With Dr Felicity Nicholson. For up-to-date information on health issues across Africa, click here.
Travelling in the developing world presents different issues regarding health compared with Western countries. By taking sensible precautions you can greatly reduce your risk of catching any serious disease, and visitors to Sudan are unlikely to encounter any medical problem more acute than a bout of travellers’ diarrhoea. That said, you should seek up-to-date advice at least two months before travelling to ensure that you have all necessary immunisations and anti-malarial drugs before departure.
Hepatitis A vaccine (Havrix Monodose or Avaxim) comprises two injections given about a year apart, though you will have cover from the time of the first injection. The course typically costs £100 and, once complete, gives you protection for 25 years. The vaccine is sometimes available on the NHS. Hepatitis B vaccination should be considered for longer trips (two months or more) and by those working in a medical setting or with children. The vaccine schedule comprises three doses taken over a six-month period, but for those aged 16 or over it can be given over a period of 21 days. The rapid course needs to be boosted after one year. A combined hepatitis A and B vaccine, ‘Twinrix’, is available, though at least three doses are needed for it to be fully effective.
The newer, injectable typhoid vaccines (eg: Typhim Vi) last for three years and are about 85% effective. Oral capsules (such as Vivotif) may also be available for those aged six and over. Three capsules taken over five days last for approximately three years but may be less effective than the injectable version. Typhoid vaccines are particularly advised for those travelling in rural areas and when there may be difficulty in ensuring safe water supplies and food.
Meningitis vaccine (containing strains A, C, W and Y) is recommended for all travellers, especially for trips of more than four weeks. A single dose of the Meningitis Menveo vaccine costs around £65 and lasts for three years. It has the added advantage over the older polysaccharide vaccine of preventing nasal carriage and therefore transmission to family and friends on return. Rabies is prevalent across Sudan and vaccination is highly recommended, especially for those travelling more than 24 hours from medical help or who will be coming into contact with animals. Pre-exposure vaccination with three doses will remove the need for part of the post-exposure treatment which is expensive and unlikely to be found in Sudan. The pre-exposure course needs to be administered over a minimum of 21 days and will cost a total of around £50.
Proof of vaccination against yellow fever is needed for entry into Sudan if you are coming from another yellow fever endemic area. It is also recommended for travellers to areas south of the Sahara Desert where there is disease unless there is a specific contraindication to the vaccine. There is no risk in the city of Khartoum. The World Health Organization (WHO) suggests that this vaccine should be taken by those over nine months travelling to Sudan, although proof of vaccination is only officially required for those over one year of age. If the vaccine is not suitable for you, then you must obtain an exemption certificate from your GP or travel clinic or if the vaccine is needed because you are travelling to risk areas then you should consider not going as yellow fever can be fatal in the non-immune individual.
Travel clinics and health information
A full list of current travel clinic websites worldwide is available on www.istm.org. For other journey preparation information, consult www.travelhealthpro.org.uk (UK) or http://wwwnc.cdc.gov/travel/ (US). Information about various medications may be found on www.netdoctor.co.uk/travel. All advice found online should be used in conjunction with expert advice received prior to or during travel.
Survival guides typically tell you what to do once you’re neck-deep in the brown stuff. This isn’t a smart position to be in. Avoiding getting into trouble in the first place is infinitely preferable.
Preparation is key. Using reliable information sources, establish where you’re going, how you’re going to get there, and how you’re going to get back. Always have a plan B. Tell this information to someone you trust. Keep your eyes and ears open and be flexible: choosing to change your plan in light of new information is much better than being forced to change it on the hop when circumstances conspire against you. Listen to your gut: evolution has given you the ‘hunch’ for a reason.
Gunfire and bombings
There is a general threat of terrorism in Sudan and both the government and foreign forces have been responsible for bomb attacks in the country in recent years. A US diplomat and embassy driver were shot dead in Khartoum in 2008, and the border with South Sudan is a known target for bombing raids purportedly targeted at militants but more often hitting civilians. Try to avoid drawing attention to yourself: don’t wear military-style clothing or anything that could be mistaken for uniform; avoid using a camera flash or any equipment that is especially shiny else it catch the light and be mistaken for a weapon firing; and consider carefully any markings on your vehicle. Words such as ‘Press’ and ‘UN’ can provide immunity but equally can make you a target.
If you are indoors and hear shots, remain in the building, lock the doors and stay away from windows. If there are a number of people inside, stay together as a group and raise the alarm by phone. If the firing comes closer, move into an internal room or under the stairs if possible. If you have time, place wet mattresses against the walls of the room you are in so as to absorb fragments of plaster and flying glass.
If you are caught outside, your first priority is to take cover. Don’t look for the person firing but move away from the sound. Keep your head down and find somewhere from where you can better assess the situation and your escape route. If you need to look out, look round not over the object you are hiding behind. Unlike in the movies, a car door will not protect you from bullets and you should avoid hiding behind a petrol tank: if it is hit it will explode. If a car is the only source of shelter, squat behind the engine block (located between the two front tyres). When you move, move individually rather than as a group and abandon any equipment that will slow your escape.
In the event of an explosion, take cover immediately. Drop to the floor if there is nothing to protect you as it reduces the likelihood of being hit by flying debris. Assess the situation and then, when it is safe to do so, move away from the sound of the bomb. Do not remain on the site, and do not stay with the crowd: there is always the threat of a second explosion.
Crowds, protests and riots
Demonstrations can occur at short notice in Khartoum and in Sudan’s other major cities and usually focus on economic or political concerns. Although they may appear peaceful there is no guarantee they will remain so, and government forces have been known to disperse crowds aggressively. The best advice is to avoid all street protest. There is no safety in numbers and even a benign-feeling crowd can swiftly attract a violent response.
If you are unavoidably caught in a riotous crowd, keep your head down and avoid confrontation. Look for a way out (even if it is into a neighbouring building) and avoid bottlenecks where there is a risk of being trampled. Remove or cover up any clothing that may be misconstrued as uniform; walk rather than run to avoid attracting unwanted attention; and remain inside your car if at all possible – it is safer to drive out than walk.
If you face armed riot forces (including police or government troops), try to get out of their way swiftly but without drawing unnecessary attention to yourself. Even if live rounds are not being fired, rubber bullets and water cannons can both cause serious injury and even death. If you cannot avoid being hit, stay low to the ground and roll into a ball with your back to the weapon. Keep your face covered with your arms.
Tear gas and pepper spray are commonly used to disperse rioters and they stick to everything. If hit, your skin and eyes will burn, your nose will run and your mouth will water. You may cough and feel incredibly dizzy. Try to keep your face covered – any scarf or item of clothing will help. If the fabric is soaked in water it will soak up some of the gas. Avoid rubbing your eyes or skin as it will make the pain worse.
The immediate effects of gas should wear off within an hour, but you still need to decontaminate your skin and clothing. You can create an effective decontaminant solution by diluting Alka-Seltzer, Pepto-Bismol, bicarbonate of soda or similar. Use it to flush your eyes, mouth and skin. Wash your hands and face as soon as possible in a detergent-free soap and change your clothes. If you were wearing contact lenses at the time of the attack, bin them and wear glasses for the next few days.
The kidnapping of foreigners is an ongoing risk in Sudan, especially (though not exclusively) in Darfur. The victims have ranged from NGO workers to engineers, and it should be noted that it is British government policy not to make substantive concessions to hostage takers else this increases the risk of further hostage taking.
It goes without saying that you should try to avoid being kidnapped in the first place. Enlist someone with local know-how to help you make travel plans, avoid drawing attention to yourself and your possessions, and be aware of new people around you. Always let someone trustworthy know where you are going and when, and update them if your travel plans change.
If you are kidnapped, the experts advise that you accept your position as prisoner and act like one – do not behave aggressively, don’t make threats or promises, and do not draw attention to yourself if you are amongst a group. Do not escape unless you are certain that you can do so safely: you may be shot or put under closer watch, making it even more difficult for any rescuers to extract you subsequently.
Try to build a rapport with your captors: you want them to recognise you as an individual person, not as ‘the enemy’ or a commodity. Talk about your children (real or imaginary) and show them any pictures you have. Be polite and make an effort to communicate, even if you don’t share the same language. Make sure you eat whenever you are offered food, ask if you need first aid or medication, and try to remain patient and optimistic. A dead hostage is worth nothing to the kidnappers, and people will be working tirelessly for your release. It may, however, take some time.
The standard of driving, vehicles and road conditions in Sudan are substantially lower than they are in Europe and the US. Consequently you are at risk of traffic accidents whether you drive yourself, hire a car and driver, or use public transport. Pedestrians and cyclists also need to be hyper-aware of other road users.
Across Sudan only major roads are tarred and street lighting is rare, as are working headlights on other vehicles. If there is a seatbelt available, wear it. Don’t use your mobile phone whilst driving (it is illegal even in Sudan) and expect a variety of vehicles (both motorised and four-legged) to approach you at speed from any angle. Keep your wits about you.
Checkpoints (both official and less-official) are a regular nuisance in Sudan, particularly close to airports and other sensitive areas. Approach them slowly and have copies of your documents easily to hand: on top of the dashboard is ideal. Deal with guards politely and be patient as they examine your paperwork, vehicle, etc. Sharing a cigarette or some sweets may speed up proceedings, as will taking tea or passing round a bottle of water (you don’t have to drink from it afterwards). If there is a problem, genuine or otherwise, try to negotiate rather than being confrontational. Make an effort to understand who is in charge and talk to him directly. If you have to make a payment, request a receipt and make the issuing officer sign it.
Car-jacking is a problem across Africa and, although currently uncommon in Sudan, it is still a possibility. Be aware of motorists around you, vary your route so it is not predictable, and if you feel uncomfortable do not stop, even at traffic lights. Do not pick up hitchhikers.
Traditional Sudanese families are very much divided on gender lines, and this influences everything from the tasks people do to who they meet with, where they sit in the home, and what they eat. Whilst foreign women are often considered as ‘honorary men’ and may be given the option to move between these male- and female-dominated spheres, foreign men are unlikely to be able to do so.
The vast majority of women travellers have favourable impressions of the country, and it is generally considered safe for single women. The threat of crime and physical harassment are relatively low, particularly compared with neighbouring countries, and Sudanese (both men and women) will often go out of their way to help a woman travelling on her own. That said, you should take the usual precautions: travel with a companion wherever possible, make sure that you are not out late at night, and dress in a manner that does not attract undue attention. If you feel uncomfortable in a situation, leave quickly and head for a well-populated place. Cafés, hotels and bus stations are ideal.
One area that does have potential pitfalls for women is the cheapest end of the accommodation market. Lokandas are based on communal sleeping arrangements, so the arrival of a female traveller (even one with a male companion) can sometimes provide managers with a headache as they wonder where they are going to put you. Most tend to have smaller separate rooms that you will be offered, though if none are available you may be turned away.
Gay and lesbian travellers
Homosexuality is illegal in Sudan and it is a capital offence for repeat offenders. Discussion of homosexuality is also taboo. Though it is not uncommon for people of the same gender to share a hotel room or to hold hands in public, gay and lesbian travellers should be exceptionally cautious when discussing their sexuality and should refrain from public displays of affection.
Travelling with children
Sudan is not an easy destination for travel with children. The heat, poor infrastructure and typically basic accommodation make it better suited for older, hardier individuals. That said, the Sudanese people are very family-orientated and sites such as the pyramids, temples and the National Museum are a fantastic way to bring history alive: children approach the royal cemeteries in particular with great enthusiasm. Find a guide who can share the most interesting (and, for the children, usually goriest) stories with you and it’ll certainly be a holiday to remember.
Bring with you all the products your children will need – items such as disposable nappies and recognised brands of baby formula are not widely available. Protect your child from the sun and make sure they keep drinking – children become dehydrated very quickly, especially if they have had an upset stomach. Hygiene is an ongoing concern, so several packets of baby wipes and alcohol hand gel will be particularly useful.
Travelling with a disability
Sudan is not really equipped for disabled travellers. It is rare to see severely disabled Sudanese in public, in part due to the shortcomings of the healthcare system, and buildings tend not to be wheelchair-accessible. Whilst you may find support at individual hotels, this cannot be counted upon when out and about or using public transport. If you are disabled and considering a trip to Sudan, it is advised you approach a tour operator, discuss your individual situation and establish what provisions, if any, can be made.