Health & safety
Lonely Planet’s Healthy Travel is packed with useful information including pretrip planning, emergency first aid, immunisation and disease information, as well as what to do if you get sick on the road. Other recommended references include Travellers’ Health by Dr Richard Dawood (Oxford University Press); International Travel Health Guide by Stuart R Rose, MD (Mosby); and The Travellers’ Good Health Guide by Ted Lankester (Sheldon Press), an especially useful health guide for volunteers and long-term expatriates working in the Middle East.
Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures (in many countries doctors expect payment in cash). It’s also worth ensuring your travel insurance will cover repatriation home or to better medical facilities elsewhere. Not all insurance covers an emergency flight home or to a hospital in a major city, which may be the only way to get medical attention for a serious emergency. Your insurance company may be able to locate the nearest source of medical help, or you can ask at your hotel. In an emergency contact your embassy or consulate.
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There is a wealth of travel health advice on the internet. The World Health Organization (www.who.int/ith) publishes a superb book, International Travel and Health, which is revised annually and is available online at no cost. Another website of general interest is MD Travel Health (www.mdtravelhealth.com), which provides complete travel- health recommendations for every country, updated daily, also at no cost. The Centers for Disease Control & Prevention (www.cdc.gov) website is also a useful source of travel-health information.
Following is a list of other items you should consider packing in your medical kit.
Acetaminophen/paracetamol (Tylenol) or aspirin
Adhesive or paper tape
Antibacterial ointment (eg Bactroban) for cuts and abrasions
Antibiotics (if travelling off the beaten track)
Antidiarrhoeal drugs (eg loperamide)
Antihistamines (for hay fever and allergic reactions)
Anti-inflammatory drugs (eg ibuprofen)
Bandages, gauze, gauze rolls
DEET-containing insect repellent for the skin
Iodine tablets (for water purification)
Oral rehydration salts
Permethrin-containing insect spray for clothing, tents, and bed nets
Scissors, safety pins, tweezers
Steroid cream or cortisone (for allergic rashes)
Syringes and sterile needles (if travelling to remote areas)
A little planning before departure, particularly for pre-existing illnesses, will save you a lot of trouble later. See your dentist before a long trip; carry a spare pair of contact lenses and glasses (take your optical prescription with you); and carry a first-aid kit.
It’s tempting to leave planning to the last minute – don’t! Many vaccines don’t ensure immunity for the first two weeks, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (also known as the yellow booklet), which lists all the vaccinations you’ve received. This is mandatory for countries that require proof of yellow-fever vaccination, but it’s a good idea to carry it wherever you travel.
Travellers can register with the International Association for Medical Assistance to Travellers (IAMAT; www.iamat.org). Its website can help travellers to find a doctor with recognised training. Those heading off to very remote areas may like to do a first-aid course (Red Cross and St John’s Ambulance can help) or attend a remote medicine first-aid course such as the one offered by the Royal Geographical Society (www.rgs.org).
Bring your 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 you’re carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity.
The World Health Organization (WHO) recommends that all travellers, regardless of the region they are travelling in, should be vaccinated against diphtheria, tetanus, measles, mumps, rubella and polio, as well as hepatitis B. While making travel preparations, take the opportunity to ensure that your routine vaccination cover is complete. The consequences of these diseases can be very severe and outbreaks do occur in the Middle East.
The incidence of crime, violent or otherwise, in Egypt is negligible compared with most Western countries. Most visitors and residents would agree that Egyptian towns and cities are safe to walk around in during the day or night. Unfortunately, the hassle factor often means that this isn’t quite the case for an unaccompanied foreign woman.
Apart from the issues discussed here, you should be aware that the Egyptian authorities take a dim view of illegal drug use.
Terrorist acts against foreign tourists in 1997, 2004, 2005 and 2006 resulted in a great many deaths, and have led to the government giving security the highest possible priority. This can be annoying for travellers, as convoys and tourist-police escorts can be a real drag.
That said, we can’t blame the government for doing its utmost to convince tourists that their security is of paramount importance to Egypt. After all, the income derived from tourism constitutes an extraordinary 20% or so of the country’s GDP. Generally speaking, we’d say that Egypt is presently no more or less dangerous than any other country, your own included.
Scams, hustles & hassle
Egyptians take hospitality to strangers seriously. You’ll receive a steady stream of salaams (greetings) and the odd ahlan wa sahlan (hello/welcome) inviting you to sit and have shai (tea). A lot of this is genuine, particularly in rural areas, where drink, food and transport are frequently offered with no expectation of remuneration.
But in more touristy places – notably around the Egyptian Museum and Pyramids in Cairo, and all around Luxor – a cheery ‘Hello, my friend’ is double-speak for ‘This way, sucker’. One traveller wrote to us about feeling like a ‘walking wallet’ in Egypt, and we knew exactly what she meant.
Be warned that you’ll become a magnet for instant friends who just happen to have a papyrus factory they’d like to show you. You’ll be showered with helpful advice such as ‘the museum is closed, take shai with me while you wait’ – of course the museum isn’t closed and refreshments will be taken at a convenient souvenir shop. As an English-speaker you might be asked to spare a moment to check the spelling of a letter to a relative in the USA, and while you’re at it how about some special perfume for the lady…
It’s all pretty harmless stuff but it can become very wearing. Everyone works out a strategy to reduce the hassle to a minimum. Years ago, we heard a story about a traveller keeping touts away by jabbing his finger at his chest and saying, ‘Ya Russki’ (I’m Russian). Not only were the hustlers defeated by the language, everyone knew that the Russians had no money. But now that Egypt is a popular holiday destination for newly rich Muscovites, the street entrepreneurs are just as fluent in Slavic sales patter as they are in English, German, French, Dutch and Japanese.
About the only way to deal with unwanted attention is to be polite but firm, and when you’re in for a pitch cut it short with ‘Sorry, no thanks’.
Aside from the hustling, there are countless irritating scams. The most common involves touts who lie and misinform to get newly arrived travellers into hotels for which they get a commission.
If you do get stung, or feel one more ‘Excuse me, where are you from?’ will make you crack, simmer down and wise up – by acting rudely or brusquely you may offend one of the vast majority of locals who would never dream of hassling a foreigner and is only trying to help a guest to the country.
Theft never used to be a problem in Egypt but it seems to be becoming a bigger one. In the past couple of years we’ve received a stream of letters from readers concerning money disappearing from locked rooms, even hotel safes. Our advice is to keep your cash and valuables on your person at all times.
There are also a few areas where pickpockets are known to operate, notably on the Cairo metro and the packed local buses from Midan Tahrir to the Pyramids. Tourists aren’t the specific targets, but be careful how you carry your money in crowded places.
Generally though, unwary visitors are parted from their money through scams, and these are something that you really do have to watch out for.
Deep vein thrombosis (DVT)
Deep vein thrombosis (DVT) 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 blood 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 of the foot, ankle or calf, 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 seek medical attention immediately.
To prevent the development of DVT on long flights, you should walk around the cabin, contract the leg muscles while sitting, drink plenty of fluids and avoid alcohol and tobacco.
Jet lag & motion sickness
Jet lag is common when crossing more than five time zones; it results in insomnia, fatigue, malaise or nausea. To avoid jet lag try drinking plenty of fluids (nonalcoholic) and eating light meals. Upon arrival, seek exposure to natural sunlight and readjust your schedule (for meals, sleep etc) 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.
Heat exhaustion occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt. It is particularly common in hot climates, if you take unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. You’re already dehydrated by the time you feel thirsty – aim to drink sufficient water so that you produce pale, diluted urine. Treatment consists of fluid replacement with water or fruit juice or both, and cooling by cold water and fans. The treatment of the salt-loss component consists of taking in salty fluids such as soup or broth, and adding a little more table salt to foods than usual.
Heat stroke is much more serious. This occurs when the body’s heat-regulating mechanism breaks down. Excessive rise in body temperature leads to sweating ceasing, irrational and hyperactive behaviour and eventually loss of consciousness and even death. Rapid cooling by spraying the body with water and fanning is an ideal treatment. Emergency fluid and electrolyte replacement by intravenous drip is usually also required.
Insect bites & stings
Mosquitoes may not carry malaria but can cause irritation and infected bites. They also spread dengue fever. Using DEET-based insect repellents will prevent bites.
Bees and wasps only cause real problems to those with a severe allergy (anaphylaxis). If you have a severe allergy to bee or wasp stings, you should carry an adrenaline injection or similar.
Sandflies are located around the Mediter-ranean beaches. They usually only cause a nasty itchy bite, but can also carry a rare skin disorder called cutaneous leishmaniasis. Bites may be prevented by using DEET-based repellents.
Scorpions are frequently found in arid or dry climates. They can cause a painful bite which is rarely life threatening.
Bed bugs are often found in hostels and cheap hotels. They lead to very itchy, lumpy bites. Spraying the mattress with an appropriate insect killer will do a good job of getting rid of them.
Scabies are also frequently found in cheap accommodation. These tiny mites live in the skin, particularly between the fingers. They cause an intensely itchy rash. Scabies is easily treated with lotion available from pharmacies; people who you come into contact with also need treating to avoid spreading scabies between asymptomatic carriers.
Do not walk barefoot or stick your hand into holes or cracks. Half of those bitten by venomous snakes are not actually injected with poison (envenomed). If bitten by a snake, do not panic. Immobilise the bitten limb with a splint (eg a stick) and apply a bandage over the site and firm pressure, similar to a bandage over a sprain. Do not apply a tourniquet, or cut or suck the bite. Get the victim to medical help as soon as possible so that antivenin can be given if necessary.
Tap water is not safe to drink throughout Egypt. Stick to bottled water or boil water for 10 minutes, use water-purification tablets or a filter. Do not drink water from rivers or lakes, as it may contain bacteria or viruses that can cause diarrhoea or vomiting.
The following diseases are all present within Egypt.
Spread through close respiratory contact, diphtheria causes a high temperature and severe sore throat. Sometimes a membrane forms across the throat requiring a tracheostomy to prevent suffocation. Vaccination is recommended for those who are likely to be in close contact with the local population in infected areas. The vaccine is given as an injection alone or with the tetanus vaccine, and lasts 10 years.
This is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, can cause prolonged lethargy and delayed recovery. Symptoms include dark urine, a yellow colour to the whites of the eyes, fever and abdominal pain. Hepatitis A vaccine (Avaxim, Vaqta, Havrix) is given as an injection: a single dose will give protection for up to a year, while a booster 12 months later will provide a subsequent 10 years of protection. Hepatitis A and typhoid vaccines can also be given as a single-dose vaccine (Hepatyrix or ViATIM).
Hepatitis B is transmitted by infected blood, contaminated needles and sexual intercourse. It can cause jaundice and affects the liver, occasionally causing liver failure. All travellers should make this a routine vaccination. (Many countries now give hepatitis B vaccination as part of routine childhood vaccination.) The vaccine is given alone, or at the same time as the hepatitis A vaccine (Hepatyrix). A course will give protection for at least five years. It can be given over four weeks or six months.
HIV is spread via infected blood and blood products, sexual intercourse with an infected partner and from an infected mother to her newborn child. It can be spread through ‘blood to blood’ contacts such as contaminated instruments during medical, dental, acupuncture and body-piercing procedures, and sharing used intravenous needles.
Malaria is found in certain parts of some oases; risk varies seasonally. Risk of malaria in most cities is minimal, but check with your doctor if you are considering travelling to any rural areas. It is important to take antimalarial tablets if the risk is significant. For up-to-date information about the risk of contracting malaria, contact your local travel health clinic.
Anyone who has travelled in a country where malaria is present should be aware of the symptoms of malaria. It is possible to contract malaria from a single bite from an infected mosquito. Malaria almost always starts with marked shivering, fever and sweating. Muscle pains, headache and vomiting are common. Symptoms may occur anywhere from a few days to three weeks after the infected mosquito bite. The illness can start while you are taking preventive tablets if they are not fully effective, and may also occur after you have finished taking your tablets.
This generally spreads through contaminated food and water. The vaccine is given in childhood and should be boosted every 10 years, either orally (a drop on the tongue) or as an injection. Polio may be carried asymptomatically, but it can cause a transient fever and, in rare cases, potentially permanent muscle weakness or paralysis.
Rabies spreads through bites or licks from an infected animal on broken skin. Rabies is fatal. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of postbite vaccine isn’t available within 24 hours. Three injections are needed over a month. If you have not been vaccinated, you will need a course of five injections starting within 24 hours or as soon as possible after the injury. Vaccination does not provide you with immunity, it merely buys you more time to seek appropriate medical help.
Rift Valley Fever
This haemorrhagic fever is spread through blood and blood products, including those from infected animals. It causes a flulike illness with fever, joint pains and occasionally more serious complications. Complete recovery is possible.
Also known as bilharzia, this is spread by the freshwater snail. It causes infection of the bowel and bladder, often with bleeding. It is caused by a fluke and is contracted through the skin from water contaminated with human urine or faeces. The Nile is known to be a source of bilharzia, but paddling or swimming in any suspect freshwater lakes or slow-running rivers should be avoided. Possible symptoms include a transient fever and rash. Advanced cases of bilharzia may cause blood in the stool or in the urine. However, there may be no symptoms. A blood test can detect antibodies if you have been exposed, and treatment is then possible in specialist travel or infectious-disease clinics.
Also known as TB, this is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccine is recommended for those likely to be mixing closely with the local population. It is more important for people visiting family or planning on a long stay, and those employed as teachers and health-care workers. TB can be asymptomatic, or symptoms can include cough, weight loss or fever, months or even years after exposure. An X-ray is the best way to confirm if you have TB. BCG gives a moderate degree of protection against TB. It causes a small permanent scar at the site of injection, and is usually only given in specialised chest clinics. As it’s a live vaccine it should not be given to pregnant women or immunocompromised individuals. The BCG vaccine is not available in all countries.
This is spread through food or water that has been contaminated by infected human faeces. The first symptom is usually fever or a pink rash on the abdomen. Septicaemia (blood poisoning) may also occur. Typhoid vaccine (Typhim Vi, Typherix) will give protection for three years. In some countries the oral vaccine Vivotif is also available.
This vaccination isn’t required for the Middle East. However, the mosquito that spreads yellow fever has been known to be present in some parts of the Middle East. It is important to consult your local travel-health clinic for the latest details, as part of your predeparture plans. Any travellers from a yellow-fever endemic area will need to show proof of vaccination against yellow fever before entry. This normally means if arriving directly from an infected country or if the traveller has been in an infected country during the previous 10 days. We would recommend, however, that travellers carry a certificate if they have been in an infected country during the previous month, to avoid any possible difficulties with immigration. There is always the possibility that a traveller without an up-to-date certificate will be vaccinated and detained in isolation at the port of arrival for up to 10 days, or even repatriated. The yellow-fever vaccination must be given at a designated clinic. It is valid for 10 years. It is a live vaccine and must not be given to immunocompromised or pregnant travellers.
In Cairo, you can obtain a yellow-fever vaccine at the medical clinic in Terminal 1 of Cairo airport (approximately E£60). Note that you must show proof of having a yellow-fever vaccination before being allowed entry to or from Sudan.
Travelling with children
All travellers with children should know how to treat minor ailments and when to seek medical treatment. Make sure the children are up to date with routine vaccinations, and discuss possible travel vaccinations well before departure as some vaccines are not suitable for children aged under one year.
In hot, moist climates any wound or break in the skin may lead to infection. The area should be cleaned and then kept dry and clean. Remember to avoid contaminated food and water. If your child is vomiting or experiencing diarrhoea, lost fluid and salts must be replaced. It may be helpful to take rehydration powders with you, to be reconstituted with boiled water. Ask your doctor about this.
Children should be encouraged to avoid dogs or other mammals because of the risk of rabies and other diseases. Any bite, scratch or lick from a warm-blooded, furry animal should immediately be thoroughly cleaned. If there is any possibility that the animal is infected with rabies, immediate medical assistance should be sought.
El Gouna Hospital & Hyperbaric Centre (065-358 0011, 012 218 7550, 012 219 0383; Al-Gouna)
Marsa Shagra Decompression Chamber (012 218 7550, satellite 0195-100 262; Marsa Shagra) Located 24km north of Marsa Alam.
Naval Hyperbaric & Emergency Medical Center (065-344 9150, 065-354 8450; Corniche, Hurghada)
Sharm el-Sheikh Hyberbaric Medical Center (069-366 0922/3, 24hr emergency 012 212 4292; email@example.com; Sharm el-Sheikh; 10.30am-6pm)
Sharm el-Sheikh International Hospital (069-366 0893/4/5; Sharm–Na’ama Bay Rd, Sharm el-Sheikh)
Dr Adel Taher (012 212 4292; Sharm el-Sheikh)
Dr Hanaa Nessim (012 219 0383; Hurghada)
Dr Hossam Nasef (012 218 7550; Hurghada)
Availability & cost of health care
The health care systems in Egypt are varied. Care can be excellent in private hospitals and those associated with universities, but patchier elsewhere. Reciprocal payment arrangements with other countries rarely exist and you should be prepared to pay for all medical and dental treatment.
Medical care is not always readily available outside major cities. Medicine, and even sterile dressings or intravenous fluids, may need to be bought from a pharmacy. Nursing care may be limited or rudimentary, as this is something families and friends are expected to provide. The travel assistance provided by your insurance may be able to locate the nearest source of medical help, otherwise ask at your hotel. In an emergency contact your embassy or consulate.
Standards of dental care are variable and there is an increased risk of hepatitis B and HIV transmission via poorly sterilised equipment. Keep in mind that your travel insurance will not usually cover you for anything other than emergency dental treatment.
For minor illnesses such as diarrhoea, pharmacists, who are well qualified, can often provide valuable advice and sell over-the-counter medication. They can also advise whether more specialised help is needed.
To prevent diarrhoea, avoid tap water unless it has been boiled, filtered or chemically disinfected (iodine tablets). Eat only fresh fruits or vegetables if cooked or if you have peeled them yourself, and avoid dairy products that might contain unpasteurised milk. Buffet meals are risky. Food should be piping hot; meals freshly cooked in front of you in a busy restaurant are more likely to be safe.
If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing lots of salt and sugar. A few loose stools don’t require treatment but, if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention.
Emotional stress, exhaustion and travelling through different time zones can all contribute to an upset in the menstrual pattern. If using oral contraceptives, keep in mind that some antibiotics, diarrhoea and vomiting can stop the pill from working and lead to the risk of pregnancy – remember to take condoms with you just in case. Condoms should be kept in a cool, dry place or they may crack and perish.
Emergency contraception is most effective if taken within 24 hours after unprotected sex. The International Planned Parent Federation (www.ippf.org) can advise about the availability of contraception in different countries. Tampons and sanitary towels are not always available outside major cities in the Middle East.
Travelling during pregnancy is usually possible, but there are important things to consider. Have a medical checkup before embarking on your trip. The most risky times for travel are during the first 12 weeks of pregnancy, when miscarriage is most likely, and after 30 weeks, when complications such as high blood pressure and premature delivery can occur. Most airlines will not accept a traveller after 28 to 32 weeks of pregnancy, and long-haul flights in the later stages can be very uncomfortable. Antenatal facilities vary greatly between countries in the Middle East and you should think carefully before travelling to a country with poor medical facilities or where there are major cultural and language differences from your home country. Taking written records of the pregnancy, including details of your blood group, is likely to be helpful if you need medical attention while in a foreign country. Try to find an insurance policy that covers pregnancy, delivery and postnatal care, but remember that insurance policies are only as good as the facilities available.