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P: swine flu. To find out more Kelly McEvers traveled to the Red Sea Port of Jeddah, the gateway to the pilgrimage.

KELLY MCEVERS: Muslims from around the world have been coming here for Hajj for more than a millennium. It's one of the five pillars of Islam. Every Muslim who is able is supposed to make the journey to Mecca at least once in a lifetime.

(SOUNDBITE OF CHANTING)

MCEVERS: Non-Muslims aren't allowed into Mecca. But there are plenty of Hajj videos online. This one shows thousands and thousands of people packed together, circling the sacred stone known as the Kaaba. This proximity is exactly the problem, says Ebrahim Shahul of the American Centers for Disease Control and Prevention.

SHAHUL EBRAHIM: There is no space in between the persons. They stand shoulder to shoulder, touching of objects of religious significance. And when we pray, we prostrate on the ground where you would touch also the carpets or the floor. So there could have been some body fluids.

MCEVERS: Ebrahim is here to consult with Saudi health officials. He says it's more difficult to restrict people's movements during a huge religious ceremony like Hajj, than it was in Mexico when the first big wave of H1N1 appeared.

EBRAHIM: What happened in Mexico City was to close churches and to prohibit or limit the number of people attending funerals, or people going to restaurants. The entire Hajj is against all those principles.

MCEVERS: So you can close churches. You can close schools. But you can't close Hajj. Is that what you mean?

EBRAHIM: If it has never been done in 1,430 years, I don't think anybody is prepared to call for that.

MCEVERS: So instead, the goal is to mitigate the spread of H1N1. The Saudi government is offering the H1N1 vaccine to health care workers, security forces and anyone else working on the pilgrimage. And officials recommend that pilgrims be vaccinated at least two weeks before leaving their home countries. But many countries can't afford that - only a handful, like China, have pledged to comply. Saudi officials say pilgrims over 65 and under 12, and pilgrims who are pregnant or sick should stay home. Deputy Health Minister Ziad Memish stresses that these are recommendations, not requirements.

ZIAD MEMISH: We've made it clear that the Kingdom of Saudi Arabia will not turn anybody away. So anybody who comes in, after he's been cleared by his country, they we'll take care of them.

MCEVERS: That means pilgrims who come by sea or by air, here to the Jeddah Airport, will be greeted by health inspectors as soon as they arrive. So I'm standing outside the Hajj terminal. It's a separate terminal just for pilgrims. Thousands of people are arriving every day. When they do arrive, they will be sent through a heat sensor and screened for a fever. If they have a fever, they will be kept here at the Hajj terminal until that fever disappears. If they don't have a fever, Memish says, the pilgrims will be given packets with masks, hand sanitizer and information about H1N1. If they later contract symptoms during Hajj, they'll be given anti-virals but won't be isolated. On the road from the Hajj terminal to Mecca is a gas station and rest stop for pilgrims.

So here with a bus full of pilgrims from Bangladesh, most of them are elderly folks. When you ask them about H1N1, they're not - it doesn't seem like it's a big concerned. They're not wearing masks. They're not traveling with hand sanitizer or any of these things that you hear about from officials. 74-year- old Maoud Abshel-Jawan(ph) says he saved up his entire life to make the Hajj.

MAOUD ABSHEL: Yes, first time I have come here.

MCEVERS: He says he was screened at the airport but then let through.

ABSHEL: I have no cough, any problem. But I am suffering from diabetes and low pressure.

MCEVERS: Saudi health officials say it's sick and elderly pilgrims, like Abshel-Jawan, who they worry about the most. People likely to spread the flu here or, worse, take it back home with them. But they're also the same people, Saudi officials say they simply can't turn away.

For NPR News, Kelly McEvers.

(SOUNDBITE OF MUSIC)

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