Health and Emergency Preparedness for Mass Gatherings at the 2034 FIFA World Cup in Saudi Arabia: A Systematic Review and Targeted Evidence Update

The Fédération Internationale de Football Association (FIFA) World Cups are complex mass gatherings that place simultaneous demands on public-health surveillance, environmental risk management, emergency medical services, crowd safety, and health-system resilience.Saudi Arabia's selection to host the 2034 tournament creates an opportunity to adapt capabilities developed through decades of Hajj operations to the very different context of a global football event.This review synthesises evidence from major mass gatherings and incorporates post-Qatar 2022 and World Cup 2026 evidence to define practical priorities for 2034.The original review searched PubMed, the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Web of Science, and the Cochrane Library for 2000-2025 and retained 43 records according to the documented screening log.A targeted update undertaken in September 2026 searched PubMed/MEDLINE and primary sources from major international, national, and sporting authorities.Because this update was not a complete rerun of the original four-database strategy, newer evidence was synthesised narratively and was not added to the original screening denominator.Post-Qatar studies support dedicated tournament medical services, improved clinician notification, open-source epidemic intelligence, and wastewater surveillance.World Cup 2026 evidence adds cross-jurisdictional dashboards, port-health surveillance, early-warning systems, pathogen-specific risk assessment, and multi-hazard environmental planning.Contemporary Saudi Hajj operations demonstrate large-scale heat prevention, surge care, referral, and emergency logistics.For Saudi Arabia 2034, the evidence favours an all-hazards model built around heat action plans, interoperable multi-layer surveillance, unified incident command, distributed emergency care, crowd-safety intelligence, mental-health pathways, multilingual communication, and predefined post-event evaluation.The central implementation principle is to strengthen routine national systems rather than construct temporary parallel systems for the tournament.