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Health

Due in part to its dryness and relative isolation, your chances of getting seriously ill with a virus or other infectious disease in Iran are fairly small.

The most common reason for travellers needing medical help is as a result of accidents. If you are unfortunate enough to need a hospital, Iran is home to some of the best in the Middle East. Many doctors have been trained in Europe or North America and, especially in the larger cities, you shouldn't have too much trouble finding one who speaks English. In remoter areas, medical facilities are more basic.

Planning trip
A little planning before departure, particularly for preexisting illnesses, will save you trouble later. See your dentist before a long trip; carry a spare pair of contact lenses and glasses (and take your optical prescription with you); and carry a first-aid kit. Many vaccines don't ensure immunity for two weeks, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you have received. There are no compulsory vaccinations for entering Iran but it is a good idea to be vaccinated against tetanus, typhoid, meningitis, polio, diphtheria and hepatitis A. For a long stay consider vaccinations against tuberculosis. While yellow fever is not a problem in Iran, if you are arriving from a country where it is a problem you might be asked to show proof of yellow fever vaccination before you are allowed in the country.

Travellers can register with the International Association for Medical Advice to Travellers (IAMAT; www.iamat.org). Its website can help travellers to find a doctor with recognised training.

Bring medications in their original, clearly labelled, containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician's letter documenting their medical necessity.

Insurance
Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health costs, because banking sanctions mean it will be very difficult for insurers to pay doctors direct in Iran. It's also worth ensuring your travel insurance will cover repatriation home or to better medical facilities elsewhere, if necessary. Your insurance company might be able to locate the nearest source of medical help, but it's faster to ask your hotel or, in an emergency, call your embassy or consulate. Travel insurance usually covers emergency dental treatment.

Not all insurance covers emergency aeromedical evacuation home or to a hospital in a major city, which may be the only way to get medical attention for a serious emergency.

Recommended Vaccinations
The World Health Organization recommends that all travellers regardless of the region they are travelling in should be covered for diphtheria, tetanus, measles, mumps, rubella and polio, as well as hepatitis B. While making preparations to travel, take the opportunity to ensure that all of your routine vaccination cover is complete. However, in Iran outbreaks are rare.

Availability & Cost of Health Care
There are few, if any, reciprocal medical arrangements between Iran and other countries so be prepared to pay for all your medical and dental treatment. The good news is that costs are negligible. The quality of hospitals varies from place to place, but in Tehran, Esfahan and Shiraz, in particular, you will find international-standard hospitals and well-trained doctors. Wherever you are, locals will direct you to the nearest and/or most appropriate treatment centre.

Every major hotel in the main Iranian cities has doctors or paramedics on call. Tourists should be aware that US embargo could be problematic for credit-card payments.

Medical care is not always readily available outside major cities. Medicine, and even sterile dressings or intravenous fluids, may need to be bought from a local pharmacy, which are usually very well stocked. Nursing care may be limited or rudimentary as this is something families and friends are expected to provide.

Standards of dental care are variable and there is an increased risk of hepatitis B transmission via poorly sterilised equipment. Note that few dentists operate during the 28 days of Ramadan. Travel insurance usually only covers emergency dental treatment.

Infectious Diseases
The following infectious diseases are present in Iran, but reports of travellers being infected are extremely rare.

Diphtheria
Diphtheria is spread through close respiratory contact. It causes a high temperature and severe sore throat and, sometimes, a closure of the throat requiring a tracheostomy to prevent suffocation. Vaccination is recommended for those likely to be in close contact with the local population in infected areas. The vaccine is given as an injection alone, or with tetanus, and lasts 10 years.

Hepatitis A
Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, can cause prolonged lethargy and delayed recovery. Symptoms include dark urine, a yellow colour to the whites of the eyes, fever and abdominal pain. Hepatitis A vaccine (Avaxim, VAQTA, Havrix) is given as an injection: a single dose will give protection for up to a year while a booster 12 months later will provide a subsequent 10 years of protection.

Hepatitis B
Infected blood, contaminated needles and sexual intercourse can all transmit hepatitis B. It can cause jaundice, and affects the liver, occasionally causing liver failure. All travellers should make this a routine vaccination. The vaccine is given singly, or at the same time as the hepatitis A vaccine (hepatyrix). A course will give protection for at least five years. It can be given over four weeks, or six months.

HIV
HIV remains mercifully rare in Iran but the growing use of prostitutes and, more problematically, the large number of intravenous drug users, means the HIV rate is rising. For some longer-term visa types Iran requires a negative HIV test.

Malaria
Malaria is present in some areas, such as Sistan and Baluchestan, southern Fars and Khuzestan, particularly in summer. Check with your doctor about which anti-malarial drugs to take, and make sure you have insect repellent with you. Mosquito coils and the like can be purchased everywhere. Still, it's worth knowing that malaria almost always starts with shivering, fever and sweating. Muscle pains, headache and vomiting are common. Symptoms may occur anywhere from a few days to three weeks after the infected mosquito bite. The illness can start while you are taking preventative tablets if they are not fully effective, and may also occur after you have finished taking your tablets.

Rabies
Rabies is present in Iran and any dog bites or licks on broken skin should be treated with suspicion, as rabies can be fatal. Few dogs in Iran are kept as pets,so they are not domesticated in the same way as in Europe or North America. In particular, avoid sheepdogs as they are trained to see off unwelcomed guests. Stand still and if necessary make as if you are throwing a stone in their direction, shouting angrily.

Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of post-bite vaccine is not available within 24 hours. If you are bitten, regardless of whether you have been vaccinated or not, wash the wound in soap and water, apply antiseptic and seek medical help as soon as possible. Three injections are needed over a month. If you have not been vaccinated you will need a course of five injections starting within 24 hours of the injury. Vaccination does not provide immunity; it merely buys more time to seek appropriate medical help.

Tuberculosis
Tuberculosis (TB) is found in Iran, especially in the southeast. TB is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccine is recommended for those likely to be mixing closely with the local population, though it is not a guarantee against infection.

Traveller's Diarrhoea
While water is safe to drink almost everywhere in Iran, avoiding tap water unless it has been boiled, filtered or chemically disinfected can help you avoid diarrhoea. Freshly prepared meals are best, while pre-prepared dishes like khoresht should be avoided by those with fragile stomachs.

If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing lots of salt and sugar. A few loose stools don't require treatment, but if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, is accompanied by fever, shaking, chills or severe abdominal pain you should seek medical attention.

Heat Illness
Heat exhaustion occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt, and travellers will be especially susceptible during Iran's oven-hot summers, particularly if you are engaging in a greater level of exercise than you usually would. Be especially careful on desert treks out of places like Yazd.

Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty - aim to drink sufficient water such that you produce pale, diluted urine. Electrolyte replacement sachets are the easiest and fastest way to treat dehydration; they are available in Iran, though it makes sense to carry them from home. Alternatively, fluid replacement with water or fruit juice or both, and cooling by cold water and fans is recommended. The treatment of the salt loss component consists of salty fluids as in soup or broth, and adding a little more table salt to foods than usual.

Heatstroke is much more serious. This occurs when the body's heat-regulating mechanism breaks down. An excessive rise in body temperature leads to sweating ceasing, irrational and hyperactive behaviour and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is an ideal treatment. Emergency fluid and electrolyte replacement by intravenous drip is usually also required.

Insect Bites & Stings
Mosquitoes may not carry malaria but can cause irritation and infected bites. Using DEET-based insect repellents will prevent bites. Mosquitoes also spread dengue fever. Bees and wasps only cause real problems to those with a severe allergy (anaphylaxis). If you have a severe allergy to bee or wasp stings you should carry an adrenaline injection or similar.

There are plenty of scorpions in Iran's deserts and they can cause a painful bite, though contrary to popular misconception, they are rarely life threatening.

Mercifully, Iran doesn't seem to suffer too badly from bed bugs, though occasionally they do pop up in hostels and cheap hotels. They lead to very itchy, lumpy bites. Spraying dubious-looking mattress with insecticide will help get rid of them, or use a sleep sheet.
Scabies might also be found in cheap accommodation. These tiny mites live in the skin, particularly between the fingers. They cause an intensely itchy rash. Scabies is easily treated with lotion available from pharmacies; people who you come into contact with also need treating to avoid spreading scabies between asymptomatic carriers.

Water
Tap water is safe to drink and clean teeth in major cities of Iran, though many travellers stick to bottled water, which is widely available. Do not drink water from rivers or lakes as this may contain bacteria or viruses that can cause diarrhoea or vomiting.

In many of the smaller towns, the water comes directly from the qanat, which are fed by melt water and is therefore relatively safe. However, in out-of-the-way places and in the heat of summer it is better to take proper precautions.

Travelling with Children
All travellers with children should know how to treat minor ailments and when to seek medical treatment. Make sure the children are up to date with routine vaccinations, and discuss possible travel vaccines well before departure as some vaccines are not suitable for children aged under one year old.

If your child is vomiting or experiencing diarrhoea, lost fluid and salts must be replaced. It may be helpful to take rehydration powders for reconstituting with boiled water.

You won't see many dogs in Iran, but if you do, children should avoid them, and other mammals, because of the risk of rabies. Any bite, scratch or lick from a warmblooded, furry animal should immediately be thoroughly cleaned. If there is any possibility that the animal is infected with rabies, immediate medical assistance should be sought.

Women's Health
Emotional stress, exhaustion and travelling through different time zones can all contribute to an upset in the menstrual pattern. If using oral contraceptives, remember some antibiotics, and diarrhoea and vomiting can stop the pill from working and lead to the risk of pregnancy. Apart from condoms, you should bring any contraception you will need. Tampons are almost impossible to find in Iran, but sanitary towels are available in cities.

Travelling during pregnancy is usually possible but be sure to have a check-up before embarking on your trip. The most risky times for travel are during the first 12 weeks of pregnancy, when miscarriage is most likely, and after 30 weeks - most airlines will not carry a traveller more than about 32 weeks pregnant. Antenatal facilities vary between cities in Iran and there are major cultural and language differences. Taking written records of the pregnancy, including details of your blood group, are likely to be helpful if you need medical attention. Ensure your insurance covers pregnancy, delivery and postnatal care.

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