The Illness that Permits the Breaking of the Fast 

All praise is due to Allah, Lord of the Worlds, and peace and blessings be upon the Trustworthy Guide, our Master Muhammad, and upon his family and all his companions. To proceed:

Allah the Almighty has prescribed fasting despite the hardship it entails, making it obligatory upon His servants as a mercy to them, a means for the forgiveness of their sins, a purification for their souls, and a cleansing of their hearts from their ailments. Allah says {what means}: "Allah intends for you ease and does not intend for you hardship" (Al-Baqarah/185). In addition, the Messenger of Allah, peace and blessings be upon him, said: "When any one of you is observing Saum (fasting) on a day, he should neither indulge in obscene language nor should he raise the voice; and if anyone reviles him or tries to quarrel with him he should say: 'I am observing fast.'" (Reported by Bukhari & Muslim).

However, a person may be afflicted by certain conditions that render fasting difficult or impossible, such as travel or illness. This may cause him severe harm and unbearable hardship, which the established principles and overarching objectives of Islamic law (Maqasid al-Shariah) do not accept, as they call for warding off harm, facilitating matters for Muslims, and removing unbearable hardship wherever it is found.

Hence, Allah the Almighty has granted a concession for the ill person to break the fast during the days of Ramadan. Allah says {what means}: "So whoever among you is ill or on a journey [during them] - then an equal number of days [are to be made up]" (Al-Baqarah/184).

Illness is defined as: what causes a change in the natural state towards corruption. However, illnesses vary greatly according to their type, severity, and effects on the human body. Therefore, illness, in terms of its permissibility for breaking the fast, can be divided into three categories:

Firstly: The illness that does not permit its bearer to break the fast:

This is a minor illness with which fasting is not difficult, such as some simple ailments that are unrelated to fasting.

Examples include: headache, fever, toothache, or a pain in a finger or foot. This also includes illnesses where the person can delay taking medication until after breaking the fast or at the pre-dawn meal (Suhoor). It also includes diabetic patients whose condition is stable and controlled solely by diet or by blood sugar-lowering medications. This is the position of the majority of scholars.

Imam Al-Nawawi said: "As for the minor illness that does not entail apparent hardship, it is not permissible to break the fast, without disagreement among our scholars." [Al-Majmu' Vol.6/P.363].

The Dhahiri school and Ibn Sirin held the view that any illness whatsoever permits breaking the fast.

Tarif ibn Shihab Al-'Atardi said: "I entered upon Muhammad ibn Sirin during Ramadan while he was eating. When he finished, he said: 'Indeed, this finger of mine hurt me.'"

Al-Bukhari said: "I fell slightly ill in Naysabur, and that was during the month of Ramadan. Ishaq ibn Rahawayh visited me with a group of his companions and said to me: 'Have you broken your fast, O Abu 'Abdillah?' I said: 'Yes.' He said: 'I feared you might be too weak to accept the concession.'" (Al-Jami' li Ahkam al-Qur'an by Al-Qurtubi Vol. 2/P.276).

This opinion is considered remote, and the fatwa follows the view of the majority of scholars: that a minor illness with which fasting is not difficult does not permit breaking the fast.

Secondly: The illness that permits its bearer to break the fast:

This is what scholars call 'the illness for which a concession is granted'; meaning, its bearer is permitted to break the fast, but it is not obligatory upon him.

With this illness, the person is capable of fasting, but it would cause harm and hardship, though not to the point of death, nor would it necessarily lead to the increase of a life-threatening illness or the aggravation and worsening of the illness in the person's body. Scholars differed regarding this type. The Hanafi and Shafi'i schools held that breaking the fast is permissible in such an illness. The Malikis held that breaking the fast is recommended and fasting is disliked.

Al-Qurtubi said: "The second type: when he is capable of fasting but with harm and hardship. For this person, breaking the fast is recommended, and none would fast [in this state] except an ignorant person." (Al-Jami' li Ahkam al-Qur'an Vol.2/P.276).

Imam Abu Hanifah said: "If a man fears for himself while fasting that if he does not break his fast, the pain in his eye or his fever will increase, then he should break his fast." (Al-Mabsut by Al-Sarakhsi Vol.4/P.230).

Al-Kasani said: "As for illness, the type for which a concession is granted is that which one fears will increase due to fasting. This is what was alluded to in Al-Jami' al-Saghir..." Then he said: "It is narrated from Abu Hanifah that if the person is in a state where it is permissible to pray sitting down, then there is no harm in breaking fast." (Bada'i' al-Sana'i' Vol.2/P.94).

Accordingly, the position of the majority of scholars is: if a person has an illness that causes him pain and suffering, or he fears its persistence, or he fears its increase, then breaking the fast is valid for him.

Moreover, any illness that, in the predominant medical opinion, increases due to fasting – such as diabetes, where the patient suffers from high blood sugar – then it is recommended for the bearers of such an illness to break the fast.

Thirdly: The illness that necessitates breaking the fast:

This is the illness with which fasting is impossible, or one fears death from the illness, or it would lead to severe weakness, or the exacerbation of a life-threatening illness. Examples include diabetic patients undergoing kidney dialysis.

In this case, it is obligatory upon the ill person to break the fast, provided he is certain of the occurrence of death, severe harm, or that it is most likely to occur, based on the assessment of trustworthy, specialized physicians. Physicians must explain to their patients the extent of fasting's impact on their health and the potential complications that may pose a danger to their lives or exacerbate their illnesses, which would make fasting impermissible for them.

In this situation, the ill person would be sinning by fasting, because it involves casting oneself into destruction. Allah says {what means}: "And do not kill yourselves [or one another]. Indeed, Allah is to you ever Merciful" (An-Nisa'/29), and His saying: "And do not throw [yourselves] with your [own] hands into destruction" (Al-Baqarah/195).

Al-Kasani said: "And the absolute, rather obligatory, permitting factor is that from which death is feared; because it involves casting oneself into destruction, and this is not for establishing the right of Allah, which is obligation. The obligation does not remain in this condition; rather, it is forbidden. Therefore, breaking the fast becomes permissible, rather obligatory." (Bada'i' al-Sana'i' 2/94).