Religious scholars and health experts urge Muslims suffering from chronic or mild diseases to consult their physician and to undertake thorough checkups before fasting. Patients in critical condition are told not to fast at all.

Zainab Bibi, 65, has diabetes, hypertension and rheumatic heart disease. “My doctor has stopped me from keeping fasts. I didn’t fast last year and won’t this year because of my chronic illnesses.”

Bibi intends to make up for her missed Ramadan fasts during the winter when the days are shorter and cooler.

Dr. Amanullah Safi, a lecturer of community medicine, says that observing the fast is a personal matter. People with certain illnesses, however, are exempted from the fast, he explains.

Patients with kidney problems, for example, such as those with kidney stones or who need to undergo dialysis, find fasting during the long, summer months very difficult because they can’t hydrate properly.

Also, diabetic patients who use insulin twice or sometime three times a day can suffer from low sugar levels in the blood if they fast, causing a variety of health issues.

People with these and similar ailments must consult with their physician regarding their ability to fast.

“If diabetic or kidney patients keep the fasts in the hot summer, they might face harsh consequences caused by dehydration,” explains Safi. “Also, patients with intestinal or stomach ulcers who remain hungry for long periods of time can get perforated ulcers, which often requires surgery,” he says.

Dr. Nighat Shafiq, assistant professor of oral biology, says they tell patients coming in for tooth extraction, fillings and root canal treatment not to observe the Ramadan fast on the day of their treatment.

The dentists do, however, allow some patients coming in for oral treatments to fast if it is possible for the dentists to use special equipment that prevents the swallowing of water.

Muslims Battling Cancer

Oncologists explain that both chemotherapy and physiotherapy require hydration. Patients going through an acute phase of cancer shouldn’t fast, they say, because they can experience kidney failure or increased levels of uric acid in the blood, causing gout.

“Drugs used in chemotherapy kill cancer cells. This releases uric acid into the body, which can lead to kidney failure. This is why it’s important for cancer patients to hydrate,” says one oncologist.

“Vomiting and diarrhea are two common side effects of chemotherapy. As a result, cancer patients discharge water frequently and they are in need of drinking considerable quantities of water to avoid dehydration. During chemotherapy, it’s impossible for a cancer patient to observe the fast,” he explains.

Another oncologist explains that stable cancer patients undergoing prolonged therapy but who have the stamina to fast can do so while being cautious.

Dr. Halilur Rehman, deputy medical superintendent, says patients with liver disease who are given the green light to fast by their physicians need to make sure they have a balanced diet alongside their medical treatments.

As for patients with heart disease, Rehman says, “Angina patients who frequently take medicine shouldn’t observe the fast. If these patients don’t take their medicines on time their blood pressure can get out of control leading to heart attack.”

Fasting Concession

Mufti Abdul Malik Hameedi, a scholar in a religious seminary, says that observing fasts in the holy month of Ramadan cleanses a Muslim both physically and spiritually.

He says that Islam has given concession to the ill for not keeping fasts, but that after recovery they must make up for their missed fasts.

“Healthy people have to keep fasts because their ransom isn’t acceptable. There are people who have lifelong illness. Such people have to pay ransom to feed the poor on daily basis in the holy month of Ramadan,” he explained.

“It is clear from hadiths that when Ramadan became obligatory for the first time, it was also a hot summer season as it is now. May Allah give us the strength to follow Islam practically,” he says.