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Why were pilgrimage routes to Mecca important in the spread of cholera?

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A woman in a pink dress receives medical treatment from nurses administering an IV at a crowded hospital in Saint-Marc, Haiti. — cholera A woman with cholera being treated by nurses at St. Nicholas Hospital in Saint-Marc, Haiti, 2010.

Pilgrimage routes to Mecca were significant in the spread of cholera because they functioned as "relay stations" for the disease as it moved from East to West. During the 19th and early 20th centuries, these routes facilitated the transmission of the cholera bacterium, with 27 epidemics recorded during pilgrimages between the 19th century and 1930.1

The hajj and other pilgrimage travels were particularly instrumental in amplifying the spread of the disease during the fourth cholera pandemic. The high volume of travelers moving through these routes created ideal conditions for the fecal-oral route of transmission, as contaminated water and food sources could easily infect large groups of people who then carried the pathogen to their home regions. The severity of these outbreaks is evidenced by historical records, such as the 1907–08 hajj, during which more than 20,000 pilgrims died of the disease.213