Tuesday, February 17, 2026

Medical Fiqh of Fasting: A Practical Guide

- Dr. Mohammed Habeeb Haris
(Alim Graduate and
Radiology Consultant) 


Why Medical Fiqh of Fasting Matters

Ramadan is not only a month of spiritual elevation — it is also a month of clinical complexity.

Fasting in Ramadan is both an act of worship and a physiological state. For Muslim doctors and medical students, this dual dimension creates a unique responsibility. We are not only fasting individuals; we are also clinical advisors for fasting patients.

Allah says in Surah Al-Baqarah (2:183):

“O you who believe, fasting has been prescribed for you as it was prescribed for those before you, so that you may attain taqwa.”

And in (2:185):

“Allah intends ease for you and does not intend hardship for you.”

Understanding the medical fiqh of fasting allows us to:

  • Counsel patients accurately

  • Prevent unnecessary hardship

  • Avoid both undue strictness and careless leniency

  • Integrate Shariah principles with sound medical knowledge

This post provides a comprehensive yet structured overview — without omitting any of the essential rulings — tailored specifically for Muslim healthcare professionals.

What Is Fasting (Sawm)?

Linguistically

Sawm means to abstain, withhold, or refrain.

Legally (Shar’i Definition)

Fasting is:

Abstaining from eating, drinking, and sexual gratification from true dawn (Fajr) until sunset (Maghrib), with intention, by one who is legally required and capable of fasting.

Essential Components of a Valid Fast

A fast is valid when the following are fulfilled:

1. Abstinence from Entry into the Digestive Tract 

This includes:

  • Solids

  • Liquids

  • Visible gases (with intention - like smoke, fumes, steam, mist)

Entry can occur through:

  • Mouth

  • Nose

  • Anus

  • Direct insertion into GI lumen

From mouth or nose, once something reaches the inner throat beyond a point where one cannot stop its further passage down the GIT, the fast is invalidated.

2. Abstinence from Sexual Gratification

Includes:

  • Vaginal intercourse

  • Anal intercourse (Haraam even while not fasting)

  • Ejaculation through physical stimulation (Haraam even while not fasting)

3. Time Frame

  • From true Fajr

  • Until Maghrib

One must stop eating before Fajr enters — regardless of when the Adhan is called.

4. Intention (Niyyah)

  • A firm resolution in the heart

  • Verbal articulation is not required

5. Eligibility

The Ramadan fast is obligatory on the person who is:

  • Muslim

  • Sane

  • Post-pubescent (baligh/Adult)

  • Free from menstruation (haiz)

  • Free from post-natal bleeding (nifas)

Important Clarifications 

  • Being in a state of janabah at Fajr does NOT invalidate the fast.

  • If intercourse / ejaculation occurred before Fajr and ghusl is done after Fajr — the fast is valid.

  • A wet dream during fasting does not break the fast.

  • Forgetful eating/drinking/intercourse does not break the fast.

The Prophet ﷺ said:

“Whoever forgets that he is fasting and eats or drinks, let him complete his fast, for Allah has fed him and given him drink.”
(Bukhari, Muslim)

Who Is Exempt from Fasting?

Allah intends ease, not hardship (2:185).

The Prophet ﷺ warned:

“Whoever omits even one fast of Ramadan without excuse or illness cannot compensate (the reward and blessings) for it even if he fasted for the rest of his life.”
(Nasai, Abu Dawud, Tirmidhi)

So exemptions are serious — but real.

1. Those for Whom Fasting Is Unlawful

  • Women in menstruation

  • Women in post-natal bleeding

They must make up the fast later.

2. Those Required to Fast But May Be Excused

Those who must make up the fast later

- Sick individuals

- Pregnant women

- Lactating women

- Travellers (48 miles or more)

Those who must give Fidya (Substitute Charity).
    - The terminally ill (who are not expected to recover)

    - The extremely elderly and Frail (Shaikh Faani)


    3. Those Not Required But May Fast

    • Pre-pubescent children - Older/healthy Children (9-10 years and above) should be encouraged to fast in Ramadan (at least a few days) to form habit of fasting.

    Sickness: A Clinical Framework

    Sickness is NOT an automatic waiver.

    A person may break the fast if there is reasonable fear that:

    • The illness will significantly worsen (allowed to break the Fast)

    • Recovery will be significantly delayed (allowed to break the Fast)

    • Harm to life or organ will occur (breaking the Fast will become Obligatory/Wajib in this)

    How Is “Reasonable Fear” Determined?

    1. Consultation with an Religiously upright and expert Muslim doctor (having Ilm and Taqwa)
      (If unavailable → non-Muslim doctor + personal judgment)

    2. Past experience

    3. Clear signs: vomiting, bleeding, dehydration, fainting

    4. Common knowledge

    As physicians, our assessment matters.

    Pregnancy & Lactation

    Pregnancy is not an automatic exemption.

    If fasting poses:

    • Risk to mother

    • Risk to baby

    She may skip the fast and make it up later. Assess the risk as mentioned above for sickness.

    Chronic Disease Preparation

    Patients with chronic illness should:

    • Have a pre-Ramadan Doctor consultation and Medical Tests

    • Trial fast in Sha’ban (Try to keep Nafl Fasts a few days before Ramadan as a trial) 

    • Adjust diet, activity and schedule medication timing to suhoor/iftar

    • Risk stratification (low, moderate, high risk)

      Proactive planning prevents / reduces Ramadan emergencies.

    Travel

    Conditions:

    • Must leave city boundary before Fajr

    • If still inside at Fajr → must fast

    Example:
    Fajr 5:30 am, departure 7:00 am → must fast.

    If weakness / difficulty occurs during travel → may break fast (qadha required).

    Although excused, fasting is better if able. Also avoid unnecessary travel to not lose focus in Ramadan worship.

    Key Terminologies

    • Qadha: Making up missed fast

    • Kaffarah: Expiatory penalty

    • Fidya: Substitute payment

    What Breaks the Fast?

    All actions fall into four categories:

    1. Break fast → Qadha + Kaffarah

    2. Break fast → Qadha only

    3. Do not break → Disliked (are Makruh and decrease the Rewards)

    4. Do not break → Permissible

    When Are Both Kaffarah + Qadha Required?

    Only when ALL are present:

    • It is a Ramadan fast

    • Broken intentionally

    • Fast Broken in a clear direct manner (Suratan)

    • Without valid excuse

    Explanation:

    - Direct eating or drinking (Suratan) means:

    1. Entry into the digestive tract through the mouth 

    and

    2. The thing ingested is that which humans normally consume for either of the following:

    • Nutrition
    • Medicine
    • Enjoyment

    - Actual intercourse
    (Vaginal or Anal sex)

    Kaffarah (Expiation)

    In sequence:

    1. Free a slave; if not possible as in current times, then

    2. Fast 60 consecutive days (no Eid days in between but Haidh days excused for women); if absolutely not possible, then

    3. Feed 60 poor persons two meals

    Feeding options:

    • ½ sa’ (1.6 kg) wheat

    • 1 sa’ (3.2 kg) dates/barley

    • Monetary equivalent

    One can

    a. feed the same sixty poor people to their fill for two meals, or

    b. feed one poor person to his fill for two meals per day for sixty days, or

    c. give sixty poor people half a sa’a of wheat or flour or its monetary value, or

    d. give sixty poor people 1 sa’a of dates or barley or its monetary value, or

    e. give one poor person either c or d for sixty days. (cannot give 1 poor person the total amount of 60 days in 1 day)

    One kaffarah covers all past violations.

    What Breaks the Fast (Qadha Only)?

    • Entry of food or drink or medicine into the digestive tract through an opening other than the mouth (nose, anus, direct percutaneous tubes)

    • The thing ingested is that which humans do not normally consume (soil, pebbles)

    • Breaking fast due to illness or fear of illness

    • Accidental swallowing of liquid or solid (while gargling, etc.)

    • Mistimed suhoor or iftar (due to misunderstanding/doubt)

    • Forced breaking

    • Swallowing chickpea-sized debris left between the teeth from a previous meal

    • Swallowing a pebble, or a handful of salt or other items that people wouldn’t typically eat, or would dislike to eat.

    • Accidental swallowing during wudu

    • Swallowing toothpaste/mouthwash

    • Inhaled smoke/fumes/visible gases intentionally

    • Ejaculation via physical stimulus/masturbation (haraam act)

    • Breaking non-Ramadan fast

    • Suppository in anus

    • Nose drops / nasal spray (due to high chance of going down the throat, hence to be avoided)

    • Rectal Enema

    • Injecting medicine directly into GI lumen

    • Deliberately vomiting a mouthful or more, whether one swallows it or not.

    • Swallowing unintentional vomit

    Vomiting Rules Simplified

    • Unintentional vomiting (not swallowed) → valid

    • Intentional vomiting (mouthful or more) → qadha

    • Swallowed back in both → qadha

    Asthma Inhalers/Nebulisers

    Invalidate fast (medicine goes through throat).
    Require qadha only.
    No kaffarah if medically necessary.

    Endoscopy, Bronchoscopy, Colonoscopy

    Invalidate fast (due to gel/anesthetic/medicine during insertion).
    Require qadha only.

    Rectal Exam/Transrectal USG

    As gel is used on the gloves or probe while inserting in anal canal, it will break the fast. If only dry, powderless glove is used for PR, it won't break the fast.

    Gum Bleeding

    • If blood > saliva and swallowed → breaks the Fast

    • If taste detected and swallowed → breaks the Fast

    • Otherwise doesn't break the Fast

    Actions That Do NOT Break the Fast But Are Disliked (Makrooh) 

    Generally, doing things that make fasting very difficult by causing weakness or acts that increase the risk of breaking the Fast are Makruh and decrease the rewards of Fasting.

    • Tasting or chewing something without an excuse, provided that it is not swallowed 

    • Kissing with desire which might lead to sexual intercourse or ejaculation

    • Excessive gargling or nasal rinsing in wudu or ghusl (risks water going down the throat)

    • Using Toothpaste or mouthwash, (risk of swallowing)

    • Blood donation if weakening

    • Collecting saliva in the mouth and then swallowing it

    • Backbiting

    • Ejaculation due to thoughts or just watching (no physical stimulus) — does not break but reduces reward

    What Does NOT Break the Fast?

    This section is critical for medical professionals.

    The following do NOT invalidate fasting, however, some are with conditions mentioned in brackets:

    • Forgetful eating, drinking or intercourse

    • Wet dream

    • Waking in janabah

    • Small food particle stuck between teeth in suhoor and swallowed in Fasting (size < chickpea)

    • Oil/lotions on skin/hair

    • Kohl/eye drops

    • Dust/smoke or even a fly entering the throat unintentionally

    • Miswak (unless significant solid particles are swallowed)

    • Bathing

    • Non-passionate touching or kissing in which there is no fear of falling into sexual intercourse or ejaculation.

    • Blood tests

    • Blood donation (if not weakening)

    • All injections (IM, IV, SC, intrathecal, nutrient drips — unless directly into GI lumen. IV nutrient fluids without need will make it Makrooh and should be avoided)

    • Lumbar puncture/Spinal anesthesia

    • Sublingual (unless dissolved particles are swallowed- should avoid if not an emergency)

    • Dental work (if nothing swallowed - but Risky and should be avoided)

    • Ear drops (with intact tympanic membrane does not break the fast. Ear sprays/drops will invalidate if clearly felt at the back of the lower throat when there is a large ruptured ear drum. If it is not felt in the back of the lower throat will not invalidate, but will be disliked/Makrooh and best avoided if there is such a rupture)

    • Lip balm (if not swallowed - but Risky and should be avoided)

    • Urinary catheter

    • Hemodialysis or peritoneal dialysis

    • Vaginal ultrasound/instrumentation

    • Medicinal skin patches

    • Acupuncture

    • Dry nasal/throat swab

    • Cupping (though may weaken). The Prophet ﷺ was cupped while fasting (Bukhari)

    Modern anatomy confirms no digestive connection for eyes, ears, urethra, vagina.

    Imsaak (Withholding)

    If during Ramadan:

    • A traveler arrives home

    • A woman becomes pure during the day

    • A child becomes adult

    • A person accepts Islam

    They must abstain from eating/drinking/sex for the rest of the day. The first two need to do Qadha later.

    Fidya: When Fasting Is Permanently Impossible

    Applies only if:

    • Cannot fast

    • Cannot make up later

    • Not expected to recover

    Examples:

    • Extremely elderly

    • Terminally ill

    Amount per day:
    ½ sa’ (1.6 kg wheat) or monetary equivalent.

    If recovery occurs → fidya already given will be considered as voluntary charity, and qadha is required.

    Fidya After Death

    If one had the opportunity to make up but did not:

    • A will should instruct payment from 1/3 estate.

    If no will:

    • Heirs not obligated

    • May pay voluntarily

    If death occurred before opportunity to do Qadha:

    • No sin

    • No fidya


    Final Reflection

    Medical fiqh of fasting is not theoretical knowledge — it is practical, clinical, and spiritual guidance.

    As Muslim healthcare professionals, we must:

    • Prevent harm

    • Preserve worship

    • Avoid unnecessary hardship

    • Avoid careless concessions

    • Guide patients responsibly

    May Allah grant us understanding, sincerity, and excellence in both our fasting and our service to humanity.

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