Travel health in Cambodia

Health care in Cambodia is poor. Even the best hospitals have inadequate facilities, low standards of cleanliness, and appalling patient care, so they should only be used in a dire emergency. For anything serious, if you can travel, get to Bangkok. Should you have no option but to go to a Cambodian hospital, try to get a Khmer speaker to accompany you.

In Phnom Penh and Siem Reap, a couple of private Western-oriented clinics offer slightly better care than the hospitals but at a higher cost. Wherever you seek medical attention, you will be expected to pay upfront for treatment, medication and food.

All towns have a number of pharmacies (typically daily 7am–8pm) stocking an extensive range of medications, although staff aren’t required to have a dispensing qualification. Check expiry dates before you buy anything. Fake medicines abound; unfortunately, there’s no easy way to determine if what you’re buying is the real thing. Whenever possible, buy only in Phnom Penh or Siem Reap , which have a couple of reputable pharmacies employing qualified personnel who can help with diagnosis and remedies for simple health problems.

If you’ll be travelling for an extended period, consider getting a pre-trip dental check-up. The only places to get reliable dental treatment are Phnom Penh and Siem Reap. If you wear glasses, it’s worth taking a copy of your prescription (or a spare pair of glasses); you can get cheap replacements made in Phnom Penh and Siem Reap.

Vaccinations and immunisations

It’s worth checking before you leave that you are up to date with routine immunisations, such as tetanus and diphtheria. For Cambodia, you should consider immunising yourself against hepatitis A, tuberculosis and typhoid; inoculations against hepatitis B, rabies and Japanese encephalitis are recommended if you are going to be at a particular risk (for example, if you’re working in a remote area). You’ll need to produce proof that you’ve been vaccinated against yellow fever if you arrive from an infected area (West and Central Africa or South America).

Consult your doctor or travel clinic as early as possible since completing a full course of immunisations can take up to eight weeks. All inoculations should be recorded on an international travel vaccination card, which is worth carrying with you in case you get sick.

Hepatitis

Hepatitis A, a viral infection of the liver, can be contracted from contaminated food and water – shellfish sold by hawkers and untreated water are particular risks in Cambodia – or by contact with an infected person. Symptoms include dark-coloured urine, aches and pains, nausea, general malaise and tiredness, with jaundice following after a few days. A blood test is needed for diagnosis, and rest, plenty of non-alcoholic fluids and a high carbohydrate diet are recommended for convalescence. A single shot of immunoglobulin offers short-term protection against hepatitis A.

Far more serious is hepatitis B, passed via contaminated body fluids; it can be contracted through non-sterile needles (including those used in tattooing and acupuncture), sexual contact or a blood transfusion that hasn’t been properly screened. Symptoms include nonspecific abdominal pain, vomiting, loss of appetite, dark-coloured urine and jaundice. Immunisation may be recommended if you are staying in Asia for longer than six months. If you think you have contracted hepatitis B, it’s essential to seek medical attention.

A combined vaccine is available, offering ten years of protection against hepatitis A and five years against hepatitis B; your doctor can advise on its suitability.

Tuberculosis, rabies and tetanus

Tuberculosis, contracted from droplets coughed up by infected persons, is widespread in Cambodia and is a major cause of death in children. You may have been inoculated against the disease in childhood, but if you’re unsure, consider a skin (Heaf) test, which will determine if you already have immunity.

Rabies is contracted from the bite or saliva of an infected animal. Vaccinations are recommended if you’re going to be spending a long time in rural areas, but even if you’ve been vaccinated, if you are bitten (or licked on the eyes, nose or mouth or an open wound), seek immediate medical assistance. If treated quickly, treatment is typically very effective. Once symptoms appear, rabies cannot be treated and is almost always fatal.

Tetanus is a bacterial infection that causes muscular cramps and spasms. It comes from spores in the earth and can enter the blood circulatory system through wounds and grazes. If left untreated, it can cause breathing problems and sometimes death. It’s worth checking if you’ve been vaccinated against tetanus in the last ten years and getting a booster if necessary.

Typhoid and cholera

Typhoid and cholera, bacterial infections that affect the digestive system, are spread by contaminated food and water, and outbreaks are thus usually associated with particularly unsanitary conditions.

Symptoms of typhoid include tiredness, dull headaches and spasmodic fevers, with spots appearing on the abdomen after about a week. Vaccination is suggested if you plan to stay in rural areas of Cambodia, but it doesn’t confer complete immunity, so it remains important to maintain good standards of hygiene. Outbreaks of cholera are a regular occurrence in Cambodia. Symptoms include sudden, watery diarrhoea and rapid dehydration. There is no effective vaccine, but antibiotics can treat the infection.

COVID-19

Cambodia suffered as much as anywhere else from the COVID-19 epidemic, which swept the globe in 2020. Although the virus had become endemic and was well under control at the time of writing, it is always wise to be up to date with any available boosters and to keep an eye on the news for any new variants or regional spikes in infections.

General precautions

Cambodia is a hot and humid country, and dehydration is a potential problem. Headaches, dizziness, nausea and dark urine indicate the onset of dehydration. Cuts and raw blisters can rapidly become infected and should be promptly treated by cleaning and disinfecting the wound and then applying an air-permeable dressing.

Bites and stings

Insects are legion in Cambodia and are at their worst around November, at the start of the dry season, when stagnant pockets of water are left from the rains. Even during the hot season (March–May), they come out in the evenings, swarming around light bulbs and warm flesh – they’re annoying rather than harmful, except for mosquitoes.

If you’re heading to the coast, it's a good idea to take insect repellent. Sand flies can be an issue, delivering bites that may become red and itchy; try to resist scratching.

Sun and heat

Even when the sky is overcast, the Cambodian sun is fierce, and you should take precautions against sunburn and heat stroke wherever you are. Cover up, use a high-protection-factor sunscreen, wear a hat and drink plenty of fluids throughout the day.

Hygiene and stomach complaints

Though catering facilities at many restaurants and food stalls can appear basic, the food you’ll be served is usually absolutely fresh; all ingredients are bought daily and are mostly cooked to order. When selecting a place to eat, a good rule of thumb is picking one popular with locals. Food from street hawkers is usually fine if cooked in front of you. Tap water isn’t drinkable, but bottled water is available everywhere – stick to that and be cautious with ice, which is often cut up in the street from large blocks and handled by several people before it gets to your glass (though in Western restaurants it will probably come from an ice-maker).

Stomach complaints

The most common ailment is an upset tummy. Travellers’ diarrhoea often occurs in the early days of a trip due to the change in diet, though stomach cramps and vomiting may mean food poisoning. If symptoms persist for more than a couple of days, seek medical help, as you may need antibiotics to clear up the problem.

Most diarrhoea is short-lived and can be handled by drinking plenty of fluids and avoiding rich or spicy food. Activated charcoal tablets help by absorbing the bad bugs in your gut and usually speed recovery; they’re sold across the counter at pharmacies, but consider bringing some from home. It’s often a good idea to rest up for a day or two if your schedule allows. In the event of persistent diarrhoea or vomiting, it’s worth taking oral rehydration salts, available at most pharmacies (or make your own from half a teaspoon of salt and eight teaspoons of sugar per litre of bottled water).

Unless you’re going on a long journey, avoid taking Imodium and Lomotil. These can bung you up by stopping gut movements and can extend the problem by preventing your body from expelling the bugs that caused the diarrhoea in the first place.

Dysentery and giardiasis

If blood or mucus is present in your faeces and you experience severe stomach cramps, you may have dysentery, which requires immediate medical attention. There are two forms of the disease, the more serious of which is amoebic dysentery. Even though the symptoms may recede over a few days, the amoebae will remain in the gut and can attack the liver; treatment with an antibiotic, metronidazole (Flagyl), is thus essential. Equally unpleasant is bacillary dysentery, which is also treated with antibiotics.

Giardiasis is caused by protozoa, usually found in streams and rivers. Symptoms, typically watery diarrhoea and bad-smelling wind, appear around two weeks after the organism has entered the system and can last up to two weeks. Giardiasis can be diagnosed by analysing stool samples under a microscope and is treated with metronidazole.

Mosquito-borne diseases

Given the prevalence in Cambodia of serious diseases spread by mosquitoes, including multi-resistant malaria, it is important to avoid being bitten. Mosquito nets often aren’t provided in guesthouses and hotels, so it’s worth bringing your own.

Wearing long trousers, socks and a long-sleeved top will reduce the chances of being bitten. Insect repellents containing DEET are the most effective, although you may want to consider a natural alternative such as those based on citronella.

Malaria

Malaria is prevalent year-round and can be found throughout the country, with the exception of Phnom Penh, Siem Reap and the area immediately around the Tonle Sap. There’s a high risk of malaria in northeastern Cambodia and in the central northern section of the country north of Kompong Thom between Stung Treng and Anlong Veng – if you’re travelling to these areas, anti-malarial pills are usually recommended. Malaria risks in the remainder of the country are relatively low, and antimalarials aren’t usually advised except for those with medical conditions or those spending a long time in rural areas – although it’s important to check the latest situation and seek professional medical advice before making a decision.

Malaria is contracted from the night-biting female anopheles mosquito, which injects a parasite into the bloodstream. After an incubation period of around twelve days, chills, fevers, and sweating ensue, often along with aching joints, a cough and vomiting. The symptoms repeat after a couple of days. In Cambodia, the dangerous falciparum strain of the disease predominates; if untreated, it can be fatal.

Anti-malarial medication needs to be started in advance of arriving in a risk area. Malarone (atovaquone/proguanil) and doxycycline are the two most frequently prescribed antimalarials for Cambodia. Mefloquine (Larium) is also sometimes recommended, but it has the drawback of well-publicised side effects and may not be effective in northern provinces close to the Thai border, thanks to the presence of mefloquine-resistant malaria in these areas. Note that taking antimalarials doesn’t guarantee that you won’t contract the disease, a fact that reinforces the need to avoid being bitten.

Dengue fever

Outbreaks of dengue fever occur annually in Cambodia. Spread by the day-biting female aedes mosquito, this viral disease takes about a week to develop following a bite. It resembles a bad case of flu; symptoms include high fever, aches and pains, headache and backache. After a couple of days, a red rash appears on the torso, gradually spreading to the limbs. There may also be abnormal bleeding, which requires medical attention.

No vaccine is available, and there is no effective treatment. Paracetamol can be taken to relieve the symptoms (not aspirin, which can increase the potential for bleeding), but you should also drink plenty of fluids and get lots of rest. Although the symptoms should improve after five or six days, lethargy and depression can last for a month or more – consult a doctor if symptoms persist. Anyone who has previously contracted dengue fever is at particular risk if they subsequently contract a different strain, which can result in dengue haemorrhagic fever. In this condition, the usual symptoms of dengue fever are accompanied by abdominal pain and vomiting; immediate medical help should be sought, as it can be fatal.

Zika

The Zika virus is also transmitted by the aedes mosquito. Occasional cases have been reported in Cambodia, while the disease’s presence in nearby countries, including Thailand and Vietnam, creates the potential for future outbreaks.

Japanese encephalitis

Japanese encephalitis is a serious viral disease carried by night-biting mosquitoes that breed in rice fields. The risk is highest between May and October. It’s worth considering vaccination if you will be in rural areas of Cambodia for an extended time or are visiting during the high-risk period. Symptoms, which appear five to fifteen days after being bitten, include headaches, a stiff neck, flu-like aches and chills; there’s no specific treatment, but it’s wise to seek medical advice and take paracetamol or aspirin to ease the symptoms.

Sexually transmitted diseases

Cambodia has one of Asia’s highest levels of HIV/AIDS infection, much of it the result of the country’s burgeoning sex trade. An estimated 0.6 percent of the adult population aged 15–49 carries the disease, although rates are slowly falling from a high of 2 percent at the beginning of the millennium thanks to vigorous intervention by health services. Syphilis and gonorrhoea are also rife. Condoms are widely available, although it’s best to stick to Western brands wherever possible.

Medical resources