Abstract
BACKGROUND: The Mahakumbh Mela 2025 in Prayagraj, India, was one of the world's largest religious mass gatherings, hosting more than 660 million pilgrims. Delivering effective emergency and inpatient care in this dynamic, resource-limited setting posed unique challenges, including risk of infectious disease outbreaks, environmental stressors, and infrastructural constraints. This study documents the institutional experience of managing healthcare services during the event. METHODOLOGY: This retrospective, mixed-methods study was conducted at the Sub-Center Hospital Sector 20 organised by AIIMS, Raebareli (UP). All patients attending between 8 January and 24 February 2025 were included. Quantitative data from 57,950 OPD and 1,190 IPD records including electronic medical records, laboratory reports, and field journals were analysed using SPSS v24. Qualitative insights were obtained from reflective journals and operational notes maintained by healthcare personnel. These were thematically summarised through an inductive, pragmatic approach to identify contextual challenges, workflow dynamics, and adaptive strategies. Ethical approval (IEC No. 2024-5-OTH-EXP-9) and administrative permissions were obtained. DISCUSSION: Fever (30.6%), respiratory (23.8%), and gastrointestinal (22.0%) illnesses predominated in OPD cases. IPD admissions most frequently involved SOB (37.6%), chest pain (4.4%), and seizures (1.6%), with 3.2% acute myocardial infarctions identified. Key challenges included crowd density, dust exposure, and limited access to care. Skill-building trained over 1,000 personnel in emergency protocols and BLS, contributing to effective healthcare delivery. CONCLUSION: This institutional experience underscores the critical need for robust preparedness, skilled manpower, advanced diagnostics, and technology enabled coordination in managing healthcare during mass gatherings. The success at Mahakumbh 2025 demonstrates that large-scale health crises can be effectively mitigated with multidisciplinary coordination and strategic preparedness.