Dear Hadi,
Assalamu alaykum,
I would really appreciate guidance on the following matter according to the Hanafi madhhab.
I have read that individuals with chronic illnesses may be exempt from fasting, and that fasting could even be sinful. However, I have also come across opinions stating that people with diabetes may still be required to fast and make up missed fasts. This has left me uncertain about my own situation.
I have cystic fibrosis and CF-related diabetes, both of which are chronic conditions. To manage my health, I take at least 9 different medications daily including multiple insulin injections. While I can choose when to take my medications, there are certain times of day that are medically optimal. Although my diabetes is currently well controlled, I am unsure whether fasting would be harmful in the long term.
I also came across the following resource discussing the medical risks of fasting with cystic fibrosis, which suggests that one may be exempt but should consult an imam:
https://www.cysticfibrosis.org.uk/about-us/resources-for-cf-professionals/supporting-clinicians/resources-for-clinicians/nutrition-leaflets/fasting-during-ramadan
My main concern is that while fasting may not be immediately life-threatening, it could potentially cause long-term harm. I am also underweight and struggle to gain weight due to cystic fibrosis, and I worry that fasting could worsen this. At the same time, I am concerned about whether I am sinful for not properly exploring this matter and trying to take the easy way out by avoiding fasting without sufficient justification. My doctor is not Muslim, so I am unsure how to weigh their medical advice in this context.
With all this said, am I considered exempt from fasting and if not, how do I make up for 15 Ramadans of missed fasts without causing harm?
JazakAllah khair for your time and guidance.
Dear Reader,
Thank you very much for your question, and for being so concerned about trying to do the right thing. While we do not offer fatwas in this column, we will share with you our understanding of the situation and our sincerest advice.
According to the Hanafi madhab, the obligation to fast in Ramadan is lifted from a person for whom fasting causes real harm or a strong likelihood of harm, whether that harm is immediate or long-term. This ruling is not limited to situations where fasting is life-threatening in the short term.
The Hanafi jurists define illness (marad) that permits not fasting as a condition where fasting will likely:
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worsen the illness,
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delay recovery,
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or cause significant harm based on reasonable medical assessment or prior experience.
This applies even if the harm is gradual or cumulative, not necessarily sudden or dramatic. Preservation of life and health (hifz al-nafs) is a foundational objective of the Shariah, and acts of worship are never intended to cause damage to the body entrusted to a person by Allah.
Medical guidance specific to cystic fibrosis—including the resource you referenced—indicates that fasting may pose risks, particularly with respect to nutrition, blood sugar control, hydration, and long-term health outcomes. Even if fasting may not cause immediate collapse, we believe (and Allah SWT knows best) that the reasonable concern of long-term harm places this situation squarely within the Hanafi definition of illness that permits exemption.
In Hanafi fiqh, a person is not required to subject themselves to harm in order to test whether fasting will damage them. Rather, if trustworthy medical advice or well-grounded concern indicates harm, that is sufficient. The physician’s religion is not a condition for accepting medical expertise; what matters is competence and honesty. Classical jurists accepted the assessment of non-Muslim physicians in matters of health.
Furthermore, the Hanafi madhab explicitly states that if fasting is likely to cause harm, fasting becomes impermissible, not merely optional. In such cases, refraining from fasting is not sinful—rather, persisting despite harm may itself be blameworthy.
Given that both of your conditions are chronic and ongoing, and that fasting risks worsening your health and nutritional status, the ruling aligns more closely with permanent or long-term inability, in which case the obligation shifts from fasting or making up fasts to fidya, if financially able.
Finally, the very fact that you are concerned that you may be falling short or seeking ease unjustifiably demonstrates that this is not a matter of negligence or convenience, but sincere caution on your part in fulfilling Allah’s commands correctly. Allah does not require acts of worship that compromise the very life and health He has commanded us to protect.
For these reasons, according to Hanafi principles, we believe exemption from fasting is justified in your case, with no sin incurred, and with fidya offered as appropriate and if you are financially able to do so.
In peace.