Traveller safety in Asia

Medical matters for travellers: Delhi belly

Gastroenteritis is a common problem among travellers. The Travel Health Pro website identifies most of Asia as a high-risk area, reporting that more than 20% of travellers to the region are likely to experience gastro problems or ‘traveller’s diarrhoea’ while there. However, they noted that certain countries may not pose the same high risk. The Mayo Clinic, for example, highlights Japan and Singapore as low-risk. The groups outlined as being more susceptible to gastrointestinal issues while travelling included young adults; individuals with health conditions such as weakened immune systems, inflammatory bowel disease, diabetes, and kidney, liver, or heart disease; and those using acid-suppressing medications.

In terms of volume, the top types of claims we receive are medical, trip cancellation, and baggage claims

Dr Slabbert and Saunders said that at World Travel Protection they see gastroenteritis cases “across all areas of Asia. This occurs despite many travellers being aware of ‘Bali’ or ‘Delhi belly’ and the risks of street food, poor hand hygiene, and unbottled water.”

McCauley said that “in 2023, Bali belly accounted for almost a quarter of all claims amongst our Australian customers”.

The risk of infectious diseases

Dr Slabbert and Saunders stressed that “travellers to Asia should consider potential health risks such as infectious diseases – for example, dengue and malaria”.

Page agreed. “There are certain parts of Asia that can have a higher propensity for certain tropical diseases (dengue fever, malaria). A specific outbreak of one of these diseases would bring a higher risk to travellers.”

“Depending on the time of travel, some of these diseases can be more prevalent – for example in the wet season, when consideration should be given to malaria prophylaxis,” said Dr Slabbert and Saunders. In the last 12 months, they noted that World Travel Protection has witnessed a surge in cases of dengue fever in both Thailand and Indonesia.

According to the World Health Organization, there was a 300% rise in dengue cases in Thailand in 2023 compared with 2022

According to the World Health Organization (WHO), there was a 300% rise in dengue cases in Thailand in 2023 compared with 2022. Other countries highlighted for experiencing a high incidence of dengue cases included Indonesia, Bangladesh, the Philippines, Vietnam, Cambodia, Laos, and Nepal, particularly in the southeastern Terai region and Gandaki province.

Page concluded that “the traveller’s activity pattern can affect the likelihood of infection, however: if a traveller chooses to sit outside at night (or dusk), when disease-carrying insects are more active, they are at higher risk. The traveller who is only outside during the day, and then spends the evening indoors, faces a lower risk.”

Winter sports and road traffic accidents biggest causes of injury

Alongside gastroenteritis and dengue fever, Dr Slabbert and Saunders said World Travel Protection has seen a rise in claims due to injury. They attributed the surge in injury claims in Japan to ski-related accidents, and in Thailand and Bali to road traffic accidents involving mopeds and motorbikes.

At Southern Cross, McCauley said, “we do offer a skiing add-on and travellers are taking this up for added protection. Interestingly we’re seeing strong uptake among 18–30-year-olds when travelling to Japan, with 40% more Australian travellers taking up this option than over the same period as last year. Travellers must still meet various commitments including wearing a helmet and not skiing off-piste.”

Amber Moon, Brand Manager of Alpha Travel Insurance, pointed out that “most standard travel insurance won’t provide cover for ‘extreme’ sports as standard, so it’s something customers should consider carefully”.

Page explained: “Every policy is different: a lot of insurers will offer extreme sports coverage as an upgrade, but certain other things will be excluded. Such variations can depend on the insurer, the policy, the traveller’s age, the dates of travel, etc. Travellers really need to do their homework to make sure they understand what might be covered in a basic package, versus what’s available as an add-on.”

“In addition,” said Moon, “one thing we do see quite often is travellers in places like Thailand who rent motorcycles and then have nasty accidents (either because they have little experience or because of other road users). A customer might not consider this an ‘extreme’ activity, and riding without a helmet might not be a legal requirement in the country, but would be a requirement of their travel insurance – if it even covers motorcycling as standard.”

According to WHO’s latest report on global road safety, in 2021, Southeast Asia recorded the highest number of fatalities from road traffic accidents worldwide, making up 28% of the total global count. In 2022, the report indicates that road traffic accidents in Thailand resulted in a death toll of 17,000, with an additional 15,000 individuals sustaining life-changing injuries.

Bali is another location in Southeast Asia where road traffic accidents involving motorcyclists are frequent. According to Jasa Raharja Bali’s data, reported on Social Expat, between January and November 2023, road traffic accidents caused 425 deaths in Bali, and 3,008 injuries. In 2022, there were 68 motorbike accidents recorded involving foreign nationals.

The main factors contributing to increased deaths among tourists include driving without a licence, not adhering to driving rules and regulations, driving without a helmet, driving under the influence of alcohol, and the use of mobile phones while driving.

McCauley told us that “Asian countries in general see a high rate of moped accidents, with customers injured while riding a moped or scooter. From time to time, we have also had customers severely injured by other riders, simply while crossing a street.

“For those choosing to ride a moped, scooter, or motorbike, it is extremely important to make sure the travel insurance policy covers them for use and hire,” she said. “Customers should also be aware of local laws and regulations about moped or motorbike use – for example, whether a licence is required either in the customer’s home country or locally.

“Southern Cross offers moped and motorbike cover as an add-on. We have noted that 18–30-year-olds have the highest proportion of purchasing the SCTI moped add-on, but this does vary by destination. The top destinations for this add-on to policies are Cambodia, Vietnam, Indonesia, and Thailand.”

SCTI noted that 18–30-year-old policyholders have the highest proportion of moped claims, at 38%. “Some of the injuries received required extensive medical care,” added McCauley.

Moon told ITIJ that, for UK travellers, “a common mistake is people think they are covered to ride mopeds and scooters up to 50cc with a UK driving licence. However, if the licence was issued after 1 February 2001, you need to have taken a compulsory basic training course to be covered for medical and related expenses by your travel insurance. We always encourage customers to check their policy wordings to ensure they are covered for the use of electric scooters, as some policies exclude it,” she said.

Page concluded that “policies can be extremely extensive – and cover most activities – but it’s incumbent on the traveller to carefully read their policy to understand what might be covered as part of the basic package, as well as any additional add-ons or upgrades needed to cover the specific activities to be undertaken on their particular trip.”

Rabies risk, and a surge in animal bites

In 2021, Southeast Asia recorded the highest number of fatalities from road traffic accidents worldwide

According to SCTI’s data, in Asia, “over 1% of claims are to do with an animal, i.e. a monkey or dog bite. These types of injuries generally require medical evaluation and are likely to require a set of urgent rabies vaccinations. Comparing this with Europe, only 0.1% are animal related, with 0.2% for the USA,” said McCauley.

Dr Slabbert and Saunders noted that the majority of injury claims attributed to animal bites at World Travel Protection are “occurring in Bali due to monkey bites with subsequent rabies and animal bite infection risk”.

Policy and claims patterns

Southern Cross reported that the highest uptake of policies among their customers is for trips to Indonesia, Singapore, Japan, and Thailand.

“More than 25% of all policies sold to our New Zealand customers are for Indonesia. This is even higher among our Australian customers at 35%,” said McCauley.

She outlined the seasonal policy sales patterns, noting that Southern Cross saw a peak in sales “for Indonesia for July, while policy sales for Japan peak between September and January, reflecting Japan’s status as a key skiing destination”.

“Just under half of all SCTI policies sold across New Zealand and Australia have a travel length between two and six weeks,” she continued. “More than half of policies sold are for individuals while just under a third are for two adults.”

As favoured destinations among customers, Southern Cross’s data also highlighted Indonesia, Thailand, and Japan as the top three countries where the most claims are made against policies purchased.

“Medical claims account for more than half of all claims, with the highest proportion from China, Cambodia and Thailand,” stated McCauley.

“While we are seeing an increase in the proportion of claims from travellers to Asia where the policyholder is 41–50 years old, 18–40-year-old customers account for more than half of claims received,” she said.

At World Travel Protection, Dr Slabbert and Saunders found that most trauma injuries caused by road traffic accidents “are occurring in the age bracket of 20–40 years of age, and mostly in males”.

They told us: “Covid cases requiring assistance from World Travel Protection and often hospitalisation tend to occur in the over-50 age group. Dengue, malaria, and gastroenteritis cases are spread across all ages.

“In the older age bracket, we manage injuries occurring from slips and falls requiring hospitalisation,” they said. Regarding location, they noted that “in the over-70 age group, our cases occur in

Thailand, Singapore, and the Philippines with a decrease of cases in Indonesia. Often these travellers are visiting family or returning to visit their birthplace.

“In the 20–30 age range, there are more assistance cases occurring in Japan and Vietnam rather than Thailand and Indonesia.”

In addition, Page said: “Travellers that fall into an older age demographic are naturally going to have more underlying health issues, so it’s more likely that they could have a health-related mishap while travelling; if it’s serious enough, that could certainly lead to a claim.

“Similarly, there is a demographic of travellers that typically lead a more sedentary lifestyle but then decide, while on vacation, that they’re very interested in adventure sports activities. A drastic change in activity, like this, can cause problems,” he said.

Among elderly customers and children, Feti’a Assistance said dehydration is also a common issue.

Healthcare facilities

Considering the various potential health risks, how prepared is the healthcare sector in Asia to address these diverse concerns?

Healthcare standards vary across Asia, with quality and accessibility often differing even within countries due to factors like urbanisation, socioeconomic gaps, and governmental policies. Hong Kong, Singapore, South Korea, Japan, Taiwan and Thailand are consistently recognised for their exceptional healthcare facilities.

Dr Slabbert and Saunders explained: “Healthcare varies widely across Asia due to diverse healthcare systems. Countries like Singapore and Japan are considered to be centres of excellence with advanced healthcare infrastructure while in other countries, particularly those with popular remote destinations, care can vary and be very challenging. In these instances, it is important that World Travel Protection is notified as soon as possible about an injury or illness so that we can assess if care in location is appropriate and, if not, move the traveller to the right healthcare facility in the right timeframe to receive the right care. World Travel Protection evacuates and repatriates travellers every year requiring a higher level of care across Asia, including a high number of high-altitude helicopter evacuations in Nepal, for instance.”

Hong Kong, Singapore, South Korea, Japan, Taiwan and Thailand are consistently recognised for their exceptional healthcare facilities

McCauley agreed that the standard of healthcare “varies from city to city and country to country. Sadly, it is common for some facilities to have poor sanitation, contributing to infection, and to experience persistent power outages, affecting treatment,” she said.

Cambodia Assistance by Feti’a told us that, in Cambodia, the two main cities with higher-tier facilities are Siem Reap and Phnom Penh, “so, outside of these two main cities, we usually need to transfer patients if the symptoms are severe or if surgery or hospitalisation is needed. We can do ground ambulance, boat, or helicopter transfers. Most cases can now be handled in Cambodia, but sometimes we need to evacuate to Bangkok, Thailand.”

McCauley said: “Depending on the illness or injury, in some cases, we will work to transfer a patient to a centre of excellence such as Bangkok. This helps to avoid medical complications down the track. It can also enable easier repatriation when and if the customer is able to be transferred home to New Zealand or Australia.

“Our key piece of advice is that customers or their support person should contact their insurer as quickly as possible on admission to a healthcare facility,” she concluded.