International travel and health

Injuries and violence

Recent data indicate that just over five million people worldwide lose their lives to injuries and violence each year while hundreds of millions more are injured, some of whom are left with lifelong disabilities. Travellers may well be exposed to similar risks and are more likely to be killed or injured through violence or unintentional injuries than to be struck down by an exotic infectious disease (see “10 facts on injuries and violence” at http://www.who.int/features/factfiles/injuries/en/). Road traffic collisions are the most frequent cause of death among travellers. The risks associated with road traffic collisions and violence are greatest in low- and middle-income countries, where trauma care systems may not be well developed. Injuries also occur in other settings, particularly in recreational waters in association with swimming, diving, sailing and other activities. Travellers can reduce the possibility of incurring these injuries through awareness of the dangers and by taking the appropriate precautions.

Road traffic injuries

Worldwide, an estimated 1.2 million people are killed each year in road traffic crashes and as many as 50 million more are injured. Projections indicate that road traffic fatalities will be the fifth leading cause of death by the year 2030 unless urgent action is taken to address the issue.

In many low- and middle-income countries, traffic laws are inadequately enforced. The traffic mix is often more complex than that in high-income countries and involves two-, three- and four-wheeled vehicles, animal-drawn vehicles and other conveyances, plus pedestrians, all sharing the same road space. The roads may be poorly constructed and maintained, road signs and lighting inadequate and driving habits poor. Travellers, both drivers and pedestrians, should be extremely attentive and careful on the roads.

There are a number of practical precautions that travellers can take to reduce the risk of being involved in, or becoming the victim of, a road traffic collision.

Precautions
  • Obtain information on the regulations governing traffic and vehicle maintenance, and on the state of the roads, in the countries to be visited.
  • Before renting a car check the state of its tyres, seat belts, spare wheels, lights, brakes, etc.
  • Know the informal rules of the road; in some countries, for example, it is customary to sound the horn or flash the headlights before overtaking.
  • Be particularly vigilant in a country where the traffic drives on the opposite side of the road to that used in your country of residence.
  • Do not drive after drinking alcohol.
  • Drive within the speed limit at all times.
  • Always wear a seat-belt where these are available.
  • Do not drive on unfamiliar and unlit roads.
  • Do not use a moped, motorcycle, bicycle or tricycle.
  • Beware of wandering animals.

In addition, travellers driving vehicles abroad should make sure that they carry their personal driving licence as well as an international driving permit and that they have full insurance cover for medical treatment of injuries.

Injuries in recreational waters

Recreational waters include coastal waters, freshwater lakes and rivers, swimming pools and spas. The hazards associated with recreational waters can be minimized by safe behaviour and simple precautions.

The most important health hazards in recreational waters are drowning and impact injuries, particularly head and spinal injuries. It is estimated that more than 300 000 deaths are caused by drowning every year. In addition, many more cases of “non-fatal drowning” occur, often with lifelong effects on health.

Drowning may occur when an individual is caught in a tide or rip current, is trapped by rising tides, falls overboard from a boat, becomes trapped by submerged obstacles, or falls asleep on an inflatable mattress and is carried out to sea. In swimming pools and spas, drowning or near-drowning and other injuries may occur close to outlets where suction is strong enough to catch body parts or hair so that the head is trapped under water. Drowning in swimming pools may be related to slip–trip–fall incidents leading to loss of consciousness on impact. If the water is not clear it may be difficult to see submerged swimmers or obstacles, increasing the chances of an accident in the water.

Children can drown in a very short time and in a relatively small amount of water. The factor that contributes most frequently to children drowning is lack of adult supervision. Children in or near water should be constantly supervised by adults.

Drowning is also a hazard for those wading and fishing. Falling into cold water, particularly when wearing heavy clothing, may result in drowning as swimming ability is hampered.

Impact injuries are usually the result of diving accidents, particularly diving into shallow water and/or hitting underwater obstructions. Water may appear to be deeper than it is. Impact of the head on a hard surface may cause head and/ or spinal injuries. Spinal injuries may result in various degrees of paraplegia or quadriplegia. Head injuries may also cause concussion and loss of memory and/ or motor skills.

Drowning and impact injuries in adults are frequently associated with alcohol consumption, which impairs judgement and the ability to react effectively.

A detached retina, which can result in blindness or near-blindness, may be caused by jumping into water or jumping onto other people in the water.

Precautions
  • Adopt safe behaviour in all recreational waters: use life jackets where appropriate, pay attention to, and seek information from local residents regarding, tides and currents, and avoid outlets in spas and swimming pools.
  • Ensure constant adult supervision of children in or near recreational waters, including small volumes of water.
  • Avoid consumption of alcohol before any activity in or near water.
  • Check the depth of the water carefully before diving, and avoid diving or jumping into murky water as submerged swimmers or objects may not be visible.
  • Do not jump into water or jump onto others in the water.

Interpersonal violence

Interpersonal violence is a significant risk in many low-and middle-income countries. Of the approximately 600 000 murders each year, more than 90% occur in low- and middle-income countries. For every murder, scores of people sustain non-fatal injuries requiring medical attention, and hundreds experience more insidious forms of violence and abuse leading to long-term physical and mental health consequences, behavioural disorders and social problems. While there are no epidemiological studies to date that examine how travelling for holiday purposes may increase or reduce involvement in violence, there is emerging evidence to show how it substantially increases known risk factors for violence, including alcohol and illicit drug use among young adults.

Precautions
  • Moderate consumption of alcohol and avoid illicit drugs.
  • Avoid becoming involved in verbal arguments that could escalate into physical fighting.
  • Leave the scene if you feel threatened by the mood and tone set by other people’s behaviour.
  • Avoid going to someone else’s private home or hotel room until you know them well.
  • Be alert to the possibility of muggings during the day as well as at night.
  • Keep jewellery, cameras and other items of value out of sight and do not carry large sums of money on your person.
  • Avoid isolated beaches and other remote areas.
  • Use taxis from authorized ranks only.
  • Avoid driving at night and never travel alone.
  • Keep car doors locked and windows shut.
  • Be particularly alert when waiting at traffic lights.
  • Park in well-lit areas and do not pick up strangers.
  • Employ the services of a local guide/interpreter or local driver when travelling to remote areas.
  • Vehicle hijacking is a recognized risk in a number of countries. If stopped by armed robbers, make no attempt to resist and keep hands where the attackers can see them at all times.
Further reading

WHO information on violence and injury prevention available at: http://www.who.int/ violence_injury_prevention/en

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