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Iraq



Capital: Baghdad

Time Zone: +3 hours. No daylight savings time in 2008.
Tel. Country Code: 964
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). United Kingdom Style Adaptor Plug. Grounding Adaptor Plugs C, D and F.


Travel Advisory - Iraq

There is a low risk of malaria in North Africa and the Middle East, but other insect-transmitted diseases, such as leishmaniasis and viral infections, are potential threats. Safe water precautions, safe needle, and insect-bite prevention measures are important.

Dr. Rose Recommends for Travel to Iraq


Resource Links

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World Health Organization
CDC
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Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies


• U.S. citizens may contact the consular section of the U.S. Embassy in Baghdad, Iraq located in the International Zone via their e-mail address at usconsulbaghdad@state.gov; via landline at 1-240-553-0589 (this number rings in Baghdad); or the U.S. Embassy's website at http://iraq.usembassy.gov. The after-hours number in case of extreme emergency is GSM 1-914-822-1370 or Iraqna 07901-732-134.

Canadian diplomatic and consular matters for Iraq are handled by the Canadian Embassy in Amman, Jordan.
• Embassy of Canada
Abdalhameed Shoman Street
Pearl of Shmeisani Building
Amman, Jordan
Tel: [962] (6) 520 3300
Fax: [962] (6) 520 3396
E-Mail: amman@international.gc.ca
Website: http://www.amman.gc.ca

• British Embassy
International Zone
Baghdad
Consular Section
Ocean Cliffs (opposite Al Rasheed Hotel, International Zone)
Baghdad
Tel: [964] (0) 7901 911 684
During Embassy working hours
[964] (0) 7901 360 9060 or [964] (0) 7901 935 149
Consular: +1 914 360 9060 or +964 7901 935 149
E-mail: britishconsulbaghdad@yahoo.co.uk
Website: www.britishembassy.gov.uk/iraq

Entry Requirements

HIV Test: Testing required for visits lasting 5 days or more. Contact the Iraqi Embassy in Washington (202-483-7500) for details.

Required Vaccinations: A yellow fever certificate of vaccination is required for all travelers arriving from a yellow-fever-infected area in Africa or the Americas.

Passport Information

Passport/Visa: Passports valid for at least six months and visas are required for most private American citizens. An Iraqi visa may be obtained through the Iraqi Embassy in Washington D.C. Travelers should not rely on obtaining a visa upon arrival at an airport or port of entry in Iraq. Visitors to Iraq who plan to stay for more than 10 days must obtain a no-fee residency stamp. In Baghdad, the stamps are available for all visitors at the main Residency Office near the National Theater. Contractors in the International Zone may also obtain exit stamps at the Karadah Mariam Police Station (available Sunday and Wednesday, 10:00-14:00.). There is a 10,000 Iraqi Dinar (USD 8) penalty for visitors who do not obtain the required residency stamp. In order to obtain a residency stamp, applicants must produce valid credentials or proof of employment, two passport-sized photos, and HIV test results. An American citizen who plans to stay longer than two months must apply at the Residency Office for an extension. American citizens who stay fewer than 10 days may obtain an exit stamp at the airport. Americans traveling to Iraq for the purpose of employment should check with their employers and with the Iraqi Embassy in Washington, DC for any special entry or exit requirements related to employment. American citizens whose passports reflect travel to Israel may be refused entry into Iraq or may be refused an Iraqi visa, although to date there are no reported cases of this occurring.

EXIT REQUIREMENTS: U.S. Citizens who remains longer than 10 days must obtain an exit stamp at the main Residency Office before departing the country. In Baghdad, they are available for all visitors at the main Residency Office near the National Theater. Contractors in the International Zone may also obtain exit stamps at the Karadah Mariam Police Station (available Sunday and Wednesday, 10:00-14:00). Exit stamp fees vary from USD 20 to USD 200, depending on the length of stay, entry visa and other factors. Those staying fewer that 10 days do not need to get an exit stamp before passing through Iraqi Immigration at the airport. Visitors who arrive via military aircraft but depart on commercial airlines must pay a USD 80 departure fee at the airport (Note: For information on entry requirements for other countries, please go to the Entry/Exit Requirements section in the Consular Information Sheet for the country you are interested in. You may also contact the U.S. embassy or consulate of that country for further information.

Visit the Iraqi Embassy web site at http://www.iraqiembassy.org for the most current visa information. The Embassy is located at 1801 P Street NW, Washington, DC 20036; phone number is 202-483-7500; fax is 202-462-5066.

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

Polio: one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).


Rabies: Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection.

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL and Boostrix are new tetanus-diphtheria-pertussis (Tdap) vaccines that not only boost immunity against diphtheria and tetanus, but have the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccines can be administered in place of the Td vaccine when a booster is indicated.

Typhoid: Recommended for all travelers.

Yellow Fever: Travelers >1 year of age entering the country from an infected area are required to present a certificate of immunization against yellow fever.

Hospitals / Doctors

Basic modern medical care and medicines are not widely available in Iraq. The recent conflict in Iraq has left some medical facilities non-operational and medical stocks and supplies severely depleted. The facilities in operation do not meet U.S. standards, and the majority lack medicines, equipment and supplies. Because the Baghdad International Airport has limited operations for security reasons, it is unlikely that a private medical evacuation can be arranged.
• All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available or be of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance.

Destination Health Info for Travelers

AIDS/HIV: The prevalence of HIV in the Middle East is estimated at 0.4%. As in other regions, known high-risk groups in the Middle East include men who have sex with men, female sex workers and their clients, injecting drug users and prisoners. The quality of the available data, however, is seriously lacking. No country in the Middle East conducts systematic surveys of groups at high risk of infection.
• The development of AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.

Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.

Avian Influenza A (Bird Flu): Since November 2003, the World Health Organization (WHO) has confirmed human cases or deaths from avian influenza in Azerbaijan, Bangladesh, Cambodia, China, Djibouti, Egypt, Indonesia (including Bali), Iraq, Laos, Burma, Nigeria, Pakistan, Thailand, Turkey and Vietnam. The WHO has not advised against travel to any of the affected countries.

The country’s first human fatality with the H5N1 avian influenza virus occurred in 2006. A suspected case of H5N1 avian influenza in birds was reported in Mar 2008 from Al-Fedagiya village in the Fao area. Avian influenza H5N1 virus, excreted in the droppings of infected birds, is endemic in Iraq.
• Avian influenza A (H5N1) is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.

• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of influenza A (H5N1) in birds, including those countries which have reported associated cases of human infection.
To date, no cases of avian influenza A (H5N1) illness have been identified among short-term travelers visiting countries affected by outbreaks among poultry or wild birds.

The usual vaccines against influenza are not protective against bird flu. Oseltamivir (Tamiflu) is somewhat effective in the treatment of avian influenza A (H5N1). It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe cases.

The World Organisation for Animal Health (OIE) has confirmed cases of avian influenza in birds in a number of countries throughout the world. For a list of these countries, visit the OIE website: http://www.oie.int/downld/avian%20influenza/A_AI-Asia.htm

Cholera: This disease is reported active in this country, with multiple outbreaks, reflecting a widespread breakdown in water safety and sanitation. Nine provinces have already been affected, with Babil accounting for the majority of cases, followed by Baghdad and Kerbala. Other provinces in which cholera cases have been reported include Anbar, Basra, Diala, Diwanyia, Misan and Najaf.
Source: WHO: http://www.who.int/csr/don/2008_09_29c/en/index.html
Although this disease is active in this country, most travelers are at low risk for infection. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)

Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic in the Middle East. A prevalence of 17.5% anti-HEV antibodies has been reported in Iraqis in the northern Kurdish region. An outbreak of hepatitis E was reported in September 2004 from Sadr City in Baghdad and from Mahmudiya, a town south of Baghdad. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals may serve as a viral reservoir. In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 4% to 7%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic with a prevalence of 0.5% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Leishmaniasis: Leishmaniasis is widespread in Iraq, but mostly as cutaneous leishmaniasis (CL). The peak transmission season typically begins in May. Currently, the disease continues to spread in the southern province of Qadisiyah, about 130 km (81 mi) south of Baghdad, with at least 275 cases in 2008; sixty-three of these cases were visceral leishmaniasis (kala-azar), the remaining 212 cases CL.
• The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite in the evening and at night and are usually found in forests, the cracks of stone or mud walls, rubbish heaps, and animal burrows. Since 2003, when the conflict began, the destruction of public health and sanitation systems has resulted in an increase in sandfly activity and subsequent disease transmission. Cutaneous leishmaniasis is not fatal, but can cause facial lesions and crater-shaped sores, leaving patients seriously disfigured. Kala-azar can be fatal, and causes fever, weight loss, anemia, and swelling of the spleen and liver.
• All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.

Malaria: Malaria occurs in northern Iraq. Risk areas include rural and urban areas in the northern
provinces of Dahuk, Ninawa, Irbil, Tamin, and As Sulaymaniyah below 1,500 meters elevation. Small, scattered, sporadic outbreaks probably occur in the southern and central areas from the Tigris-Euphrates River basin to the border with Iran. Nearly all cases of malaria in Iraq are currently of the vivax variety. Chloroquine-resistant falciparum malaria has not been reported. There is no malaria in Baghdad.
Chloroquine prophylaxis is recommended in endemic areas.

A malaria map is located on the Fit for Travel website (www.fitfortravel.nhs.uk), which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Iraq page on the Destinations menu or A-Z Index.

Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in malaria endemic areas of this country.
• Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.

Other Diseases/Hazards: Boutonneuse fever (infrequently reported)
• Brucellosis (usually transmitted by raw goat or camel milk)
• Crimean-Congo hemorrhagic fever (tick-borne; the virus is also transmitted through exposure to livestock)
• Dengue fever (may occur in southern regions)
• Echinococcosis (carried by stray dogs; reported sporadically from rural and urban areas)
• Measles (outbreaks reported)
• Relapsing fever (louse-borne; endemic in northern Iraq)
• Sand fly fever (risk may be limited to the southwestern border with Saudi Arabia)
• Typhus (flea-borne; sporadic cases in southern areas)

Rabies: Rabies is transmitted by jackals, foxes, and stray and sometimes viscous dogs. Pre-exposure rabies vaccine is recommended for travel longer than 3 months, for shorter stays in rural when travelers plan to venture off the usual tourist routes and where they may be more exposed to the stray dog population; when travelers desire extra protection; or when they will not be able to get immediate medical care.
• All animal bite wounds, especially from a dog, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment, regardless of your vaccination status. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Even if rabies vaccine was administered before travel, you will need a 2-dose booster series of vaccine after the bite of a rabid animal.

Schistosomiasis: Risk occurs near the Tigris and Euphrates Rivers, especially in the central regions. No transmission occurs south of Basra. Schistosomiasis is transmitted through exposure to contaminated water while wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection.
• All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: High risk. There is a high incidence of shigellosis and salmonellosis in this country as well as outbreaks of an acute watery diarrheal syndrome. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetables. Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.

Tuberculosis (TB): Tuberculosis is highly endemic in Iraq with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.

Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended for all people traveling to or working in Iraq, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.