Prevention is the key to staying healthy in Morocco, and a little planning before departure will save you trouble later. With luck, your worst complaint on your trip will be a bad stomach; infections are usually associated with poor living conditions and poverty, and can be avoided with a few precautions. Car accidents are a common reason for travellers to need medical help. Medical facilities can be excellent in large cities, but in more remote areas may be basic.
Although no specific vaccinations are required for Morocco, America’s Centers for Disease Control and Prevention (CDC) suggests the following as routine:
The CDC also suggests the following for Morocco:
Don’t leave health matters until the last minute: some vaccines don’t ensure immunity for two weeks, so visit a doctor four to eight weeks before departure.
Before leaving home, ensure that all your routine vaccination cover is complete. Ask your doctor for an international certificate of vaccination, listing all the vaccinations you’ve received.
Consider packing the following items in your medical kit:
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 helpful. If carrying syringes or needles, ensure you 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).
Useful to consult prior to departure:
CDC (www.cdc.gov/travel) US government website.
Health Canada (http://www.hc-sc.gc.ca/hl-vs/travel-voyage/index-eng.php) Canadian government website.
International Association for Medical Advice to Travellers (www.iamat.org) Gives access to its online database of doctors with recognised training.
NHS (www.fitfortravel.nhs.uk) UK government website.
Smarttraveller (www.smartraveller.gov.au) Australian government website.
International Travel Health Guide by Stuart Rose MD
The Travellers’ Good Health Guide by Ted Lankester
Travellers’ Health by Dr Richard Dawood
Those heading to very remote areas may like to do a first-aid course, such as those offered by the American Red Cross and St John’s Ambulance. Particularly if you’re going trekking, you could take a wilderness medical training course, such as that offered by the Royal Geographical Society (www.rgs.org).
Spreads Through close respiratory contact and, occasionally, infected milk or milk products.
Symptoms and effects Can be asymptomatic, although symptoms can include a cough, weight loss or fever months or even years after exposure. An X-ray is the best way to confirm if you have tuberculosis.
Prevention BCG vaccine is recommended for those mixing closely with the local population, whether visiting family, planning a long stay, or working as a teacher or health-care worker. As it’s a live vaccine it should not be given to pregnant women or immuno-compromised individuals.
Spreads Through contaminated food (particularly shellfish) and water.
Symptoms and effects Jaundice, dark urine, a yellow colour to the whites of the eyes, fever and abdominal pain. Although rarely fatal, it can cause prolonged lethargy and delayed recovery.
Prevention Vaccine (Avaxim, VAQTA, Havrix) is given as an injection, with a booster extending the protection offered. Hepatitis A and typhoid vaccines can also be given as a combined single-dose vaccine (hepatyrix or viatim).
Spreads Through food or water that has been contaminated by infected human faeces.
Symptoms and effects Initially, usually fever or a pink rash on the abdomen. Septicaemia (blood poisoning) may also occur.
Prevention Typhim Vi or typherix vaccine. In some countries, the oral vaccine Vivotif is also available.
A yellow fever certificate (proof of vaccination) is not required for entry to Morocco
Spreads Through the bite of an infected sandfly or dog. It may be found in rural areas in the Atlas Mountains, where sandflies are more prevalent between June and October.
Symptoms and effects Slowly growing skin lump or sores. It may develop into a serious, life-threatening fever, usually accompanied by anaemia and weight loss.
Prevention and treatment Avoid sandfly bites. There is no vaccine, but treatment with an antimonial drug such as Glucantime or Pentostam is straightforward, usually involving an injection.
Spreads Through infected blood, contaminated needles and sexual intercourse.
Symptoms and effects Jaundice and liver problems (occasionally failure).
Prevention Travellers should make this a routine vaccination, although Morocco gives hepatitis B vaccination as part of routine childhood vaccination. It is given singly, or at the same time as hepatitis A.
Spreads Through bites or licks on broken skin from an infected animal. Rabies is endemic to Morocco.
Symptoms and effects Initial symptoms are pain or tingling at the site of the bite with fever, loss of appetite and headache. If untreated, both ‘furious’ and less-common ‘dumb’ rabies are fatal.
Prevention and treatment People travelling to remote areas, where a reliable source of post-bite vaccine is not available within 24 hours, should be vaccinated. Any bite, scratch or lick from a warm-blooded, furry animal should immediately be thoroughly cleaned. If you have not been vaccinated and you get bitten, you will need a course of injections starting as soon as possible after the injury. Vaccination does not provide immunity, it merely buys you more time to seek medical help.
Morocco has an HIV infection rate of 0.15%, primarily among men who have sex with men, sex workers and intravenous drug users.
Spreads Through infected blood and blood products; sexual intercourse with an infected partner; ‘blood to blood’ contacts, such as through contaminated instruments during medical, dental, acupuncture and other body-piercing procedures, or sharing used intravenous needles.
Primary medical care is not always readily available outside major cities and towns. Your hotel may be able to recommend the nearest source of medical help, and embassy websites sometimes list doctors and clinics. In an emergency, contact your embassy or consulate.
Pharmacies These are generally well stocked, and pharmacists can provide advice (usually in French) covering common travellers’ complaints. They can sell over-the-counter medication, often including drugs only available on prescription at home, and advise when more specialised help is needed. Double-check any unfamiliar purchases; readers have reported receiving incorrect and potentially dangerous medication for their conditions.
Doctors and clinics If you are being treated by a doctor or at a clinic, particularly outside the major cities, you will often be expected to purchase medical supplies on the spot – even including sterile dressings or intravenous fluids.
Dental care Standards are variable – Marrakshi street dentists around the Djemaa el-Fna aren’t recommended! Travel insurance doesn’t usually cover dental work other than emergency treatment.
Causes Strains of travel – unfamiliar food, heat, long days and erratic sleeping patterns – can all make your body more susceptible to an upset stomach.
Prevention Water is generally safe to drink in cities, but elsewhere you should only drink treated water. Eat fresh fruits or vegetables only if they are cooked or if you have washed or peeled them yourself. Buffet meals, which may have been kept sitting warm for some time, can be risky; food should be piping hot. Meals freshly cooked in front of you (like much street food) or served in a busy restaurant are more likely to be safe. Be sensible, but not paranoid: food is one of the treats of visiting Morocco, so don’t miss out.
Hygiene Pay close attention to personal hygiene. Many Moroccan meals are eaten with the hand, so always wash before eating and after using the toilet. Even the smallest restaurant will have a sink, but soap is less common, especially at cheap hotels. Antibacterial hand gel, which cleans without needing water, is useful.
Treatment Drink plenty of fluids, and preferably an oral rehydration solution; pharmacies stock these inexpensive sels de réhydration orale. Avoid fatty food and dairy products. A few loose stools don’t require treatment, but if you start having more than four or five a day, take an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, and is accompanied by fever, shaking chills or severe abdominal pain, seek medical attention.
Causes Mosquitoes, sandflies (found around the Mediterranean beaches), scorpions (common in southern Morocco), bees and wasps, bedbugs and scabies (both found in cheaper accommodation).
Symptoms and effects More likely to be an irritant than a health risk. Sandflies have a nasty, itchy bite, and can carry the rare skin disorder leishmaniasis. Scorpions have a painful sting that is rarely life-threatening. Bedbugs lead to very itchy, lumpy bites. Tiny scabies mites live in the skin, particularly between the fingers, and cause an intensely itchy rash.
Prevention and treatment DEET-based insect repellents. Spraying a mattress with an appropriate insect killer will do a good job of getting rid of bedbugs. Scabies is easily treated with lotion available from pharmacies; people you come into contact with also need treatment to avoid spreading scabies between asymptomatic carriers.
The chances of seeing a snake in Morocco, let alone being bitten by one, are slim. Nevertheless, there are a few venomous species, such as the horned viper, found in the southern desert areas. Snakes like to bask on rocks and sand, retreating during the heat of the day.
Prevention Do not walk barefoot or stick your hand into holes or cracks.
Treatment If bitten, do not panic. Half of those bitten by venomous snakes are not actually injected with poison (envenomed). Immobilise the bitten limb with a splint (eg a stick) and apply a bandage over the site, with firm pressure, similar to applying 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.
Causes Lack of oxygen at high altitudes (over 2500m) affects most people to some extent. The effect may be mild or severe, and occurs because less oxygen reaches the muscles and the brain at high altitudes, requiring the heart and lungs to compensate by working harder. There is no hard-and-fast rule as to what is too high: Acute Mountain Sickness (AMS) has been fatal at 3000m, although 3500m to 4500m is the usual range.
Symptoms and effects Symptoms of AMS usually (but not always) develop during the first 24 hours at altitude. Mild symptoms include headache, lethargy, dizziness, difficulty sleeping and loss of appetite. Potentially fatal, AMS may become more severe without warning. Severe symptoms include breathlessness, a dry, irritative cough (which may progress to the production of pink, frothy sputum), severe headache, lack of coordination, confusion, irrational behaviour, vomiting, drowsiness and unconsciousness.
Prevention If trekking, build time into your schedule to acclimatise, and ensure your guide knows how to recognise and deal with altitude sickness. Morocco’s most popular trek, to Jebel Toubkal, reaches the 4167m summit relatively quickly, so many people may suffer even mildly. The longer treks in the M’Goun Massif also reach heights of around 4000m. Treks in the Rif Mountains and Jebel Sarhro are considerably lower, so don’t carry the same risks.
Treatment Treat mild symptoms by resting at the same altitude until recovery, or preferably descend – even 500m can help. Take paracetamol or aspirin for headaches. If symptoms persist or become worse, immediate descent is necessary. Drug treatments should never be used to avoid descent or to enable further ascent. Diamox (acetazolamide) reduces the headache of AMS and helps the body acclimatise to the lack of oxygen. It is only available on prescription, and those who are allergic to sulfonamide antibiotics may also be allergic to Diamox.
Causes Occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt. This is particularly common in hot climates when taking unaccustomed exercise before full acclimatisation.
Symptoms and effects Headache, dizziness and tiredness.
Prevention Dehydration is already happening by the time you feel thirsty – drink sufficient water to produce pale, diluted urine. Morocco’s sun can be fierce, so bring a hat.
Treatment Consists of fluid replacement with water, fruit juice, or both, and cooling by cold water and fans. Treating salt loss consists of consuming salty fluids such as soup or broth, and adding a little more table salt to foods than usual.
Causes Extreme heat, high humidity, physical exertion or use of drugs or alcohol in the sun and dehydration. Occurs when the body’s heat-regulating mechanism breaks down.
Symptoms and effects An excessive rise in body temperature leads to the cessation of sweating, irrational and hyperactive behaviour, and eventually loss of consciousness, and death.
Treatment Rapid cooling by spraying the body with water and fanning is ideal. Emergency fluid and electrolyte replacement by intravenous drip is usually also required.
Tap water is chlorinated in Morocco’s cities and generally safe to drink – certainly safe to clean your teeth with. Elsewhere, stick to treated water – filter or purify it.
Bottled water is available everywhere, although there is an environmental cost through the mountains of discarded (and unrecycled) plastic bottles.
Off the beaten track, water drawn from wells or pumped from boreholes should be safe, but never drink water from rivers or lakes, as this may contain bacteria or viruses that can cause diarrhoea or vomiting.
Tampons and sanitary towels are widely available in Morocco, as are condoms.