Showing posts with label Fasting. Show all posts

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?

Consultation with an Religiously upright and expert Muslim doctor (having Ilm and Taqwa)
(If unavailable → non-Muslim doctor + personal judgment)
Past experience
Clear signs: vomiting, bleeding, dehydration, fainting
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:

Break fast → Qadha + Kaffarah
Break fast → Qadha only
Do not break → Disliked (are Makruh and decrease the Rewards)
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:

Free a slave; if not possible as in current times, then
Fast 60 consecutive days (no Eid days in between but Haidh days excused for women); if absolutely not possible, then
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.

Friday, February 16, 2024

Diabetes and Fasting - Medical and Fiqh Guidelines

Diabetes and Fasting
-Dr. Mohd. Habeeb Haris MD (Consultant Radiologist and Alim graduate)

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterised by sustained high blood sugar levels.

Fasting in Ramadhan is one of the five pillars of Islam and is an obligation on all adult Muslims in general, unless they have a valid Shara'i excuse. Fasting can be accompanied by significant changes in: both energy and nutritional intake; in the diet composition; in the working hours; and the usual way of life, which can cause significant metabolic and physiological changes to occur, leading to significant impact on the management and complications of diabetes. The drug doses and timings also would need to be altered.

Diabetic patients are at a high risk for development of a wide range of potential fasting-related complications such as dehydration, hypoglycaemia, hyperglycaemia, and diabetic ketoacidosis (DKA). It should not be overlooked, however, that fasting can be quite beneficial for certain diabetic patients provided that they strictly adhere to the evidence-based guideline and pious physicians’ advice. [Effects of Ramadan Fasting on Social, Psychological and Physical Well Being to Health. International Journal of Contemporary Microbiology. 2015;1(2):25–29]

Current world data show that 4 Muslim-majority countries are ranked within the top 10 diabetes worldwide prevalence. These countries are Pakistan (prevalence 30.8%; rank 1), Kuwait (prevalence 24.9%; rank 2), Egypt (prevalence 20.9%; rank 8), and Qatar (prevalence 19.5%; rank 10).
[Wisevoter, “Diabetes rates by country 2023- wisevoter,” 2023, https://wisevoter.com/country-rankings/diabetes-rates-by-country/]

Since a significant number of Muslims globally have diabetes, many of whom would be fasting in Ramadhan every year, the medical professionals need to be aware of their specific medical needs and the need for providing appropriate medical guidance to such patients. The most important of this is to answer the question - can the diabetic patient safely fast or not?

It's important to correctly guide these patients, based on sound medical evidence and Islamic requirements. If the doctor goes overboard and prevents all diabetics from fasting, he will be answerable to Allah for preventing people from carrying out an important religious obligation. And if he allows even high risk patients to fast due to religious zeal, he will be legally and morally responsible for any complications the patient may suffer due to it.

Ultimately, it's for the treating physician to advise and assist the patient in deciding whether he should fast or not. However, to assist the doctors in making a sound decision, the International Islamic Fiqh Academy has given certain guidelines. But these are from 2009, and the newer treatment protocols and devices like continuous glucose monitoring devices and Insulin pumps might enable a wider range of diabetic patients to fast safely.

The main idea behind these guidelines is to categorise the risk of developing serious adverse effects from fasting.

The treating physicians should keep all these factors in mind and decide for themselves how much to rely on this risk categorisation while advising their patients.

Guidelines of International Islamic Fiqh Academy:

"The International Islamic Fiqh Academy (IIFA) of the Organization of the Islamic Conference, holding its 19th session (in Sharjah, United Arab Emirates, in April 2009) has stated the following (Resolution No. 183 (9/19) regarding diabetes and fasting:

Medical Classification of Diabetic Patients

First Category

Patients with a very high probability to encounter severe complications from fasting, as medically confirmed. The sickness state of a patient of this category falls under one or more of the following cases:

• Patients who face severe hypoglycaemia during the three months preceding the month of Ramaḍān.

• Patients who face repetitive ups and downs in the ratio of blood sugar.

• Patients who encounter the problem of hypoglycaemia unawareness (loss of symptoms of hypoglycaemia), a state which occurs in some diabetic patients, especially those who are classifiable under type I who face repetitive hypoglycemias for long periods.

• Patients who are known for facing difficulty in controlling diabetes for long periods.

• Cases of “Diabetic Ketoacidosis” complication or (Diabetic Coma) complication.

• Patients of diabetes type I.

• Patients who suffer from other severe diseases that accompany diabetes.

• Diabetic patients who have to do work that require hard physical effort.

• Diabetic patients who undergo dialysis.

• Diabetes during pregnancy.

Second Category

This category includes patients who have a relatively high probability of encountering complications on fasting according to the most-likely opinion of physicians. The sickness status of these patients falls under one or more of the following cases:

Those who suffer high levels of blood sugar as when the level of glycated hemoglobin (HbA1c) exceeds 10%.

Those who suffer renal insufficiency.

Those who suffer large artery diseases (such as cardiovascular diseases).

Those who live alone and receive medication through injection of insulin or by sugar control medicines, which reduce sugar through stimulation of the insulin producing cells in the pancreas.

Those who suffer other diseases, making them vulnerable to additional risks.

Old patients who suffer other diseases.

Patients who receive medical treatments that affect the brain.

Shariah Rulings regarding Patients in Categories I and II

Cases of these two categories are based on certainty or “high probability” that fasting will cause grave harm to them, as per the judgement of specialised and trustworthy physicians. Therefore, a patient who faces any of the cases cited above for identification of patients in these two categories should not fast. It is not permissible for him to fast in order to avoid inflicting harm upon himself. Allāh the Almighty said, «And make not your own hands contribute to your destruction,» (Al-Baqarah, 195) and He سبحانه وتعالى also said, «Nor kill (or destroy) yourselves for verily Allāh hath been to you Most Merciful.» (Al-Nisāʾ, 29) The treating physicians should explain to patients of these two categories how fasting is risky for them and enlighten them about the high probability that they may face complications which could – most likely – be serious to their health or lives. Physicians should also adopt all possible suitable medical procedures, which could enable the patient to fast without facing harm.

Rulings that relate to non-fasting in Ramadan for sickness excuse shall apply to patients in categories I and II in compliance with the directives of Allāh the Almighty Who said, «But if any of you is ill, or on a journey, the prescribed number (should be made up) from days later and for those who can do it (With hardship), is a ransom, the feeding of one that is indigent.» (Al-Baqarah, 184)

If the doctor (after a thorough medical assessment) warns the patient that there is a high or very high risk of serious complications, then the patient would be sinful for fasting against such advise, but his fasting is valid.

Third Category

These are patients who have the medium probability of encountering complications from fasting. This category includes diabetic patients whose cases are stable and well controlled through suitable medicines that reduce sugar by stimulating the insulin producing cells in the pancreas.

Fourth Category

Patients who have low probability to encounter complications from fasting. This category includes diabetic patients whose cases are stable and well-controlled through diet only or by using medicines that reduce sugar by increasing the efficacy of the insulin in the body without stimulating the insulin-producing cells in the pancreas.

Shariah Rulings Regarding Patients in Categories III and IV

Leaving the Fast during the month of Ramaḍān is not allowed for patients in these two categories since medical findings do not indicate harmful complications that could affect their health or lives. Contrarily, some of these patients could even benefit from fasting. So, they should fast.
Physicians have to stick to these rulings and decide suitable treatment for each case separately.

Recommendations

1. Physicians are required to have a suitable degree of knowledge about Shariah rulings relating to this subject. This necessitates the preparation of such material by relevant bodies and disseminating it among those who need it.

2. Fiqh scholars and Islamic preachers are requested to advise fatwa seekers to consult physicians who know medical and religious dimensions of fasting and who fear Allah the Almighty in providing advice on a case by case basis.

3. Due to the severity and seriousness of dangers that could originate from complications of diabetes in case of fasting, and which could badly affect the health and lives of diabetic patients, guidance and information should be provided through all possible means, including sermons at mosques and through mass media, in order to enlighten patients about the rulings above; raising awareness about the disease and how it can be dealt with is essential to mitigate its effects and make it easy to accept Shariah rulings and medical advice pertaining to it.

4. IOMS, in cooperation with the Academy, should assume the task of preparing an information booklet on this subject in Arabic and other languages (spoken by Muslims) and work for its dissemination among physicians and Fiqh scholars, and make it available online for patients to benefit thereof.

5. Calling upon ministries of health in Muslim countries to launch national programs in areas of prevention, medical treatment, medication and awareness about diabetes and their Shariah rulings." [End of quote from IIFA]

Conclusion:

So, before deciding whether to fast or not, the patient should consult a knowledgeable and God-fearing doctor and also consult a good Islamic scholar, so that a correct decision can be taken from both medical and Islamic perspective.

Summary chart from Shaikh Dr. Rafaqat Rasheed's lecture on Fiqh of fasting.

Trial Fasting when in doubt:

When there is some doubt on the ability (and safety) of the patient to fast, Shaikh Dr. Rafaqat Rasheed (General Practitioner and Islamic scholar from UK) suggests trial fasting for diabetics and patients of other chronic diseases before the month of Ramadhan (preferably in Shaban) so that they can get an idea if they can safely fast or not.

Diabetes education and Ramadhan fasting

"In all patients with diabetes, Ramadhan-focused education is of paramount importance for heightening their awareness of the possible associated risks, and formulation of effective strategies to minimise them. High-risk individuals who choose to fast should have access to ample education and support so that the potential risks, particularly those of hyper- and hypoglycaemia can be minimised. It should be emphasised that in all educational programs, optimal blood glucose monitoring should be considered as the principal consideration for minimisation of the risk of complications.

Prior to Ramadan, clinicians should perform a comprehensive evaluation and assessment for all patients with diabetes who intend to fast during Ramadan, and consider individualised approaches for their patients.

Lifestyle and diet modification can be considered as another key component of Ramadan Fasting education in individuals with diabetes. The fasting-feeding nature of the ritual can predispose diabetic patients to hypoglycaemia during the day and hyperglycaemia after iftar at night. In most Islamic cultures, consumption of high-calorie, high-fat, and carbohydrate-rich meals, confectionaries, and beverages is commonplace in Ramadan, which can adversely affect blood glucose levels and increase the risk of development of hyperglycaemia and related complications. This should be strongly discouraged in all educational programs.

Moreover, due to the high risk of hypoglycaemia and dehydration, patients with diabetes should be prohibited from strenuous exercise, particularly late in the evening and before iftar. Patients should also be informed that consumption of large amounts of high glycemic index (GI) carbohydrates and alternations in physical activity and sleeping patterns can lead to weight gain during Ramadan.

Symptoms of hypoglycaemia and hyperglycaemia should be clearly explained to diabetic patients, and they need to be thought to measure their blood sugar and immediately discontinue fasting if they develop. They also need to be advised that, in case of hypoglycaemia, a small amount of a fast-acting carbohydrate (a glass of fruit juice) should be consumed, and they need to retest their blood glucose levels again after 20 min."

"Drinking large amounts of water and liquids before dawn (at suhur time) should be discouraged, and instead, moderate and continuous consumption of water and beverages during non-fasting hours should be promoted."

"The advantages of the use of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) systems need to be mentioned to them, so that they procure and use them if affordable.

The type, dose, and timing of the anti-diabetic medications each patient takes is immensely influential in the management of potential risks involved in their use, but most antidiabetic agents used for treatment of type 2 diabetes are generally considered safe. It should be mentioned, however, that in patients who take several glucose lowering medications, the risk of hypoglycaemia may be amplified. Particularly, in patients who take a basal insulin in combination with a DPP4I, metformin, or other glucose lowering agents, the risk of hypoglycaemia can greatly increase."

(Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update

Ali Tootee and Bagher Larijan- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088403/#CR3 -This article has good details about the management of type 1 and type 2 diabetes in fasting. I recommend it to all doctors treating diabetics)

Fiqh Ruling (From 'Islamic guidelines on contemporary medical issues' by Mufti Abu Bakar Qasmi):

Concession for Diabetic Patients:

If the doctor opines that fasting is harmful for a patient of diabetes, the patient is allowed to skip or break the fast. If Allah grants him health, he must observe the missed fasts later. If there is no hope of recovery, he should pay fidyah for every fast missed.

Diabetes patient can pay the expiation for fast:

If someone is very old and is having uncontrolled diabetes and is medically not expected to be able to fast in the future too, then he/she is allowed to pay the expiation (fidyah) instead of fasting. (derived from Radd Al-Muhtar: 2/427)

Quantity of Fidyah:

The expiation (fidyah) is to give one Sadaqat al-Fitr or its monetary equivalent to the poor for each missed fast. The expiation amount is half saa’ of wheat, which is equivalent to 1 kilogram 574 grams and 640 milli-grams. (Idhah Al-Masa’il: 90)