By Cllr Rabina Khan

London, (The Muslim News):  Whilst we welcome the month of Ramadan, this year presents exceptional challenges for Muslim health care professionals who will be working in the NHS while fasting (abstaining from food and water from dawn until sunset). Although fasting is obligatory for all able-bodied Muslims under normal circumstances, health care workers’ own health may be at risk when fasting, due to the requirement of wearing PPE for extended periods.

PPE can be uncomfortable to wear under normal conditions, but in fasting Muslims, this can lead to dehydration and increased fatigue, thereby impacting mental alertness and concentration. This not only presents problems for the health care workers, but also increases the risk of error and the subsequent risk to the patients under their care.

Although many A&E departments have suggested that staff should take a break after wearing PPE for a couple of hours, this increases the risk of infection and is not practical, as it takes some time to don and doff PPE and perform hand hygiene. In addition, depending on the situation, it may not be possible for staff to take a break every two hours.

To help address this situation, the British Board of Scholars and Imams (BBSI) has consulted with front-line clinicians in acute care settings such as A&E and ICU, and has produced some guidelines for those staff who treat COVID-19 patients, although not all are workable.

The suggestions of swapping shifts, buddying up towards the end of the shift and commencing fast but breaking it according to the working circumstances, is not feasible. There is enormous pressure on the NHS workforce, so trying to swap shifts is NOT recommended, neither is taking leave or requesting exemptions from frontline duties because of the fast. In addition, the duty of care towards patients and respecting other work colleagues must always take priority over fasting.

The BBSI is unable to impose set rules for all circumstances, as it is only the experienced clinician who can decide what is viable at the time. However, they have stated that if a person cannot adapt to fasting during shifts, it is permissible to not fast on those days; but when they are not at work, then it remains obligatory to fast. Those not able to fast have to make up for missed fasts on other days.

The NHS has issued guidance on how to support colleagues during Ramadan and Iftar (Breaking the Fast), which has been provided by the NHS Muslim Network and the British Islamic Medical Association. (BIMA). Amongst other considerations, they have advised that “Despite the additional pressure on the NHS, it is essential that managers consider these guidelines for the health and well-being of Muslim staff in a way that doesn’t negatively impact patient welfare and care. And, likewise, it is advised that staff observing Ramadan have early conversations with managers to mitigate any risks to the service and to patient care.”

The conclusion is that each person has to make a decision based on their particular circumstances and that of the care setting concerned, but that their own health and that of the patients takes priority during the pandemic. It is therefore permissible not to fast during working shifts if it places additional pressure on the NHS and risks the safety of patients, colleagues, and oneself.

Cllr Rabina Khan is councillor for Shadwell Ward, Liberal Democrat Party

[Image: 3D medical illustration of 2019 Novel Coronavirus, derived from a CDC released image from www.scientificanimations.com/Creative Commons]