Health & Safety in Egypt

Staying Healthy

Public health standards are low in Egypt, with little government investment in programs to improve it. Eating in restaurants that do not regularly serve foreign clientele or drinking water that has not come from a well-sealed bottle is asking for a bout of traveler's diarrhea or worse (including cholera and hepatitis). Most problems are easily avoided by following a few simple rules:

• Only drink bottled water. If the water doesn't taste right, even if it was unsealed in front of you, send it back and get another.

• Eat in restaurants with a high volume of foreigners whenever possible, particularly expats. Word gets around quickly when someone gets sick.

• Avoid the muddy banks of the Nile and other waterways. Schistosomiasis, or bilharzia, a parasitic disease caused by flatworms that live close to shore, remains a problem in Egypt.

General Availability of Healthcare

Contact the International Association for Medical Assistance to Travelers (IAMAT) (tel. 716/754-4883 or, in Canada, 416/652-0137; www.iamat.org) for tips on travel and health concerns in the countries you're visiting, and for lists of local, English-speaking doctors. The U.S. Centers for Disease Control and Prevention (tel. 800/311-3435; www.cdc.gov) provides up-to-date information on health hazards by region or country and offers tips on food safety. Travel Health Online (www.tripprep.com), sponsored by a consortium of travel medicine practitioners, may also offer helpful advice on traveling abroad. You can find listings of reliable medical clinics overseas at the International Society of Travel Medicine (www.istm.org).

Common Ailments

Tropical Illnesses -- There is a very limited risk of P. falciparum and P. vivax malaria in the oasis of Fayum during the summer months (June-Oct). It has been a decade since any indigenous case was reported, but you should still use a good insect repellant and a mosquito net at night if you are visiting the oasis during these months. Antimalarial medications are not recommended by the World Health Organization for tourists planning to visit Fayum.

Egypt's first confirmed case of the H5N1 strain of avian flu was back in March 2006. By July 2007, there had been 37 more cases and 15 fatalities. These outbreaks will occur periodically as long as Egypt's standards of public hygiene remain low and people and livestock intermix freely. Travelers should check the news and the websites of the World Health Organization (www.who.int/countries/egy/en) and the Centers for Disease Control and Prevention (wwwn.cdc.gov/travel/destinationEgypt.aspx) for updates before traveling. Note that in the event of a serious outbreak, acquiring Western medical supplies in Egypt would be extremely difficult.

Dietary Red Flags -- Tap water in Egypt is not potable and should be avoided. Only drink bottled water from a sealed bottle, and if you have doubts about the contents, get another one. This is not usually a problem, as upmarket and tourist restaurants will automatically provide bottled water. In private homes, you may be offered glasses of tap water. Particularly outside a big city, in any kind of rural settings, these are best politely refused.

Fresh fruit juice from the street-side juice shops are a judgment call but generally best avoided. Sniff the air inside the shop and make your choice.

Green salads are best avoided as well, even in high-end hotels. Not only are they often washed in contaminated water, but they can contain bacteria because of agricultural practices. Also avoid fruit that you have not peeled yourself, and chicken and eggs that have not been thoroughly cooked.

Bugs, Bites & Other Wildlife Concerns -- There is rabies in Egypt and care should be exercised not only with wildlife, but semi-domestic animals such as cats and dogs.

The deserts of Egypt contain a variety of poisonous insects and snakes. Take care when hiking; wear closed-toe shoes, and don't go reaching into nooks and crannies. Turn over rocks with a stick and watch where you're putting your feet. Choose your guide with care, and make sure that he has received at least basic first-aid training and knows what to do in the event of emergencies.

Mosquitoes and a variety of other biting insects may not be life-threatening, but they can certainly spoil the fun. Five-star resorts spray heavily for insects and keep rooms pristine. If you are staying in midrange or budget-range accommodations, I recommend having some good bug repellant handy, as well as a can of insecticide. It's best to bring the repellant with you, but there are a variety of lethal sprays available on the local market, including Raid.

Respiratory Illnesses -- Air quality is a serious problem in Egypt -- in Cairo, in particular. Some government sources say that the situation has improved in recent years, but levels of lead and particulate in the capital still often exceed even relatively lax domestic standards and are frequently several times the amounts considered safe under international standards. Tourists with asthma or other respiratory problems should limit the amount of time they spend in Cairo.

Sun/Elements/Extreme Weather Exposure -- Heat stroke and excessive sun are both potential problems in Egypt, particularly during the summer months. You should be prepared with sunblock, a good sun hat, and a way to replace electrolytes lost to sweating, such as oral rehydration salts, which are available over the counter at almost any Egyptian pharmacy for around LE1 (18?/9p) a dose.

AIDS -- Figures differ on the number of HIV/AIDS cases in Egypt. UNAIDS estimated there to be about 5,300 people living with HIV in Egypt in 2006. It seems likely that the number of cases is underreported, however, given the social stigma associated with AIDS, the low awareness of preventive measures among IV-drug users and other high-risk groups, and the difficulty involved in obtaining anonymous testing. Condoms are readily available in pharmacies.

What to Do if You Get Sick Away From Home

We list the best private clinics and hospitals in Cairo in the "Fast Facts" section, but keep in mind that even here, service is well below Western standards.

At any hospital in Egypt, you will be expected to pay upfront and in cash for any treatment. Keep this in mind in the event of an emergency -- arriving at the clinic with your wallet is very important.

Medicare and Medicaid do not provide coverage for medical costs outside the U.S. Before leaving home, find out what medical services your health insurance covers. To protect yourself, consider buying medical travel insurance.

Very few health insurance plans pay for medical evacuation back to the U.S. (which can cost $10,000 and up). A number of companies offer medical evacuation services anywhere in the world. If you're ever hospitalized more than 150 miles from home, MedjetAssist (tel. 800/527-7478; www.medjetassistance.com) will pick you up and fly you to the hospital of your choice virtually anywhere in the world in a medically equipped and staffed aircraft 24 hours day, 7 days a week. Annual memberships are $225 individual, $350 family; you can also purchase short-term memberships.

U.K. nationals will need a European Health Insurance Card (EHIC) to receive free or reduced-cost health benefits during a visit to a European Economic Area (EEA) country (European Union countries, plus Iceland, Liechtenstein, and Norway) or Switzerland. The European Health Insurance Card replaces the E111 form, which is no longer valid. For advice, ask at your local post office or see www.dh.gov.uk/travellers.

If you suffer from a chronic illness, consult your doctor before your departure. Pack prescription medications in your carry-on luggage, and carry them in their original containers with pharmacy labels -- otherwise they won't make it through airport security. Carry the generic name of prescription medicines in case a local pharmacist is unfamiliar with the brand name. Try to avoid buying prescription drugs in Egypt (even if they are dramatically cheaper than back home), as the quality control of drug production is not guaranteed.

Safety

Staying Safe -- One of the enormous advantages that Egypt offers visitors is that it is generally very safe when it comes to petty crime. Independent travelers and groups alike can wander at will, exploring deserted temples and crowded tourist sites without worrying about anything other than being overcharged for souvenirs and taxi rides. On the other hand, there is the potential for problems with home-grown terrorist attacks. It has been a number of years since there's been an incident in Upper Egypt, but the same is not true for the Sinai and Cairo. There were a series of shootings and bombings targeting the tourism industry in Cairo and on the Sinai Peninsula in 2005 and 2006. The government now overstates the problem in Cairo and Upper Egypt for political reasons, but it is quite possibly understating them in the medium to long term on the Sinai Peninsula. The politically and economically repressive conditions that gave rise to the 2005 and 2006 attacks have not been ameliorated, and the heavy-handed security response will probably prove counterproductive.

In terms of street crime and random violence, Egypt is a remarkably safe country. Although there is potential for violence, it takes a lot of provocation and occurs in areas and situations that tourists are unlikely to encounter.

Women in particular, however, will find themselves subject to a high level of verbal harassment in public areas. In more crowded areas, this will escalate to groping, and in less crowded areas to self-exposure.

For both men and women, personal safety is based on the usual rules. Keep away from street fights -- absent a professional civil police force, these can turn nasty quickly and tempers can run pretty hot in Egypt. It is highly unlikely for a foreigner to be consciously targeted, but collateral damage is always a possibility. Avoid badly lit, deserted places after dark. Most heavily touristed areas are fine at all times of day and night.

The threat to personal safety from political instability is low. Cairo has seen sporadic, usually low-key, demonstrations by various pro-democracy and reform groups in recent years, and these are best avoided. The government routinely deploys plainclothes operatives to harass and intimidate, and there is a very real risk to locals and foreigners alike of being assaulted by the police in the vicinity of these demonstrations. Women perceived as being involved in the demonstration are particularly at risk, as security forces have been known to sexually assault female participants as a way of discouraging further participation.

In any dealing with the police in Egypt, keep in mind that this is not the kind of coherent, professional organization that you expect in the West. Officer and management positions are assigned by social class and connection, and lower positions are not paid a living wage. Corruption is rife. If you find yourself on the wrong side of the law, do not hesitate to buy yourself out of trouble either directly or through the mediation of a lawyer. At its most basic, this will involve paying a few pounds to a traffic cop for parking your car in a no-parking zone (which is most of Cairo). For more serious problems, your focus will be getting out of the country (with the assistance of your embassy's consular section, if needed).

That said, law enforcement agencies will generally work hard to accommodate foreigners when they have a problem. Don't expect any actual police work in the event of a theft or accident, but they should be able to provide a friendly face, a glass of tea, and pro-forma services such as a police report for insurance purposes.

Drugs such as a hashish and cannabis are officially illegal, and penalties, at least in theory, are harsh. Signs at the airport warn of severe penalties for drug possession and trafficking in Egypt. In practice, the situation is a little murkier. Though it is generally only Egyptian nationals and non-tourist foreigners who get into serious trouble for drug offenses, any kind of involvement in illegalities can leave you open to blackmail and a host of other best-avoided entanglements.

The traffic is perhaps the greatest routine threat to personal safety in Egypt. Extreme care should be exercised in crossing the road and in driving. Highways are particularly dangerous, and unless you have high confidence in your driving ability, you should hire a driver from a reputable firm. Avoid driving outside the city at night.

Many governments maintain advisory pages online that provide useful, up-to-date information on everything from the potential for political instability to the latest outbreaks of avian flu. See "Travel Warnings" in the "Online Traveler's Toolbox" later in this chapter. Registration with your country's embassy in Cairo can also help consular officials warn you of problems and contact you in the event of a situation back home.

Dealing With Discrimination

Egypt remains, unfortunately, a society in which racism and sexism is both prevalent and acceptable.

Egyptians are particularly biased toward other Africans, whom they regard as inferior both socially and economically. African-American visitors, even holding their U.S. passport in their hands and speaking English, will probably find problems getting past security at some restaurants and hotels, and African-American women have reported higher-than-average levels of sexual harassment.

Asians, or people who look Asian, will find a different set of problems. Over the last 10 years, an increasing number of economic migrants from China have drawn the attention of Egyptian authorities. Generally the attitude of people in the street will tend more toward parochial curiosity than outright discrimination, but police will tend to be suspicious of independent travelers, and tourists may be subject to random document checks and searches.

There is also a degree of anti-Western feeling in Egypt, which has been substantially increased by the 2004 invasion of Iraq and subsequent "War on Terror." On the whole, however, individual Egyptians recognize the difference between government policies and the intentions of citizens, and it is unlikely that resentments will be visited on individual travelers.

Similarly, though there is a high degree of acceptance of anti-Semitism in Egypt, it is rare for it to be visited on individual Jewish people.

Clothing, not surprisingly, is a major factor in how you will find yourself being treated in Egypt. When possible, smart-casual clothes are best: dress pants and long-sleeved shirts for men, long skirts or loose pants and long sleeves for women. This, of course, isn't always practical while traveling, but men should avoid shorts and tank tops, and women will experience elevated levels of harassment in direct proportion to the amount of skin they bare.

This also applies, though to a lesser degree, in the big resort towns such as Sharm el Sheikh or Hurghada. Resorts with private beaches have rigidly enforced rules regarding local access and staff who are accustomed to Western clothing habits, but the same only applies to a limited degree on the streets outside the resort walls. Here you will be under the assumption that Westerners are rich but morally lax. This will only be intensified by low-cut shirts, shorts, or tight pants.

Note: This information was accurate when it was published, but can change without notice. Please be sure to confirm all rates and details directly with the companies in question before planning your trip.