An Indian man, a Moroccan woman and a Sudanese man -- all aged 75 -- died from A(H1N1), as had a 17-year-old girl from Nigeria, Saudi health ministry spokesman Khaled al-Marghlani said.

"They all had pre-existing conditions," including the Nigerian woman who had a chest-related problem, Marghlani told AFP.

"Also, none of them took the (H1N1) vaccine," he added.

An estimated 2.5 million Muslims are expected to converge in Saudi Arabia for this year's hajj, making it the world's largest gathering since swine flu began spreading around the globe after it was first reported in April.

The fatalities in Saudi Arabia were the first among pilgrims to the holy cities of Mecca and Medina since the outbreak of swine flu, out of 20 proven cases.

Twelve infected pilgrims have been released after treatment, while four remain in hospital.

Health professionals say the infection figure remains lower than expectations ahead of the hajj, but the disease has spread among the general population of Saudi Arabia much as it has elsewhere.

On November 11, the Saudi authorities reported 70 people had died in the country from swine flu and that more than 7,000 proven cases had been recorded.

Muslims are obliged to undertake the pilgrimage once in their lifetime if they have the means.

People at risk of suffering severe consequences from swine flu -- including children, pregnant women, the elderly and individuals with chronic diseases -- have been urged to postpone going on the hajj in 2009.

But an estimated 1.5 million pilgrims from across the globe have already descended on western Saudi Arabia, and another one million are expected when the rites begin on Tuesday.

Authorities are using thermal cameras to check all arrivals for signs of infection at the air and sea terminals in Jeddah where most pilgrims arrive.

Some 20,000 health workers are deployed in Mecca, Medina and Jeddah, and hospitals have hundreds of extra beds available.

The health ministry has deployed mobile units throughout Mecca and Medina which can instantly send to a central monitoring centre the locations of infections, to monitor outbreaks.

The also have in key locations equipment which can positively identify the virus in a person suspected of infection within a few hours.

Still, despite widespread warnings, less than 20 percent have received H1N1 vaccinations prior to their arrival, according to Saudi health workers.

Fears of contagion are expected to rise when pilgrims mass on Mount Arafat, where the Prophet Mohammed gave his final sermon, on November 26, and then at the Jamarat in Mina over the next days where all partake in a ritual stoning of the devil.

While the hajj ends on November 29, hundreds of thousands of pilgrims will remain in the area for several weeks before heading back to their countries, heightening the risk of H1N1 cross-border transmission.

On Friday, World Health Organisation data showed around 6,750 people had died from swine flu worldwide since the virus was first uncovered in Mexico and the United States in April.

earlier related report
Hajj pilgrims in Saudi unfazed by swine flu
Mecca, Saudi Arabia (AFP) Nov 21, 2009 - Days before a forecast three million Muslim pilgrims pack Mecca to begin the holy ritual of the hajj, the spectre of a possible outbreak of swine flu seems to be fazing few of them.

There might be posters in the streets, plastered on hotel facades and in their lobbies warning about A(H1N1) flu, but not many of the hundreds of thousands of pilgrims already jamming Islam's holiest city are wearing face masks and many say they are not worried.

"People are not paying too much attention to all these posters," said Ashraf Abu Nimr, a 26-year-old Algerian from France as he left the Grand Mosque in the city centre.

"Personally, I'm not worried at all," added Nimr, noting that he had received a swine flu vaccination before leaving home.

Saudi and world health authorities have been mobilising since May for the world's largest gathering since swine flu began spreading across the globe.

But so far, despite a number of cases, no one on the pilgrimage has died from the disease, health ministry spokesman Dr Khaled Marghlani said.

Saudi health officials are relaxed as they await the peak day of the hajj on Thursday November 26, when pilgrims gather at Mount Arafat, where the Prophet Mohammed gave his final sermon.

"The situation is under control and, God willing, it is very reassuring," Marghlani told AFP.

As of Thursday just 20 pilgrims had been diagnosed with the disease, according to the health ministry. Eight were undergoing treatment in hospital and the others had recovered.

Ibrahim Qanan, a Palestinian pilgrim, pointed to the fact that few people are wearing surgical masks in the street, even though the Saudi authorities have been distributing them to pilgrims.

"People are not talking about the H1N1 flu. They reserve their time for their devotions, and talk a lot about football," Qanan said.

Khaled, an Egyptian who lives in the holy city, said that he welcomes the pilgrims into his barber shop "without any fear of contamination."

Nevertheless, the Saudi authorities have mobilised massively to confront the threat as the swine flu pandemic sweeps the world unabated.

As of November 11, 70 people had died in Saudi Arabia from the disease and more than 7,000 proven cases had been recorded.

For the hajj, thermal cameras have been installed at air and sea terminals in Jeddah where most pilgrims arrive, some 15,000 health workers are deployed, and hospitals have hundreds of extra beds to handle any rise in illness.

The ministry also has mobile units which can instantly send to a central monitoring centre the locations of infections, to monitor outbreaks.

In Medina, Mecca and Jeddah, the government has also placed a number of special machines to identify the virus in suspected cases.

Pilgrims themselves seem confident that the threat is low.

"The pilgrims take care of themselves. We don't need all these facilities," said Umm Said, a woman from Mauritania.

"More than a million of us pray at the same time in the heart of the Grand Mosque in Mecca, and there is no sign of the disease," she said.

For her, the pandemic is "a lie from America, to trick people into buying the vaccine and to generate fear."

But Saleh, a Bahraini, admits he is a little nervous when he is swallowed up by the crowd.

"As soon as someone sneezes I turn my head," he said with a hint of fatalism.

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