In the Name of Allah, the Most Beneficent, the Most Merciful
Almighty Allah states in the Glorious Qur’an:
“O you who believe! Fasting is prescribed to you as it was prescribed to those before you, that you may (learn) self-restraint” (Al-Baqarah, 2:183).
“…But if any of you is ill; or on a journey, the prescribed number (should be made up) from days later” (Al-Baqarah, 2:184).
In the Hadith literature, it is narrated by Abu Hurairah (RA) from the Prophet (PBUH): ‘Whoever did not fast for one day in Ramadan without a genuine excuse or a disease, then even if he fasted for a complete year, it would not compensate for that day’. The same is narrated by Ibn Mas`ud (RA) (Sahih Al-Bukhari – Vol 3),
This publication serves as a GUIDE to those, with common medical conditions, who wish to determine whether it is safe or not to fast during the Holy month of RAMADAN. This must be done in consultation with your healthcare professional.
NB: The rulings below are according to the HANAFI School of Islamic Jurisprudence.
a) Controlled Asthma: you may fast if you have well controlled Asthma. Utilise your asthma medication / pumps (inhalers) before Suhur and after Iftar. Utilising this medication during the fast will nullify your fast.
b) Uncontrolled Asthma: it is obligatory for you to use your pump, nebulise yourself and / or seek medical assistance if you have a severe asthma attack. Utilising this medication whilst fasting will break your fast. You can replace any missed fast when you are well.
a) A person may fast if he or she has mild chronic (long standing) anaemia. As a rule of thumb, it should be safe to fast if your haemoglobin level is greater than 8g%. Seek medical attention to determine why you are anaemic.
b) Sudden blood loss/ bleeding can lead to anaemia with severe weakness. A blood transfusion may be necessary in this event. It will not be safe to fast under these circumstances. The missed fast can be replaced once you are well.
A person can continue to fast if one has mild non-debilitating pain. The person is excused from fasting if he or she has severe, permanent, painful debilitating arthritis requiring multiple doses of pain killers during the day. Fidyah will be due if it is not possible to fast at a future date.
a) Local Anaesthesia: the injection of local anaesthesia does not break the fast e.g. when used for suturing of a wound. Be careful if the anaesthetic is injected into the mouth, as it may be swallowed. This will nullify the fast.
b) General Anaesthesia: the administration of general anaesthesia will break the fast. Elective (non-emergency) procedures are not advisable during Ramadan.
The individual can fast if one has Stable Angina. One should seek urgent medical assistance if one develops left sided chest pain/ Unstable Angina. Swallowing medication and putting medication under the tongue breaks the fast. Medication administered via a drip does not break the fast. The fast can be recovered once the individual is well.
If a person is taking antibiotics for a severe infection then one should defer the fast until one is well. Intravenous antibiotics do not break the fast but a person receiving intravenous antibiotics is generally too ill to fast.
The timing of antibiotics for ‘minor’ infections can be tailored to be taken once or twice daily so that the medication can be taken at Suhur or after Iftar.
Seek advice from your healthcare provider about fasting in the presence of infection.
BLOOD PRESSURE (Hypertension)
Most patients with blood pressure problems can fast. Blood pressure medication is best taken after Iftar. Twice daily medication should be taken at Suhur and after Iftar. A low salt diet is advised. Speak to your Doctor about combination pills (one tablet with two or more drugs in it).
You may need to break your fast if your blood pressure becomes dangerously elevated or drops too low. These fasts can be recovered when the blood pressure stabilises. A person having a stroke should seek urgent medical attention.
Blood tests do not break your fast. Question yourself as to why you are doing blood tests? Do not fast if the tests are being performed as a part of a serious/ severe illness. The missed fast can be replaced when you are well.
A blood transfusion does not nullify the fast. In principle, a person receiving a blood transfusion is generally too ill to fast. The fast can be replaced when the individual is well.
Donating blood does not break your fast. Although this is a noble deed, it is not advisable during fasting as you are already in a weakened state.
Bleeding due to illness or injury does NOT invalidate the fast e.g. a spontaneous nose bleed (provided the blood is not swallowed). Excessive bleeding can lead to a state of shock and organ failure. Seek urgent medical assistance if this occurs.
Cupping does not break the fast. However, those who are anaemic, should avoid cupping whilst fasting.
Also refer to “Menstruation & Post-Partum Haemorrhage”.
A woman who is breastfeeding can fast provided the fasting does not hinder her milk production or the feeding of her baby. Breastfeeding is recommended.
Fasting helps to reduce elevated cholesterol levels. Remember to take your cholesterol medication after Iftar. Do not indulge in too many deep fried fatty foods.
Covid-19 has taken the world by storm during 2020. If you are in isolation because of CONTACT with a Covid-19 patient, then you can keep your fast provided you remain asymptomatic. You may fast if you have contracted Covid-19 and you remain ASYMPTOMATIC.
If you contracted Covid-19 and you are symptomatic, such as sore throat and breathing difficulties, then do not fast and seek urgent medical attention.
A dry Covid-19 swab test into the nose and throat does not nullify the fast.
Patients with ‘early’, less sinister Cancers and those that are in remission can fast. Those, with an advanced Cancer, who are too weak, should not fast. Fidyah can be given if it is no longer possible for you to fast.
Intravenous Chemotherapy & Radiotherapy does not break your fast. Consult your healthcare provider whether you should be fasting or not.
Non-emergency dental work (e.g. extractions, fillings) is not advisable during fasting. There is an increased risk of blood or fluid being swallowed during these procedures which will nullify the fast.
A dental abscess or severe pain or may prompt an individual to seek urgent dental assistance. Localanaesthetic injection does not break the fast. One needs to keep the fast at a later stage if any fluid is swallowed.
DELIVERY OF BABIES
Please refer to “Pregnancy”
Diabetes is generally NOT a contra-indication to fasting. Fasting can provide better diabetes control. Diabetes medication taken once a day is best taken after Iftar. Doses of twice daily diabetic medication should be reversed i.e. take your morning dose after Iftar and your evening dose at Suhur time. Speak to your healthcare provider about this and the use of long acting insulins rather than short acting ones. Do not indulge in excessive sugary or deep fried foods.
A person with hypoglycaemia (very low blood sugar levels) or diabetic ketoacidosis (elevated blood sugar levels due to infection) is generally too ill to fast. The fast can be kept at a later stage i.e. when the patient’s health improves.
One can fast if the diarrhoea is mild. Medication can be taken at Suhur or Iftar if required. Severe diarrhoea can lead to dehydration, weakness and kidney failure. One should not fast in this instance. This will necessitate drinking plenty of water / rehydration solution and taking medication with each loose motion. Intravenous fluids maybe be required for patients who are severely dehydrated.
It is important to maintain a well-balanced diet and not to indulge in unhealthy meals. Increase your fluid intake between Iftar and Suhur. Consult your healthcare professional / dietician before the onset of the fasting period.
Ear drops are permitted at any time provided the ear drum is NOT perforated. Use the ear drops before Suhur and after Iftar if you have a perforated ear drum (as the drops can enter the throat via the Eustachian tube and nullify your fast).
Eye drops/ ointments, as a precaution, should be applied before Suhur and after Iftar, as they can enter the nose or throat via the tear duct system (nasolacrimal apparatus).
As a rule of thumb all endoscopy procedures (nasopharyngoscopy/ upper GI scopes/ colonoscopy) are best avoided whilst fasting as they break the fast. Emergency endoscopy procedures will also break the fast. The missed fast can be replaced once you are well.
A patient with well controlled epilepsy can fast. Medication should be taken at Suhur and / or after Iftar (speak to your Doctor about this).
It is advisable to break the fast after an epileptic attack. A patient with status epilepticus (continuous fits) is too ill to fast. The fasts can be recovered once the individual is well.
A patient with mild infection/ fever can fast. It is not advisable to fast if your temperature exceeds 38.5ºC (seek medical attention if this occurs). The fast can be kept at a later stage if you miss the fast.
One can fast if your gout is controlled. The fast is broken if one has to take tablets for severe gout/ pain (consider a pain injection as an alternative as it does not nullify the fast). The fast, if broken, can be kept when one is well. Speak to your healthcare provider about your diet in order to minimise attacks.
Menorrhagia (prolonged bleedingfrom the vagina) maybe due to an underlying medical condition such as fibroids. Try to resolve these issues by seeking medical attention before Ramadan.
One should proceed with fasting if the bleeding is not related to the menstrual cycle, if the menstrual cycle lasts longer than 10 days and/ or the patient’s health will not deteriorate during fasting.
Vaginal (internal) examinations are NOT permitted whilst fasting. Try and perform Pap smears and non-emergency gynaecological procedures outside of Ramadan.
This may prove troublesome during fasting. It is important to modify initiating factors (e.g. lack of caffeine) well before the onset of Ramadaan to negate this. Severe headaches may require the need to see your doctor to exclude a treatable cause.
HEART ATTACK (MI)
A patient having a suspected heart attack should seek emergency medical attention and should not fast. A person who has had a heart attack and is stable can fast with the permission of a Doctor/ Cardiologist.
Speak to your healthcare provider about fasting if you have an existing heart condition.
HIV patients in ‘good health’, with a normal CD4 count & a low viral load can fast. HIV medication should be taken at Suhur and / or after Iftar.
One should not fast if one develops a complication of HIV such as pneumonia or cryptococcal meningitis. Consult with your healthcare professional if you are concerned about fasting.
Injections do not break the fast.
IV (INTRAVENOUS FLUID) MEDICATION
IV fluids do not nullify the fast. It must be noted that one cannot take intravenous fluids for a ‘boost’ e.g. to rehydrate oneself or to receive glucose whilst fasting.
A person receiving intravenous fluids is generally too ill to fast and should keep the missed fasts when he or she is well.
JAUNDICE (Yellow Eyes)
Contact your healthcare professional about fasting if you have obstructive or non-obstructive jaundice.
A person may fast if they have a mild kidney or bladder infection. One may defer the fast for severe kidney/ bladder infections or painful kidney stones (hospitalisation maybe required in this instance).
Dialysis patients should consult their healthcare provider about fasting. Fidyah will be due if it is not possible to fast.
Please refer to “SLE”
Please refer to “Psychiatric Conditions”
A lady is not allowed to fast during her menses. A lady may resume fasting if the bleeding exceeds 10 days (i.e. from the 11th day) provided the bleeding is not making her weak. She should perform Ghusl before fasting.
Also refer to “Post-Partum Haemorrhage”
Mouth ulcers can be very painful and this may prevent adequate food and liquid intake. You may fast if you have mild oral (mouth) ulceration. Seek medical help if you have severe mouth ulceration as this can lead to dehydration and weight loss. The missed fasts can be replaced later in severe cases.
Nose drops and nasal sprays are not permitted while fasting and should be used before Suhur and after Iftar.
It is not advisable to interfere with the normal menstrual cycle but there is no prohibition in the use of oral contraception to control / delay menses during fasting.
Please refer to “Gynaecology”
The use of pain tablets or suppositories are not permissible whilst fasting. These can be administered at Suhur or after Iftar. The use of pain injections does not break the fast. Seek medical attention if your pain is severe and also seek advice about fasting.
A lady can fast during pregnancy provided the pregnancy does not adversely affect either her or her baby. A lady who has a complication during pregnancy e.g. pregnancy induced hypertension (high blood pressure during pregnancy) should discuss with her Doctor about fasting. She can replace these fasts at a later stage.
POST-PARTUM HAEMORRAGE (bleeding after childbirth)
A lady can begin fasting once the bleeding ceases after the delivery of her baby. Ghusl should be performed before fasting. A lady can resume fasting if the bleeding exceeds 40 days. Consult your Doctor if you have prolonged bleeding.
Fasting is a conscious act of worship hence it is not advisable for a person who is not in their ‘correct senses’ to fast. If a person was considered to be insane for the entire month of Ramadan then the person is excused from fasting and no qaza or fidyah is due.
One can fast if the psychiatric condition is well controlled. Remember to take your medication at Suhur and / or after Iftar.
Please do not hesitate to contact your Doctor if you have any query.
RADIOLOGY (X-rays/ CT/ MRI / Barium procedures)
Taking an X-Ray by itself does not break the fast. The contrast (injection) given during CT scanning and MRI does not break the fast either. Ultrasound and Mammograms are also permissible during fasting.
Barium is a liquid which is swallowed or inserted via the back passage. Therefore a Barium swallow or Barium enema will nullify the fast.
A medical examination via the rectum / back-passage will nullify the fast. The missed fast should be replaced at a later stage i.e. when the patient is wel
Please refer to “Kidney”
Smoking is harmful to the human body. It is not permissible during fasting. In general, Ramadan is the ideal training ground to quit smoking.
The use of suppositories (medication inserted via the back passage or vagina) are not allowed during fasting. Suppositories should therefore be inserted before Suhur or after Iftar.
SLE (Systemic Lupus Erythematosus)
A patient with mild, well controlled Lupus can fast. If the Lupus is advanced with complications then it may not be possible for you to fast. Consult you healthcare provider if you are unsure about fasting.
The use of skin ointments and creams are permitted during fasting. Ointments / creams / gargles used in the mouth should be used before Suhur and after Iftar.
Please refer to “Dental Treatment”
TABLETS AND ORAL MEDICATION
Tablets should only be taken before Suhur ends and after Iftar. Tablets/ Syrups / Cough mixtures break the fast if taken whilst fasting.
A person can fast if the trauma is mild/ not life threatening. Seek medical care/ advice if you have moderate to severe trauma e.g. motor vehicle accident. You can replace your fast at a later stage when you are well.
ULCERS OF THE STOMACH (Peptic Ulcers)
Seek medical help before Ramadan, if you are prone to ‘ulcers’. In principle, you should fast as a past history of ‘ulcers’ is not a contra-indication to fasting. Remember that an upper GI scope (camera examination into the food pipe/ stomach) will nullify the fast.
Do not fast if you have any complications from ulcers (perforation/ vomiting blood / blood in your stool/ severe abdominal pain/ loss of weight). Seek urgent medical attention in these cases.
Speak to your healthcare professional about fasting if you had an ulcer related operation in the past.
ULCERATIVE COLITIS AND CROHN’S DISEASE
Patients in remission should fast. Patients having an acute attack or chronic relapsing disease are advised not to fast. The missed fasts are to be made up later.
Swallowing a mouthful of vomitus, whether self-induced or otherwise, will break the fast. One should be cautious about repeated vomiting as this can lead to dehydration and acute kidney failure. Do not fast if you have severe or prolonged vomiting (seek medical attention). These missed fasts can be kept once you are well.
A vaginal examination whilst fasting will nullify the fast. This examination should only be performed in an emergency setting during Ramadan. The missed fast will have to be replaced at a later stage.
Drink sufficient water between Suhur and Iftar so that you remain well hydrated.
Please refer to “Radiology”
Please refer to “Jaundice”
Have plenty of Zam Zam, if possible. In it is Shifa’ (healing).
“ALLAH intends every facility for you. He does not want to put you into difficulties. (He wants you) to complete the prescribed period, and to Glorify HIM in that HE has guided you; and perchance you shall be grateful.” (Al-Baqarah, 2:185)
Reference: Fasting and the Patient: Some Guidelines. Durban. Islamic Medical Association of
South Africa. Second edition. 1995
With compliments from the `Ulama’ & Members of the IMA Ladysmith Branch, South Africa.
LIST OF CONTRIBUTORS
- Moulana Shamim Ahmed Qadri of Ladysmith
- Dr M.A. Sardiwalla – ENT Specialist
- Dr F.A. Khan – General Practitioner
- Dr M. Bayat – General Practitioner
- Dr Arthi Bahadoor – Medical Officer
- Dr M.I. Mulla – Specialist Surgeon
- Prof. Abu Fadl Mohsin Ebrahim
For any correspondence please contact:
Dr M.A. Sardiwalla at email@example.com