Accidents and injuries are a major cause of serious health problems abroad. About one third of a series of over 7000 medical cases reported to insurers were due to accidents. Many of these were preventable. The sense of excitement which travel induces may mean that the normal checks and precautions of everyday life are ignored. This is even more likely if influenced by alcohol.

Some of the more important risks for travellers are outlined below.

4.2  Transport

Roads: Traffic driving on the right presents a hazard to both drivers and pedestrians. It is easy to forget the direction from which traffic will be coming. Those responsible for children should take particular care.

Motor vehicles may be poorly maintained; brakes and tyres may be defective.

Driving: Other drivers may not observe rules. Even if there are no safety belt laws or speed limits in the country visited, seatbelts should be worn and speed kept to a suitable maximum and never above 70 miles an hour. Travellers should not be tempted to drive a motor cycle or moped without a helmet and adequate insurance. Any local religious and cultural rules must be acknowledged eg avoidance of sacred cows in Hindu areas. Women are not allowed to drive in certain Muslim countries. It may be more sensible for visitors to use a local driver.

Airlines: Some are safer than others (published data are available).

Ferries: Passenger ships on the whole have a good safety record; ferries, particularly in developing countries, are often overcrowded and carry inadequate lifesaving devices.

Public transport: Trains and coaches may be overcrowded; local habits such as travelling on the roofs of trains, jumping off trams and jay walking are dangerous.

4.3  Accommodation

Hotels may be built to poor standards and have inadequate fire escapes. It is a sensible precaution to note the site of emergency exits. Balconies may be unsafe and gas and electrical appliances may be in a dangerous condition.

4.4  Going out

Although muggings and murders hit the headlines, minor injury from snatching handbags and briefcases is much more common. Travellers can be easy targets by being unfamiliar with the language and surroundings and carrying more money and equipment than locals. It is best to behave in a low key manner and blend into the background, not to carry all possessions but use the hotel safe, and, if attacked, not to fight. It is sometimes wise to carry a small amount of money separately to hand over to thieves.

Many areas are not safe to wander around at night, including some which look pleasant and easy-going by day.

In some countries, producing cameras, computers or tape-recorders at the wrong time (eg near airports, railway stations) can result in arrest on suspicion of spying.

4.5  Water hazards

The dangers of water include infection as well as injury.

4.5.1  Swimming

Half the deaths due to drowning occur within two metres of safety. Local knowledge is essential to avoid dangerous currents. Diving into water of unknown depth or hazard (eg rocks) is a common cause of severe injury. One of the most dangerous dives is the running dive through surf on a gently sloping sandy beach. Children must be supervised at all times by an adult who can swim well.

Cold water is particularly dangerous and the initial physiological responses to the temperature can cause even strong swimmers to drown.

4.5.2  Infection

Visibly dirty recreational water is likely to be infected and should be avoided; also, someone in difficulties on the bottom of a murky pool may not be easily seen. Seawater is to a large extent self-cleansing, but obviously risky sites such as sewerage outlets should be avoided.

All rivers, lakes and fresh water in the tropics and sub-tropics should be assumed to be colonised with snails infected with schistosomiasis (bilharzia). The River Nile, and in Africa, Lakes Kariba, Malawi, Tanganyika and Victoria, are all infected. Wading or swimming in slow flowing rivers or lakes within endemic areas should be discouraged.

Leptospirosis can also be contracted by direct contact with water (including recreational water) contaminated by animals such as small rodents. It occurs worldwide.

4.5.3  Bites

Water is the home of many dangerous animals including sharks, crocodiles and hippopotamuses, Moray and Conger eels, groupers and garfish. Fish may also electrocute (electric eels, electric catfish, torpedo rays) or sting (weeverfish, stonefish, stingrays, scorpion fish, jellyfish, octopus). Local knowledge may help to avoid these dangers. (See Chapter 12 for more detail).

4.6  Hazardous sports and water sports

Appropriate life jackets or buoyancy aids should always be worn for sailing and windsurfing and for other water-linked sports such as angling.

Pursuits such as scuba diving, mountain climbing and hang gliding can be dangerous in unfamiliar surroundings and are best learnt in the UK before going abroad. Additional insurance may be required to cover such activities and travellers should make their insurers aware of their intention to take part in any such activities. At least 24 hours should be allowed between a dive and a flight.

4.7  Alcohol and drugs

All risks are magnified by alcohol. The general advice not to drink and drive applies as much abroad as it does at home. It is easy to drink more in a hot climate, and local drinks may be stronger than expected. There may be an expectation that over indulgence in alcohol and in some circles, drugs, are an essential part of the holiday experience. Business travellers may find that local hospitality includes potent alcoholic drinks. The possession of illicit drugs carries very severe penalties in some countries.

4.8  Political unrest

Up to date information is available from the Foreign and Commonwealth Office on areas of political unrest or terrorism (see Appendix 2, FCO website - http://www.fco.gov.uk). Information from local residents may be unreliable.

4.9  Insurance

Some countries, but by no means all, have reciprocal health care arrangements with the UK or are fellow members of the European Economic Area. Details are in the Department of Health leaflet, Health Advice for Travellers (T6). In general, they provide emergency treatment to the same standards as the local population, which may be less than we expect through our NHS; they may not cover all costs and there is no provision for repatriation of the very ill, or of human remains. Travel insurance covering both injuries and illness while travelling is therefore essential. It must be adequate in financial terms for the country or countries visited, must cover the risks of the trip and must include adequate funds for repatriation. The insurance should also include a 24-hour assistance service.