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Health & safety

Before you go


To say Afghanistan can be an unpredictable place is something of an understatement, so travel insurance is essential. However, many insurance companies regard Afghanistan as a conflict zone. Coupled with advice from government travel advisories, this means that not all brokers will issue insurance for a trip to Afghanistan. Discuss this with your broker and check the small print for exclusions on the policy before signing up. Note that insurers may make a distinction between ‘active’ and ‘passive’ war zones, where premiums reflect the level of risk. Cover for land mine injuries are often specifically excluded by some companies. A minimum of US$1 million medical cover and a ‘medivac’ clause covering the costs of being flown to another country for treatment is essential.

Specialist policies are available with some brokers aimed specifically for those working in conflict zones, although they’re not always cheap. AKE Group (in the UK 020 7816 5454, in the USA 678-560 2336; www.akegroup.com), a dedicated security and risk management company has been recommended. In the UK, also try Medicare (020 7816 2033; www.medicare.co.uk) or J&M Insurance (01992 566939; www.jmi.co.uk). In the USA, try New York International Group (212-268 8520; www.nyig.com) or Safe Passage International (303-988 9666; www.spibrokers.com).

In Afghanistan, medical services insist on payment on the spot, so collect all the paperwork you can when being treated for a claim later. Some policies ask you to call them (they’ll usually call you back) so that an assessment of your problem can be made.

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Health matters often get left to the last minute before travelling. A little planning is advisable, however – some vaccines don’t ensure immunity for two weeks, so visit a doctor four to eight weeks before departure.

Travellers can register with the International Association for Medical Advice to Travellers(IAMAT; www.iamat.org). Their website can help travellers to find a doctor with recognised training. Those heading off to very remote areas (particularly for work) may find a first-aid course useful.

Bring medications in their original, clearly labelled, containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity. See your dentist before a long trip; carry a spare pair of contact lenses and glasses (and take your optical prescription with you).

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Adequate health insurance is vital when travelling to Afghanistan. Check in advance that your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures – doctors in Afghanistan expect payment on the spot. Your policy should ideally also cover emergency air-evacuation home, which may be essential for serious problems.

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Recommended vaccinations

Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and will be able to give specific recommendations for you and your trip. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received.

Yellow fever vaccination is mandatory if arriving from a country where the disease is endemic. The World Health Organization also recommends the following vaccinations for travellers to Afghanistan:

Adult Diphtheria & Tetanus Single booster recommended if none in the previous 10 years. Side effects include sore arm and fever.

Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection. Mild side effects such as headache and sore arm occur in 5% to 10% of people.

Hepatitis B Now considered routine for most travellers. Usually given as three shots over six months, a rapid schedule is also available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually headache and sore arm. In 95% of people lifetime protection results.

Measles, Mumps & Rubella Two doses required unless you have had the diseases. Occasionally a rash and flulike illness can develop a week after receiving the vaccine. Many young adults require a booster.

Polio Only one booster is required as an adult for lifetime protection.

Typhoid Recommended unless your trip is for less than a week. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available, but the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur.

These immunisations are recommended for long-term visitors (more than one month) or those at special risk:

Japanese B Encephalitis Three injections, with a booster recommended after two years. Sore arm and headache are the most common side-effects.

Meningitis Single injection. There are two types: the quadrivalent vaccine gives two to three years’ protection; the meningitis group C vaccine gives around 10 years’ protection. Recommended for long-term visitors aged under 25.

Rabies Three injections in all. A booster after one year provides10 years’ protection Side effects are rare – occasionally headache and sore arm.

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Medical checklist

Following is a list of other items you should consider packing in your medical kit when you are travelling.

- Antibiotics (if travelling off the beaten track)

- Antibacterial hand gel

- Antidiarrhoeal drugs (eg loperamide)

- Paracetamol (eg Tylenol) or aspirin

- Anti-inflammatory drugs (eg ibuprofen)

- Antihistamines (for hay fever and allergic reactions)

- Antibacterial ointment (eg Bactroban) for cuts and abrasions

- Steroid cream or cortisone (allergic rashes)

- Bandages, gauze, gauze rolls

- Adhesive or paper tape

- Scissors, safety pins, tweezers

- Thermometer

- Pocket knife

- DEET-containing insect repellent for the skin

- Permethrin-containing insect spray for clothing, tents, and bed nets

- Sun block

- Oral rehydration salts

- Iodine tablets (for water purification)

- Syringes and sterile needles (if travelling to remote areas)

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Internet resources

There is a wealth of travel health advice on the Internet. The World Health Organization (www.who.int/ith/) is an excellent resource for travel health information, along with MD Travel Health (www.mdtravelhealth.com), which provides complete travel health recommendations for every country.

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Further reading

Lonely Planet’s Healthy Travel Asia & India is packed with useful information including pretrip planning, emergency first aid, immunisation and disease information, and what to do if you get sick on the road. Other recommended references include Travellers’ Health by Dr Richard Dawood (Oxford University Press) and The Travellers’ Good Health Guide by Ted Lankester (Sheldon Press), an especially useful health guide for long-term expatriates working in the region.

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Dangers & annoyances

Afghanistan presents unique potential risks to the traveller, with the danger of an insurgency in the south, plus warlordism and terrorist violence in some other parts of the country. It’s essential to keep abreast of the current political and security assessments both before travelling and while in-country.

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In transit

Deep vein thrombosis (DVT)

Deep vein thrombosis occurs when blood clots form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. Though most clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they may cause life-threatening complications.

The chief symptom of DVT is swelling or pain in the lower leg, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and difficulty breathing. Travellers with any of these symptoms should immediately seek medical attention.

To prevent the development of DVT on long flights you should walk about the cabin, regularly contract your leg muscles while sitting and drink plenty of fluids. Recent research also indicates that flight socks, which gently compress the leg from the knee down, encourage blood to flow properly in the legs and reduce the risk of DVT by up to 90%.

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Jet lag & motion sickness

Jet lag is common when crossing more than five time zones; it results in insomnia, fatigue or nausea. To avoid jet lag, set your watch to your destination’s time zone when you board your plane, drink plenty of (non-alcoholic) fluids and eat lightly. Upon arrival, seek exposure to natural sunlight and readjust your eating and sleeping schedule as soon as possible.

Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. Their main side-effect is drowsiness. A herbal alternative is ginger, which works like a charm for some people.

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While you're there

Women travellers

Afghanistan has a conservative culture where attitudes to women are bound up with the protection of honour. Society generally seeks to minimise contact between unrelated men and women. As a result foreign women travelling or working on their own, away from male relatives, are often viewed with a mixture of curiosity and astonishment. Being disregarded is a common reaction, and if you’re with a male companion you shouldn’t be surprised if an Afghan directs his attention and conversation in that direction.

There is no legal obligation to wear a headscarf, but in practice all foreign women do. Walking around Kabul with a bare head would attract a lot of attention; in the countryside such behaviour would be nothing short of scandalous. As a general rule, the more conservative or rural the area you are in, the more discreetly you should dress. In keeping with local sensibilities, your clothes should hide the shape of your body. Bare arms and tight fitting clothes should be avoided, but whatever you wear you’ll still have to get used to being stared at. Trying to wear the burqa is both unnecessary and a cultural no-no for foreign women. The pirhan tonban (traditional male clothes; also called shalwar kameez) of baggy trousers and long shirt is comfortable and popular with many women working in Afghanistan. Baggy clothes can also provide useful cover should you need to go to the toilet while travelling off the beaten track. Facilities in chaikhanas are usually limited.

Foreign women can interact with Afghan women in a way impossible for men. Afghan men may also make special allowances for your status. ‘I often joke that there are three genders here: male, female, and foreign woman’, commented one female NGO worker we met during research. Afghan men can sometimes be unsure about the correct protocol of dealing with a foreign woman. It’s best to wait for them to offer a hand to shake rather than offering your own, and try to avoid excessive eye contact with Afghan men you don’t know. If harassed in a public place, several women have advised making a loud scene to shame your harasser. Avoiding walking alone at night is advice we’d equally extend to foreign men. You’ll also need to cultivate patience and learn to trust your own instincts.

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