The Firstaid.co.uk guide to holiday health and safety

Planning a holiday abroad can be stressful at times. There’s flights, car hire, accommodation, activities, visas, insurance, perhaps even pet sitting to arrange. We know all you want to focus on is having a great time and making your friends jealous with your Instagram posts. But there’s something else you need to add to that list – travel health and safety. Because without being healthy and safe, you can’t really enjoy your trip, can you?

This guide to holiday health and safety will cover the following:

1. Disease & immunisation
2. Animals & rabies
3. Insects
4. Injuries, illnesses and first aid
5. Sun safety
6. Crime & terrorism
7. Extreme weather/natural disasters
8. Laws & Customs
9. Disease & immunisation

While the UK has a relatively benign climate and an advanced healthcare system, in many parts of the world there is a considerable risk of contracting serious illnesses and travellers must take this risk seriously. The level of risk varies between and within countries, and extremes of development can mean some countries have very different risks to their neighbours: compare the immunisation advice for Singapore to that for Malaysia and Indonesia as an example.

In general, the longer you stay in a country the more likely you are to contract a local disease, however your geographical location and nature of your activities will make a big difference. For example, staying in a rural area with rice paddies would put you at much greater risk from mosquito-borne diseases than a city, whereas if you’re staying at a higher altitude location in the same country there may not be any mosquitos at all. Common disease vectors include biting insects, animals, unsafe drinking water, sexual contact and unsafe needles.

A few months before you travel (at least 8 weeks), book an appointment with a GP or travel clinic and arrange to have all the immunisations they recommend based on your itinerary. Some immunisations are available for free while others are not. If you want to research your destination in advance, visit the NHS fit for travel website or the Travel Health Pro website. You are unlikely to need additional immunisations for travel to Western Europe, but do bear in mind that the distribution of diseases changes continuously and climate change is having an impact. The decision in 2019 for the Foreign Office to warn travellers about West Nile virus in Greece is a good example.

Getting immunised isn’t the only step to prevent disease, and not all diseases can be immunised against. You should take measures to prevent insect bites like using insect repellent, wearing long clothing and keeping windows shut – we will cover this more, and talk about malaria, in the insects section. You should always use condoms if engaging in sexual activity with other travellers or local people, and be aware of the prevalence of HIV in particular in your destination.

Avoid risky behaviours, like drug use, and be aware that in rural locations or countries with a weak healthcare system, needles used for basic medical care may not be safe. Should your destination have poor healthcare provision and a danger from blood-borne disease, consider taking your own sterile needles. A first aid kit fulfilling this requirement is available on our website.

Animals & Rabies

Rabies

Although many of us have a soft spot for animals, especially cats and dogs, travellers should be aware that both wild and domestic animals can pose dangers which we’re unaccustomed to in the UK. The most serious and widespread danger travellers are likely to encounter in many countries (especially in Africa, Asia & Latin America) comes from rabies, which is capable of infecting all mammals including foxes, monkeys, cats and dogs. This can then by transmitted to humans via a bite, scratch or lick of broken skin. Because they’re so common, live in close proximity to humans and are present as strays in large numbers in many countries, dogs account for up to 99% of human rabies cases. However, in 2018 a Briton died after contracting rabies from a cat in Morocco.

Once symptoms develop, rabies is untreatable and almost always fatal. It is, therefore, extremely important to seek professional medical attention if any mammal bites you, scratches you or licks an area of broken skin in a country with a known rabies risk. You will be started on a course of rabies vaccines across two weeks as well as receiving a rabies immune globulin shot. This is a considerable inconvenience but will save your life if you did contract rabies.

Although a vaccination for rabies is available (in a course of 3 doses usually over 28 days), you must still seek medical attention if you may have been exposed to rabies, as the vaccine simplifies treatment but doesn’t by itself protect you against the disease. For this reason, you should still take preventative measures.

It cannot be emphasised enough: if you’ve been harmed by an animal, you cannot wait for signs of illness to develop. If you have been bitten or scratched, follow these steps:

• Immediately clean the wound with soap and running water for several minutes
• Disinfect the wound with an alcohol or iodine-based disinfectant and dress the wound if possible
• Go to the nearest medical facility as soon as possible and explain that you have been bitten or scratched. Do not wait until you have returned to the UK

You can learn more about rabies on the NHS website.

Preventing animal bites

The best way to ensure an animal doesn’t bite or scratch you is not to touch or provoke them. However it is not always possible to avoid contact with animals in countries with a rabies risk – even some wild animals are so accustomed to humans that they may interact with you if you are nearby – temple monkeys in India are one example. It is unwise to act aggressively towards or run away from these situations, as it may incite the animal to bite you.

Dogs are, as mentioned previously, by far the most likely vector for rabies transmission. Dogs, especially stray dogs, are present in large numbers (and often poorly controlled) in both rural and urban environments in many countries – but you cannot assume that pets are safe either. The safest course of action is to avoid voluntary contact with dogs (and cats etc.), and ensure your children do the same, and stay away from them where possible.

Stray dogs, however, can be a particular danger, especially when in pack. They also tend to follow people around without encouragement and may attack without provocation. Asides from the risk of rabies, an attack by a large dog or a pack of dogs can pose significant danger to life, especially when children are involved.

Bear in mind that rabies itself causes aggression and if a dog appears to be acting strangely, give it an extremely wide berth. If a dog runs towards you, stay still and keep quiet. Let it sniff you, and when it walks away, walk away slowly and quietly in the opposite direction. If you see a pack of dogs ahead of you, take a different route to avoid them where possible. If you are approached by a pack of dogs do not act aggressively or run away from them as they may chase or attack you. Beware of dogs when jogging or cycling for the same reason. Dogs are often more active in the evening and at night.

While wild animals and stray cats and dogs pose the biggest danger of biting you and carrying rabies, please bear in mind that just because an animal is owned, it does not mean it is either well-behaved or rabies-free. Furthermore many owned animals are not trained, looked after or socialised as well as we expect in the UK. Pet dogs are often left to wander the streets and fend for themselves, meaning there may be little difference between owned and unowned animals. In any case, even pets may attack without warning. Ask yourself if petting any animal in a foreign country is worth the risk of ruining your holiday – the answer is probably no. Take particular care with your children around animals.
For tips from the WHO on avoiding dog bites, click here.

Wild animals

Here in the UK we’re not accustomed to there being any danger when we step out of our towns and cities and into the wilderness. However in many countries this isn’t the case. Dangerous animals can be found in the sea, rivers and lakes, rural locations and even urban homes – basically, some countries are like Australia!

Dangers to be aware of may include:

• Venomous snakes, spiders, scorpions and sea creatures
• Sharks
• Crocodiles and alligators
• Large predators (lions, leopards, bears, wolves etc.)
• Large herbivores (elephants, hippopotamuses, wildebeest etc.)

Some common-sense can help ensure you stay safe:

• Swim only in designated areas and take heed of warnings
• Do not walk through dense vegetation and long grasses barefoot, in sandals or in shorts
• Avoid wandering alone in areas known to have dangerous animals
• Stay in your vehicle in safari/national parks & obey the instructions of guides
• Do not attempt to approach or touch wild animals

There have been incidences reported in the media of people attempting to do things like pet wild lions on the head. Please do not do this. In general, if you aren’t sure whether an animal is dangerous or not, don’t go near it.

Insects

Biting or stinging insects are both a major annoyance and a carrier of some serious and unpleasant illnesses, whilst stings can be painful, and for some, can trigger a life-threatening allergic reaction. Insects to watch out for include bees, wasps, hornets, horseflies, midges, mosquitos and ticks.

Mosquitos are the ones you’re most likely to encounter and be bitten by, and that’s because they’re everywhere and they want to feed on your blood. Mosquito bites are often itchy and unsightly, and in many places, they can make you seriously ill, as mosquitos can carry a wide range of unpleasant diseases including malaria, dengue, yellow fever, Zika fever, chikungunya, Japanese encephalitis and West Nile virus. These are all things you can do without.

It is difficult to avoid being bitten completely but there are measures you can take to lower your risk:

• Cover exposed skin by wearing trousers and long-sleeved tops
• Wear shoes outdoors instead of sandals or flip-flops
• Apply insect repellent containing 50% DEET to all exposed skin
• Keep windows shut unless they have a mosquito screen
• Sleep under a mosquito net
• Keep a fan directed at you when indoors, as mosquitos find it difficult to fly in the turbulence created
• Stay indoors at dusk and dawn
• Wear light-coloured clothing outdoors

Check which mosquito-borne diseases are prevalent in your destination before travelling.

Malaria

Malaria is one of the best known mosquito-borne diseases, and can be fatal if untreated. As this map from the WHO shows, malaria is present in many regions of the world, especially in the tropics, with Europe, Canada, Russia, the US and Australasia being the main exceptions.

Symptoms usually appear from 7 to 18 days after infection and include a high temperature, fever, headache, muscle pains, diarrhoea and vomiting. For some countries, your healthcare professional may recommend that you take antimalarial tablets. These can reduce your chances of infection significantly but not eliminate it: there is no vaccine for malaria available. Find out more about preventing malaria here.

Injuries, illnesses, hygiene and first aid

Many travellers sustain injuries while they’re abroad, though these are usually minor. There’s lots of factors that make this more likely compared to when you’re at home – unfamiliar places, different driving habits, drinking, taking part in activities and lower safety standards or levels of economic development (litter, uneven and broken pavements, etc.) can all play a part in getting hurt while on holiday.

The first thing to be aware of is that wherever you are travelling, you should always have at least a basic travel insurance policy. This includes while you’re travelling to the EU & EEA: although British citizens are entitled to European Health Insurance Cards (at the time of writing), this doesn’t necessarily mean your treatment will be free. In non-EEA countries, medical treatment could run into the thousands – especially if you require evacuation back to the UK.

Taking some basic pharmaceuticals and first aid supplies will enable you to treat minor injuries and things like insect bites without having to take time out of your trip to visit a local doctor or pharmacy, which can be expensive, difficult and time-consuming. Here are some first aid & healthcare essentials we recommend:

• Antihistamine cream – this can reduce irritation from nettle stings, insect stings and bites. If you have been bitten by mosquitos this can be a real godsend
• Antiseptic cream – Used on bites, stings, cuts and grazes, this can help prevent infections. Particularly useful if you sustain a wound which gets dirty or is from a dirty object, or which is then submerged in untreated water
• Non-prescription painkillers (Ibuprofen, paracetamol)
• Moist wipes – Sterile wipes can be used directly on a wound while non-sterile wipes should only be used to clean the area around it
• Plasters
• Wound dressings
• Blister plasters
• Bandages
• A tick remover –if you’re spending time in grass or woodlands in temperate countries in the northern hemisphere
• Hand sanitiser
• Pocket tissues

This travel first aid kit is a good low-cost starting point for meeting your health needs on a regular 1-2 week holiday. If you’re travelling longer-term or doing more adventurous activities like trekking, we recommend a more comprehensive kit.

Remember that for minor wounds, infection is a far greater danger to your health and wellbeing than the injury itself. It’s therefore important to clean (and disinfect when necessary) and cover wounds properly.

If you are planning on taking any prescription medicines abroad, particularly any drugs including opioid analgesics, such as codeine and Tramadol, research the drug importation policies of the country you’re visiting first. In many countries, drugs that are widely available in the UK are subject to strict controls and without receiving the necessary permits before travelling, you could find yourself in legal trouble.

Illnesses and hygiene

We’ve already discussed diseases & immunisations, but less serious illnesses are also common when travelling abroad. Many of these are related to your stomach. Travelling across the world exposes us to large amounts of novel bacteria and unfortunately hygiene standards don’t match up to what we’re used to in the UK in many places. In a large number of countries drinking water isn’t safe. You can reduce your risk of contracting travellers’ diarrhoea, food poisoning and other illnesses with these steps:

• Avoid drinking tap water or brushing your teeth with it unless you know it is safe to do so
• Drink bottled, filtered, boiled or chemically treated (i.e. with water purification tablets) water. Check the seals on bottled water before purchasing as in some countries bottles may be refilled with tap water and passed off as mineral water
• Avoid having ice in your drinks
• Avoid salads & uncooked fruits and vegetables unless you wash them in clean water yourself
• Avoid food that’s been allowed to stand at room temperature in warm environments or exposed to flies
• Avoid unpasteurised dairy products
• Avoid raw or undercooked seafood or shellfish
• Be wary of food from street traders
• Wash/sanitise your hands after going to the toilet and before preparing or eating food

Even if you eat in expensive restaurants, there’s no guarantee that food won’t have been contaminated during preparation. It’s probably best to travel with over-the-counter diarrhoea medicine and consult a pharmacist or doctor if you feel seriously ill.

It’s also worth noting that in many places, any toilets you can find may lack paper and soap and be less hygienic than you might hope for. Having some tissue paper and sanitiser in your bag when you’re out all day can really help. You may find that chain restaurants and coffee shops are your best bet for a clean toilet, especially if you’d prefer a western-style toilet. Wet wipes are also useful for general cleanliness and comfort.

Sun safety

The need to either cover up or use sunscreen during summer and in warmer climes may seem obvious, but we may sometimes underestimate the strength of the sun when we’re at altitude, closer to the equator, swimming in the sea or even surrounded by snow.

Remember the strength of the sun’s rays isn’t linked to temperature and you don’t have to be hot to get burned. At high altitudes, there’s less atmosphere to absorb solar radiation which means you get a higher dose. Snow reflects UV light back at you, as does water. You’re also not immune from being burned if it’s cloudy – 80% of UV radiation penetrates clouds.

You also need to bear in mind that if you’re swimming, even if the sunscreen says it’s waterproof or water resistant, it’s very likely that your sun protection will be impaired, so you should be careful not to spend too much time in the water and reapply your sunscreen once you get out and dry off.

Your destination will affect the amount of UV radiation you’re likely to be exposed to. Although sunburn is a danger in northern latitudes during the summer, UV radiation is strongest nearer the equator because ozone in these areas is naturally thinner. These countries also tend to be sunnier and experience less seasonal variation – none at all at the equator, where you’ll get wet and dry seasons rather than warm and cold. The tropics experience high levels of UV year-round so whenever you visit, be prepared.

While fair skin tones are most at risk of sunburn (and longer term effects of overexposure to sun, such as skin cancer), many people with darker skin tones are still at risk, particularly in tropical countries. Those accustomed to the UV levels in the UK may underestimate their risk and neglect to use sunscreen. Generally speaking, the darker your natural skin tone the more time you can safely spend in the sun, but it’s better to be safe than sorry.

Crime and terrorism

There is no place in the world that is 100% safe, and depending on where you go, you may be less likely to be a victim of crime abroad than you are in your home town or city. The UK is nonetheless fortunate in that it has a lower rate of crime, political instability and terrorism than many other countries. It is important to understand the safety risks in the country you are visiting and take appropriate action. This may mean behaving differently to how you would at home, being extra vigilant and avoiding some areas and situations.

The government’s foreign travel advice is a good starting point for learning about the potential dangers you could encounter in a country (as well as giving you invaluable information about visas, local laws and customs, etc.). The level of danger can vary significantly within a country and their travel advice reflects this.

For example, while most of the country is deemed safe, there are travel warnings in place for selected regions of Turkey due to political instability/violence and the Foreign Office advises against all travel within 10km of the Syrian border. Despite this, many places in Turkey are popular tourist destinations and are very safe for foreign travellers. In some cases there may be travel warnings in place for an entire country – generally you’re unlikely to plan holidays to these countries, but in any case we suggest you take the government’s travel warnings seriously.

While some places are known for specific crimes or dangers, ranging from pick pocketing to armed hijacking, the following general tips can help you prepare for your trip:

• Monitor local news whilst abroad; situations can develop quickly
• Avoid demonstrations
• Be aware of restrictions on photography; there may be laws against taking photos of military facilities, personnel, police, government buildings, airports etc.
• Avoid walking alone after dark, particularly in quiet areas and away from tourist infrastructure
• Only take official taxis/those booked via apps and make sure you can identify the driver
• Avoid carrying large amounts of cash and be aware of your surroundings when using ATM machines
• Keep money, travel documents, expensive electronics & jewellery etc. hidden from sight or locked in a safe in your room
• Be careful not to get lost and stray into dangerous areas. Always plan your outings ahead of time
• Research where you’re visiting to see if there are some areas you should avoid. For example, many tourists visit Rio de Janeiro but you should avoid the favelas. More affluent neighbourhoods tend to be safer
• Do not resist if someone attempts to rob you, especially if they are armed
• Report all crimes to local police
• Research local scams and be savvy. Be wary of people approaching you on the street without good reason, and if something sounds too good to be true, it usually is
• Be aware of corruption. People wearing police uniforms are not always trustworthy – in some places they may not even be real police officers. If you believe a police officer is attempting to extract a bribe from you, tell them you are going to speak to your embassy. This usually acts as a deterrent
• Do not leave drinks unattended
• Lone female travellers should be extra cautious and vigilant

Remember that as a foreign tourist, you are a particularly attractive target for many criminals. Always be vigilant and attentive with your belongings.

There is a risk of terrorism in many parts of the world, including the UK. Unfortunately, there is no way of predicting such an eventuality, but you’re advised to:

• Stay vigilant and keep a watch for suspicious behaviour, vehicles or packages (unattended bags etc.)
• Familiarise yourself with emergency exits in buildings and public transport

Attackers may use bombs, guns, knives or vehicles. If you get caught up in an attack, the official advice is to:

RUN

• Run if there is a safe route
• Insist others go with you
• Don’t let them slow you down
• Leave your belongings behind

HIDE

• If you can’t run, hide
• Find cover from gunfire
• Be aware of your exits
• Lock yourself in a room if you can
• Move away from the door
• Be very quiet and turn off your phone
• Barricade yourself in

TELL

• Call the police when you are safe
• Give your location
• Describe the attacker
• Prevent others from entering the area if you are able to do so safely

Click here for an official guidance leaflet from the UK counter-terrorist police.

Extreme weather & natural disasters

Although extreme weather events and natural disasters are unpredictable, the risk varies widely around the world and it may be worth researching these risks ahead of your journey. Consider:

• Active volcanoes
• Tectonic fault lines (risk of earthquakes)
• Seasonal extreme weather (hurricanes, monsoon rains, tornadoes)
• Heatwaves
• Snow cover/extreme cold

For example, if you’re planning a trip to the Caribbean, you should be aware of the fact that the hurricane season runs from June to November and peaks in August, September and October. You may wish to consider travelling outside of this time.

Laws & Customs

The world is home to a wide variety of laws, cultures and political systems. Many things which are legal and deemed socially acceptable in the UK are illegal or controversial abroad. It is important to obey local laws and respect local customs when in public, or you could find yourself in legal trouble or even in physical danger.

You should take steps to understand these laws and customs before travelling. For example, when driving in France your car must contain warning triangles, hi-vis jackets for each occupant, and a French government certified breathalyser. All mobile phone hands-free and Bluetooth devices are also banned, as are speed camera detectors.

Some other areas where there might be legal and cultural differences that could catch you out include:

• The purchase and consumption of alcohol
• Public displays of affection
• How you dress
• Attitudes and laws regarding premarital sex, gender and sexuality
• Freedom of speech, including on social media
• Religious freedom
• Freedom of movement (some areas may be restricted or politically sensitive)

What is considered legal and acceptable varies significantly across the world. In Thailand, tattoos of the Buddha can be considered offensive, while in Malaysia tourists have been arrested for posing naked on a sacred mountain. In Dubai a British woman was recently arrested for making social media posts about Emirati residents whilst still in the UK.

In conclusion…

At the end of the day, travelling abroad is brilliant. There are many places which are beautiful and very safe to visit and most of the millions of trips abroad Britons make each year are largely trouble-free. But preparation is important to make sure your trip goes smoothly and is an enjoyable one, so it is definitely worth doing your research and taking the steps you need to protect your health. Alternatively you may find that some countries, due to cultural or other considerations, aren’t right for your holiday, and you’ll end up picking somewhere that is, which is no bad thing.

Wherever you go, we hope you have a great time!