Israel & the Palestinian Territories

Health & safety

Before you go

A little planning before departure, particularly for preexisting 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 (and take your optical prescription with you); and carry a first-aid kit with you.

It’s tempting to leave it all to the last minute – don’t! Many vaccines don’t start to ensure immunity for two weeks, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received.

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.

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Insurance

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. 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. Your travel insurance will not usually cover you for anything other than emergency dental treatment. Not all insurance covers emergency aeromedical evacuation home or to a hospital in a major city, which may be the only way to get medical attention for a serious emergency.

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Recommended vaccinations

Get your jabs well before travelling; some require more than one injection.

The World Health Organization recommends that all travellers regardless of the region they are travelling in should be covered for diphtheria, tetanus, measles, mumps, rubella and polio, as well as hepatitis B.

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Medical checklist

Following is a list of 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 (for example ibuprofen)

Bandages, gauze, gauze rolls

Insect repellent containing DEET (for the skin)

Insect repellent containing permethrin (for clothing, tents and bed nets)

Iodine tablets (for water purification)

Oral rehydration salts

Pocket knife

Scissors, safety pins, tweezers

Steroid cream or cortisone (for allergic rashes)

Sun block

Syringes and sterile needles (if travelling to remote areas)

Thermometer

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Further reading

Lonely Planet’s Healthy Travel Africa 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 Traveller’s 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 volunteers and long-term expatriates working in the Middle East.

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Dangers & annoyances

Is it safe? This is the question you’ll hear endlessly from friends and family back home when you announce your intentions to travel to the Holy Land. The truth is that fatal car crashes in your home country probably outnumber terrorist-related deaths in Israel. So while there is an inherent risk in any travel these days, your chances of getting caught up in an act of terror in Israel are extremely low. Still, it’s always a good idea to play it safe, plan ahead and get advice from locals on the ground.

Travel in the Palestinian Territories offers considerably more risk.

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Theft

Theft is as much a problem in Israel and the Palestinian Territories as it is in any other country, so take the usual precautions: don’t leave valuables in your room or vehicle and use a money belt. In hostels, it’s wise to check your most valuable belongings into the front-desk safe. On intercity buses, it’s fine to stow large bags in the luggage hold, but keep valuables with you inside. Crowded tourist spots and markets are obvious haunts for pickpockets, so stay aware of what’s happening around you.

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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 blood clots are re- absorbed 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 deep vein thrombosis 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 immediately seek medical attention.

To prevent the development of deep vein thrombosis on long flights you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids, and avoid alcohol and tobacco.

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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.

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While you're there

Availability & cost of health care

Israel has first-rate state-funded hospitals across the country, plus a number of private hospitals and clinics. Private dental clinics are found anywhere from suburban streets to shopping malls. Costs are comparable to what you’d expect at home but free clinics are available for general checkups. Large cities in the Palestinian Territories have reasonable hospital facilities but these can be crowded or short on supplies. For a list of facilities see www.healthinforum.org.

Pharmacies (beit mirkachat) in Israel are common on city streets, and pharmacists will speak English and can give advice about what medicine to take if you describe your problem. In the Palestinian Territories, medicine may be expired so check the date.

If you require any prescribed medication, take enough from home to get you through your trip and bring a copy of the prescription in case you need a refill. If you need immediate medical care ask at your hotel. In an emergency, contact your embassy or consulate.

Standards of dental care are high but keep in mind that your travel insurance will not usually cover you for anything other than emergency dental treatment.

For first aid call 101 on any phone.

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Diphtheria

Diphtheria is spread through close respiratory contact. It 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 likely to be in close contact with the local population in infected areas. The vaccine is given as an injection alone, or with tetanus, and lasts 10 years.

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Hepatitis A

Hepatitis A 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 vaccines (Avaxim, VAQTA, Havrix) are 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.

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Hepatitis B

Infected blood, contaminated needles and sexual intercourse can all transmit hepatitis B. 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 singly, 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.

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HIV

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 other body piercing procedures, and sharing used intravenous needles.

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Leishmaniasis

Spread through the bite of an infected sandfly, leishmaniasis can cause a slowly growing skin lump or ulcer. It may develop into a serious life-threatening fever, usually accompanied by anaemia and weight loss. Infected dogs are also carriers of the infection. Sandfly bites should be avoided whenever possible.

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Rabies

Spread through bites or licks on broken skin from an infected animal, rabies is fatal. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of postbite vaccine is not 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.

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Tuberculosis

Tuberculosis (TB) 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 those visiting family or planning on a long stay, and those employed as teachers and health-care workers. TB can be asymptomatic, although 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 the 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.

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Typhoid

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.

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Traveller’s diarrhoea

Traveller’s diarrhoea can occur with a simple change of diet, so even though Israeli food and water are healthy you may get an upset stomach simply because your body is not accustomed to the new foods – it may take a few days to adjust. Keep in mind that in summer, outdoor food spoils quickly, so this is a good time to avoid hole-in-the-wall shwarma joints because the hummus goes bad quickly. Eating hummus in an indoor restaurant will be safer. Be even more circumspect than usual in the Palestinian Territories.

If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing 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, or is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention.

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Heat illness

Heat exhaustion is one of the most common ailments among travellers in Israel and the Palestinian Territories. This occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt. It is particularly common in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty – aim to drink enough water that you produce pale, diluted urine. The treatment of heat exhaustion consists of replacing fluid with water or fruit juice or both, and cooling by cold water and fans. The treatment of the salt loss component consists of salty fluids as in 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. An excessive rise in body temperature leads to sweating ceasing, irrational and hyperactive behaviour and eventually loss of consciousness and 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.

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Insect bites & stings

Mosquitoes may not carry malaria but can cause irritation and infected bites. Using DEET-based insect repellents will prevent bites. Mosquitoes also spread dengue fever.

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 Mediterranean beaches. They usually only cause a nasty itchy bite but can carry a rare skin disorder called cutaneous leishmaniasis. Bites may be prevented by using DEET-based repellents.

The number of jellyfish has been increasing over the years, thanks to overfishing in the Mediterranean (fish eat jellyfish, and in the absence of predators the jellyfish have boomed). The jellyfish sting is irritating but in most cases it wears off in about 10 or 15 minutes. A particularly strong sting (or a sting to the face or genitals) requires an evaluation by a physician.

Scorpions are frequently found in arid or dry climates. They can cause a painful bite which, is rarely life threatening.

Bedbugs 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 are easily treated with lotion available from pharmacies; people who you come into contact with also need treating to avoid spreading scabies between asymptomatic carriers.

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Snake bites

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 with 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.

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Water

Tap water is safe to drink in Israel but carries an unpleasant taste (especially in Eilat, where is has been desalinised). Bottled water is available everywhere. Do not drink water from rivers or lakes; this may contain bacteria or viruses that can cause diarrhoea or vomiting.

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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 vaccines well before departure as some vaccines are not suitable for children aged under one year old.

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 for reconstituting 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.

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Women’s health

Emotional stress, exhaustion and travelling through different time zones can all contribute to an upset in the menstrual pattern. If using oral contraceptives, note that some antibiotics, diarrhoea and vomiting can stop the pill from working and lead to the risk of pregnancy – 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 readily available in Israel and the Palestinian Territories.

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, eg high blood pressure and premature delivery, can occur. Most airlines won’t accept a traveller after 28 to 32 weeks of pregnancy, and long-haul flights in the later stages can be very uncomfortable. Taking written records of the pregnancy with details of your blood group is helpful if you need medical attention while away. Ensure your insurance policy covers pregnancy delivery and postnatal care, but remember insurance policies are only as good as the facilities available.

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