OBJECTIVES: To study the health economics issues related to congestion during Hajj season in Makkah whic investigate type of health problems facing by the Malaysian pilgrims in Makkah and to identify healthcare services required by them METHODS: A cross sectional research was designed and set of questionnaire and FGD were applied as a measuring tool respectively for quantitative and qualitative analysis. A total of 379 Malaysian pilgrims were randomly selected in Makkah. RESULTS: Respiratory diseases are the major health problem facing by the Malaysian pilgrims within the congestion in Makkah, especially during the stoning session in Mina. Intensive healthcare services such as health personnel and quality medication are required in order to reduce health problem related to crowd among Malaysian pilgrims in Makkah. CONCLUSIONS: Hajj is the fifth of the five pillars of Islam. Every physically and financially affordable Muslim must undertake the Hajj once in their lifetime. The sudden surge of the large population of human congestion in close proximity in Makkah would create numerous hazardous factors involving health impact and promotes increased of communicable diseases such as respiratory tract infections in the holy land. Therefore, high demand for healthcare services that is efficient and effective is crucially required by the pilgrims during the hajj. This research provides fundamental input to the health care provider and also benefited hajj management authority to increase their management quality in the future years. Therefore, the health economics context is very important to ensure that scarce resources and funds are used in the most appropriate and efficient manner