Travellers

Health Information Sheets

November 2011

Travel to Areas of Disasters and Conflicts

 

Natural disasters, such as earthquakes, floods and tsunamis present significant challenges for travellers to affected areas. Many world regions also experience civil war or conflict, placing travellers and aid workers at risk of injury or violence. Visitors to these regions must carefully assess the current situation before their departure.

Check the Foreign and Commonwealth Office (FCO) website for advice before you go. This helps you assess the safety of your plans and ensures you are aware of any travel restrictions and specific security issues. Aid or relief organisations sending staff and volunteers to risk regions usually provide detailed information about safety and security. The NaTHNaC Country Information Pages should also be checked for specific recommendations about vaccination and malaria prevention.

 

Food and water hygiene:

Poor living conditions, damaged sewers, flooding and contaminated drinking water increase your risk of diarrhoea and stomach upsets. Good personal hygiene, including frequent hand-washing, is essential. Bottled water may not be available, so you must be prepared to purify water. Bringing water to a boil is the most reliable way, but this is not always practical. Chemical water purification tablets can protect against bacteria and viruses, but may not kill parasites like Giardia. Combining chemical treatment with a water filter offers good protection against bacteria, viruses and parasites.

Take a supply of diarrhoea treatments, including oral rehydration powders (e.g. Dioralyte®) and medicines to treat diarrhoea. Loperamide can be taken for short periods to control diarrhoea symptoms. You can also ask your doctor to prescribe a short course of antibiotics (usually the drugs ciprofloxacin or azithromycin) as an emergency treatment for diarrhoea caused by bacteria. If you have bloody stools and/or a fever or diarrhoea does not improve after a day of antibiotics, you must try to get medical help straight away.

Insects:

Floods and stagnant water attract insects and can increase your risk of illnesses like dengue fever and malaria which are spread by mosquitoes. You should follow insect bite avoidance advice carefully.

Rabies:

There is likely to be large numbers of stray animals, especially dogs, in the aftermath of any disaster or conflict. This increases your risk of rabies. Emergency rabies vaccine products are often in short supply or completely unavailable, so get advice about the rabies vaccine course before you go.

If an animal bites or scratches you, or licks a cut/open skin; immediately wash the wound or exposed area thoroughly with soap and lots of water, apply disinfectant and get urgent medical attention, even if you have had the full vaccine course.

Snakes:

Snakes may have been disturbed after natural disasters – try to avoid any contact. If you are bitten, get urgent medical attention.

Antimalarial tablets and vaccines:

See your GP, practice nurse or travel clinic as soon as you know you are travelling. You may need malaria tablets and vaccines - even last minute advice is valuable.

If malaria is a risk, it is essential you get the correct tablets for your destination. Specific guidance on malaria regions is available from NaTHNaC’s Country Information Pages. Insect bite avoidance is crucial - no malaria tablet gives 100% protection and many other insect-spread diseases are not prevented by injections or tablets. Remember, if you have any malarial symptoms, but especially fever and/or flu-like illness, either while you are away or for up to a year after your trip, you must get urgent medical help, and tell your doctor or nurse that you have travelled.

You should be up-to-date with all vaccines normally given in the UK, including the Mumps, Measles and Rubella (MMR) vaccine.

Tetanus bacteria can be found in soil everywhere in the world. Your risk increases during emergencies, as you are more likely to get a wound contaminated with dirt. Some victims of the tsunami in South East Asia survived the disaster, only to die of tetanus-related wounds. A tetanus vaccine is recommended if you have not received one in the past 10 years. In the UK, when an adult needs a tetanus booster, a single injection combining tetanus, diphtheria and polio vaccines is given.

Hepatitis B is spread by direct contact with infected blood or body fluids. This could happen during emergency medical treatment, unprotected sex or through your work if you have contact with blood and body fluids. There is a safe, effective vaccine.

Hepatitis A, cholera and typhoid - are spread by contaminated food and water. Vaccination against hepatitis A is recommended for all travellers to risk regions. Cholera vaccine should be given to aid workers in risk areas, especially if working in refugee camps. Typhoid vaccine is particularly recommended for travel to South Asia. Good food and water hygiene recommendations should always be followed, even if you have received these vaccines.

 

Other health risks:

Your risk of injury is high after a natural disaster. Dangers include electrocution from broken power lines, injuries related to building damage and accidents due to poor road surfaces. Dust, toxic chemicals and dangerous waste can be released during disasters. Follow advice carefully and wear protective equipment as necessary. In unusual situations, such as potential biological, chemical or radiation exposures, specific guidance will be issued by the UK’s Health Protection Agency and the Foreign and Commonwealth Office.

Living accommodation may be poor. Dangerously low body temperature (hypothermia) can be a hazard if you are sleeping outside. Hospitals and clinics may be damaged and there is likely to be a shortage of drugs, dressings and equipment. You should always carry a personal first aid kit, including basic medical items. Remember, toiletries are usually hard to obtain.

Be careful if you have to wade in flood waters. As well as risking drowning, you could be injured or bitten by snakes. Cuts and grazes can get infected with bacteria in contaminated water. You should also be aware of the risk of leptospirosis in flood waters contaminated with animal urine.

Strong sunlight and high temperatures can cause heat exhaustion and sunburn. Make sure you drink plenty of non-alcoholic liquids. Avoid direct sunlight as much as possible and take a supply of high factor sun screen.

Coping:

Visiting an area after a natural disaster or humanitarian crisis with the potential loss of many lives, involves facing very difficult situations. Witnessing suffering can generate feelings of anger and helplessness that may trigger mental health issues. These can include anxiety, depression and adjustment difficulties after returning home.

 

The physical dangers associated with dealing with dead bodies, such as the risk of infection, are low. However, it can be difficult to prepare adequately for the emotional and psychological impact. Reputable aid organisations offer psychological support, including pre-trip screening and post-trip debriefing.

 

General advice:

If you want to help after an emergency, contact the appropriate aid agencies or charities for advice. If you are travelling with an aid organisation, check that they provide adequate medical insurance before you leave.

 

Going to a disaster area on your own, without proper support and training is dangerous and could put a strain on already overwhelmed local emergency and medical services. Unless you have the relevant skills and experience, the best way to help is to stay at home and become involved in supporting the relief efforts.

If you are concerned about friends or relatives that may have been caught up in a disaster, contact the FCO Consular Services 24 hour phone line (emergencies only) on 020 7008 1500.

Links:

Centers for Disease Control and Prevention: Natural Disasters.

Centers for Disease Control and Prevention: Health recommendations for relief workers responding to disasters.

Foreign and Commonwealth Office: Travel Advice.

Foreign and Commonwealth Office: When things go wrong.

Foreign and Commonwealth Office: LOCATE: register with us

Health Protection Agency: Natural Disasters.

Pan American Health Organization: Management of Dead Bodies in Disaster Situations

World Health Organization: Health Action in Crises.

World Health Organization: Natural disaster profiles.