(Photo: Palestinian pilgrim gets vaccinated in Gaza Strip, 6 Nov 2009/Ibraheem Abu Mustafa)

Standing in the middle of a long queue at Jeddah airport, Mahdi Sharif is one of millions of Muslims waiting to enter Saudi Arabia to start the annual haj pilgrimage despite a global outbreak of the H1N1 flu virus.

Little fazed by the spread of the virus, Sharif, who has been waiting for two years to be selected from a raffle of 5,000 Kurdish Iraqis to visit Mecca, wears a protection mask but never thought for a second of delaying his pilgrimage.

“This year I was chosen so I came, I could not say no. The happiness of being chosen is stronger than fear (of illness),” said Sharif in a muffled voice through his medical mask.

In June, the Saudi authorities advised persons over 65 and under 12, as well as people suffering from terminal illness, and pregnant women, to postpone their pilgrimage. Several Muslim countries also imposed similar restrictions on their pilgrims and Tunisia barred its citizens from this year’s ritual.

About 580,000 pilgrims have so far arrived to the Western region of Saudi Arabia, site of the two holy mosques in Mecca and Medina, in preparation for the pilgrimage that will start on November 26.

Read the whole story here.

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Waves of H1N1 swine flu spread by some three million pilgrims travelling to and from Mecca for next month’s haj threaten to pile pressure on healthcare systems around the world, disease experts said on Thursday.

“No region can be considered free from risk,” said the U.S. and Arab experts, including Saudia Arabia’s deputy minister for preventative medicine, in a study in the journal Science.  The pilgrimage itself, in the last week of November, provides perfect conditions for the spread of the H1N1 flu virus, which is transmitted in droplets and by physical contact.

“The density of pilgrims, the nature of the rituals, and the shoulder-to-shoulder contact recommended during prayers provide a perfect transmission atmosphere,” wrote Shahul Ebrahim of the U.S. Centers for Disease Control and Prevention and Ziad Memish of Saudi Arabia’s health ministry.

Around 3 million pilgrims from more than 160 countries take part in the haj in the holy city of Mecca most years, including up to 2 million who travel from abroad.  Memish and Ebrahim also said that after the event, around 45,000 pilgrims from Europe and more than 15,000 from North America will pass though major global airline hubs on their way home, further increasing the risk of spreading the virus.

Read the full story here.

(Photo: Flu shot, 26 Oct 2009/Ralph Orlowski)

Several Muslim countries have imposed restrictions on the pilgrimage to Saudi Arabia because of worries about a major outbreak of H1N1 flu.

Here are some details from our Factbox:

* EGYPT:
– The most populous Arab state has decided to restrict umra and haj pilgrims to those over 25 and under 65. Egypt also plans to inoculate pilgrims against the H1N1 virus.
– Egypt was the first Arab country to say that the haj and the ritual of umra were a threat to its citizens’ lives.

* IRAQ:
– The health ministry says haj travel is forbidden for sick people, pregnant women, people above 65 years of age, children under 12 and obese people.
– It says it has assigned 330 doctors to go with people on the haj. While there, Iraqis will be assigned to 18 compounds where food will be prepared for them and in each compound there will be a clinic. Before going on haj one must have a checkup.

* MOROCCO:
– Morocco plans no restriction on travel for haj if the situation does not deteriorate in Saudi Arabia but has made it mandatory for its more than 30,000 pilgrims to get the anti-flu vaccine.
– Authorities will allow pilgrims to travel for haj only when they have had their passports stamped by health officials to prove they have had their vaccination, officials said.

* OMAN:
– Oman issued an order on July 6 telling high-risk groups to postpone haj.

* TUNISIA:
– Tunisia has barred its citizens from making the annual pilgrimage to Mecca for the first time because of a lack of swine flu vaccines, the government said earlier this month.
– The Ministry of Religious Affairs said a batch of H1N1 flu jabs would not arrive before mid-October, too late to ensure candidates for the pilgrimage, or haj, are vaccinated.
– Tunisia is the first country formally to cancel the pilgrimage.

(Photo: Swine flu precautions in Kuala Lumpur, 29 July 2009/Bazuki Muhammad)

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A new study into global abortion rates was released on Tuesday by the U.S.-based Guttmacher Institute, a think-tank which studies sexual and reproductive health.

Here are some of the main findings:

* ABORTION TRENDS:

– The rate of safe abortions dropped between 1995 and 2003 to 15 from 20 per 1,000 women aged 15-44, but unsafe abortions declined only slightly — to 14 from 15 per 1,000 women aged 15-44. The overall rate fell to 29 from 35 per 1,000 women.

– Globally around 70,000 women die each year from the effects of unsafe abortions, a figure that has barely changed in the last 10 years. An estimated 8 million women annually experience complications and need medical treatment, but only 5 million actually get that care.

(Photo: Anti-abortion protester in London, 27 Oct 2007/Toby Melville)

– Contraceptive use has increased in many parts of the world, particularly Latin America and Asia, contributing to a decline in the worldwide unintended pregnancy rate to 55 per 1,000 women aged 15-44 in 2008 from 69 per 1,000 in 1995.

– A number of countries in which abortion was highly restricted in the 1990s have now liberalised their laws. Since 1997, 22 countries or administrative areas within countries have changed abortion laws. In 19 of those, restrictions were eased.

* ABORTION NUMBERS: (In millions)

               TOTALS           SAFE           UNSAFE:
            1995    2003    1995    2003    1995    2003
 WORLD      45.5    41.6    25.6    21.9    19.9    19.7
 AFRICA      5.0     5.6    n/a      0.1     5.0     5.5
 ASIA       26.8    25.9    16.9    16.2     9.9     9.8
 LATIN AMERICA &
 CARIBBEAN   4.2     4.1     0.2     0.2     4.0     3.9
 EUROPE      7.7     4.3     6.8     3.9     0.9     0.5
 OCEANIA     0.1     0.1     0.1     0.1     n/a     0.02
 N.AMERICA   1.5     1.5     1.5     1.5     n/a     n/a

Sources: Reuters/Guttmacher Institute

Click here for our news story on this report: Unsafe abortions kill 70,000 a year, harm millions.

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In Israel, the death count for the H1N1, or swine flu, outbreak reached 7 yesterday, and for some citizens, fighting the virus has taken on some religious dimensions.

Israel's leading paper, Yedioth Ahronoth, wrote an article about health concerns raised by Israel's Ultra Orthodox media: kissing mezuzahs. A mezuzah is a tiny encasement holding a piece of parchment with a Jewish prayer enscribed on it. Mezuzahs are nailed to most doorways inside a Jewish home, and traditionally, Jews will touch the mezuzah and kiss their fingers when entering a house.  An ultra-orthodox journalist decided to ask seven doctors their opinion on whether this tradition could be dangerous in the Swine flu era.

According to Yedioth Ahronoth, "The doctors unanimously agreed that bacteria leave high levels of residue on such objects, but six of them refused to comment on mezuzot in particular, 'so as not to get in trouble with the rabbis'."

Only one doctor in the article affirmed that their could be a direct link between kissing a mezuzah and contracting the virus.

The results lead some rabbis to make suggestions for how to preserve the practice in light of potential health hazards. Israel's Sephardic Chief Rabbi Shlomo Amar said, "If a specific order is given in the matter, the mezuzah must be kissed from the air, to ensure that the custom is not forgotten."

It's not the first problem there's been concerning the disease and local beliefs. When it arrived in Israel earlier this year, the Ultra-Orthodox deputy health minister insisted on respect for the kosher dietary traditions that ban the eating of pork: he banned references to the illness as "swine" flu...

Earlier this week, we wrote about the "flying rabbis" trying to combat the flu: "Dozens of rabbis and Kabbalah mystics armed with ceremonial trumpets have taken to the skies over Israel to battle the H1N1 flu virus."

After the flight, Rabbi Yitzhak Batzri said "we are certain that, thanks to prayer, the danger is already behind us."

According to an article in Ha'aretz, there have been  2,148 cases of verified swine flu in Israel and half of them have been under the age of 30.

PHOTO:Israeli doctor at the health clinic in Ben Gurion Airport, Israel. The clinic was opened as part of an effort to combat the virus' spread from high-risk countries. REUTERS/Baz Ratner

Flu fears are already changing the face of some religious services, from Mexico where church gatherings are discouraged to the United States where wine shared from a common cup has been suspended in some parishes. We’ve already blogged about this but offer more detail from other places here.

U.S. Catholic bishops have issued general guidelines saying clergy and lay ministers who distribute communion wafers “should be encouraged to wash their hands before Mass begins,  or even to use an alcohol based anti-bacterial solution before and after distributing Holy Communion.”

“They should instruct people who feel ill not to receive from the cup,” containing wine which Catholics believe becomes the blood of Jesus Christ during Mass.

And while the bishops’ Committee on divine Worship said it does not see the need for widespread changes in liturgy, some churches have already made then.

In Texas where border communities have been hit by flu cases Bishop Raymundo Pena of the Diocese of Brownsville has asked priests to offer only bread to communicants, give communion in the hand and not on the tongue and ask parishioners not to hold hands during recitation of the Lord’s Prayer or to shake hands at the sign of peace during Mass.

“They may bow to their neighbor or place their hands on each other’s shoulders,” he suggested in a memo.

The archbishop of San Antonio, Jose Gomez, made a similar request of his flock.

The Archdiocee of New York says it has asked pastors to tell those worried about shaking hands during Mass that “there are other ways to offer the sign of peace, including a wave, a nod of the head or some other gesture. Handshakes are not mandated.”

The Archdiocese of Chicago  has told pastors who minister to its the 2.3 million Catholics that they may caution church-goers about drinking wine from the cup or shaking hands during mass if they think it is appropriate.

My colleague Ed Stoddard in Dallas reports that the Southern Baptist of Texas Convention, part of the largest U.S. Protestant church, had checked with several congregations in Fort Worth and Houston and none was cancelling Sunday services though they will if local authorities ask them to do so.

But it is a differnt scene in Mexico where the new strain of flu first appeared, as correspondent Michael Scott O’Boyle reports:

“Sunday Masses in Mexico City and the densely populated surrounding valley have been suspended, with a rare simulcast of Mass from the Basicilica de Guadalupe by the two national TV channels. Sparsely attended daily Masses have still been allowed  in the capital, and churches remain open to the public.

“On a national level bishops are asking that priests distribute communion by hand and congregations pass on the peace offering, but Masses are not being unifromly suspended — only in certain communities where there have been signs of the outbreak, said Fr. Jesus Aguilar from the Mexico City archdiocese.

“A huge national youth conference this weekend, aimed at fanning anti-abortion movements as certain areas of the country move to legalize abortions … had to be cancelled. Even Mexico’s cult of Saint Death is heeding the government calls, cancelling its celebrations that take place on the first of every month before street altars reared to the skeletal saint, the most famous of which is off the Tepito district, the capital’s biggest black market den.”

(Photo:A man wears a surgical mask as he prays at the Metropolitan Cathedral in Mexico City. REUTERS/Jorge Dan, April 28, 2009, MEXICO)

Jim Forsyth, our stringer in San Antonio, Texas, reports:

San Antonio has been hard hit by the swine flu, but if local Roman Catholics go to Mass to pray for deliverance from the disease, they may not get the relief they had hoped for. Archbishop Jose Gomez has issued a letter to priests in the archdiocese recommending they make changes in the Mass because of the swine flu outbreak.

“I am requesting that you offer Holy Communion under only one species, bread only,” Gomez told his priests. “Also, during the Lord’s Prayer, please suspend the holding of hands and the shaking of hands or embracing during the sign of peace.”

“Common sense would dictate that washing of hands by ministers and others who come in contact with people can be effective in preventing the spread of swine flu,” Gomez wrote.

The archbishop also held out the possibility of not holding church services at all if public health officials say gatherings may spread swine flu.

San Antonio, the oldest continuously operating Catholic diocese in the United States, has also been one of the areas hit hardest by the outbreak, with tens of thousands of students out of class due to school closings. Gomez, a native of Mexico, also asked his parishioners to pray for the families in Mexico who lave lost loved ones due to the swine flu outbreak there.

(Photos: Catholics attend Mass in Mexico City’s cathedral, 26 April 2009/Eliana Aponte)

Our Jerusalem bureau had this interesting little story today about the swine flu outbreak:

Swine flu not kosher in Israel
JERUSALEM, April 27 (Reuters) - Swine flu? Not in the Jewish state.

“We will call it Mexico flu. We won’t call it swine flu,” Deputy Health Minister Yakov Litzman, a black-garbed Orthodox Jew, told a news conference on Monday, assuring the Israeli public that authorities were prepared to handle any cases.

Under Jewish dietary laws, pigs are considered unclean and pork is forbidden food — although non-kosher meat is available in some stores in Israel.

If swine flu isn’t kosher, then it probably wouldn’t be halal either. So is swine flu being renamed anywhere in the Muslim world?

NB: The U.S. Centers for Disease Control and Prevention (CDC) website advises: “You can not get swine influenza from eating pork or pork products.”

(Photo: Pigs at a farm outside Hanoi, 27 April 2009/Nguyen Huy Kham)

Pope Benedict’s comments about condoms on his flight to Cameroon have made headlines worldwide. They have been quoted extensively on many websites run by news organisations and also by the Vatican. But that hasn’t stopped the same Vatican from editing them after the fact to try to make them sound more acceptable.

(Photo: Pope Benedict answers questions in the plane to Africa, with Rev. Georg Gänswein (L) and Cardinal Tarcisio Bertone (C), 17 March 2009//Alessandro Bianchi)

The main change on the Vatican website comes in the most controversial part, where he says: “It (AIDS) cannot be overcome by the distribution of condoms. On the contrary, they increase the problem.” This was criticised in Europe and the United States as going beyond a doctrinal question and spreading untruths about public health policies. Now the Vatican’s Bollettino (daily bulletin — here in the original Italian) has watered this down to have him say:   “On the contrary, the risk is that they increase the problem.” The Milan daily Corriere della Sera has the original transcript in Italian.

The Vatican editors also softened the pope’s talk about solutions. In the original, he said: “The problem of AIDS cannot be solved only with money …” In the new version, this comes out as: “The problem of AIDS cannot be solved only by advertising slogans …”

The Bollettino flip-flopped when it came to using the everyday word “condom” (preservativi in Italian), as the pope did when he spoke on the plane to journalists. It first replaced that with the more scientific sounding word “prophylactics” (profilattici). The term “prophylactics” has a wider meaning and could include other methods besides condoms. But abstinence, which the Vatican preaches as the most effective method against spreading AIDS, can also be described as a prophylactic measure. This seems to have dawned on the Vatican editors only after they changed Benedict’s comment to say profilattici, as Corriere documents in the screenshot here. So they later had to go back and correct the correction by switching back to preservativi.

Asked in Yaoundé about the editing, chief Vatican spokesman Rev. Federico Lombardi said he knew about the issue with the word preservativi but was not aware of any other changes. He said the Vatican’s Secretariat of State occasionally “finetunes” the pope’s unprepared spoken workds to “make them flow better in Italian” and to “join loose phrases.” The pope’s native language is German, but he is an impressive linguist, has been living in Rome since 1982 and speaks excellent Italian.

This is not the first time this has happened. Two years ago, Benedict’s comments in the plane flying to Brazil about excommunicating Catholic politicians who support abortion were changed in the final Vatican version.  In his famous Regensburg speech, he said a Byzantine emperor he quoted criticising Islam had spoken “somewhat brusquely.” The final version spun this to say he spoke “with a startling brusqueness we find unacceptable.”

Unacceptable. Interesting that he should choose that word. Is this editing of his comments unacceptable?

The Vatican has caused a stir by appearing to want to redefine death and then denying any such thing. If where there’s smoke, there’s fire, we haven’t heard the end of this yet.

It all started with a front-page article in the Vatican daily L’Osservatore Romano challenging the widely-accepted concept that brain death — the irreversible end of all brain activity — is the right standard for determining that someone has died. The article argued that doctors developed that standard 40 years ago to enable them to harvest organs for transplantation. The article by Lucetta Scaraffia, an Italian history professor and bioethicist, argued:

“The scientific justification of (the brain death standard) rests on a peculiar definition of the nervous system that is now being questioned by new research, which casts doubt on the fact that brain death leads to the disintegration of the body … The idea that the human person ceases to exist when the brain no longer functions, while the body is kept alive thanks to artificial respiration, implies an identification of the person with brain activity alone. This contradicts the concept of the person according to Catholic doctrine and thus contradicts the directives of the Church in the case of patients in a persistent coma.”

The Vatican accepts organ transplantation and the brain death standard, which is widely used in Catholic hospitals. Declaring the brain death criterion un-Catholic would mean those hospitals would have to revert to the cardiac death standard alone. But that leaves a much smaller window for removing viable organs and would make one kind of transplantation — heart transplants — all but impossible. As it is, there is already such a shortage of organs for transplantation that scandalous black markets for them exist and some experts want to see organs sold like commodities on an open market.

The Vatican has not changed its view on brain death despite holding two scientific conferences (in 2005 and 2006) to discuss it, but there are dissenters among Catholic bioethicists like Scaraffia who want to keep the debate going. She used the 40th anniversary of the pioneering Harvard Report that advocated the brain death standard to call for a reassessment.

Rev. Federico Lombardi, the Vatican’s chief spokesman, got plenty of calls asking whether this was a change in the Church’s position. “This is not a Vatican document,” he responded. “It is an article by a historian that takes some considerations into account but it is not part of Church teaching.”

End-of-life issues are some of the most difficult challengesin ethics and some bioethicists say people should choose their definition of death in advance to ensure they don’t leave the moral quandary to others.

The influential New England Journal of Medicine reopened this long-standing debate last month with an article questioning whether some patients declared brain dead were in fact really dead. Patients with massive brain damage can be declared brain dead even though their vital bodily functions continue to work, wrote Robert Truog of Harvard Medical School and Franklin Miller of the National Institutes of Health. “The arguments about why these patients should be considered dead have never been fully convincing,” they wrote.

Another criterion, the end of a heart’s beating, seems questionable when doctors can declare cardiac death and the transplant and restart the heart in another patient, they said. These cases suggested, they argued, that “the medical profession has been gerrymandering the definition of death to carefully conform with conditions that are most favourable to transplantation”.

Another article reported that doctors in Denver had taken hearts from three brain-damaged infants within 75 to 180 seconds after their cardiac deaths and then successfully implanted and restarted them in other babies.

In the same series, bioethicist Robert Veatch of Georgetown University’s Kennedy Institute of Ethics wrote that declaring cardiac death and then transplanting the same heart amounted to “ending a life by organ removal”.

Do you think the ethical issues that Scaraffia brings up justify a challenge to the brain death criterion? Or should the priority be on making sure doctors have as many organs for transplant as possible?

UPDATE:  Sandro Magister has just put out a very thorough analysis of this issue on his blog www.chiesa. For the English-language version, click here.

Whenever God is mentioned in connection with human rights, the idea is usually that there are “God-given rights” bestowed on humans.

Nepal’s Supreme Court has turned this around by bestowing basic human rights such as education and healthcare on gods. Goddesses, to be more precise. It seems that kumaris , virgin girls venerated as “living goddesses” and confined to Buddhist temples until puberty, return to their families as teenagers unprepared for real life. Critics of the tradition filed a suit that led to the Supreme Court decision.

“A directive order has been issued to the government to provide basic human rights, including education and health (care) to the child,” Supreme Court spokesman Hemanta Rawal said. “This means the child’s rights can’t be violated in the name of culture.”

Read Gopal Sharma’s story from Kathmandu here.