Introduction and background

In the height of summer, temperatures across the Gulf can soar beyond 50°C, a level of heat that the human body was never designed to endure. In recent decades, the Gulf region has become one of the fastest-warming areas on the planet, with heatwaves growing more frequent, more intense, and more deadly. Climate projections warn that parts of the Arabian Peninsula may face "unprecedented heat extremes" capable of surpassing human physiological tolerance by the end of the century. Under these conditions, a simple day outdoors can become life-threatening within minutes [1].

Heat-related emergencies have therefore shifted from being rare, seasonal events to a persistent public health concern in countries such as Saudi Arabia, the United Arab Emirates (UAE), Bahrain, Kuwait, Qatar, and Oman. These nations record some of the highest global wet-bulb temperatures, which are the lowest temperatures to which air can be cooled by the evaporation of water. This is a combined measure of heat and humidity that reflects true heat stress on the body. When wet-bulb temperatures exceed 35 degrees, even a healthy adult sitting in the shade can't maintain a safe core body temperature. Alarmingly, such conditions have already been documented in parts of the Gulf [2,3].

The consequences are evident in the region's emergency departments (EDs), where cases of heat exhaustion, heatstroke, dehydration, rhabdomyolysis, and acute renal injury rise sharply during the summer months. Exertional heatstroke, typically associated with intense physical activity under extreme heat, is especially common among the Gulf's large population of migrant laborers, who often work long hours outdoors with limited access to shade, cooling, or hydration. Studies from the UAE and Qatar show that outdoor workers represent a disproportionate share of heat-related hospitalizations and that delayed cooling and lack of early recognition significantly worsen clinical outcomes [4-6]. Yet the burden extends beyond laborers. Elderly individuals, those with chronic illnesses, pilgrims undertaking physically demanding rituals during the Hajj season, and athletes exposed to intense training are all at heightened risk. Research from Saudi Arabia has documented significant spikes in heat-related morbidity during Hajj, particularly when rituals coincide with hotter months. Despite this, gaps in public awareness, inconsistent implementation of preventive policies, and limited access to immediate cooling resources contribute to missed diagnoses and preventable complications [7,8].

Heatstroke, the most severe form of heat illness, is a medical emergency defined by a core temperature typically above 40°C and central nervous system dysfunction. Without rapid cooling, ideally within the first 30 minutes, mortality rates can exceed 80%. The urgency of timely management underscores the need to understand how heat emergencies present in the Gulf, what factors hinder prompt diagnosis, and which strategies effectively reduce morbidity and mortality in this unique climatic environment [9,10].

Given the increasing severity of climate conditions in the Gulf and the substantial human and economic burden associated with heat-related emergencies, a comprehensive synthesis of current evidence is essential. This literature review, therefore, examines the epidemiology, clinical features, diagnostic challenges, management practices, and preventive strategies surrounding heat-related emergencies in the Gulf region while identifying gaps that require further research.