Case Study in Mecca/Medina: Tobacco-Free Cities for Smoke-Free Air by WHO

In 1999, major Muslim scholars further defined the Islamic ruling on smoking. They asserted that as one of the basic tenets of Islam is the protection of the mental and physical integrity of individuals, the harmful health effects of tobacco make its consumption a contraindication of Islamic teaching. Dr Farid Wasil 1999, the Grand Mufti of Egypt declared that smoking is Haram (forbidden) in Islam because of its damaging effects to human health. This faith-based evidence and the subsequent tobacco control strategy have been central to the impetus and the justification for a focus on tobacco control and smoke-free initiatives in Mecca and Medina.

My goal in summarizing this case study is to support wider tobacco control objectives, complement the interventions outlined, and to increase awareness about the hazards of smoking and tobacco.

case study

WHO smoke-free city case study: Mecca and Medina, Saudi Arabia.  This case study aims to unpack the process for tobacco-free cities and is one in a series of nine case studies of cities that have engaged in the process of becoming smoke-free. The study examines how Mecca and Medina have taken forward smoke-free and wider tobacco control agendas by placing emphasis on banning sales of tobacco within the cities.

Mecca and Medina in Saudi Arabia are Islam’s two most sacred places and are revered by more than one fifth of the world’s population. Mecca has a population of 1.7 million and is home to the world’s largest mosque – Al Masjid al-Haram – which can accommodate up to 4 million worshippers. Medina city has a population of 1.3 million residents. Both cities attract around 8 million visitors each year. On average, between 3 and 4 million Muslims arrive in the cities – for a two month period – during the Hajj (pilgrimage) and a further 2 to 4 million arrive during the month of Ramadan.


All people have a fundamental right to breathe clean air. There is no safe level of exposure to second-hand smoke (SHS), which causes heart disease, cancer and many other diseases. Even brief exposure can cause serious damage. Only a total ban on smoking in all indoor public places, including workplaces, protects people from the harms of SHS exposure, helps smokers quit and reduces youth smoking.


An increasing number of countries have adopted legislation to accomplish smoke-free environments. Smoke-free legislation is popular wherever it is enacted, and these laws do not harm business. Any country can implement effective smokefree legislation. However, only a small proportion of the world’s population currently has meaningful protection from SHS.

Many cities have every authority to pass comprehensive smoke-free laws to eliminate SHS exposure. If comprehensive smoke-free legislation does not exist at another jurisdictional level, these cities should use their authority to adopt laws or other available legal instruments to prohibit tobacco smoke in these places. Some cities may not have adequate authority to pass strong, comprehensive legislation. However, this does not mean that they should not take action. Most cities will at least have the authority to prohibit tobacco smoke in certain types of workplaces, for example, local public transportation and municipal public buildings. They can adopt legislation prohibiting smoking indoors in whatever categories of establishments they have authority to regulate. In addition, all cities can advocate for action at other governmental levels. Mayors and other city leaders can directly advocate for national comprehensive smoke-free laws.


Although not all of the cities have yet accomplished the goal of becoming a “smoke-free city”, they provide lessons learnt in relation to political commitment for local action towards smoke-free air for their citizens and the role of civil society in urging city governments to take action, helping them to build effective partnerships and to conduct awareness campaigns that benefit enforcement and maximize compliance. We hope that these lessons can be used by municipalities to succeed with local smoke-free legislation or tobacco control programmes. Municipal success may trigger action in other cities and countries, and thus contribute to worldwide protection from exposure to SHS.


A series of actions that include specific prohibitions to restrict the sale and use of tobacco have been put into effect in both Mecca and Medina. In Medina, the actions were phased in three stages with the area being included expanding and moving outwards from the centre at each stage. In Mecca, the actions applied in one step. Actions include: prohibiting all tobacco sales within city limits and in all food stores outside the city limits; prohibition of tobacco sales beyond city limits in the neighbourhood of mosques and schools; prohibiting sales to youth below 18 years old; prohibiting waterpipe smoking in cafes and restaurants within residential areas and near mosques, schools and wedding halls.

A key tactic adopted in both cities was to extend, in a series of phases, the areas to which restrictions on tobacco sales would apply. Moving from the centre outwards, a first step was the banning of tobacco smoking in the areas surrounding the two Holy Mosques in Medina and Mecca, the banning of the sale of tobacco within one kilometre from the Holy Mosques and the transfer of waterpipe cafes beyond the areas surrounding the mosques.

Key smoke-free agendas:  Political leadership, religious doctrine, partnership working, and the WHO role.


More widely, all business groups, charitable religious groups and civil society organisations – including a particularly active anti-smoking charity in Medina – were happy to provide support to the cause. They saw it as a positive contribution to developing their society, and as a means of obeying God’s teachings by helping to prevent a “sinful behaviour” – as set out in the religious Fatwas on smoking. Increasing awareness about the hazards of smoking and the tobacco control policy in the cities amongst the public and city visitors was a key part of the overall approach.

The ban on tobacco sales eventually covered the whole of the city limits for both Medina and Mecca. Nevertheless, the country’s unique position in the Islamic World of being the land where the two holy cities “Mecca and Medina” exist provide an opportunity for spreading smoke-free and wider tobacco control messages far and wide. Not least, through exposing the millions of Muslim who visit each year, from all over the world, to the cities’ smoke-free objectives.

For more details, please visit the WHO smoke-free city  Case Study PDF

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1 Saloojee, Yussuf, Chaouki, Noureddine, Tobacco Free Mecca and Medina, 2007. World Health Organization, Regional Office for the Eastern Mediterranean. UC San Francisco: Center for Tobacco Control Research and Education. Retrieved from:

2 Khayat, M.H. The Right Path to Health , Health Education through religion, Islamic Ruling on Smoking, 2nd ed 2000. WHO Health organization, Regional Office for the Eastern Mediterranean, Alexandria, Egypt.


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