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Cambodia: Angkor Wat

Carol Ciesielski

DESTINATION OVERVIEW

Every year, more than a million tourists travel to Siem Reap, Cambodia, the gateway to the ancient Angkor temples, a collection of approximately 100 structures covering 400 km2 (150 square miles) in the northwestern Cambodia jungle. The Angkor Temple Complex is considered one of the architectural wonders of the world and, in 1992, was designated a World Heritage Site. The temples were built between the 9th and 14th centuries AD, at the height of the Khmer empire. These historical structures are decorated with intricately carved Khmer artwork depicting Hindu and Buddhist themes, providing an archaeological portrayal of the empire that ruled much of Southeast Asia for 5 centuries. After the decline of the Khmer empire, the site was largely abandoned to the surrounding jungle and remained virtually untouched until descriptions of the “lost temples of Cambodia” were published late in the 19th century. Restorations began as international visitors arrived, but the emergence of the Khmer Rouge and the ensuing decades of civil war halted most tourist travel to the site until the late 1990s. As Cambodia has emerged from more than 20 years of political and economic turmoil, the Angkor temples have become one of the most popular tourist destinations in Southeast Asia.

Cambodia is one of the poorest countries in Southeast Asia but is rapidly developing, especially with the tourist boom in its second largest city, Siem Reap. Most visitors arrive in Siem Reap via the short plane ride from Bangkok; however, flights from other Asian cities, including Singapore, Hong Kong, and Ho Chi Minh City, also serve Siem Reap. Overland travel is also possible from Bangkok and Cambodia’s capital, Phnom Penh.

Typical itineraries for visiting the Angkor Temple Complex are for 2–4 days. The temples are spread over a large area throughout the surrounding forest. The closest temple to Siem Reap, Angkor Wat, is the most famous. Other popular sites close to Siem Reap include the walled city of Angkor Thom (principally the Bayon), and Ta Prohm. These sites can get crowded, especially around sunrise and sunset. Angkor is best experienced by exploring the temples at a leisurely pace, especially in intense heat, and good walking shoes, adequate hydration, sunscreen, and insect protection are critical. The temples are several kilometers apart, ordinarily requiring some sort of transportation; the most popular are tuk-tuks or car taxis.

Map 4-09. Cambodia destination map

Map 4-09. Cambodia destination map

View Larger Map  PDF Version (printable)

HEALTH ISSUES

Immunizations

All travelers to Cambodia should be up-to-date with their routine immunizations and should be protected against hepatitis A and B and typhoid fever.

Japanese encephalitis (JE) is considered endemic throughout Cambodia; transmission occurs year-round but peaks during the May to October rainy season. The vaccine is recommended for travelers who plan to spend ≥1 month in rural areas and should be considered for short-term travelers who may be at increased risk for JE virus exposure, such as those who will spend substantial time outdoors in rural or agricultural areas, especially after dusk and during the rainy season. Travelers on a typical 2- to 4-day visit to the close-in Angkor temples, staying in air-conditioned hotels in Siem Reap, are at minimal risk, but mosquito prevention measures should be employed.

Rabies is endemic throughout Cambodia. For most travelers on a short tour of the temples, the risk is minimal. The chief risk is from dog bites, but the many monkeys and other wildlife around Angkor should be avoided. The Pasteur Institute in Phnom Penh can provide rabies vaccine and consultation.

Although yellow fever is not a disease risk in Cambodia, the government requires travelers arriving from countries with a risk of yellow fever virus transmission to present proof of yellow fever vaccination.

Other Health and Safety Risks

Travelers’ Diarrhea

Diarrhea and foodborne infections in travelers are common in Cambodia. Avoid water that is not bottled, ice, and food from street vendors. Safe, bottled water is readily available. Travelers should practice safe food and water precautions (see Chapter 2, Food & Water Precautions) and carry an antibiotic for self-treatment (see Chapter 2, Travelers’ Diarrhea for self-treatment recommendations).

Dengue

Dengue is endemic throughout Cambodia, with large epidemics every several years. Peak transmission occurs during the rainy season, although cases occur year-round even in non-epidemic years. Travelers to Cambodia should take measures to protect themselves from daytime mosquito bites to prevent dengue (see Chapter 2, Protection against Mosquitoes, Ticks, & Other Insects & Arthropods).

Malaria

The highest risk of malaria infection for the traveler in Cambodia is in forested areas. There is little to no transmission of malaria around Angkor Wat, Tonle Sap Lake around Siem Reap, and Phnom Penh. On a typical 2- to 4-day visit that involves exploring the close-in temples during the day and staying in an air-conditioned hotel in Siem Reap at night, malaria risk is minimal. However, mosquito protection measures should still be employed. Travelers planning to visit the more remote temples deeper in the forest, especially in the early morning and evening, should consider malaria chemoprophylaxis. The recommended chemoprophylaxis regimen for Siem Reap Province is atovaquone-proguanil or doxycycline.

Transportation

Driving in Cambodia is chaotic at best and is a rapidly rising cause of injury and death to passengers and pedestrians. In addition to the ever-growing number of cars and motorcycles, there is lax enforcement of traffic laws and scant understanding of rules of the road. Travelers should carefully look in every direction before crossing the street in Siem Reap. During the rainy season, road conditions deteriorate rapidly. Most travelers use tuk-tuks, which are readily available, or hire cars with a driver guide to tour the temples. The fare should be negotiated at the outset. For those who, in spite of the risk, end up riding on the back of a tuk-tuk, wearing a helmet is essential.

Safety

While in Siem Reap, travelers should use common-sense measures such as not walking alone at night. The most common type of theft is “snatch and grab” robbery. Travelers should keep belongings out of sight if traveling via tuk-tuk and carry items and bags away from the street side while walking.

Land Mines

Land mines and unexploded ordnance from the decades of conflict are still found in rural areas in Cambodia, including those located in Siem Reap Province. Given the millions of visitors to the Angkor Temples in the past decade, Siem Reap town and the areas around the popular temples appear to be low risk. However, it is wise to exercise caution, especially when venturing out to the more remote temples and forest, by staying on roads and paths and using a guide with knowledge of local hazards. Travelers should not touch anything resembling a mine or unexploded ordnance; if these items are observed, the Cambodia Mine Action Center should be notified.

Counterfeit Drugs

Local pharmacies provide a limited number of prescription and over-the-counter medications, but because the quality of locally obtained medications can vary greatly, travelers should bring an adequate supply of medications. Counterfeit drugs are commonly found and are often indiscernible from authentic medication.

Climate

Siem Reap has a tropical climate and is generally hot throughout the year. The hottest months are March through May, and heat precautions should be taken when exploring the temples from midmorning to midafternoon, especially during these months. Many travelers explore the temples in the early mornings and late afternoon, taking a midday break in the comfort of an air-conditioned restaurant. Rainy season is from late April or early May through October or November. During this time, risk of vectorborne disease transmission increases.

Medical Care

Medical facilities and services in Cambodia do not generally meet international standards. A few internationally run clinics and hospitals in Siem Reap can provide basic medical care and stabilization. Some information on health facilities and pharmacies in Siem Reap can be found on the website for the US Embassy in Phnom Penh. For anything other than basic care and stabilization, most travelers should seek medical care in Bangkok or Singapore. For this reason, travel health insurance that includes medical evacuation insurance should be strongly considered.

BIBLIOGRAPHY

  1. Behrens RH, Carroll B, Hellgren U, Visser LG, Siikamaki H, Vestergaard LS, et al. The incidence of malaria in travellers to South-East Asia: is local malaria transmission a useful risk indicator? Malar J. 2010;9:266.
  2. Embassy of the United States, Phnom Penh, Cambodia. Medical services in Cambodia. Phnom Penh: US Department of State; 2012 [cited 2012 Sep 26]. Available from: http://cambodia.usembassy.gov/medical_information.html.
  3. Ledgerwood J. Landmines in Cambodia. DeKalb, IL: Northern Illinois University [cited 2012 Sep 26]. Available from: http://www.seasite.niu.edu/khmer/Ledgerwood/Landmines.htm.
  4. Ly S, Buchy P, Heng NY, Ong S, Chhor N, Bourhy H, et al. Rabies situation in Cambodia. PLoS Negl Trop Dis. 2009;3(9):e511.
  5. Rogers WO, Sem R, Tero T, Chim P, Lim P, Muth S, et al. Failure of artesunate-mefloquine combination therapy for uncomplicated Plasmodium falciparum malaria in southern Cambodia. Malar J. 2009;8:10.
  6. Touch S, Hills S, Sokhal B, Samnang C, Sovann L, Khieu V, et al. Epidemiology and burden of disease from Japanese encephalitis in Cambodia: results from two years of sentinel surveillance. Trop Med Int Health. 2009 Nov;14(11):1365–73.
  7. US Department of State. Cambodia country specific information. Washington, DC: US Department of State; 2012 [cited 2012 Sep 26]. Available from: http://www.travel.state.gov/travel/cis_pa_tw/cis/cis_1080.html.
  8. World Health Organization. Cambodia. Geneva: World Health Organization; 2012 [cited 2012 Sep 26]. Available from: http://www.who.int/countries/khm/en/.
  9. World Health Organization. Cambodia. In: World Malaria Report 2011. Geneva: World Health Organization; 2011 [cited 2012 Sep 26]. p. 98. Available from: http://www.who.int/malaria/publications/country-profiles/profile_khm_en.pdf.
 
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