Chapter 10 Popular Itineraries Africa & the Middle East

Ann M. Buff and Erik J. Reaves

DESTINATION OVERVIEW

The Arab Republic of Egypt covers a land area of approximately 1 million km2, the same size as Texas and New Mexico combined; >95% of the country is desert. With an estimated 95 million people, Egypt accounts for one-fourth of the Arab world’s population. Egypt has long been considered the cradle of civilization, and may be the oldest tourist destination on earth. Throughout the world, Egypt is synonymous with the legends of the Pharaohs, the Great Pyramids, treasure-laden tombs, and hieroglyphs. Travelers visit Egypt to see ancient monuments and timeless river vistas along the Nile Valley. However, since the 2011 Arab Spring revolution and ongoing civil unrest, tourism has declined sharply, and travel in certain parts of the country is officially prohibited for tourists due to safety concerns.

A typical visit to Egypt includes arrival in the capital city of Cairo, the largest city in Africa and the Middle East, with a population of 19 million. Considered the “Mother of the World” by Arabs, Cairo today is a modern, cosmopolitan mix of Arab, African, and European influences. Travelers generally spend at least a few days in Cairo seeing the Egyptian Antiquities Museum, Pyramids at Giza, Citadel and Mosque of Al-Azhar, and Khan al-Khalili bazaar.

Most travelers include an Upper Nile River cruise as part of their itineraries. Nile River cruises are usually 3–7 days, with embarkation in either Luxor or Aswan. Even before 2011, riverboats did not sail through Middle Egypt because of security concerns; therefore, most travelers take short domestic flights or trains from Cairo to Luxor or Aswan. Approximately 200 riverboats are based on the Nile, and the average boat accommodates 120 passengers. The largest boats accommodate upwards of 300 passengers; chartered yachts might have just a few cabins. Riverboats have a range of accommodations from basic to 5-star luxury, and nights aboard are generally spent cruising from one port to the next.

Virtually all Nile cruises sail between Luxor and Aswan. There are 3 typical Nile cruise itineraries: a 3-night cruise from Aswan to Luxor (or the reverse), a 4-night cruise from Luxor to Aswan (or the reverse), and a 7-night cruise roundtrip from Luxor or Aswan (see Map 10-16). A standard itinerary is as follows:

• Day 1: Fly from Cairo to Aswan or Luxor. Stay in a hotel for the first night, or board the boat directly, and spend the afternoon and early the next morning visiting the sites (High Dam and Philae Temple in Aswan or Karnak Temple, Luxor Temple, Valley of the Kings, and Hatshepsut Temple in Luxor).
• Days 2–6: Visit the temples of Edfu, Esna, and Kom Ombo, and enjoy the passing riverside scenes of ancient villages, minarets, traditional feluccas, and farmers in galabiyas. Most travelers have breakfast aboard and then depart the boat for sightseeing early in the day to avoid the crowds and heat. Most travelers will be back aboard by mid-to-late afternoon. Dinner and entertainment follow in the evening.
• Final day: Disembark and return to Cairo or travel to a Red Sea resort.

Egypt is also a beach destination, with thousands of miles of Mediterranean and Red Sea coastlines. Alexandria, Egypt’s second largest city, with 5 million people, is located on the Mediterranean Sea and has a string of beaches and seafood restaurants. The World War II battlefield of El-Alamein lies along the Mediterranean coast, and divers will find an array of sunken cities and wartime wrecks to explore offshore. Egypt’s Red Sea coast has reefs offshore, with diving and snorkeling traditionally centered in Hurghada.

Edged by coral reefs and teeming with tropical fish, the Sinai Peninsula has excellent diving, snorkeling, and beaches; Sharm el Sheikh is the most developed and visited area of the Sinai. Visits to Mount Sinai (7,497 ft [2,285 m] above sea level) and Saint Catherine’s Monastery in the mountainous interior are popular destinations, especially with religious pilgrims. Adventure travelers favor desert jeep safaris and camel treks to remote oases and spectacular wadis. Travelers start in Cairo or Assyut and follow the “Great Desert Circuit” through 4 oases and the White Desert. Tourists might be banned from travel to remote locations, including the interior of the Sinai Peninsula, for safety reasons. Military and police road checkpoints are common, and security services enforce official travel restrictions.

HEALTH ISSUES

In addition to being up-to-date on routine vaccines, hepatitis A and B and typhoid vaccines are recommended for travelers to Egypt. Hepatitis C virus infection and hepatitis B virus infection are major public health problems. Travelers should be cautioned to protect themselves from all bloodborne pathogens by avoiding unprotected sex, invasive medical and dental procedures, injection drug use, and tattooing. Modern hospitals and clinics cater to the expatriate communities in Cairo and Alexandria and to tourists in the Red Sea resort areas.

Travelers’ Diarrhea

In most large international tourist hotels, the tap water is adequately chlorinated, but bottled water is generally provided for drinking. Tap water is not safe to drink in other locations. Eating thoroughly cooked meat and vegetables in tourist hotels, on Nile River cruise ships, and in tourist restaurants is generally safe. Eating raw or undercooked ground meat or shellfish should be avoided. As in many developing countries, the safety of uncooked vegetables and salads is questionable. The risk of diarrhea in Egypt is high. Clinicians should consider prescribing an antibiotic for travelers to Egypt to empirically self-treat diarrhea.

Schistosomiasis

Schistosoma mansoni and S. haematobium are endemic in Egypt. Travelers to Egypt should avoid wading, swimming, or other contact with freshwater, including the Nile River and irrigation canals. Swimming in saline pools of desert oases, chlorinated swimming pools, the Mediterranean Sea, or Red Sea does not pose a risk for acquiring schistosomiasis.

Rabies

As in most other developing countries, rabies is endemic throughout Egypt. For most travelers on a package tour, the risk will be minimal. However, travelers should be aware that there are large numbers of stray dogs and cats in urban and tourist areas, and should be advised to avoid contact with domestic or wild mammals. Rabies vaccine is available for preexposure and postexposure prophylaxis; human rabies immune globulin (HRIG) is also available (see Chapter 4, Rabies). Rabies vaccine and HRIG are imported.

Environmental Concerns

Temperature and weather conditions vary widely in Egypt. The desert is extremely hot in summer (>100°F; >38°C) and can be cold in winter (<32°F; <0°C). Thirst is a late indicator of dehydration, and travelers should drink fluids regularly in the heat. Because sweat evaporates immediately, people can become dehydrated without realizing it. Travelers who are elderly or take diuretic, anticholinergic, or neuroleptic medications are at increased risk of heat-associated illnesses. To stay cool and protect themselves from sun exposure, travelers should wear a hat and lightweight, loose-fitting clothing, as well as use sunscreen.

Sandstorms occur sporadically in the desert. Desert sand, dust, and smog can cause eye irritation and exacerbate asthma or other lung disorders. Travelers who wear contact lenses should ensure that they pack eyeglasses and contact lens care supplies.

Motion Sickness

Generally, the Nile is a slow, smooth river. However, the combination of diesel fuel, heat, and motion can cause distress for travelers. Most travelers do not consider the possibility of motion sickness on a river, so they are unprepared. Onboard medical services vary greatly. Travelers who know that they are sensitive to motion should carry anti–motion sickness medication.

Insects

Mosquitoes and other biting insects can be problematic for travelers. Avoiding insect bites will prevent local discomfort and irritation and reduce the risk of vectorborne diseases. Dengue has been reported rarely in travelers who visited Egypt. Although West Nile virus seroprevalence rates are high (24%) and transmission widely distributed, infections in returning travelers appear to be rare.

Isolated local transmission of malaria was last reported in Aswan Governorate in 2014. Although malaria prophylaxis is not recommended, travelers should practice insect precautions (see Chapter 3, Mosquitoes, Ticks, & Other Arthropods). Vectorborne diseases should be considered in travelers with fever returning from Egypt.

BIBLIOGRAPHY

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