. Plans are being made for 8 million people to be hospitalised in the UK due to the coronavirus and cases are expected to double every 5-6 days.

Evidence shows that the elderly and those with conditions such as diabetes, high blood pressure, immunosuppression and chronic lung disease are at a higher risk of mortality from the coronavirus. Those over 80 years of age have an almost 15% chance of dying if infected with the virus.

We have appraised the situation and evidence for our community based on what we know about the coronavirus. We have certain characteristics that place us at higher risk than the general population. These include:

  • an increased incidence of long-term illnesses such as diabetes and high blood pressure
  • an elderly population that often live with extended family making isolation difficult
  • frequent community congregations for social events (e.g. weddings) and religious purposes (e.g. madrassah & mosques) 

Alongside this we have specific risk factors for spreading the virus, which include: 

  • Densely populated spaces with general lack of adequate ventilation
  • Handshaking and hugging amongst congregants
  • Prostration on carpets where the virus may remain infectious
  • Sharing of ablution facilities

In light of the above, we must emphasise our strong concern that mosques and madrassahs – confined public spaces that fulfil the above criteria – can contribute to significant viral transmission in our populations.

Individuals may have the coronavirus and be contagious without demonstrating any symptoms, for up to 2 weeks.

Measures to advise only those who are unwell or at risk to stay at home are unlikely to be effective, as apparently ‘healthy’ individuals may become infected off each other and transmit the coronavirus back to their families and thus spread it further.

It is also important to highlight that there are simply insufficient hospital beds, particularly in the intensive care units, to handle the anticipated surge in demand.

In Italy doctors have been asked to actively decide who is offered treatment based on patients’ age, medical history and whether they have children. The Chief Medical Adviser has also indicated we are to expect deaths as a result of health service being overwhelmed.

We do not want our community to panic or act rashly, especially in our duty to Allah and His houses of worship, and are aware of the comfort and security our community institutions and mosques offer us in times like these.

But we must stress that it is unsafe and harmful to continue business as usual, or even with significant adjustments​ that some institutions have made to date. 

We recognise this is a decision for scholars, imams and mosques committees to make and we urge them to take steps to mitigate harms.

Our aim and intention is to clearly outline the harm that continuing any congregational activities will have on our communities, especially to our elders and those most vulnerable, even with restrictions in place.

Allah is the Disposer of all our affairs, the Protector of us all.

Updated: COVID-19 Guidance for Mosques in the UK

This is an update of previous guidance published on the 6th of March 2020 found here

Last updated 12 March 2020

BritishIMA_Logo

Dear Mosque Leaders, Staff and Volunteers,

Asalaam alaykum, Peace be with you

This is an update to the guidance issued on 6 March 2020 regarding the coronavirus, COVID19.[1] Emergency legislation will be introduced next week as containment measures to control the spread of the virus in the UK have not been successful.[2] The World Health Organization has now declared COVID-19 to be a pandemic.[3] This will have a significant impact on mosques, madrasas and Islamic centers due to frequent congregation and social contacts. 

What has happened?

At the time of writing, 456 cases have been diagnosed in the UK, and sadly 8 people have died.[4] This number is expected to significantly rise within days, particularly affecting the elderly, and action by everybody is required now to prevent the disease from overwhelming the health system. The worldwide fatality rate for those aged over 80 years is currently 14.5%. COVID-19 is also more deadly in people with cardiovascular disease, diabetes, immune suppression, and chronic lung disease.[5]

What are the plans now?

The UK’s Chief Medical Officers and public health bodies are using a model of ‘reasonable worst case scenario’ which draws on a variety of situations, some of which may never occur.[6] These are balanced between the impact to the economy, society and public order. For instance, the premature closing down of public spaces can create fatigue, quickly become ineffective and contribute to panic. As local communities, it is imperative that we prioritise the safety of congregants specifically, over and above the economy.

In order to control the spread of COVID-19, mosques, madrasas and Islamic centers in the UK are strongly advised to take the following actions urgently:

1.  Plan for suspension of congregational activities

This is not being currently advised but is highly likely in the coming days, should the outbreak continue at the projected rate. Therefore, it is advised that urgent action is taken to consider and organise the following, which may require a graded introduction to support the community:

  1. Communication – establish communication channels with attendees e.g. through WhatsApp, Telegram, email, website, or social media 
  2. Fundraising – set up online fundraising channels and donation portals for attendees to be able to support the mosque remotely if they are unable to attend
  3. Seriously consider shortening activities – reduce khutbah, salah and any reminders to shortest time possible. Suspend praying of sunnah and nawafil prayers in the mosque, as well as external events.
  4. Monitor – check guidance from public health bodies which suggest suspension may be necessary, and if advised by public health bodies, be prepared to announce suspension of Jum’ah and daily fardh salah in congregation
  5. Online services – consider live-streaming programmes or showing programmes through a video-link so as to still be able to provide a service and reach congregants

2.  Advise congregants to keep good hygiene

The Prophet Muhammad (peace be upon him) said “Cleanliness is half of faith”. With the COVID-19 outbreak, it is now more important than ever to advise congregants to:

  1. Avoid attending – strongly advise attendees to not attend if they have any symptoms of being unwell no matter how minor or trivial
  2. Avoid physical contact – educate attendees on avoiding handshaking, hugging and close physical contact
  3. Regular cleaning schedule – clean the building regularly and thoroughly, particularly the carpets and wudhu facilities using the appropriate equipment and products[7]
  4. Use hand gel – provide hand sanitiser throughout the building, especially at entrances
  5. Use disposable towels – advise using disposable paper towels if wudhu has to be done in the mosque, and remove communal towels from the wudhu area
  6. Prepare at home – recommend attendees to perform wudhu at home and bring their own prayer mats
  7. Read advice posters and resources – prominently display hand hygiene advice, in different languages if required [8]
  8. Identify and maintain an isolation room – for symptomatic attendees

3.  Support for socially vulnerable and isolated

“Social distancing” is a strategy designed to limit public interaction to delay the spread of the disease and limit its impact on health services. This can be from self-isolation as result of suspected COVID-19, or from not having the usual access to the mosque community and space. This isolation could affect the most vulnerable in our communities, in particular the elderly.

The Prophet Muhammad (peace be upon him) said, “Seek out the vulnerable among you. Verily, you are only given provision and support due to your support of the weak.” (Tirmidhi). Therefore it is strongly advised to:

  1. Volunteers – identify volunteers who can support those who need support with daily activities e.g. buying food, deliveries, in case they have to self-isolate due to symptoms.
  2. Broadcast – consider broadcasting reminders and services on social media, radio and other media to maintain the link with the vulnerable during isolation.
  3. Regular check-ins – if necessary, establish regular pastoral support with the community via telephone or video-messaging to maintain morale.

What about madrasas/schools?

Current guidance does not support closing schools, but this too is highly likely and remains under constant review. Madrasas may wish to review the above guidance and follow it accordingly. Please be aware that whilst children are not thought to be severely affected by COVID-19, they can pass it onto elderly and vulnerable people.

What about Friday Jum’ah Prayers? Friday Jum’ah prayers constitute a large gathering and the recommendation to temporarily suspend them is very likely in the next few days. The current advice is not to suspend them, however a graded approach to reducing core services at the mosque is recommended to prepare the community for this (see action 1 above).

What about Muslim burials?

Current guidance from the National Burial Council is available on how to handle, wash and bury deceased Muslims who have died due to COVID-19.[9] It is important that mosques and the community are aware family members may not be able to attend the Janazah prayer due to selfisolation and should offer appropriate support/alternative arrangements for these families.

Will it affect Ramadan?

Looking at epidemiological data from other countries, it’s likely that the pandemic will stretch well into Ramadan during April/May 2020. Authorities in the Kingdom of Saudi Arabia have decided to suspend iftar and itikaf in Masjid Al Haram at present. UK mosques must similarly prepare for the very likely possibility of suspending iftar programs and congregational tarawih prayers.

Update on Hajj and Umrah

The suspension on travel for Umrah in Saudi Arabia remains. If you have members of your congregation who were planning to travel for Umrah or Hajj, please advise them to contact their travel operator and monitor the situation with the Saudi government channels. The Council of British Hajjis has issued guidance on this.[10] The effect on Hajj this year remains uncertain. 

Please note: In situations such as this, there will always be a wide spectrum of opinions on what are appropriate precautions to take given the circumstances, so consulting your local scholars early is essential, as well as bearing in mind the importance placed in Islam on the preservation of life. We would advise everyone – especially those who may disagree with some of the above guidance – to weigh up their position against the impact in what may be a life or death situation, especially for the most vulnerable in our community.

Collated by:

British Islamic Medical Association
Muslim Council of Britain
Thursday 12 March 2020
[email protected] 
www.mcb.org.uk/coronavirus  


[1] https://www.britishima.org/covid19guidanceformosquesandislamiccentres/

[2] https://www.bbc.co.uk/news/uk51786936

[3] https://www.who.int/dg/speeches/detail/whodirectorgeneralsopeningremarksatthemediabriefingoncovid1911march2020

[4] https://www.gov.uk/guidance/coronaviruscovid19informationforthepublic#numberofcases

[5] https://www.cdc.gov/coronavirus/2019ncov/specificgroups/highriskcomplications.html

[6] https://www.gov.uk/government/publications/coronavirusactionplan/coronavirusactionplanaguidetowhatyoucanexpectacrosstheuk

[7] https://www.nhs.uk/live-well/healthy-body/how-to-prevent-germs-from-spreading/  

[8] https://campaignresources.phe.gov.uk/resources/campaigns/101-coronavirus-/resources

[9] http://nbc.org.uk  

[10] http://cbhuk.org/news/general-news/coronavirus-outbreak-advice-hajj-umrah-travellers/

Covid-19 Advice

Coronavirus Infographic for UK Muslim Community There is a lot of information circulating about the coronavirus. BIMA & MCB would like to advise the Muslim community to take these precautions as suggested by the NHS & experts. We have summarised key information in this infographic, but please be aware that the situation is changing often and is correct as of 05/03/2020.

Covid-19 Guidance for Mosques and Islamic Centres

*This guidance is out of date*

The latest version is found here.

Asalaam alaykum,

We are writing to clarify the facts we currently know regarding the coronavirus, Covid-19, and how it is related to mosques in the UK. This guidance is equally applicable to other centres and congregational activities.

Currently we know that Covid-19 is spreading in the UK with the possibility it could spread rapidly. The government has recently increased the risk to the population from mild to moderate, and moved from a containment strategy to one of delaying the spread of the virus.

This is a rapidly evolving situation that has significant implications for the public, particularly in mosques where large numbers of people frequently congregate.

What is Covid-19?

SARS-CoV-2 is the technical name of this coronavirus, which is from the same family of viruses that cause the common cold. The initial symptoms it causes are similar to the viruses that give flu-like symptoms[1].

The virus is spread in the same way and has the same potential  complications. At present, the mortality rate is thought to be 3.4%. This is higher than influenza (<1%, which is typically the most serious type of viral illness), but this figure is often changing as new evidence comes to light from cases around the world. 

The illness caused by the SARS-CoV-2 virus is called Covid-19, and predominantly affects the respiratory system causing breathing problems. It is particularly dangerous in elderly people and those with pre-existing health conditions which makes them vulnerable. Most of the deaths from this virus across the world have occured in this group.

Our current understanding is that the coronavirus spreads in the saliva from an infected person landing on another, usually through coughing, sneezing or touching an infected surface. It is more likely to spread in crowds. There are cases where individuals have picked up Covid-19 without obvious exposure to known individuals or travel to affected countries.

 

Contact and travel guidance

At present, the advice from the UK government is that worshippers should not attend the​   mosque if they have:

  • been to the Hubei province in China, Iran, South Korea or Northern Italy in the last 14 days
  • flu-like symptoms (even if mild) and have returned, in the last 14 days, from mainland

China, Italy, South Korea, Cambodia, Hong Kong, Japan, Laos, Macau, Malaysia, Myanmar, Singapore, Taiwan, Thailand, Vietnam

  • flu-like symptoms and have been within 2 metres of a confirmed case of Covid-19[2]

In these instances, they should self isolate – that is to stay at home, not go out, and have no contact with the public – and visit NHS111 Online or call 111.[3] Do not attend your GP practice or pharmacy as this places others at risk. This information is constantly changing and mosques should be vigilant for updates. 

It is important to note that there has been recent legislation which allows employees to claim statutory sick pay earlier, but also laws to enforce isolation if advised by health professionals.

What about Umrah and Hajj?

Covid-19 is currently prevalent in many countries across the world and we know there is an increased risk of spread of the virus where there are crowds of people.

The Saudi Arabia authorities have, as of 4th March 2020, suspended Umrah for local residents and foreigners as a precaution to prevent the spread of the virus. This is not unprecedented in Islamic history due to outbreaks of disease, fire, and war. 

It is not clear at the moment how long this suspension will last, and there is a possibility this could affect Hajj this year, but at the moment there is no way of telling. We would advise keeping up to date on the latest travel advice for UK citizens to Saudia Arabia and to speak with your travel agent.[4]

If you hear of an [outbreak of] plague in a land, do not enter it; and if the plague occurs in a place while you are in it, do not leave that place​”

(Bukhari 5396)

The current advice is to avoid unnecessary international travel, particularly to & from areas or countries where there is a high number of Covid-19 cases.

Will wearing face masks help?

It is not advised to wear a face mask unless you are a carer of somebody who has Covid-19, or you have flu-like symptoms yourself and are wearing it to prevent the spread to others.

A mask is unlikely to help prevent catching the infection as masks are usually ill fitting, not changed regularly, and can actually make it more likely as the virus can sit on the mask surface increasing the chance of infection if touched.[5]

What about visiting the sick?

As we are unclear about the extent of the virus’ spread, nor who is ill with a common cold and who may have Covid-19, we must limit contact with those who are unwell during this period. Pastoral and communal support can still be provided via telephone and video, as well as assisting with activities that do not require close contact.

What should mosques do about congregational prayers and Ramadan?

At present there is no advice on restricting gatherings. However, there is the possibility that we may be advised to do so and/or quarantine certain areas. Now is a good opportunity for mosques to plan for such a situation and understand how it might work in practice.

If we were told as such by the authorities, we would expect the mosque committee and scholars to show clear, decisive leadership and follow the public health advice which may include considering the suspension of congregational prayers and events.

If the situation was to continue until Ramadan, the advice regarding fasting should follow similar religious rulings to other flu-like illnesses, based on the information we have at present (unless severely ill with Covid-19). We are likely to understand this disease better in the coming weeks so the advice on the risk to individuals may change. 

What measures can attendees take to protect against Covid-19?

Attendees should be reminded and encouraged to wash their hands thoroughly with soap and water, for 20 seconds, after touching surfaces or before eating. They should avoid touching their face, particularly after touching surfaces. 

They shouldn’t share items such as cups, utensils, towels etc. They should be advised to avoid close contact with others, particularly actions such as hugging and shaking hands when greeting each other.[6]

If they cough they should do so into their sleeve or a tissue, throw it away, and then wash their hands with soap. If attendees have a cough or flu-like illness prior to attending themosque, they should avoid attending to prevent the spread of a possible infection.​ 

What can mosque management do?

Mosque staff members and volunteers can help prevent the spread of infection by being vigilant​  with cleaning and reminding attendees to adhere to good hygiene measures. All surfaces that are touched by attendees should be getting regularly cleaned with a suitable disinfectant, including sinks, toilets, kitchen surfaces and carpets.

Disposable cloths should preferably be used, or reusable cloths that are disinfected after each use. A two mop bucket technique should be used, with one for detergent and one for rinsing, cleaning and drying them after use.[9] The building and rooms should be kept well ventilated at all times.

Displaying posters produced by public health bodies regarding hygiene and handwashing will help educate attendees and disseminate accurate information.[10]

Materials in non-English languages are forthcoming and will be available soon to download from the public health websites. Mosques should also consider having mechanisms to rapidly communicate with their congregation, if not already in place.

What to do if a worshipper becomes unwell while at the mosque?

In the event a member of staff or worshipper becomes unwell while at the mosque and has arrived from any affected countries or areas, or is identified as having had close contact with a​ confirmed case, they should be moved to a separate room for isolation.

This room should preferably be well ventilated with an open window, and one where the door can be closed. If it is not possible to isolate them in a room then they should be moved to an area at least two meters away from other people. If it is possible, provide them with a face mask and ask them to wear it.

NHS 111 should be called for further advice and the unwell person kept isolated until advised otherwise. At present, there is no need to close the mosque or send anyone who has been in contact with the unwell person home.

If the person needs to go to the bathroom whilst waiting for medical assistance, they should use a separate bathroom if available.  The bathroom should be cleaned with disinfectant before being used by anyone else. 

 

What steps should we take now?

Given the complexity and rapidly evolving nature of Covid-19 it is important we establish clear lines of communication between experts, scholars and mosques – should these not already exist.

Mosques should ensure they have plans in place as described above, including for contingencies in the event the guidance changes, and also start proactively educating their congregation and community.[7]

Currently there is no advice from authorities to avoid public gatherings. We know, however, that this virus spreads more easily in crowds and it is more severe in the elderly.

With a significant number of our congregation being elderly and the close proximity during prayer, we strongly advise informing attendees who have a new cough, shortness of breath, runny nose or fever, to stay away from congregational prayer and the mosque for the time being. This is​ to protect themselves but also our vulnerable members too, and to limit the spread of the disease.

We encourage mosque committees to share this document to help dispel false narratives that are circulating.[8] Mosques may also consider announcing key messages to the congregation before prayers and reinforcing current guidance.

 

How can we stay up to date with the latest information?

The British Islamic Medical Association (BIMA) is at hand to answer queries to help with the Muslim communities readiness to deal with Covid-19. The Muslim Council of Britain (MCB) also has a website with relevant information to help with decision making.[11]

This guidance is correct as of 6th March 2020 and is very likely to change in the coming days and weeks so please keep checking for updates.

The unity between mosques and our communities in times like these is essential. 

May Allah ﷻ protect us and our families, and give us tawfiq​  ​.

 

[1] https://www.nhs.uk/conditions/coronavirus-covid-19​      

[2] https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public

[3] https://111.nhs.uk/

[4] https://www.gov.uk/foreign-travel-advice/saudi-arabia/health#coronavirus

[5] https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-​    u se-masks 

[6] https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

[7] https://campaignresources.phe.gov.uk/resources/campaigns/101/resources/5016

[8] https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

[9]  ​https://www.nhs.uk/live-well/healthy-body/how-to-prevent-germs-from-spreading/

[10] Public Health England​, ​Public Health Wales, Health Protection Scotland​, Public Health Agency Northern Ireland

[11]  www.mcb.org.uk/coronavirus  

THE SUICIDE OF DR SRIDHARAN SURESH

We would like to extend our heartfelt condolences to the family of Dr Suresh. A family man, devoted colleague and experienced clinician – the circumstances around his suicide starkly highlight serious failures in investigating healthcare professionals accused of misconduct.[1]

The current system of investigation takes on the presumption of guilt until proven innocent; often results in immediate removal from work, loss of earnings and reputation; drags on through a byzantine process with multiple agencies taking years; and results in wearing down and effectively ruining the career of the accused. The system is not just broken, it is complicit in pushing many to the brink of suicide. [2][3] And for far too many, such as in the case of Dr Suresh, it has pushed them beyond that brink.

We strongly agree with the need to protect patients and the public from the misconduct of healthcare professionals, and recognise that complaints are a part of modern clinical practice. However, they need to go hand in hand with equally strong and rapid measures to protect healthcare professionals from the harms that come from being under investigation. Not to mention recognise the added stresses from dealing with vexatious complaints and false allegations.

This is especially important for healthcare professionals from minority ethnic backgrounds where the intersection of race, culture and faith leads to an experience where discrimination from patients, staff and institutions is more likely. Professionals from these backgrounds often struggle to access appropriate support, experience a greater proportion of complaints, and have a worse outcome compared to peers when under investigation.[4]

This is becoming a crisis with systemic failings seen in every case of suicide under investigation: these are not acceptable occupational hazards by any measure. We are calling on all the various bodies involved to do more than simply learn lessons. We need parity between the protection offered to healthcare professionals under investigation and the support to patients whilst investigating alleged misconduct. Anything less will mean more clinicians like Dr Suresh finding themselves unable to see a way out.

[1] BBC News. Coroner to write to GMC after doctor killed himself. 2020. [ONLINE] https://www.bbc.co.uk/news/uk-england-tees-51665759

[2] Bourne T, Wynants L, Peters M, et al. (2015) The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey. BMJ Open

[3] Horsfall S (2014) Doctors who commit suicide while under GMC fitness to practice investigation (General Medical Council, London)

[4] British Medical Association. 2020. This must be a turning point. [ONLINE] Available at: https://www.bma.org.uk/connecting-doctors/b/the-bma-blog/posts/this-must-be-a-turning-point

BIMA Updated Position on Fluenz Vaccine

The British Islamic Medical Association (BIMA) is an umbrella body aiming to unite Muslim healthcare professionals. Our role as BIMA is to ensure differences of opinions from jurists are respected; to inform scholars & the Muslim community on the importance of herd immunity, and vaccine efficacy, as well as the risks of illnesses like influenza and benefits of vaccination.

Influenza can kill and cause serious illnesses and BIMA advice is for all those who are elderly and at risk adults to have their injectable flu vaccination on an annual basis to protect against these illnesses. The injectable flu vaccine is permissible according to all Islamic jurists as this does not contain pork derived products. The intranasal flu vaccine for children, known as Fluenz, contains pork derived products.

There is ongoing concern in the Muslim community about the use of pork derived products in the intranasal Fluenz vaccine. This has been compounded by the market availability of a pork free alternative – an injectable flu vaccine – which commissioners have not made routinely available for children. BIMA advises all those who are concerned to consult local scholars & healthcare professionals that they trust in order to make an informed decision for their own children.

BIMA has been in conversation with Public Health England (PHE) to provide alternative options to parents of Muslim children in England who consider Fluenz impermissible. We are hoping to continue with these discussions with PHE so that those wishing to avoid porcine vaccines are not disadvantaged.

We would also like to clarify our position based on a leaflet circulated in 2015 which seems to suggest BIMA viewed the intranasal vaccine for children, Fluenz, as impermissible. This is not the case, as this is the remit of jurists – who in this case had summarised their views of its impermissibility with our input.

BIMA will continue to work with public health bodies in order to improve the low vaccination uptake in Muslim communities through education and lobbying for greater inclusion.

Job interview success – be yourself

Image from qimono from Pixabay

By Dr Emma Wiley, microbiology registrar

Interviews can often be daunting as you prepare to present the best version of yourself in both a professional and personal capacity. The more you want the vacancy, the more stressful things can become. It’s always important to take a step back, breathe and remember to just be yourself. 

First impressions

I still remember the day I went for my Microbiology Specialist training interview for the Registrar post. I looked across the room to the rest of the group and saw a sister veiled in niqaab. I instantly felt sorry for her and thoughts about how she would ever get a job rushed to mind. “I doubt they will seriously consider her” I thought.

That morning, I had been contemplating about whether or not to wear my own hijab for the interview. In the end I concluded that if I wanted to be competitive in the field, maybe it was best I went without it on this occasion. 

We both got jobs. I got my third choice speciality selection and she got my first.  It was in that moment that I realised Allah is the bestower of rizq (provision) and I had horribly miscalculated. Within a few months I had committed to wearing hijab and that was how I began my Specialist training.

Growth and authenticity

Many years later I interviewed for a Consultant post. This time I was interviewing as me – hijab, no make up and a CV with the word ‘Muslim’ on it. I repeatedly wavered as to whether this was the right course of action, the difference being, I now knew that my faith was in Allah – Ar Razzaaq, the Sustainer.

I spoke confidently about voluntary work with various Islamic societies during the interview. I listed my BIMA dress codes work as the thing I was most proud of on the application form and founding ‘Muslim Women of Merton’ as a source of joy and satisfaction in my life. 

As I reflected on the interview process afterwards with my coach tears came to my eyes. It had taken courage to be authentic, to honour who I was and the things I truly valued. It was a risk I knew I had to take and I was aware it could have gone very wrong.

Success

This time things had worked out, Alhumdulillah. I had been shortlisted for two jobs on the basis of that CV and I was able to turn down my second choice.

In interviewing for the post I was seen and heard in a way I had never been been seen and heard before during that interview – I’d been me. The Chief Executive later described my interview as one of the best Consultant interviews he had sat on and that I brought ‘joy’ to the Trust. The Medical Director said she was grateful I had chosen to apply to the Trust and that they were lucky to have me.

So my advice to all striving in the medical field as muslims is to be your authentic self through and through. Take risks where necessary and do not consume yourself or belittle your abilities in fear of Islamophobia – you might be just what they’re looking for! 

People recognise and value authenticity, no matter what package it comes in; be it hijab or niqaab. Be yourself, because only then can you be transformative. 

Letter to RCGP Annual Conference 2019

Dear Professor Helen Stokes-Lampard,

I hope this message finds you well.

As the President of the British Islamic Medical Association, I would like to take this opportunity to thank you for reviewing your invite to Julia Hartley-Brewer to speak at the RCGP Annual Conference.

Like many others, we were concerned at her initial invitation as she has a long history of anti-immigrant and Islamophobic rhetoric. Statements such as “Islam is still rooted in the values of the dark ages and until we accept that we will never get rid of radicalism” which she has made without apology go beyond the realm of genuine political differences and comfortably into open discrimination and vilification of an entire community. Indeed, had she said that about another faith or race, there would be no question of it being acceptable.

We are weary of insinuations of no-platforming, or ultimatums from members replacing constructive dialogue. The freedoms to criticise and resist are fundamental to our democratic society. We welcome robust debate around the role of immigration, race, faith and modern British society.

Equally essential are our freedoms to be safe and to uphold the responsibilities to protect communities who lack the privileges and means to challenge discrimination.

We know that this decision will attract criticism from those who see her words and position as legitimate. And those who use the cloak of freedom of speech as cover to demonise minorities.

We would like to add our voices and that of our members, to those who appreciate the College for making this difficult decision. And in doing so indicating to colleagues and patients that our shared values encompass many diametrically opposing viewpoints from a position of inclusion and respect for all.

We hope to continue our work with the College in supporting General Practice and primary care for the future and making our communities more inclusive as we promote holistic, person-centered health and well-being.

Yours sincerely,
Dr Sharif Kaf Al-Ghazal
President, British Islamic Medical Association

Response by BIMA to the GMC statement regarding a complaint involving a GP and patient wearing a face veil

We, the British Islamic Medical Association (BIMA), would like to thank the General Medical Council (GMC) for their balanced and reasonable response to the recent highly publicised complaint involving Dr Keith Wolverson and an unnamed member of the British public who wears a niqab (face veil) [1]. 

We hope that this incident is handled in a way that protects the dignity of both the patient and the doctor in question, and await further details as they are made available. Due to the public nature of the discussion and some troubling responses from the general public and fellow professionals alike – we would like to make the following observations: 


1. The facts of this incident are unclear therefore there should be no rush to judgement
This is an ongoing investigation where there are clearly two sides of the story and facts are yet to be established [2]. We oppose presuppositions being made towards Dr Wolverson of racism or Islamophobia just as we reject the narrative that the patient or her husband are seeking to blow an innocent request out of all reasonable proportion.
 
2. This should never have been a debate about the niqab

We must be clear here that the issue is not about whether the niqab belongs in British society, or whether it is part of genuine Islamic tradition, or whether it is morally right or wrong. These issues are completely outside the realm or the expertise of the profession.

3. We worry about the implications of taking complaints public

It is not advised that GMC complaints be taken to the press whilst still under investigation. Yet despite this advice, Dr Wolverson has engaged with The Sun and then subsequently with the Daily Mail. His choice to publicise the issue and the platforms he chose – tabloids with a long history of anti-minority, xenophobic and Islamophobic articles – has caused a swell of negative opinion directed at all Muslim women who wear the niqab. 

In the current environment, it is extremely unlikely that a member of an ethnic minority, a female, a Muslim, and one that wears the niqab – would be portrayed fairly by the tabloid press. The level of Islamophobia whipped up by this single news story has been as easily predictable as it has been disheartening. 

No matter the outcome, we feel that trial by media and the vagaries of public opinion is never the right answer to a complaint – for the clinician or the patient. We appreciate that clinicians are operating in increasingly pressured environments where mistakes, errors in judgement and compassion fatigue are more likely to occur.
 
Furthermore, we recognise the significant burden that complaints cause clinicians, especially if they are unsubstantiated or vexatious in nature, and the desire to respond robustly to them. It is imperative that professional regulators continue their reforms of fitness to practice processes to protect staff from such harms. 

4. We are concerned by the assertions of extremism from professional colleagues

There have been a significant number public comments made by healthcare professionals that have crossed the line from supporting a professional colleague into demonising the entire Muslim community and recycling Islamophobic tropes. Sadly they are so numerous that we cannot list them here, but cover most of the stereotypes outlined in the APPG on British Muslims report [3]. 
 
The fact that healthcare professionals harbour these views, especially in the absence of any evidence, is alarming. It clearly reflects that the insidious trend of intolerance and Islamophobia in our society has not spared our colleagues in the health sector. This needs to be a priority area where we explore the impact Islamophobia is having on patients, staff and the health system.

Dr Wolverson’s own comments in this regard are unhelpful, where he alleges that the husband orchestrated the complaint against him, and that this is “not the way towards social cohesion. We tolerate too much extremism, I’m afraid, and don’t challenge it” [4].

5. There is no evidence the niqab prevents communication

Many have argued that it is not possible to consult effectively with a patient wearing a niqab. We reject this assertion and urge those who ascribe to it to reflect how they may practice with greater inclusivity and respect diversity. Busy clinicians communicate safely every day to patients with strong accents on the telephone, during surgery wearing face masks, and behind curtains during examinations.

This position is supported by published evidence: a 2011 University of York study into the effects of face coverings and acoustics demonstrated negligible transmission in sound from communicating with niqab wearers. In fact, only surgical masks were shown to have significant effects on sound transmission. The authors suggest that reports of niqab unintelligibility may stem from heavy accents or an element of prejudice, rather than on grounds of speech perception [5]. In the same year another study in the Netherlands examined the facial expressions of niqab wearers and found that expressions of happiness, sadness, anger and fear could be recognised amongst niqab wearers [6].

There are caveats such as when communicating with those who lipread, are hard of hearing, or in critical emergencies, but these are the exceptions that prove the rule. Many women who observe the niqab may remove it in these circumstances, and there are many cases where clinicians have positive relationships with such patients. It is through partnership with our patients that any such barriers can be bridged. 



[1] The Doctors’ Association UK http://www.facebook.com/TheDoctorsAssociationUK/posts/341973273185889 
[2] Wooller S, Pattinson, R. Family GP could be struck off for asking Muslim mum to remove veil during appointment because he couldn’t hear her. The Sun 18 May 2019 https://www.thesun.co.uk/news/9100445/gp-faces-axe-muslim-woman-remove-niqab/
[3] Report on the inquiry into a working definition of Islamophobia / anti-Muslim hatred. The All Party Parliamentary Group on British Muslims 2018.
[4] Jones, D. GP facing the sack for asking a Muslim woman to lift her veil so he could hear what was wrong with her little girl says he’s ‘bowled over’ by public’s support after 59,000 sign petition. Daily Mail 25 May 2019 https://www.dailymail.co.uk/news/article-7069015/GP-asked-mother-surgery-lift-veil-no-longer-career.html  
[5] Llamas C, Harrison P, Donnelley D and Watt D. Effects of Different Types of face Covering on Speech Acoustics and Intelligibility. University of York 2011.
[6] Kret M, Gelder B. Islamic Headdress influences how emotion is recognized from the eyes. Frontiers in Psychology. 2012 Vol 3. Article 110.

An overview of Islamic legal and bioethical considerations regarding termination of pregnancy

 A submission to the NICE call for evidence regarding termination of pregnancy guidelines currently under review

Guideline Scope

Draft Guideline

The UK is currently home to at least 3.4 million Muslims [1] who, to varying degrees, will refer to Islamic jurisprudential and ethical teachings to inform/guide their healthcare decisions, including that of termination of pregnancy (TOP). It is therefore pertinent for TOP providers to be aware of this system of ethics used by some of their patients, in order to effectively engage in patient-centred shared decision making with them.

 

TOP is not permitted in Islamic law, except under legal exception [2-5]. The applicability of such exceptions depends on the gestational age of the foetus, as the gestational age at which ensoulment is believed to occur dictates the foetus’ subsequent full legal status. There is a difference of opinion among contemporary Muslims jurists, of differing legal schools of thought, about when ensoulment occurs with two major opinions being at 120 days[1] gestation (or 19 weeks post-LMP [6]) and 40 days[2] gestation (or ~8 weeks post-LMP)[3]

 

Before ensoulment, TOP is permitted to avoid intolerable difficulty or severe loss/hardship associated with the pregnancy or rearing the child thereafter. Common examples would include TOP to prevent threat to the life of the mother, severe injury (or substantial risk thereof) to the physical/mental health of the mother, severe hardship associated with rearing a child with a congenital abnormality (judged on a case-by-case basis) and severe hardship associated with the social circumstances of the woman’s pregnancy (although financial difficulties are generally not acceptable in isolation). After ensoulment, some Islamic jurists may permit TOP under certain situations where the mother’s life is at risk. In any case, where a patient indicates Islamic law to be influential to their decision on TOP, consultation of that patient with a qualified and experienced Islamic scholar for the purposes of providing individualised, case-by-case guidance may be appropriate and helpful.

 

Furthemore, Islamic law does not permit Muslim healthcare professionals, even whilst living and working in the UK, to approve or conduct TOP procedures in patients (Muslim or otherwise) requesting TOP not fulfilling Islamic legal criteria.

 

Apart from Islamic jurisprudential teachings, Muslim patients’ TOP decision may also be influenced by ethical/theological beliefs [7, 8], including about the wrongness of abortion from day one, fate and acceptance of God’s will, how it is not their decision to interfere in God’s creation, the blessings of caring for a handicapped child, the reward associated with undergoing hardship in pregnancy and thereafter, the belief in hardship being a test from God, fear of God’s punishment for terminating a pregnancy due to putting one’s own interests before that of an unborn child, and, the importance of self-sacrifice to bring a child, albeit through difficulty or illness, into the world . These considerations may be influential for a Muslim patient in deciding to continue her pregnancy, despite Islamic jurisprudential edicts permitting TOP in her case.

 

Furthermore, cultural (non-religious) factors may also affect Muslim patients’ decisions for TOP. This may include a perceived stigma from their local community or pressure from their partner, spouse or family members (both in favour of or against TOP). It may also include secular beliefs about the immorality of bringing children into the world with severe foetal anomaly and subjecting them to suffering.

 

Apart from the above, Muslim patients’ decision to terminate a pregnancy will also, naturally, be influenced by factors that patients of other (or no) faith are also influenced by, including ease of access to TOP services, information about the procedure, concerns regarding safety, confidentiality and the care they will receive, their emotional/psychological health after the procedure, and the subsequent support available to guide their reproductive decision making, including the use of contraception.

 

Importantly, just because a patient appears Muslim, or admits to belonging to the Islamic faith, should not prompt healthcare professionals to assume that such patients will follow the letter of their faith. It is therefore paramount that healthcare professionals are sufficiently trained to sensitively gauge and appreciate the variety and interplay of factors that a Muslim patient will consider, including (but not limited to) the teachings of their faith, in order to discuss the various options available to them (including the continuation of pregnancy).

In the context of these various factors that influence Muslim patients (and Muslim doctors’) decisions to participate in TOP, the British Islamic Medical Association offers the following responses to the recent draft NICE guideline on Termination of Pregnancy, published 12 April 2019.

 

 

Information should be tailored specifically to account for the beliefs, values and concerns of Muslim patients, in a sensitive manner, to aid them (and those whom the patient freely chooses to accompany them, including their spouse/family members) to engage in a process of informed decision making, including the option of continuing pregnancy and its implications

In cases where a Muslim woman does choose TOP, prompt referral is essential due to the time limit of ensoulment under which the Islamic legal exception for TOP is likely to apply, should the patient see this as influential to her decision.

Muslim doctors and trainees (and other healthcare professionals, including students, nurses and midwives) may conscientiously object to refer, approve or participate in TOP procedures/services for both Muslim and non-Muslim patients, regardless of circumstances, gestational age or the fulfilment of Islamic legal criteria. Services should therefore be designed in a way which do not pressurise Muslim healthcare professionals against their right to conscientiously object, but also do not delay TOP service provision to women who will nonetheless seek an appointment/referral through another healthcare professional or, self-refer.

Muslim clinicians should however provide care for women suffering from complications due to TOP, whatever the reason or grounds for that TOP. 

Minimal delay in the provision of TOP for Muslim patients is essential, due to the legal time limit of ensoulment. Healthcare professionals should therefore enquire about whether a Muslim patient has any specific time limits in mind which would affect her TOP decision and ensure swift access to TOP services accordingly, including prioritisation.

It is a reality that the majority of TOPs in the England are carried out under the Royal College of Obstetricians and Gynaecologists (RCOG) Ground C during the first trimester, due to unwanted pregnancy, though not necessarily any real or foreseeable risk to the mental health of the pregnant woman [9]. Furthermore, the British Medical Association (BMA) also issued that “Given the risks associated with pregnancy and childbirth, and the risks of a woman having to continue a pregnancy against her wishes (compared with the minor risks associated with early medical abortion), there will always be medical grounds to justify termination in the first trimester”. On this, Islamic law requires the presence of intolerable difficult or severe hardship/loss regarding the mental/physical health of the pregnant woman to justify a TOP. Therefore, the technique of utilising relative risk does not hold legal weight in Islamic abortion law. For this reason, it is not unlikely that a proportion of Muslim clinicians would conscientiously object to partaking in TOP procedures in (the majority of) women requesting TOP on the grounds of unwanted pregnancy, even if it be integral to their speciality training curriculum. In this regard, NHS Trusts, higher educational institutions, Royal Colleges, and postgraduate deaneries involved in speciality training should provide clear information and guidance on the process of conscientious objection. Furthermore, an environment of tolerance for objecting trainees should prevail and under no circumstances should trainees perceive disadvantage in obtaining speciality training posts due to a foreseeable (or actual) decision to object to partake in TOP.

 

Muslim patients may freely and wilfully request the inclusion of their spouse or family members in their TOP (or continuation of pregnancy) decision. Healthcare professionals should respect and facilitate this, and not stigmatise women for their decision to include others in their reproductive choice. Healthcare professionals must also not apply pressure on Muslim women to partake in their decision alone, if that is not what they want. Similarly, healthcare professionals should be conscious of third parties seeking to influence the decision of a Muslim patient against her will and should provide adequate safeguarding in such a situation.

Healthcare professional should also not stigmatise or judge Muslim women for wanting to continue with their pregnancy based on underlying theological beliefs, even if they do not sit with the personal viewpoints of the healthcare professional involved in that shared-decision.

Information provision should not only be limited to the experiences of women who have had a TOP but should also include information about women considering TOP (for various reasons), as well as information on the experiences of women who chose to continue with their pregnancy despite initially considering/deciding on a TOP. This is in lieu of the fact that women should be aware of their freedom to change their decision at any time during the process. It is essential that information provision from all healthcare professionals involved in the TOP care pathway is holistic and includes information on the continuation of pregnancy, as opposed to being limited to the experiences and options of the type/time of TOP procedure, and the implications thereafter.

It is essential that healthcare professional involved in TOP-decisions with women first gauge the extent to which a woman wishes to be informed about the intricacies of the process.  This is to avoid undue distress to the patient, in what already may be a difficult and sensitive decision.

Muslim women may wish for foetal remains to be buried according to Islamic funeral rites. Healthcare professionals should therefore adequately explain the process of discharging foetal remains and do so in a manner sensitive of the status that a Muslim patient (and her family) may award to the deceased foetus.

It has been shown that there is a higher incidence of foetal anomalies in pregnancies borne to British Muslim women, thought to result from their higher incidence of cousin marriages amongst certain ethnic and cultural groups within the Muslim community [11, 12]. For this reason, consideration of TOP due to foetal anomaly may be more common among Muslim women than the general female population. In this regard, we recommend that:

·         Pre-natal screening for foetal anomalies should not be withheld from Muslim women, just because they are unsure about whether they would have a TOP. In this regard, all patients have the right to information about their pregnancy, so that they can make as well-informed choices as possible.

·         The provision of information about the nature of the anomaly, whether it directly causes risk to the health of the Muslim patient during her pregnancy, or the expected responsibility (i.e. hardship) associated with supporting a disabled child is essential. This is because such information forms the basis of the Islamic legal exception permitting TOP in the case of foetal anomaly, thus is likely to be influential to a Muslim patient’s decision on TOP due to foetal anomaly.

·         Muslim patients should be made aware of the support available to them should they wish to continue with a pregnancy involving a foetal anomaly. Healthcare professionals should also engage in discussion about the patient’s social support structures in this regard.

·         In cases of familial diseases, we recommend genetic/diagnostic tests be offered to at-risk, pregnant Muslim women as early as possible, allowing them to consider TOP in good time before the time of ensoulment.

 

 

In the case of a surgical TOP, Muslim women, due to various religious or cultural factors, may request a female doctor to carry out their procedure. Some Muslim patients may see this as more important than others. TOP services should therefore attempt, where possible, to facilitate this request, including referral to other TOP providers.

In the context of wanting to preserve (all parts of) foetal remains from a TOP for an Islamic burial, Muslim women may have specific sensitivities about how to handle said foetal remains during an at-home expulsion. In this regard, healthcare professionals should fully explain to the patient what to expect during an at-home expulsion, as well as the option of medical termination under hospital admission purely for the purposes of more sensitive handling of foetal remains and respectful discharge of said remains to the patient/family thereafter.

TOP providers should provide the option of in-house counselling or psychological interventions, as opposed to referring to community mental health services, in the interest of maintaining a woman’s confidentiality and providing prompt support.

Apart from counselling, Muslim women may request access to Muslim chaplaincy services to provide support before, during and after TOP. We recommend that TOP service providers explore links with approved local hospital and community Muslim chaplains and establish a referral pathway for women who request it.

It is also essential that both male and female Muslim chaplains are there to listen and offer spiritual and pastoral care without judgment and in a confidential manner, whatever the reason for the TOP, or the week of gestation that the TOP was carried out at.

We, the British Islamic Medical Association, recommend the commissioning of research into the development of culturally and religiously sensitive TOP care pathways for Muslim women. This could include, but is not limited to:

·         What factors affect a British Muslim woman’s decision to terminate her pregnancy?

·         What barriers, if any, exist to British Muslim women accessing TOP services?

·         Do British Muslim women’s experience of TOP services evidence that they are provided in a way which reflects and accounts for their concerns, beliefs and values?

·         To what extent would the sensitivity of the 18-21 week foetal anomaly scan be affected, were it to be offered earlier at 14-16 weeks to Muslim women, allowing them time to consider TOP (before 19 weeks post-LMP) for other foetal anomalies not screened for during the early pregnancy (10-14 week) scan?

[1] Hanafi, Shafi’I and Ja’fari schools.

[2] Maliki and Hanbali schools

[3] Although some other jurists have also argued 80 days or 5 months.

References

1.     Ons.gov.uk. (2019). Muslim population in the UK 2018 – Office for National Statistics. [online] Available at: https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/muslimpopulationintheuk/ [Accessed 21st May 2019].

2.     Sekaleshfar F. Abortion Perspectives of Shiah Islam. Studies in Ethics, Law, and Technology. 2008. 2(3): Article 4.

3.     Ekmekci P. Abortion in Islamic Ethics, and How it is Perceived in Turkey: A Secular, Muslim Country. J Relig Health. 2017. 56(3): 884–895.

4.     Al-Matary A. et al Controversies and considerations regarding the termination of pregnancy for Foetal Anomalies in Islam. BMC Med Ethics. 2014. 15:10.

5.     Asmen O. Abortion in Islamic Countries – Legal and Religious Aspects. Medicine and Law. 2004. 23:73-89

6.     Lmo.ir (2016). Mu’āyināt Siqt-i-Darmāni. Available at: http://lmo.ir/web_directory/54768-مشاهده-یک-خدمت.html?id=54&cnt_id=54&sisOp=view [Accessed 21st May 2019]

7.     Ahmed S. et al. Attitudes towards prenatal diagnosis and termination of pregnancy for thalassaemia in pregnant Pakistani women in the North of England. Prenatal Diagnosis. 2006. 26 (3): 248-257

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Eid Mubarak

Assalamo Alaikom

Eid-ul-Fitr is here, and may Allah bless you and your families with a wonderful Eid.

Although there may be a tinge of sadness as we approach the end of Ramadan, this sadness should not prevail. We should be grateful that we have been able to participate in this blessed month, we should count our blessing that we have managed to fast, offer Sadaqah and pray taraweeh and qiyam. It should not be a farewell however as we should keep up all the good works we do in Ramadan during the rest of the year.

Ramadan is not merely a month, it is a way of life and the beginning of a new journey. Let us now say farewell and let us allow Ramadan to live within us so we can keep living it long after it has ended.

Fasting is not exclusive to Ramadan. The Qur’an should not be sent back to the bookshelves after Ramadan. The mosque is not only open during Ramadan.

I am hoping that our good deeds during this month are all accepted inshaAllah and that we can build on them during the upcoming year. Ramadan should offer us the opportunity to recharge our spiritual batteries and face the challenges ahead inshaAllah.

Eid Mubarak

Sharif Kaf Al-Ghazal

Ramadan Mubarak

O you who have believed, decreed upon you is fasting as it was decreed upon those before you that you may become righteous.” (2:183)

Ramadan is upon us and what a delightful guest it is. A holy month in which Allah offers us the biggest opportunity for redemption. It is imperative we make the most of this chance.

Fasting is obviously a crucial part of the holy month. But fasting goes beyond simply hunger and thirst. Amongst the benefits of fasting and the hunger that it causes is the motivation to do more for others who are less fortunate than yourself. Fasting itself is a detox for us – a chance for our bodies to flush away the toxins and rid ourselves of habits of excessive consumption. As healthcare professionals we understand the need to take great care of what we place into our body and Ramadan offers the opportunity to reflect on that. 

Beyond fasting, additional forms of worship are strongly encouraged. Work on your relationship with Allah (SWT). Pray the extra sunnah prayers. Take time to reflect and read the Quran and evaluate its connection to your life. 

Furthermore, worship to Allah isn’t necessarily a solitary affair. Giving to charity (Sadaqa), serving others for the sake of Allah (SWT), engaging in voluntary work are all opportunities to gain good deeds.   

Ramadan is a good opportunity to reflect and evaluate yourself and your relationship with Allah. Strive to organise your life to minimise waste, over-consumption and the ills that come with this. 

Some people these days are too inflexible and intolerant towards others. We, as health care professionals and students should go out of our way to display the best of character to our patients and colleagues when interacting with them, following in the example of our beloved prophet (PBUH) when interacting with the people. In Ramadan it is even more crucial to do this and it is also worth reflecting more on how we can improve our levels of compassion towards patients and colleagues.

Moreover, we need to show that fasting is not affecting our work efficiency and that we are just as productive as we are when not fasting. Fasting helps concentrate our mind and soul so should help us physically too. We cannot allow our hunger and thirst to become distractions. And any hunger cannot turn into frustration or anger either.

Fasting teaches endurance, empathy, and sacrifice — three qualities all great healthcare professionals recognise and share. Let us focus on these qualities and look to embed them in our daily lives.

May Allah accept all our good deeds inshaAllah. 

Sharif Kaf Al-Ghazal, President, BIMA