Personal safety

Take care of your personal safety abroad

Key messages

• Travellers should take precautions to maintain their personal safety abroad.

• The Foreign, Commonwealth & Development Office advice on safety and security for the destination should be checked (ideally before booking the trip).

• Road traffic accidents are a significant cause of injury and death for travellers. These are more common in low- and middle-income countries.

• Alcohol is a frequent factor in accidents and injuries and can promote risky behaviour. Excessive alcohol use may invalidate insurance claims.

• Informal and illicit production of fake alcohol is common in many parts of the world and may be a poisoning hazard (e.g. methanol). Methanol poisoning can be fatal.

• Travel health insurance should be obtained to cover planned activities, pre-existing health problems and belongings.

Overview

Most travellers have a safe trip without experiencing problems, but basic precautions should be taken to maintain personal safety. The Foreign, Commonwealth & Development Office (FCDO) website contains destination specific safety advice. Travellers should research their destination before departure (ideally prior to booking a trip) and follow the advice. Care should be taken to look after important documents, insurance details, contact numbers and belongings. Travellers should dress and behave appropriately, avoid obvious displays of wealth and learn about local laws and customs before they travel. For example, public displays of affection are unacceptable in some regions and alcohol is banned in certain countries.

Road traffic accidents (RTAs) are a significant cause of injury and death in international travellers and young travellers are at greatest risk [1, 2]. The World Health Organization (WHO) estimates that over a million people are killed and 20-50 million people are injured worldwide every year as a result of RTAs. Most of these deaths and injuries occur in low- and middle-income countries [3, 4].

Some accidents and injuries can be prevented by careful behaviour. Alcohol may be a factor, as it can affect judgement and lower inhibitions. Ideally alcohol should be drunk only in moderation.

Risk for travellers

Transport safety

Travellers may feel safe because they are not planning to drive whilst overseas. However, they can be injured as passengers, pedestrians, or cyclists. WHO estimates that there are 1.19 million road traffic deaths each year and RTAs are the leading cause of death for children and young adults aged from five to 29 years old [5].

For drivers and passengers, factors identified as increasing risk of traffic injuries include: excessive speed, not wearing seat belts or not using child restraints, drinking and driving, two- and three-wheel motorised vehicles (motor bikes and Tuk Tuks) and not wearing helmets. Old, poorly designed and/or badly maintained roads and vehicles also contribute to RTAs [6]. Availability of emergency care, such as ambulance services and accident and emergency departments vary worldwide and can be very poor or even non-existent in low-income countries. Lack of emergency care can adversely affect the outcome of accidents or injuries [7]. Death rates after RTAs are higher in resource poor countries, with highest rates in Africa and lowest in Europe [5, 8].

Even in resource rich countries like New Zealand, foreign drivers have been identified as a major problem in rental car crashes [9]. Many hire car drivers were not used to driving on the left side of the road. Lack of familiarity with driving on the right-hand side of the road can be dangerous for UK drivers abroad. In the US, tourists were found to be at greater risk of injury from an RTA than local people [10].

Rail, air, and large cruise ship travel is usually safe. However, overcrowding, and poor maintenance may lead to unsafe conditions on many local buses and ferries.

Other safety risks

Drowning is a potential hazard associated with holiday travel. In one study looking at tourist accidents, drowning was second to RTAs as a cause of death [11].

Falls from balconies have become more common in UK travellers and can cause serious injury and death [12].

While most trips are trouble free, the FCDO reports that sexual assault of both female and male travellers is being reported more often. Unfamiliar surroundings and lack of local knowledge may increase vulnerability. Sexual assault is traumatic anywhere, but can be more difficult to deal with abroad, in unfamiliar surroundings.

Specific advice on rape and sexual assault for travellers is available from the FCDO. Returning travellers can get support and advice from their local sexual health clinic if they have not been able to access these services abroad.

Fake (counterfeit) medicines and alcohol are an issue in some countries. Poisoning is occasionally reported in travellers who have consumed local spirits spiked with methanol [13-16].

People, including British travellers, have died, or suffered serious illness abroad after drinking alcoholic drinks contaminated with methanol [15, 16].

Methanol is a clear, colourless, flammable liquid alcohol made from distilling wood. It is used in many commercial products, like antifreeze, fuel and paint thinners. It is not meant for human consumption [17].

Methanol has been used in the manufacture of fake (counterfeit) replicas of well-known alcohol brands like vodka or illegal local spirits/'bootleg alcohol'. Drinking methanol, even in very small amounts, is extremely dangerous and can cause coma, convulsions, blindness, nervous system damage and death. Symptoms are often delayed for 12-24 hours and occasionally up to 48 hours [18].

Symptoms of methanol poisoning can be similar to those of alcohol poisoning and may include:

• Confusion.
• Dizziness.
• Drowsiness or fatigue (feeling very tired).
• Vomiting.
• Changes in vision, including not being able to see, blurred vision or difficulty looking at bright lights.
• Abdominal and muscle pain.

All travellers should seek urgent medical attention if they (or anyone they are travelling with) shows signs of alcohol-induced methanol poisoning or drink-spiking [15]. See 'Know what is in your drink?' for more information about methanol poisoning.

Ayahuasca ceremonies

Ayahuasca is a traditional plant used in 'spiritual cleansing' ceremonies by some indigenous communities in South America. At these ceremonies, people drink a brew containing a hallucinogenic drug called dimethyltryptamine (DMT), a class A substance in the UK. Ayahuasca's interaction with existing medical conditions is not well understood. People have suffered serious illnesses, and in some cases death, after consuming it. Some Ayahuasca retreats are in remote areas, making it difficult to get medical help [19].

Kava ceremonies

In some South Pacific islands, a traditional drink called Kava is used in ceremonies and sometimes offered in bars and hotels [20, 21]. Kava has been associated with liver toxicity [21], including fatal liver failure, and has been banned in the UK since 2003 [22].

Carbon monoxide poisoning can be an accommodation hazard if fuels such as gas, oil, coal and wood don't burn fully. Breathing in this poisonous gas (that has no smell or taste) can make people unwell and can kill those exposed to high levels. Incorrectly installed, poorly maintained or poorly ventilated household appliances such as cookers, heaters and central heating boilers are the most common causes of accidental exposure to carbon monoxide.

When the overseas deaths of British nationals are analysed, the same trends are seen. Deaths from natural causes (such as heart disease) are most common with those from accidents and injuries second most common [11, 23]. Travellers should make sure that any pre-existing medical conditions are evaluated and stable prior to their trip.

Before travel

FCDO advice on specific risks should be consulted before travel. Travel insurance is likely to be invalidated (cancelled) if visiting a country contrary to FCDO advice. Travellers should research their destination and cultural sensitivities and pack appropriate clothing. Consider if other equipment will be necessary such as car seats for children. Carrying a medical/first aid kit tailored to the destination is worthwhile.

It is sensible to take photocopies or scan in travel documents, passports and emergency contact details and store in a place away from the originals and/or store online in a secure place. Family/friends should be kept informed of travel plans.

Travel health insurance should be obtained; the FCDO website contains advice on what the policy should cover. Travellers should be aware that pre-existing health conditions and certain activities such as adventure sports may be excluded unless they have been specifically mentioned to the insurance company.

If visiting European Union (EU) or European Economic Area (EEA) countries UK travellers can apply for a free UK Global Health Insurance Card GHIC (EHIC arrangements expired on 31 December 2020). A GHIC allows UK travellers access to state emergency healthcare in EU and EEA countries, at a reduced cost, or sometimes for free. However, a GHIC is not an alternative to travel insurance.

Consider packing a carbon monoxide monitor which has been approved to the latest British or European Standard (BS Kitemark or EN50291). These are available from DIY or hardware stores.

During travel

Travellers should be aware of the risks and follow the common sense precautions outlined below:

• Check the tyres, brakes, lights and safety belts on any hire vehicle and use vehicle safety belts and child safety restraints (take these from UK if necessary). Never exceed local speed limits.
• Avoid driving or being driven at night, especially in areas with poor roads and lighting, where possible.
• Be aware of local traffic patterns even if walking or cycling.
• Avoid travelling alone at night unless you are sure of the area.
• Wear a helmet if riding a horse, bicycle or motorbike.
• Consult with a reputable source (e.g. airport or hotel information, restaurant) for a reliable taxi service.
• Consider obtaining safety statistics for your airline, cruise ship, or for driving in your destination country (see resources below).
• Drink alcohol responsibly and be aware of your limits.
• Never accept drinks from strangers, including free "shots" in bars, or leave your drink unattended and make sure all drinks are prepared in front of you.
• Always buy alcoholic drinks from a reputable vendor and check bottle seals are intact. Take extreme care when buying spirit-based drinks. Bottles may appear to be genuine when they're not, and labels may not be accurate. If the price of alcohol looks too good to be true, it probably is. Check branded products; do not purchase products with labels that are poorly printed or with typographical errors.
• Contaminated drinks can include:
• Local spirits.
• Free "shots" of spirits.
• Spirit-based drinks, such as cocktails.
• Brand name alcohol - criminals may make counterfeit replicas of well-known alcohol brands containing high amounts of methanol [15].
• Never drink and drive or swim after drinking.
• Dress modestly and avoid wearing expensive jewellery or clothing that attracts attention. If appropriate, use a safe to store valuables.
• Remain vigilant at all times with money and other valuables.
• Be aware of scams and be cautious of strangers approaching you in the street. It is generally advised not to resist muggers.
• Check fire exits in discos, clubs and hotels.
• Avoid sharing rooms with strangers and try to book accommodation ahead.
• Check locks work properly.
• Seek reliable local advice on avoidance of marine or land animal hazards and safe places to swim.
• Check water depth before diving (feet first, first time) and avoid swimming alone.
• Supervise children at all times in and near water.
• NEVER dive into a swimming pool from a balcony.
• Avoid contact with fresh or salt water known to contain harmful algae (sometimes called blue-green algae). The algae can produce toxins that make people and animals sick. Follow local authority safety guidance.
• Remember when you are abroad, you need to obey the laws of the country you are in, which may be very different from laws in the UK.
• Never use illegal drugs or carry them for others.

Resources

• ABTA: Staying safe on holiday
• Association for Safe International Road Travel
• Centers for Disease Control and Prevention: Harmful algal Blooms and Your Health
• Food Standards Agency: Fake alcohol
• Foreign, Commonwealth & Development Office: Support for British nationals abroad
• Foreign, Commonwealth & Development Office: Overseas road safety checklist
• Foreign, Commonwealth & Development Office: Reduce your risk from terrorism while abroad
• Foreign, Commonwealth & Development Office: Foreign travel advice
• Foreign, Commonwealth & Development Office: Taking action to prevent balcony incidents abroad
• Royal Society for Prevention of Accidents: Staying safe on holiday
• Suzy Lamplugh Trust: Personal safety advice
• Travel Aware: Travel Aware
• US Centres for Disease Control: Cruise Ship Travel
• UK Civil Aviation Authority: Passengers and public
• UK Health Security Agency: Methanol health effects, incident management and toxicology
• World Health Organization: Death on the roads