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Travel Advisory July 31, 2023

Ethiopia - level 3: reconsider travel.

Reissued with obsolete COVID-19 page links removed.

Reconsider travel to Ethiopia due to  sporadic violent conflict, civil unrest, crime, communications disruptions, terrorism and kidnapping in border areas .

Do Not Travel To:

• Tigray Region and border with Eritrea due to  sporadic violent conflict, civil unrest, and crime .
• Afar-Tigray   border areas  due  to sporadic violent conflict, civil unrest, and crime .
• Amhara Region due to  sporadic violent conflict and civil unrest .
• Gambella and Benishangul Gumuz Regions due to  crime, kidnapping, ethnically motivated violence, and sporadic violent conflict
• Oromia Region – Specific areas due to sporadic violent conflict, civil unrest, and ethnically motivated violence.
• Southern Nations and National People (SNNP) Region due to  sporadic violent conflict, civil unrest, and ethnically motivated violence.
• Border area with Somalia due to  terrorism, kidnapping, and landmines .
• Border areas with Sudan, and South Sudan due to  crime, kidnapping, civil unrest, and sporadic violent conflict.
• Border areas with Kenya due to the potential for  terrorism and ethnically motivated violence.

The security situation in Addis Ababa is stable. However, there is sporadic violent conflict and civil unrest in other areas of Ethiopia, and the security situation may deteriorate without warning. The U.S. Embassy is unlikely to be able to assist with departure from the country if the security situation deteriorates. Due to sporadic violent conflict and civil unrest throughout parts of Ethiopia, travel by U.S. government personnel is routinely assessed for additional restrictions. Please see information on  What the Department of State Can and Can't Do in a Crisis .

U.S. officials have limited ability to provide services to U.S. citizens outside of Addis Ababa and have very limited consular access to U.S. citizens detained by Ethiopian authorities. The government of Ethiopia has previously restricted or shut down internet, cellular data, and phone services before, during, and after civil unrest. These restrictions impede the U.S. Embassy’s ability to communicate with and provide consular services to U.S. citizens in Ethiopia.

Please contact the Embassy’s American Citizen Services Unit at  [email protected]  for further assistance.

Read the  country information page  for additional information about travel to Ethiopia.

If you decide to travel to Ethiopia:

• Monitor local media for breaking events and be prepared to adjust your plans.
• Be aware of your surroundings.
• Stay alert in locations frequented by U.S. citizens/Westerners/foreign travelers.
• Carry a copy of your passport and visa and leave originals in your hotel safe.
• Have evacuation plans that do not rely on U.S. government assistance.
• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive Alerts and make it easier to locate you in an emergency.
• Alerts and make it easier to locate you in an emergency.
• Follow the Department of State on  Facebook  and  Twitter .
• Review the  Country Security Report for Ethiopia .
• U.S. citizens who travel abroad should always have a contingency plan for emergency situations. Review the  Traveler’s Checklist.
• Visit the CDC page for the latest  Travel Health Information  related to your travel.

Tigray Region and Border with Eritrea – Do Not Travel

Due to sporadic violent conflict, civil unrest, and crime, the Tigray Region and the border with Eritrea are restricted for travel by U.S. government personnel, with limited exceptions to support humanitarian capacity and priority diplomatic engagement efforts. Border roads with Eritrea are closed and conditions at the border may change with no warning.

Afar-Tigray Border Area – Do Not Travel

Due to sporadic violent conflict, civil unrest, and crime, the Afar-Tigray border area is restricted for travel by U.S. government personnel, with limited exceptions to support humanitarian capacity and priority diplomatic engagement efforts.

Amhara Region – Do Not Travel 

Due to sporadic violent conflict and civil unrest, the Amhara Region is currently off-limits for U.S. government personnel, with limited exceptions to support humanitarian capacity and priority diplomatic engagement efforts.

Gambella Region – Do Not Travel

Due to crime, kidnapping, the potential for ethnically motivated violence, and sporadic violent conflict, the Gambella Region is restricted for travel by U.S. government personnel, with limited exceptions to support humanitarian capacity and priority diplomatic engagement efforts.

Benishangul Gumuz Region – Do Not Travel

Due to crime, kidnapping, the potential for ethnically motivated violence and sporadic violent conflict, the Benishangul Gumuz Region   is restricted for travel by U.S. government personnel, with limited exceptions to support humanitarian capacity and priority diplomatic engagement efforts.

Oromia Region – Specific Areas – Do Not Travel

Due to sporadic violent conflict, civil unrest, and ethnically motivated violence, the following zones in Oromia are restricted for travel by U.S. government personnel, with limited exceptions to support humanitarian capacity and priority diplomatic engagement efforts: the entirety of Horro-Guduru Wollega, East Wollega, West Wollega, Kelem Wollega, Illubabor, and Bale. Other areas in Oromia include portions of North, West, and Southwest Shewa to the immediate north and west of Addis Ababa; the Boset and Fentale woredas of East Shewa zone between Welenchiti and Awash; portions of the Borena zone surrounding Bule Hora; and portions of Guji zone to the east of Bule Hora.

Southern Nations and National People (SNNP) Region – Specific Areas – Do Not Travel

Due to sporadic violent conflict, civil unrest, and ethnically motivated violence the following towns and areas in SNNP are restricted for travel by U.S. government personnel, with limited exceptions to support humanitarian capacity and priority diplomatic engagement efforts: Gedeo, Konso zones and the Amaro and Derashe special woredas.

Border Area with Somalia – Do Not Travel

Terrorists maintain a presence in Somali towns near the Ethiopian border, presenting a risk of cross-border attacks and kidnappings. Landmines are present in this region. U.S. government personnel are not permitted to travel to the border areas with Somalia, with limited exceptions to support humanitarian capacity efforts.

Border Areas with Sudan and South Sudan – Do Not Travel

Crime, kidnapping, the potential for ethnically motivated violence, and sporadic violent conflict exist near the Ethiopian borders with Sudan and South Sudan. This includes but is not limited to the Nuer Zone and the Jore Woreda of the Agnuak Zone in the Gambela region, and the Pawe, Guba, Dangur, Dibati, and Bulen woredas, and the Metekel zone in the Benishangul Gumuz Region. U.S. government personnel are not permitted to travel to the border areas of Sudan and South Sudan, with limited exceptions to support humanitarian capacity efforts.

Border Areas with Kenya – Do Not Travel

Terrorists, particularly Al-Shabaab, maintain a presence in this area, and ethnically motivated violence has been reported. This includes but is not limited to the Borena zone and surrounding areas. U.S. government personnel are not permitted to travel to the border areas with Kenya, with limited exceptions to support humanitarian capacity efforts.

Visit our website for advice if you decide to  Travel to High-Risk Areas .

Embassy Messages

View Alerts and Messages Archive

Quick Facts

Yes (www.evisa.gov.et)

Yellow fever certificate required if traveling from a country with risk of yellow fever transmission; recommended for all areas in Ethiopia except Afar and Somali regions.

1,000 ETB for all travelers; 1000 USD or other foreign currency equivalent if person resides in Ethiopia; 3,000 USD or other foreign currency equivalent if person is not residing in Ethiopia. Excess currency may be confiscated.

1,000 ETB (4,000 ETB if travelling to Djibouti) and 3,000 USD or other foreign currency equivalent.

Embassies and Consulates

U.s. embassy addis ababa.

Entoto Street PO Box 1014 Addis Ababa, Ethiopia Telephone: +251-11-130-6000 Emergency After-Hours Telephone: 011-130-6000 Fax: +251-11-124-2435 and +251-11-124-2419 Email: [email protected]

Destination Description

Learn about the U.S. relationship to countries around the world.

Entry, Exit and Visa Requirements

Please visit the Embassy's COVID-19 page more information on entry/ exit requirements related to COVID-19 in Ethiopia. 

Requirements for Entry:

• World Health Organization (WHO) card with yellow fever vaccination if coming from country with risk of yellow fever transmission ( countries with risk of YF transmission )

Visas:  All U.S. citizens are required to obtain a visa to legally enter Ethiopia.  Do not travel to Ethiopia unless you have an approved e-Visa. Travelers without a valid visa will be denied entry. To avoid any disruption to your travel print and carry a copy of your e-Visa with you.  Please, visit  https://www.evisa.gov.et/visa/apply  to apply for an e-Visa before traveling to Ethiopia.  Contact the  Embassy of Ethiopia  for the most current visa information. Overseas inquiries about visas should be made at the nearest Ethiopian embassy or consulate.

The Ethiopian Immigration and Citizenship Service strictly enforces immigration regulations and expects all foreign nationals to be in the country under legal status. There is a daily fine if you overstay your visa.  This fine must be paid in full in U.S. dollars at immigration in order to obtain an exit visa and be permitted to depart the country.

Foreign Currency Restrictions:

• Visitors to Ethiopia, including transit passengers who do not plan to exit Bole International Airport, may hold up to a maximum of 1,000 ETB per trip to and from Ethiopia. Persons residing in Ethiopia can enter with 1,000 USD or other foreign currency equivalent. Persons not residing in Ethiopia can enter with 3,000 USD or other foreign currency equivalent. Travelers must declare all foreign currency exceeding the above limits.
• Residents of Ethiopia may not hold foreign currency for more than 30 days after declaring it. Nonresidents may hold foreign currency for the duration of their visa.
• When departing Ethiopia, nonresidents carrying more than the equivalent of 3,000 USD in foreign currency and residents carrying any amount of foreign currency must produce a valid bank document or foreign currency customs declaration that is less than 30 days old.
• These regulations are strictly enforced, and failure to comply will likely result in the confiscation of excess or undeclared currency.

Ivory, Animal Skins, Souvenirs, Precious Stones and Minerals, Antiques/Artifacts:

• Travelers transporting ivory may be detained, imprisoned, or fined and the ivory may be confiscated.
• Souvenirs that are copies of antiques or religious artifacts require a proper receipt and may still be confiscated.
• Export permits processed by the Export Section of the airport customs office are required for antiques, including religious artifacts, Ethiopian crosses, and animal skins and other wildlife parts. Contact the Ethiopian Wildlife Conservation Authority for a permit.
• There are limits on the amount of precious stones and minerals that can be exported for personal use. Check with local authorities.
• Contact the Ethiopian Ministry of Revenue s if you have any questions about exports.
• See our Customs and Import Restrictions information sheet .

Electronics:

• Laptop computers and video equipment intended for anything other than personal use must be declared upon arrival and departure.
• Some recording devices may require special customs permits. If these items are being used for work, you should contact the Ethiopian Embassy  before you travel.
• The U.S. Embassy cannot assist with obtaining permits or the return of confiscated equipment.

HIV/AIDS: The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ethiopia. Please verify this with the Ethiopian Embassy before you travel.

Find information on  dual nationality ,  prevention of international child abduction  and  customs regulations  on our websites.

Safety and Security

Terrorism: Al-Qa’ida and its regional affiliate, Somalia-based al-Shabaab, maintain a presence throughout East Africa. In late 2020, Ethiopian security officials announced the arrest of al-Shabaab and ISIS members who were accused of planning attacks in Addis Ababa and other parts of Ethiopia. Current information indicates that terrorist organizations continue to plan terrorist attacks against U.S. citizens and Western targets and interests in East Africa, as well as against high-profile targets within those countries that contribute troops to the African Union Mission in Somalia, including Ethiopia.

Terrorist groups and those inspired by such organizations are intent on attacking U.S. citizens abroad. Terrorists are increasingly using less sophisticated methods of attack – including knives, firearms, and vehicles – to more effectively target crowds. Frequently, their aim is unprotected or vulnerable targets, such as: 

• High-profile public events (sporting contests, political rallies, demonstrations, holiday events, celebratory gatherings, etc.) 
• Hotels, clubs, and restaurants frequented by tourists 
• Places of worship 
• Schools 
• Parks 
• Shopping malls and markets 
• Public transportation systems (including subways, buses, trains, and commercial flights)

For more information, see our  Terrorism  page.

Civil Unrest: Ethiopia has experienced sporadic and spontaneous civil unrest throughout the country, some of which has ended in violence. During such episodes, the Ethiopian government often curtails or limits mobile telecommunications, internet access, and social media. If this happens, you may be unable to contact family and friends or emergency services. The U.S. Embassy does not provide internet access to private individuals.

U.S. government personnel must request permission for personal and official travel outside of Addis Ababa and are required to carry personnel tracking devices and, in some cases, satellite phones.

U.S. government personnel may not take personal trips to:

• All national border regions of Ethiopia
• Gambella (except Gambella City)
• Benishangul Gumuz (except Assosa City)
• Some areas in western and southern parts of Oromia region
• Tigray region
• Amhara region

U.S. government personnel may only travel to Gambella City and Assosa City by plane. 

Western areas of Oromia: Wollega zones that include Kellem Wollega, West Wollega, Horro-Guduru Wollega and parts of East Wollega have reported civil unrest including fighting involving armed groups.

Southern areas of Oromia: West Guji zone has reported civil unrest including fighting involving armed groups.

Ethiopia’s Southern Nations, Nationalities, and People’s Region (SNNPR): Civil unrest in the region, particularly in Bench Sheko Zone and Konso Special Woreda, has resulted in deaths, looting, and the burning of buildings.

Border with Kenya: There have been numerous incidents of inter-ethnic conflict reported near the border areas with Kenya, as well as attacks attributed to the Oromo Liberation Army (OLA or OLF-Shane). Criminal activity in this border area remains a concern.

Tigray and Border with Eritrea: Due to conflict in the region, Tigray and the border with Eritrea are currently off-limits for U.S. government personnel. Due to the current situation in Tigray, the border roads with Eritrea are closed. Conditions at the border may change with no warning.

Border with South Sudan (Gambella Region): The security situation in the region is volatile. Sporadic inter-ethnic clashes are common along the western border area with South Sudan. Past tribal conflict between Anyuak, Nuer, and Highlanders resulted in numerous casualties. As with other border areas, landmines and criminal activity remain a concern.

Border with Sudan: There have been numerous incidents of armed clashes reported near the border area between Sudan and Ethiopia over disputed land.

Somali Region (eastern Ethiopia): Al-Shabaab maintains a presence in Somali towns near the Ethiopian border, presenting risk of cross-border attacks and kidnapping. As with other border areas, landmines and criminal activity remain a concern. U.S. government personnel may not take personal trips to the Somali region.

Afar: Violent crime, including the armed assault of foreigners, has occurred in the Danakil Depression in Afar. While recent reports may indicate the Danakil Depression area is safe for tourism, please note that tourism was previously targeted for attacks in 2007, 2012, and 2017. It is not recommended to use the Mekelle route to this or other tourist sites in the Afar region due to the current situation in the Tigray region. Travelers should remain alert for changing conditions and the potential for criminal activity in these areas. Travel to areas bordering Tigray is not recommended due to conflict in that region. Additionally, ethnic conflicts between Afar and Somalis in the southern border areas of Afar have been reported.

Amhara: As a result of the Tigray conflict, tensions continue to exist along the Amhara-Tigray regional border, with occasional clashes including gunfire. Ethnic violence has been reported. While attacks are mostly related to inter-ethnic disputes and foreigners have not been targeted, attacks can occur at any time with the risk of being caught in violence. If you are travelling in the area, monitor local media and follow the advice of local authorities.

Crime in Addis Ababa: Pickpocketing, purse snatching, theft from vehicles and other petty crimes are common in Addis Ababa. Theft of passports is common in Bole International Airport, including inside the airport terminal and during airport transfers. Thieves are active throughout the city at all times, particularly on Bole Road, in the Piazza, the Merkato, and other areas frequented by tourists and foreigners. Violent robberies have also occurred in this area, with victims stabbed or beaten. Further, a number of violent robberies on hikers in Entoto Park, Yeka Park (behind the British Embassy), and the Guellele Botanical Gardens in Addis Ababa have been reported.

Safety Precautions:

• Review your personal safety and security posture, remain vigilant, and exercise caution when visiting prominent public places and landmarks where westerners gather on a routine or predictable basis.
• Avoid unattended baggage or packages left in any location, including in taxis.
• Monitor consular messages.
• Avoid travel outside of major towns, particularly along border areas (Kenya, Eritrea, Somalia, Sudan, and South Sudan).
• Avoid walking alone.
• Do not display cash and valuable personal property.
• Secure your valuables and travel documents.
• Drive with doors locked and windows closed or rolled up enough at all times to prevent theft while stopped in traffic.

Demonstrations  occur frequently. They may take place in response to political or economic issues, on politically significant holidays, and during international events.

• Even demonstrations intended to be peaceful can turn confrontational and possibly become violent.
• Avoid areas around protests and demonstrations.
• Check local media for updates and traffic advisories.

International Financial Scams:  See the  Department of State  and the  FBI  pages for information.

Victims of Crime: U.S. citizen victims of crime in Addis Ababa should contact the Addis Ababa Police at 011-111-1011 or 991 from your local cell phone and may call the U.S. Embassy at 011-130-6000/6911. Crimes occurring outside of Addis Ababa should be reported to the Ethiopian Federal Police at 011-126-4359/4377. Remember that local authorities are responsible for investigating and prosecuting crime.

See our webpage on  help for U.S. victims of crime overseas .

We can: 

• Help you find appropriate medical care
• Assist you in reporting a crime to the police 
• Contact relatives or friends with your written consent 
• Provide general information regarding the victim’s role during the local investigation and following its conclusion 
• Provide a list of local attorneys
• Provide our information on  victim’s compensation programs in the U.S.
• Provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution 
• Help you find accommodation and arrange flights home
• Replace a stolen or lost passport 

Domestic Violence: U.S. citizen victims of domestic violence are encouraged to contact the Embassy for assistance. 

Tourism:  The tourism industry is unevenly regulated, and safety inspections for equipment and facilities do not commonly occur. Hazardous areas/activities are not always identified with appropriate signage, and staff may not be trained or certified either by the host government or by recognized authorities in the field. In the event of an injury, appropriate medical treatment is typically available only in/near major cities. First responders are generally unable to access areas outside of major cities and to provide urgent medical treatment. U.S. citizens are encouraged to purchase medical evacuation insurance. See our webpage for more  information on insurance providers for overseas coverage .

Local Laws & Special Circumstances

Criminal Penalties: You are subject to local laws. If you violate local laws, even unknowingly, you may be expelled, arrested, or imprisoned. Please note that in the event you are arrested and then released on bail, standard practice is that the police will retain foreign passports pending a final hearing. Individuals establishing a business or practicing a profession that requires additional permits or licensing should seek information from the competent local authorities, prior to practicing or operating a business.

Furthermore, some laws are also prosecutable in the United States, regardless of local law. For examples, see our website on  crimes against minors abroad  and the  Department of Justice  website. 

Photography: It is illegal to take pictures of government buildings, military installations, police/military personnel, and key infrastructure such as roads, bridges, dams, and airfields. If you are caught photographing prohibited sites, you could be fined, your photographic equipment could be confiscated, and you could be detained and/or arrested. As a general practice, you should avoid taking pictures of individuals without their clear consent.

Arrest Notification: If you are arrested or detained, ask police or prison officials to notify the U.S. Embassy immediately. See our  webpage  for further information.

Phone Service: Cellular phones are the main method of communication in Ethiopia; other telephone service is unreliable, and landlines are nearly non-existent. Cell phones brought into Ethiopia must be registered with the Ethiopian Revenue and Customs Authority. Phones can be registered either at Bole International Airport or at any Ethio Telecom shop. SIM cards are available for local purchase from Ethio Telecom, but will only work with phones that have been registered. As noted, cell phone access may be cut off without warning.

Currency: The Ethiopian Birr (ETB) is the currency of Ethiopia and, with the exception of international hotel bills, payment for commercial transactions in any other currency is illegal. Credit cards are accepted at only a few outlets in Addis Ababa. Foreign currency may only be exchanged legally at banks.

Ethiopian Refugee Camps: All access to refugee camps must be preapproved by the UNHCR and Ethiopian government. You may be detained and deported if you attempt to gain access without proper permissions.

Calendar: The Ethiopian calendar is the principal calendar used in Ethiopia. Some Ethiopians set their clocks differently than is standard practice elsewhere, resulting in significant time differences. Double check bookings and appointments to avoid confusion.

Faith-Based Travelers: See the following webpages for details:

• Faith-Based Travel Information
• International Religious Freedom Report  – see country reports
• Human Rights Report  – see country reports
• Hajj Fact Sheet for Travelers
• Best Practices for Volunteering Abroad  

LGBTI Travelers: Consensual same-sex sexual activity between adults is illegal and punishable by imprisonment under the law. There have been periodic detentions and interrogations of some LGBTI persons, and alleged physical abuse. Ethiopians do not generally publicly identify themselves as LGBTI due to severe societal stigma. There are some reports of violence against LGBTI individuals; reporting is limited due to fear of retribution, discrimination, or stigmatization. There is no law prohibiting discrimination against LGBTI persons and some LGBTI activists have reported being followed and at times fearing for their safety. Outside the major international hotels, same-sex couples may be unable to share a room. See our LGBTI Travel Information page and section 6 of our Human Rights Report for further details.

Travelers Who Require Accessibility Assistance: See The Ethiopian Center for Disability and Development guidebook with information on accessible hotel accommodations and transportation (including the new Addis Ababa metro). Persons with disabilities have limited access to transportation, communication, accommodations, and public buildings. There are few sidewalks and no curb-cuts, and most buildings lack functioning elevators. Landlords are required to give persons with disabilities preference for ground floor apartments.

Students: See our  Students Abroad  page and  FBI travel tips .

Women Travelers: Domestic violence, including spousal abuse, is pervasive. Domestic violence and rape cases often are delayed significantly and given low priority. Female genital mutilation/cutting (FGM/C) is illegal, but the prohibition is not actively enforced. Many women and girls have undergone FGM/C. It is much less common in urban areas. See our travel tips for Women Travelers .

Natural Disasters: Ethiopia’s geographic location in the western escarpment of the Great Rift Valley and the Horn of Africa increases its vulnerability to natural disasters, including flooding (and related landslides) during the summer rainy season, drought, and seismic events.

Consult the  CDC website for Ethiopia  prior to travel.

For emergency services in Ethiopia, dial the following numbers:

• Addis Ababa Police Commission Emergency: 991/922
• Fire (Addis Ababa): 939
• Traffic Police (Addis Ababa): 945
• Ambulance (Ethiopian Red Cross Society in Addis Ababa): 907

Medical care is extremely limited and health care facilities are only adequate for stabilization and emergency care. There is a shortage of physicians and other qualified medical personnel, as well as medical supplies, including, but not limited to, respirators, oxygen, and medications.  Emergency, ambulance, and psychiatric services are also limited. All care providers, both public and private, require payment or a cash deposit in Ethiopian birr before treatment is performed.

Ambulance services are not present throughout the country or are unreliable in most areas except Addis Ababa. Ambulances are also not generally staffed with trained paramedics and often have little or no medical equipment. Injured or seriously ill travelers may prefer to take a taxi or private vehicle to the nearest major hospital rather than wait for an ambulance.

The U.S. Embassy in Addis Ababa will not pay medical bills.   Be aware that U.S. Medicare/Medicaid does not apply overseas. Most hospitals and doctors overseas do not accept U.S. health insurance. Some clinics will require payment prior to service or prior to checkout.

Medical Insurance:  Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments. See the Embassy webpage for more information on insurance providers for overseas coverage. Visit the  U.S. Centers for Disease Control and Prevention  for more information on the type of insurance you should consider before you travel overseas. It is strongly recommended that you obtain supplemental insurance to cover medical evacuation. 

Always carry your prescription medication in its original packaging, along with your doctor’s prescription. If the quantity of drugs exceeds that which would be expected for personal use, a permit from the Ministry of Health is required. Check with the Ethiopian Food and Drug Administration (EFDA) at +251-11-552-41-22 or *8484* to ensure the medication is legal in Ethiopia. 

Altitude:   Many cities in Ethiopia, including Addis Ababa, are at high altitude. Be aware of the symptoms of altitude sickness and take precautions before you travel.  Visit the U.S. Centers for Disease Control and Prevention website for more information about  travel to high altitude locations .

The following diseases are prevalent in Ethiopia:

• Diarrheal diseases 
• Cholera 
• Hepatitis A 
• Malaria 
• Measles 
• Meningitis 
• Polio 
• Rabies 
• Schistosomiasis 
• Tuberculosis 
• Yellow Fever

Vaccinations:  Ensure you are up to date on all  vaccinations  recommended by the U.S. Centers for Disease Control and Prevention. Note that when traveling to certain other countries from Ethiopia, proof of Yellow Fever vaccination may be required. 

Further health information:

• World Health Organization
• U.S. Centers for Disease Control and Prevention (CDC)

Air Quality:  Visit  AirNow Department of State  for information on air quality at U.S. Embassies and Consulates.

The U.S. Embassy maintains a list of  doctors and hospitals but does not endorse or recommend any specific medical provider or clinic. 

Travel and Transportation

U.S. government officials and their families are advised to travel between major cities by air. They are prohibited from using inter- or intra-city bus transportation and travelling by road outside urban areas at night.

Road Conditions and Safety: Traffic accidents occur regularly in Addis Ababa and throughout the country. Roads are ill maintained, inadequately marked, and poorly lit. Excessive speed, erratic driving habits, pedestrians, stray animals, and lack of vehicle maintenance pose other hazards. Travel with other vehicles outside of cities during daylight hours only, due to the threat of roadside bandits, and be sure to carry additional fuel, a spare tire, and provisions. Professional roadside assistance service is not available.

Traffic Laws: You will need an Ethiopian driver’s license to drive in Ethiopia. In order to obtain an Ethiopian’s driver’s license, you will need an authenticated copy of your U.S. driver’s license. For more information on authentication, visit the Department of State’s Office of Authentications . The Embassy does not authenticate U.S. driver’s licenses. Use of cell phones while driving is prohibited. Use of seat belts is required. It is illegal to give money to beggars who approach vehicles stopped in traffic.

Accidents: In the event of an automobile accident, remain inside the vehicle and wait for police. It is illegal to move your vehicle before a police officer arrives. If a hostile mob forms or you feel your safety is in danger, however, leave the scene and proceed directly to the nearest police station to report the incident.

Public Transportation: Public transport is unregulated and unsafe. Avoid all travel by public transportation and hire private transport from a reliable source. Buses are in poor mechanical condition and are often filled well beyond capacity.

While taxis are available in Ethiopia, most do not meet U.S. safety standards. In Addis Ababa, green and yellow metered taxis are generally newer and in better condition than other taxis. The hiring of private transportation from a reliable source and/or use of hotel provided transportation is recommended.

See our Road Safety page for more information.

Aviation Safety Oversight: The U.S. Federal Aviation Administration (FAA) has assessed the government of Ethiopia’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Ethiopia’s air carrier operations. Further information may be found on the FAA’s safety assessment page .

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

Review information about International Parental Child Abduction in Ethiopia .  For additional IPCA-related information, please see the  International Child Abduction Prevention and Return Act ( ICAPRA )  report.

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Travel Vaccines and Advice for Ethiopia

Said to be one of the oldest nations in the world, Ethiopia has a lot to offer those visiting its borders. The country has stunning landscapes with varying terrain and history going to prehistoric times.

Enjoy rafting on the Omo River, see the enormous crocodiles in Lake Chomo, or hike to historic churches. These gorgeous sites offer unique experiences that you can only get in Ethiopia.

Enjoy the hub of city life in Addis Ababa. Sit in the plaza and sip some coffee while taking in the culture and hospitality of the country.

Do I Need Vaccines for Ethiopia?

Yes, some vaccines are recommended or required for Ethiopia. The CDC and WHO recommend the following vaccinations for Ethiopia: hepatitis A , hepatitis B , typhoid , yellow fever , rabies , meningitis , polio , measles, mumps and rubella (MMR) , Tdap (tetanus, diphtheria and pertussis) , chickenpox , shingles , pneumonia and influenza .

COVID-19 vaccination is recommended for travel to all regions, both foreign and domestic. Check with your local Passport Health clinic if immunization is offered in your area.

See the bullets below to learn more about some of these key immunizations:

• COVID-19 – Airborne & Direct Contact – Recommended for all unvaccinated individuals who qualify for vaccination
• Hepatitis A – Food & Water – Recommended for most travelers
• Hepatitis B – Blood & Body Fluids – Recommended for travelers to most regions.
• Typhoid – Food & Water – Recommended for travelers to most regions.
• Yellow Fever – Mosquito – Required if traveling from a region with yellow fever. Recommended for all travelers over 9 months of age. Generally not recommended for Afar and Somali provinces.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travelers and those who may come in contact with animals.
• Meningitis – Airborne & Direct Contact – Located in the meningitis belt, vaccination is recommended during the dry season (Dec. – June)
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
• Influenza – Airborne – Vaccine components change annually.
• Polio – Food & Water – While there is no active polio transmission in Ethiopia, it is vulnerable for outbreaks. Considered a routine vaccination for most travel itineraries. Single adult booster recommended.

See the tables below for more information:

Ethiopia sits in the meningitis belt. This region of Africa is known for it’s meningitis transmission from December through June. Make sure you are vaccinated against all forms of meningitis before your trip.

Ethiopia requires proof of yellow fever vaccination if you are arriving from a region where the virus is present. Immunization is generally recommended for travel to Ethiopia, except if travel is limited to Afar and Somali provinces.

Mosquito-borne diseases like malaria and dengue are in Ethiopia. Make sure you’re protected with antimalarials, repellents and netting. A travel health specialist will help you determine what protection is right for you.

Visit our vaccinations page to learn more. Travel safely with Passport Health and schedule your appointment today by calling or book online now .

Do I Need a Visa for Ethiopia?

A visa is required for entry to Ethiopia. Passports must have at least six months’ validity and one blank page for entry/exit stamps.

Sources: Embassy of Ethiopia and U.S. State Department

Proof of yellow fever and polio vaccination may be required at entry.

What Is the Climate Like in Ethiopia?

Ethiopia’s main climate is tropical monsoon. Weather will vary depending on the region. Here are 3 of the major cities and what you can expect when you travel:

• Addis Ababa – The capital of Ethiopia is on the foothills of Mount Entoto. With an elevation of around 7,874 feet, you can experience a pleasant climate year round. Expect average temperatures in the 60-70’s. The main wet season is from June to September with higher temperatures.
• Mekele – This city is located in the Tigrayan Highlands in the north of the country. The warmest it gets is low-80’s and the coolest is low-60’s. Be cautious of traveling during the wet months. Many roads can be inaccessible due to flooding.
• Adama – Also known as Nazret or Nazareth, this city is a major weekend destination located near Addis. With a similar elevation of Addis Ababa, the climate is about the same.

Most of the major cities in Ethiopia have a similar elevation to Addis Ababa. If you’re traveling to lower regions, the climate can be hotter and drier depending on the time you travel.

Be sure to take this into account when packing your bags.

Is It Safe to Travel to Ethiopia?

Ethiopia has had some terrorist attacks over the last few years. Travelers should take extra precautions especially in the Oromia and Amhara regions.

Be cautious of areas with large gatherings. If you think a protest may be forming try to leave the area as a precaution.

Remain alert and cautious if traveling near bordering countries of Ethiopia. There is a high threat of landmines along the western border and tensions are high due to ethnic conflicts.

Ethiopia has a low crime rate compared to other African countries. As with any major city, be wary of pick-pocketing and other theft that are common in Addis Ababa. Many of the crimes are petty but some violent robberies have been known to occur.

Stay alert, take your surroundings into consideration, plan your trips ahead of time, and make sure you have everything you need.

Avoid an Embarrassing Stop

Over 70% of travelers will have diarrhea., get protected with passport health’s travelers’ diarrhea kit .

Lalibela is a small town in Ethiopia that is famous for its churches made from rock. These churches are very old, constructed in the 12th and 13th centuries. Visitors can explore the churches and see the beautiful carvings and paintings.

Lalibela is also a religious town, and many festivals are held there throughout the year. One of the most popular festivals is called Timkat and takes place in January. Visitors can also go on guided treks to see the surrounding mountains and beautiful landscape.

The town has a rich history, and visitors can learn about it by visiting the local museum. It also has markets where visitors can buy souvenirs and try the local food.

Lalibela offers a unique experience that combines religion, culture and history, making it a great place to visit in Ethiopia.

What Should I Pack for Ethiopia?

What you need to take to Ethiopia will depend on when you are traveling. Make sure you bring these items with you:

• Rain Gear – If you’re visiting during the wet season bring protective gear against the rain. Consider bringing waterproof shoes. They can help so you don’t need to pack extra socks in your day bag.
• Comfortable Hiking Shoes – A lot of Ethiopia’s wonders involve varying terrain and activities like hiking or climbing. Pack shoes you’ve already broken in and are comfortable wearing for long periods of time.
• Lightweight Jacket – With varying elevation you may find yourself needing to layer. Higher elevations have a different climate. Be sure to have a decent jacket you don’t mind carrying around for when it gets warmer.

United States Embassy in Ethiopia

It’s recommended that you enroll in STEP, the Smart Traveler Enrollment Program, with the U.S. Department of State. It’s a free program that will offer you information from the Embassy on safety conditions, help the U.S. Embassy contact you in an emergency, and help your family and friends get in touch with you in the case of an emergency.

U.S. Embassy Addis Ababa Entoto Street PO Box 1014 Addis Ababa, Ethiopia Telephone: +(251) 11 130-6000 Emergency After-Hours Telephone: 011 130-6000 Fax: +(251) 11 124-2435 and +(251) 11 124-2419

Note that the Embassy is also closed on both Ethiopian and American Holidays.

The embassy’s services may vary depending on individual needs and circumstances. It’s important for travelers to visit the embassy’s website or contact it directly for more information.

Ready to start your next journey? Call us at or book online now !

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On This Page: What Vaccines Do I Need for Ethiopia? Do I Need a Visa for Ethiopia? What Is the Climate Like in Ethiopia? Is It Safe to Travel to Ethiopia? Lalibela What Should I Pack for Ethiopia? United States Embassy in Ethiopia

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Runway offers many of the most commonly prescribed travel medications. Create your Ethiopia treatment plan and initiate a consultation with one of our licensed physicians today, so you can explore more and worry less.

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If you’re venturing to one of the oldest countries in the world, and the only African nation to largely avoid colonization, prepare to experience incredible ancient rites and customs passed on for thousands of years. Not only is Ethiopia deeply fascinating and unlike any other country, but it’s also incredibly beautiful, with epic landscapes spanning from mountains, to highlands, to deserts, to canyons.

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About travel and border health service

Globalization and technology have made the world more connected than ever. Human mobility is a complex and dynamic phenomenon that has been attributed to amplify the spread of infectious diseases.

If you are not prepared, international travel can be hazardous to your health. The first step in preparing for international travel is to consult with a travel health service center. The World Health Organization (WHO) recommends that travelers consult with a travel health professional at least 2 weeks before departure.

The Travel and Border Health Service Directorate at Ethiopian Public Health Institute ensures the existences of the recommended International Health Regulation (IHR-2005) principles concerning travel-related diseases of public health interest.

Travel Health Services include

• Consultation : The health professionals will assess your individual needs taking into account each destination on your itinerary, personal medical needs and so on. Based on WHO latest information issued, the health professionals will provide a personal recommendation.
• Recommended vaccine : Not a must to have but taking a vaccination recommended and this include the majority of travel vaccines.
• Required vaccines : These are required by a country for entry in order to protect the health of their citizens form travelers who may import the disease. Yellow fever, meningitis and polio are the most common required vaccines.

Information For Travellers

What is cholera.

Cholera is an acute bacterial intestinal infection caused by toxigenic Vibrio cholera O1 or O139. The disease often causes profuse watery diarrhea, vomiting, circulatory collapse, and shock. Many infections are associated with milder diarrhea or have no symptoms at all but if left untreated severe cholera cases up to 50% can be deadly.

Cholera is endemic to 50 countries primarily found in South and Southeast Asia and Africa but currently, other destinations including countries in the Caribbean and Middle East have active Cholera Transmission.

As the bacteria can be found in fresh and salty water the infections are mostly acquired from untreated drinking water or the feces of an infected person. Other common vehicles include raw or undercooked food, especially fish and shellfish.

People who do not follow hand washing recommendations, and/or do not use latrines or other sanitation systems are at increased risk for infection. Travelers with the greatest risk for exposure & infection are those going to endemic or outbreak areas, humanitarian aid workers, refugees and internally displaced people.

What are the symptoms of cholera Infection?

Infection is often mild or asymptomatic, but severe cholera occurs in about 10% of cholera episodes and is characterized by profuse watery diarrhea, described as rice-water stools, often accompanied by nausea and vomiting that can rapidly lead to severe dehydration, and death within hours.

Apart from clinical diagnosis laboratory confirmation is made using numerous diagnostic methods including rapid diagnostic tests and RT-PCR.

Timely rehydration therapy is the basis of cholera treatment with oral rehydration solution and, if necessary intravenous fluids and electrolytes. Antibiotics will also reduce fluid requirements and duration of illness and are indicated in conjunction with rehydration treatment.

Travelers most importantly should follow the way to prevent cholera infection by practicing safe food and water handling precautions and frequent hand washing.

Cholera is a vaccine-preventable disease and generally, routine vaccination is not recommended for travelers if you are not at the greatest risk for exposure & infection (i.e., humanitarian aid workers, going to endemic or outbreak areas, and health care workers in direct contact with cases) and currently, no country or territory requires vaccination against cholera as a condition for entry.

Useful tips

• Cholera is an acute watery diarrheal disease with a high fatality if left untreated.
• Choler is endemic in South and Southeast Asia, Africa, the Middle East, and the island of Hispaniola.
• Travelers who consistently observe safe food, water, sanitation, and hand hygiene precautions have virtually no risk of infection
• Cholera is a vaccine-preventable disease.
• While in Ethiopia, for any inquiries please call toll-free 8335 or visit  https://ephi.gov.et/travel-health-service/

Marburg virus disease

What is Marburg virus disease?

Marburg virus disease (MVD) is a rare but severe hemorrhagic fever caused by the Marburg virus, members of the filovirus family.

Marburg virus was first recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany and in Belgrade, Yugoslavia (now Serbia). The first people infected had been exposed to Ugandan imported African green monkeys or their tissues while conducting research. That same year, an American traveller developed MVD after returning to the US from Uganda and recovered. Both travellers had visited a well-known cave inhabited by fruit bats in a national park.

The reservoir host of Marburg virus is a type of cave-dwelling fruit bat native to Africa called the Egyptian rousette bat. Bats infected with Marburg virus do not show obvious signs of illness. Primates (including people) can become infected with Marburg virus, which can cause serious illness or death. Many past outbreaks started with male mine workers in bat-infested mines and then spread within their communities.

What are the symptoms of MVD?

After an incubation period of 2-21 days, symptom onset is sudden and marked by fever, chills, headache, myalgia (Muscle pain) and non-itchy rash. Severe watery diarrhea, abdominal pain and cramping, nausea and vomiting can begin on the third day. Symptoms become increasingly severe and can include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction.

Clinical diagnosis of Marburg virus disease (MVD) can be difficult, as early nonspecific manifestation of the disease may mimic other infectious diseases such as malaria, typhoid fever and meningitis or viral haemorrhagic fevers that may be endemic in the area (such as Ebola). Confirmation is made using numerous diagnostic methods including RT-PCR.

Prevention and treatment of MVD

Preventive measures against Marburg virus infection include avoiding fruit bats and sick non-human primates and precautions to prevent the secondary transmission (person-to-person) including wearing of personal protective equipment’s (PPEs). Better awareness can lead to earlier and stronger precautions against the spread of Marburg virus.

Currently there are no vaccines or antiviral treatments approved for MVD. However, supportive care including rehydration with oral or intravenous fluids and treatment of specific symptoms, improves survival.

• MVD is preventable disease, but it kills in a short time.
• MVD is a disease that can easily be transmitted from person to person through contact with the body fluids of an infected person.
• MVD can be prevented by washing hands regularly with soap and water.
• Report any suspected cases of MVD to the nearest health facility
• While in Ethiopia , for any inquire please call toll free 8335 or visit https://ephi.gov.et/travel-health-service/

Ebola Viral disease

What is Ebola virus disease (EVD) 

Ebola virus disease is a deadly hemorrhagic disease caused by Virus called Ebola virus. The disease often causes high fever and bleeding from various body holes. The current outbreaks of Ebola viral disease in Uganda is caused by species  Sudan Ebolavirus disease. O utbreaks by the species of Sudan virus first reported in southern Sudan in June 1976, since then seven outbreaks, four in Uganda and three in Sudan have been reported.

The virus is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as fruit bats, chimpanzees, gorillas, monkeys, forest antelope or porcupines found ill or dead or in the rainforest. The virus then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with either blood or body fluids of a person who is sick with or has died from EVD or objects that have been contaminated with body fluids (like blood, feces, vomit) from a person sick with EVD or the body of a person who died from EVD.

The incubation period ranges from 2 to 21 days. People infected with Sudan virus cannot spread the disease until they develop symptoms, and they remain infectious as long as their blood contains the virus.

What are the symptoms of Ebola?

Symptoms of EVD can be sudden and include fever, fatigue, muscle pain, headache, and sore throat later followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function. In some cases, the patient might present both internal and external bleeding (for example, bleeding from the gums, or blood in the stools).

The diagnosis of EVD can be difficult, as early nonspecific manifestation of the disease may mimic other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation is made using numerous diagnostic methods including RT-PCR.

Prevention and treatment of EVD

Supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms improve survival.

There are no licensed vaccines or therapeutics for the prevention and treatment of Sudan virus disease.

• Ebola is preventable disease, but it kills in a short time.
• Ebola is a disease that can easily be transmitted from person to person through contact with the body fluids of an infected person.
• Ebola can be prevented by washing hands regularly with soap and water.
• Report any suspected cases of Ebola to the nearest health facility

What is mPox (Monkey pox)?

mPox is a viral zoonosis disease (Animal origin) caused by infection with mPox virus. Previously mPox occurs in central and West Africa but the current outbreak is occurring around the world in areas where mPox is not usually found.

The mode of transmission is Human-to-human to animal-to-human transmission. Human-to-human transmition occurs from close contact with respiratory secretions and skin lesions of an infected person or recently contaminated objects. Transmission can also occur via the placenta from mother to fetus or during close contact during and after birth.

Animal-to-human transmission can occur by bite or scratch of infected animals and from direct contact with the blood or other bodily fluids and lesions of infected animals.

Symptoms of mPox

People infected with mPox develop a rash that can look like pimples or blisters and the rash may be painful or itchy, similar to those seen in the past in smallpox patients, although it is clinically less severe.

The symptoms of mPox can include Fever, Headache, Muscle and back pain, swollen lymph nodes, Chills, Exhaustion and Respiratory symptoms (e.g. sore throat, nasal congestion, or cough). The illness typically lasts from 6 to 13 days but can range from 5 to 21 days.

Who is at risk?

Anyone in close contact with a person with mPox can get it and should take steps to protect themselves.

Prevention and treatment Measures

There is no specific vaccine and treatment developed for mPox but some clinical studies demonstrated that Smallpox vaccine is about 85% effective in preventing the disease.

Travelers can  protect themselves  against infection by taking the following steps.

• Avoid close, skin-to-skin contact including kissing, hugging, or having sex with people who have a rash that looks like mPox.
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer; especially before eating or touching your face and after you use the bathroom.
• In Central and West Africa, avoid contact with animals that can spread mPox virus, usually rodents and primates.
• If you have symptoms of MPox or had close contact with someone who has mPox, talk to your healthcare provider.
• If you have symptoms, do not travel until you recover or confirm you do not have mPox.

Yellow Fever

What is yellow fever ?

Yellow fever (YF) is a serious illness caused by the YF virus. YF is usually passed on to humans by the bite of an infected mosquito. YF can vary from a flu-like illness that gets better on its own over several days to a severe illness with fever, jaundice (turning yellow), bleeding and organ failure. There is no specific medicine to treat YF. Up to 5% of infected people will die if they are not treated immediately.

Occurrence of YF disease?

The disease in Africa and Latin America in 44 countries. It causes with a estimation of 200,000 illnesses and up to 30,000 deaths, and the data shows the YF proved to be found in some places in our country.

The main symptoms of yellow fever

Many people do not experience symptoms, but when these do occur, the most common are:

• Muscle pain with prominent backache,
• Loss of appetite, and
• Nausea or vomiting.

A small percentage of patients, however, enter a second phase, more toxic phase within 24 hours of recovering from initial symptoms. High fever returns and several body systems are affected, usually the liver and the kidneys. In this phase people are likely to develop jaundice (yellowing of the skin and eyes, hence the name ‘yellow fever’), dark urine and abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes or stomach.

How to Prevent?

• Wearing long -sleeved shirts and
• Insect repellents,
• The travelers should have the vaccine at least 10 days before you travel
• The vaccine provides lifelong protection

Note: Travelers to YF areas should do both things

What is the Treatment ?

A person who feels the above symptoms should immediately go to the health center and get the necessary professional advice and examination. If a person infected with yellow fever does not get early diagnosis and medical help, it can lead to death.

• Take the vaccine before Travel
• Any persons with high fever and yellow eyes should seek to a health facility as they may have yellow fever; Notify the nearest health office or governing body immediately.

Ethiopia Travel Advice and Travel Advisories

Ethiopia travel vaccines and advice.

Some might not see Ethiopia first come to mind when travelling. If you think it’s all about deserts, then think again. This country certainly has charm and originality to spare. Rich in history and culture, it is worthy of its name as the   Cradle of humanity .  Unsuspected landscapes and ancient architectural remains such as the fascinating Orthodox Christian heritage all add to its fame. For avid hikers, walk through its high volcanic plateaus. You will find a particularly rich fauna and flora. Its magnificent lakes, which contrast with its dizzying peaks, are also suitable for many water activities. It should be noted that Ethiopia has one of the mildest climates in Africa. This allows you to enjoy the charm of this country whenever throughout the year.

Recommended travel vaccinations for Ethiopia

Recommended medication for travelling to ethiopia, current weather in ethiopia, medical care in ethiopia.

The Ethiopian health situation has recently collapsed due to many factors: inequality of basic care access between urban and rural areas, lack of medicines, shortage of medical personnel and equipment, and rudimentary facilities. Care provided in urban centres is still far from sufficient, even in the capital Addis Ababa. Even quality doctors struggle to operate with old equipment.

Pharmacies are not well-stocked, and the few pharmaceuticals available are unreliable. Ethiopia is also often struck by a shortage of drugs. For this reason, the US Embassy recommends that travellers carry enough prescriptions and medications to prevent sickness whilst travelling. However, if you are bringing a large number of drugs into the country, you require permission from the Ministry of Health. Before visiting Ethiopia, consult your doctor for advice.

To call for an ambulance, call  907  for the red cross in Addis Ababa.

Is Ethiopia Safe for Travel?

Do i need a visa to visit ethiopia, embassy of canada to ethiopia information.

• A legal problem
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Canadian Embassy to Ethiopia Street Address: Old Airport Area, Nefas Silk Lafto Sub City, Kebele 04, House No.122, Addis Ababa, Ethiopia

Tel.:  251 (0) 11 317 0000 Fax:  251 (0) 11 317 0040

Email:   [email protected]

Click here to access the embassy’s website

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Latest update

Reconsider your need to travel to Ethiopia overall due to the risk of civil unrest and the threat of armed conflict.

Other levels apply in some areas.

Ethiopia (PDF 807.58 KB)

Africa (PDF 1.68 MB)

Local emergency contacts

Fire and rescue services, medical emergencies.

Call 991 or go to the hospital.

Call 991 or go to the local police station.

Advice levels

Reconsider your need to travel to Ethiopia overall.

Do not travel to: 

• Tigray Regional State
• Amhara Regional State
• Benishangul-Gumu Regional State
• Gambela Regional States
• Within 30km of the border with Tigray Regional State and Amhara Regional State in Afar Regional State 
• Kelam Welega, West Welega, East Welega, Horo Guduru Welega, North Shewa, West Shewa, Bale and Borena in Oromia Regional State 
• Somali Regional State except for Nogob, Erer, Sitti and up to 40km of Ethiopia’s border with Somalia in Fafan 
• the border areas of Ethiopia  with Eritrea (including Danakil Depression), Sudan, South Sudan, Kenya and Somalia (including parts of Somaliland)

Do not travel  to the following locations due to the security situation including the risk of terrorist attacks, kidnapping, civil unrest and armed conflict: 

Exercise a high degree of caution  in  Addis Ababa and central Ethiopia. 

Exercise a high degree of caution  in  Addis Ababa and central Ethiopia due to the security situation.

• The security situation in several parts of Ethiopia remains uncertain, particularly in Tigray Regional State, Amhara Regional State, and t he northern areas of Afar Regional States bordering Tigray, southern parts of  Somali Regional State, K elam Welega, East Wollega, West Wollega, Horo Guduru Welega, North Shewa, Bale and Borena of the Oromia Regional State and Benishangul Gumuz Regional State. Do not travel to international borders except the border shared with Djibouti. Security could deteriorate with little warning. Monitor the media and follow local warnings. Do not travel to affected areas. 
• There's a state of emergency in place in Amhara Regional State. If you’re in Amhara we recommend that you shelter in place until it is safe to leave the region. Expect roadblocks and flight disruptions. Stay vigilant and monitor local media and contact your travel provider for the latest update. 
• Some commercial flights to Tigray have resumed. Security conditions in Ethiopia are fluid and roads can be closed at any time. Expect checkpoints on major roads. Telecommunication networks have been restored to most parts of Tigray and Northern Amhara, but some communications may not be reliable. Monitor local media and follow the instructions of local authorities.
• Terrorists have reportedly been planning attacks in Ethiopia. Attacks could occur with little or no warning. Possible targets include hotels, markets, places of worship, government buildings, transport hubs and aircraft. Avoid possible targets and be alert on days of national significance. You're strongly encouraged to maintain a high level of vigilance.
• Violent assaults can occur, and foreigners may be targets. Be aware in areas around Meskel Square, Hyatt Regency, Hilton and Sheraton hotels, Yeka Hills/Entoto and Bole Road. Don't walk alone or at night.
• The risk of kidnapping is higher in southern parts of Somali Regional State and near the borders with South Sudan and Kenya. Several active terrorist groups have the intent and capability to kidnap foreigners.  If d espite our advice you plan to travel to an area where there's a threat of kidnapping, get professional security advice.
• Landmines are a hazard in border areas with Eritrea, Sudan and Somalia. If you travel near these borders despite our advice, stick to well-travelled roads.

Full travel advice: Safety

• Health facilities are limited in Addis Ababa. 
• In rural areas, facilities are inadequate. If you're seriously ill or injured, you'll need medical evacuation out of the country. Ensure your health insurance covers this.  The availability and timeliness of medical evacuation services may be affected.
• Yellow fever is widespread in Ethiopia. Get vaccinated before you travel. Malaria is present everywhere in Ethiopia except Addis Ababa and areas above 2000m. Consider taking anti-malarial medication.
• HIV/AIDS is widespread. Take precautions if you're taking part in high-risk activities.
• Ethiopia is free of wild poliovirus. However, the disease may still come in from nearby countries. Some cases of the rarer vaccine-derived strain of polio have been found in Ethiopia. Check your vaccinations are up to date before you travel.
• Due to major renovations at the Black Lion Hospital in Addis Ababa, emergency services may be severely impacted. Contact the Australian Embassy Addis Ababa for a list of 'known medical providers'. 

Full travel advice: Health

You should comply with the law, including on carrying identification documents at all times, possession of foreign currency and possession of weapons. You should avoid confrontation and follow the instructions of the authorities.

• Ethiopian laws can be quite different from Australia and penalties may appear harsh by Australian standards. Get professional advice if you're involved in legal matters.
• If you're in a road accident, don't move your vehicle before a police officer arrives. It's illegal to do so.
• Understand and follow local laws. It's illegal to buy or remove cultural artefacts without a permit, or export certain amounts of precious stones. It's also illegal to own ivory or to interact with beggars or vendors in traffic.
• Be careful when taking photos. It's illegal to photograph the Presidential Palace, military sites and military personnel.
• Same-sex sexual acts are illegal. If found guilty you could face up to 15 years imprisonment. 
• Ethiopia also has conservative dress and behaviour standards.

Full travel advice: Local laws

• You must have a visa to enter Ethiopia. Visa applications must be made  online . Entry and exit conditions can change at short notice. You should contact the nearest embassy or consulate of Ethiopia for the latest details.
• The security situation in Ethiopia remains uncertain (see ' Safety '). Domestic commercial flights to and from the Regional State of Tigray have resumed. Contact airlines or your travel provider for the latest update.
• The official currency is the Ethiopian Birr (ETB). You can exchange US dollars at the international airport, major banks and hotels. It's difficult to change Australian dollars. ATMs issue small amounts of local currency. Large hotels, restaurants and large shops accept credit cards in Addis Ababa. Have multiple ways to access money.

Full travel advice: Travel

Local contacts

• The Consular Services Charter  details what the Australian Government can and can't do to help you overseas.
• Our ability to provide consular assistance in do not travel areas of Ethiopia is extremely limited.
• To stay up to date with local information, follow the Embassy’s social media accounts.
• If you need urgent consular assistance call the Consular Emergency Centre (CEC) on +61 2 6261 3305.

Full travel advice: Local contacts

Full advice

Civil unrest and political tension.

The security situation in parts of Ethiopia remains uncertain, including in the Tigray Regional State, Amhara Regional State, and the northern areas of Afar Regional States bordering Tigray, southern parts of Somali Regional State, in East and West Wollega zones of the Oromia Regional State and Benishangul Gumuz Regional State. Do not travel to international borders, except the border shared with Djibouti.

The Amhara militia (Fano) has taken control of several areas of Amhara Regional State. If you're in Amhara Regional State, shelter in place until it's safe to leave the region. Mobile and internet networks may be disrupted. Expect roadblocks and flight disruptions. Stay vigilant, monitor local media and contact your travel provider for the latest update. Follow the advice of local authorities.

Commercial flights have resumed to and from Tigray. Some international land borders are closed. Telecommunication networks have been restored to most parts of Tigray but communications may not be reliable.

If, against our advice, you travel to 'Do Not Travel' areas of Ethiopia, you should:

• ensure that your travel documents are up to date
• have a contingency plan in place if you need to leave quickly
• monitor local media for information on the evolving situation
• expect a heightened security presence  and stop at all checkpoints and roadblocks
• you should comply with the law, including on carrying identification documents at all times, foreign currency limits and possession of weapons
• avoid areas where demonstrations and large gatherings are taking place
• follow the instructions of local authorities 
• if you need urgent consular assistance call the Consular Emergency Centre (CEC) on +61 2 6261 3305 or email  [email protected] . 

Security measures, including curfews and movement restrictions may be implemented in Ethiopia at short notice.  The government may disrupt mobile networks and internet connections. Restrictions may change rapidly and without warning. They can impact the Embassy’s ability to provide consular support to Australians.

International events and political changes can trigger demonstrations. Public protests and events that draw large groups of people can turn violent. Avoid crowds or protests.

Ethiopian security forces aren't widespread in the country. They generally may not be able to respond to incidents.

Terrorism is a threat worldwide. Reports say terrorists are planning attacks against a range of targets in Ethiopia. These include commercial and public places that foreigners visit.

Terrorists may use events such as international meetings or days of national or religious significance to mount attacks. An attack could happen at any time.  You’re strongly encouraged to maintain a high level of vigilance.

Possible targets for terror attacks include:

• clubs, hotels, resorts, restaurants and bars
• schools, places of worship, embassies and government buildings
• landmarks, tourist areas, markets and marketplaces, shopping centres and malls, and western businesses
• political and sporting events
• outdoor recreation events and public gatherings, including large religious festivals and concerts

Terrorists also target transport including:

• aircraft and airports
• petrol stations
• buses and bus terminals
• railways and other transport infrastructure

Some local hotels, have received bomb threats in the past.

To protect yourself from terrorism:

• avoid the kinds of public places known to be terrorist targets
• have an exit plan if there's a security incident
• be alert in the lead up to, and on days of, national or religious significance
• monitor the news for any emerging threats
• take official warnings seriously
• follow instructions from local authorities

If there's an attack, leave the affected area immediately if it's safe to.

More information:

Kidnapping occurs across the world with political, ideological, and criminal motives. Foreigners, including Australians, have been kidnapped while travelling overseas. Kidnapping can occur anywhere, anytime, including in destinations that are usually considered lower risk.

Several active terrorist groups have the intent and capability to kidnap foreigners.  The threat of kidnapping is particularly high in southern parts of Somali Regional State. Kidnapping is also a risk near the Kenyan and South Sudanese borders.

If despite our advice you travel to an area with a high risk of kidnapping, you should be aware that our ability to provide consular assistance in these destinations is limited.

To reduce the risk of kidnapping:

• always be alert to your personal security and surroundings
• get professional security advice for travel in locations with a heightened kidnap risk
• check your accommodation has appropriate security measures
• avoid isolated locations, particularly when travelling alone
• notify family or friends of planned travel and share your location
• avoid talking about your money or business affairs
• only use ATMs in public places and during daylight hours
• avoid giving personal details to strangers online or over the phone

The Australian Government's longstanding policy is that it doesn't make payments or concessions to kidnappers.

Ransom payments to kidnappers have funded further terrorist attacks and criminal activity. Paying a ransom to terrorist groups will likely break Australian counter-terrorism financing laws.

Border areas

Do not travel to the border areas of Ethiopia  with Eritrea (including Danakil Depression), Sudan, South Sudan, Kenya and Somalia (including parts of Somaliland).

Don't travel to the border of Ethiopia with Kenya.

There are armed groups. Cross-border violence happens along the border. Violent crime includes:

• armed robbery
• tribal and clan disputes

Don't travel to the border of Ethiopia with Somalia (including parts of Somaliland). 

Violent clashes between government forces and insurgents are common in this border region. Tensions are high.

Firearm, grenade and landmine attacks on security forces are common. Civilians have been killed and injured.

The threat of terrorist attack, including kidnapping, is particularly high. 

Serious armed clashes have occurred along the border between the Somali and Oromia Regional State.

Sudan and South Sudan

Don't travel to the border of Ethiopia with Sudan and South Sudan. This includes rural and border areas of Gambela Regional State. 

The security situation in these areas is extremely unstable. There's a high threat of violent crime and civil unrest from armed groups and tribal clashes. The risk of bandit attacks and kidnapping is high.

The area also has landmines. 

Don't travel to the border of Ethiopia with Eritrea, including Danakil Depression. The situation is still unstable. The area has a heavy military presence and landmines.

Cross-border conflict or other violence can occur at any time .

Unprovoked violent assault occurs, including in popular tourist areas in Addis Ababa. Avoid walking alone at night.

If you're a victim of violent crime, especially rape , visit a doctor as soon as possible as HIV/AIDS is widespread.

Keep an eye on local information sources about crime. Always pay close attention to your belongings.

Petty crime is common and includes:

• pickpocketing
• bag snatching
• jewellery theft
• thefts from vehicles stopped at traffic lights

Petty crimes often take place in crowded areas such as:

• the Mercato open air market
• tourist spots including Piazza and Meskel Square 

These crimes are often carried out by groups of children. Some robbery victims have been assaulted.

Keep your car windows and doors closed and locked at all times, including when moving.

Don’t leave valuables on show in your car.

Highway robberies and armed carjackings have been reported outside the main urban centres.

Cyber security 

You may be at risk of cyber-based threats during overseas travel to any country. Digital identity theft is a growing concern. Your devices and personal data can be compromised, especially if you’re connecting to Wi-Fi, using or connecting to shared or public computers, or to Bluetooth. 

Social media can also be risky in destinations where there are social or political tensions, or laws that may seem unreasonable by Australian standards. Travellers have been arrested for things they have said on social media. Don't comment on local or political events on your social media. 

More information:  

• Cyber security when travelling overseas  

Climate and natural disasters

Ethiopia experiences  natural disasters  and  severe weather , including drought, flooding and plagues of locusts.

Ethiopia is in an active earthquake and volcanic zone .

If a natural disaster occurs:

• keep your passport in a safe, waterproof place
• monitor local media and other sources such as the Global Disaster Alert and Coordination System
• follow the advice of local authorities
• keep in contact with friends and family

Several areas of Ethiopia are experiencing severe drought. Local services may be affected. Drinking water and basic food may be hard to find. An increase in disease has been reported.

Some areas of Ethiopia experience severe flooding. Flash flooding may occur in the rainy season from July to September. Some roads can't be used.

Travel insurance

If you travel to Ethiopia, check your  travel insurance . If you plan to travel to ‘Do not travel’ parts of Ethiopia, you'll likely need a specialised insurance policy that covers travel to high-risk destinations. 

Your policy needs to cover all overseas medical costs, including medical evacuation. The Australian Government won't pay for these costs.

If you can't afford travel insurance, you can't afford to travel. This applies to everyone, no matter how healthy and fit you are.

If you're not insured, you may have to pay many 1000s of dollars up-front for medical care. 

Due to major renovations at the Black Lion Hospital in Addis Ababa, emergency services may be severely impacted.

• what activities and care your policy covers
• that your insurance covers you for the whole time you'll be away

Physical and mental health

Consider your physical and mental health before you travel, especially if you have an existing medical condition.

See your doctor or travel clinic to:

• have a basic health check-up
• ask if your travel plans may affect your health
• plan any vaccinations you need

Do this at least 8 weeks before you leave.

If you have immediate concerns for your welfare, or the welfare of another Australian, call the 24-hour Consular Emergency Centre on +61 2 6261 3305 or contact your  nearest Australian Embassy, High Commission or Consulate  to discuss counselling hotlines and services available in your location.

• General health advice

Medications

Not all medication available over the counter or by prescription in Australia is available in other countries. Some may even be considered illegal or a controlled substance, even if prescribed by an Australian doctor.

If you plan to bring medication, check if it's legal in Ethiopia. Take enough legal medication for your trip.

Carry a copy of your prescription and a letter from your doctor saying:

• what the medications are
• your required dosage
• that it's for personal use

Health risks

Insect-borne diseases

Yellow fever  is widespread in Ethiopia. Yellow fever is a potentially fatal virus spread by mosquitoes. It's prevented by vaccination. Get vaccinated before you travel and carry your vaccination card. Some countries require you to present your Yellow Fever vaccination card if you have travelled in Ethiopia.

Malaria is found in Ethiopia except for the capital Addis Ababa and areas above 2000m. Chloroquine-resistant strains are reported in some areas.  Consider taking medication to prevent chloroquine-resistant malaria.

Other insect-borne diseases include:

• chikungunya
• leishmaniasis
• African sleeping sickness

To protect yourself from disease:

• ensure your accommodation is insect-proof
• use insect repellent
• wear long, loose, light-coloured clothing

Get medical advice if you develop a fever, muscle pain, rash or bad headache.

HIV/AIDS is widespread. Take precautions if taking part in activities that put you at risk of infection.

Other health risks

Waterborne, foodborne and other infectious diseases are also common. These include:

• tuberculosis
• brucellosis

Serious outbreaks sometimes occur.

Bilharzia (schistosomiasis) and other waterborne diseases are spread through freshwater lakes and rivers.

• do not swim in fresh water
• avoid wading through flood waters and waterways

To protect yourself from food and water borne illness:

• drink boiled water or bottled water with sealed lids
• avoid ice cubes
• avoid raw and undercooked food, such as salads

Get medical advice if you have a fever or diarrhoea.

Infectious diseases

Ethiopia is still vulnerable to international spread of the wild poliovirus .

Stay up to date with recommended polio vaccinations, including a booster dose, through the  Australian Immunisation Handbook .

Altitude sickness

The altitude in the mountain regions of Ethiopia, including in the capital city of Addis Ababa, can cause problems. People with lung, heart or chest problems should take extra care. Even if you're healthy, you can still be affected.

Symptoms of altitude sickness include:

• coordination problems

In severe cases, fluid can build up in your lungs, brain or both, which can be fatal.

To protect yourself from altitude sickness:

• ascend slowly, especially above an altitude of 2500m
• rest when needed and don't push your body
• avoid alcohol and cigarettes

If you're affected by severe altitude sickness, get to lower ground as soon as possible.

Medical care

Medical facilities.

Health facilities are limited in Addis Ababa and inadequate in rural areas.

Due to major renovations at the Black Lion Hospital in Addis Ababa, emergency services may be severely limited.

If you become seriously ill or injured, you'll need to be moved to a place with better facilities. Medical evacuation can be very expensive.

You're subject to all local laws and penalties, including those that appear harsh by Australian standards. Research local laws before travelling.

If you're arrested or jailed, the Australian Government will do what it can to help you under our Consular Services Charter . But we can't get you out of trouble or out of jail.

Death penalty

Ethiopia applies the death penalty for serious offences, including aggravated murder.

Penalties for drug offences are severe. They include long jail sentences and heavy fines.

Carrying or using drugs

Family law in Ethiopia can differ a lot from Australian law. This includes divorce, child custody and child support. Laws affecting business activities can also be very different.

Get professional advice on your rights and responsibilities if you're engaging in business or family-related matters.

If you're in an accident, it's illegal to move your vehicle before a police officer arrives.

If you’re arrested the Government of Ethiopia may not tell the Australian Government. Authorities may not permit Australian Embassy staff to visit you.

Same-sex sexual acts are illegal in Ethiopia. If found guilty you could face up to 15 years imprisonment. 

In Ethiopia, it's also illegal to:

• buy or remove Ethiopian antiquities, animal skins or other cultural artefacts, including some Ethiopian crosses, without a permit
• export precious stones and minerals beyond prescribed limits for personal use — check with local authorities before you buy
• give money to or buy something from a beggar or vendor in traffic

It's illegal to take photos:

• near military zones or of military personnel
• near the Presidential Palace in Addis Ababa
• where signs clearly prohibit photography

Advice for LGBTI travellers

Australian laws

Some Australian criminal laws still apply when you're overseas. If you break these laws, you may face prosecution in Australia.

staying within the law and respecting customs

Dual citizenship

Ethiopia doesn't recognise dual nationality.

Despite this, if you’re of Ethiopian heritage and you’re arrested, the Government of Ethiopia may not tell the Australian Government. Authorities may not permit Australian Embassy staff to visit you.

Always travel on your Australian passport .

Dual nationals

Local customs

Standards of behaviour and dress are conservative in Ethiopia. Take care not to offend.

If in doubt, seek local advice.

Time and calendar differences

The Julian calendar is used in Orthodox Christian areas in the highlands. Some Ethiopians set their clocks differently from standard practice elsewhere. This leads to significant time differences.

Ethiopian Airlines and other large international airlines use standard international time.

To avoid confusion, always check bookings and appointments.

Visas and border measures

Every country or territory decides who can enter or leave through its borders. For specific information about the evidence you'll need to enter a foreign destination, check with the nearest embassy, consulate or immigration department of the destination you're entering. 

You must have a visa to enter Ethiopia. Visa applications must be made  online . 

Visa conditions

Check your visa's expiry date. If you overstay your visa, there is a daily fine.

Other formalities

Yellow fever vaccination.

You may need a valid yellow fever vaccination certificate  to enter Ethiopia. Some airlines may want to see one when you leave. You should carry a valid Yellow Fiver International Vaccination Certificate.

Find out about returning to Australia after exposure to yellow fever .

Countries with a risk of yellow fever

Banned or restricted items

Satellite phones, drones and binoculars cannot be imported to Ethiopia without prior approval. Seek advice from your travel provider on permissions required. Unapproved items may be confiscated by authorities.

There are no guidelines covering the use of drones in Ethiopia. They may be confiscated at airports or at the border. Seek and carry written permission from the Ethiopian Government before using drones.

US Department of Homeland Security

Some countries won't let you enter unless your passport is valid for 6 months after you plan to leave that country. This can apply even if you're just transiting or stopping over.

Some foreign governments and airlines apply the rule inconsistently. Travellers can receive conflicting advice from different sources.

You can end up stranded if your passport is not valid for more than 6 months.

The Australian Government doesn't set these rules. Check your passport's expiry date before you travel. If you're not sure it'll be valid for long enough, consider getting a new passport .

Lost or stolen passport

Your passport is a valuable document. It's attractive to people who may try to use your identity to commit crimes.

Some people may try to trick you into giving them your passport. Always keep it in a safe place.

If your passport is lost or stolen, tell the Australian Government as soon as possible:

• In Australia, contact the Australian Passport Information Service .
• If you're overseas, contact the nearest Australian embassy or consulate .

Passport with X gender identifier

Although Australian passports comply with international standards for sex and gender, we can’t guarantee that a passport showing 'X' in the sex field will be accepted for entry or transit by another country. Contact the nearest  embassy, high commission or consulate of your destination  before you arrive at the border to confirm if authorities will accept passports with 'X' gender markers. 

More information:   

• LGBTI travellers  

The official currency is the Ethiopian Birr (ETB).

Currency controls are strict in Ethiopia. If you have more than USD3,000 or the same amount in another foreign currency, you must declare it when you arrive and depart. You may be required to show receipts to demonstrate expenditure. This covers all forms of currency, not only cash. You are unable to depart Ethiopia with more than ETB2,000 in cash. 

If you arrive or depart with more than USD3,000, the entire amount in your possession can be seized by authorities.

It's difficult to exchange Australian dollars in Ethiopia. However, most banks exchange US dollars.

There are ATMs in major Ethiopian cities. ATMs can't always be used for cash advances and can run out of cash unexpectedly. Always travel with ETB.

Credit cards are accepted at major hotels and an increasing number of other outlets, mostly in Addis Ababa. Poor power supply and internet outages may affect their reliable operation.  Consider carrying a backup supply of cash.  

Check with your bank to make sure your card will work in Ethiopia.

Local travel

Landmines are a hazard in the border areas with Eritrea, Sudan and Somalia. If you travel near these borders despite our advice, stick to well-travelled roads. See Safety

Driving permit

If you want to drive in Ethiopia, you can apply to convert a valid Australian licence to a local one. It's an Ethiopian Government requirement that your Australian license first be authenticated by the Department of Foreign Affairs and Trade in Australia and then by the Australian Embassy in Ethiopia for it to be recognised. See the  Ethiopian Embassy  for more information.

International driving permits aren't recognised in Ethiopia.

Road travel

Driving in Ethiopia can be dangerous because of:

• poor road conditions
• poorly maintained vehicles
• local driving practices
• poor lighting
• people and animals, particularly camels, wandering on roads

Security forces sometimes close roads, including highways. Closures can occur without notice.

Due to the deteriorating security situation, we advise you avoid non-essential travel to and around Ethiopia.

Car accidents

Drivers involved in car accidents can face severe punishments, including prison and fines.

If you're in a car accident, it's illegal to move your vehicle before a police officer arrives. However, if you feel unsafe, leave the area immediately and report to the nearest police station.

If you plan to drive in Ethiopia:

• become familiar with local traffic laws and practices before driving
• drive legally
• don't drink and drive
• keep your car windows and doors closed and locked at all times, including when moving
• avoid driving at night, where possible

If you're stopped by police, follow their instructions.

If rocks are thrown at your car, leave the area as quickly and safely as possible.

To protect yourself when travelling outside Addis Ababa:

• get local advice on road and security conditions along your planned route before you travel
• leave details of your travel itinerary with a reliable person
• travel in a group where possible
• carry a well-stocked medical pack
• consider carrying a satellite phone — regular telephones, including the mobile network, are unreliable

Driving or riding

Motorcycles

Check with your insurer whether your policy covers you when using a motorbike or similar vehicle. Your policy may not cover accidents that occur while using these vehicles.

Always wear a helmet. Make sure your passenger does too.

Only use registered taxis and authorised limousines. Arrange these through your hotel or via one of the app-based booking services. Avoid flagging down taxis in the street.

Consider sitting in the back seat rather than the front.

Not all taxis are metered. Ensure the meter is on or agree on the fare before you leave.

Public transport

Ethiopia has bus and limited rail services. However, safety standards aren't the same as in Australia. Buses have been attacked outside Addis Ababa.

Petty crimes occur on public transport. Take care of your belongings when travelling on buses and trains.

Transport and getting around safely

Commercial flights to and from the Regional State of Tigray have resumed.

DFAT doesn't provide information on the safety of individual commercial airlines or flight paths.

Check Ethiopia's air safety profile with the Aviation Safety Network.

Emergencies

Depending on what you need, contact your:

• family and friends
• travel agent
• insurance provider

Always get a police report when you report a crime.

Your travel insurer should have a 24-hour emergency number.

Consular contacts

Our ability to provide consular assistance in the 'Do not travel' areas of Ethiopia is extremely limited. If you need urgent consular assistance call the Consular Emergency Centre (CEC) on +61 2 6261 3305 or email [email protected] . 

Read the Consular Services Charter for what the Australian Government can and can't do to help you overseas.

Australian Embassy, Addis Ababa

Turkish compound (off Cape Verde street)

Bole Subcity, Woreda 3

PO Box 3715

Addis Ababa, Ethiopia

Phone: +251 11 6672651 / 6672652 / 6672693 / 6672694

Email: [email protected]

Website: ethiopia.embassy.gov.au

Facebook: @AusEmb.ET

X (Twitter): @AusEmbET

Check the Embassy website for details about opening hours and any temporary closures.

24-hour Consular Emergency Centre

In a consular emergency, if you can't contact an embassy, call the 24-hour Consular Emergency Centre (CEC) on:

• +61 2 6261 3305 from overseas
• 1300 555 135 in Australia

Travelling to Ethiopia?

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Travel Vaccines and Advice for Ethiopia

Said to be one of the oldest nations in the world, Ethiopia has a lot to offer those visiting its borders. The country has stunning landscapes with varying terrain and history going to prehistoric times.

Enjoy rafting on the Omo River, see the enormous crocodiles in Lake Chomo, or hike to historic churches. These gorgeous sites offer unique experiences that you can only get in Ethiopia.

Enjoy the hub of city life in Addis Ababa. Sit in the plaza and sip some coffee while taking in the culture and hospitality of the country.

Do I Need Vaccines for Ethiopia?

Yes, some vaccines are recommended or required for Ethiopia. The PHAC and WHO recommend the following vaccinations for Ethiopia: COVID-19 , hepatitis A , hepatitis B , typhoid , cholera , yellow fever , rabies , meningitis , polio , measles, mumps and rubella (MMR) , Tdap (tetanus, diphtheria and pertussis) , chickenpox , shingles , pneumonia and influenza .

See the bullets below to learn more about some of these key immunizations:

• COVID-19 – Airborne – Recommended for all travellers
• Hepatitis A – Food & Water – Recommended for most travellers
• Hepatitis B – Blood & Body Fluids – Recommended for travellers to most regions.
• Typhoid – Food & Water – Recommended for travellers to most regions.
• Cholera – Food & Water – A risk in some regions. Especially recommended for those visiting rural areas.
• Yellow Fever – Mosquito – Required if travelling from a region with yellow fever. Recommended for all travellers over 9 months of age. Generally not recommended for Afar and Somali provinces.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travellers and those who may come in contact with animals.
• Meningitis – Airborne & Direct Contact – Located in the meningitis belt, vaccination is recommended during the dry season (Dec. – June)
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
• Influenza – Airborne – Vaccine components change annually.
• Polio – Food & Water – While there is no active polio transmission in Ethiopia, it is vulnerable for outbreaks. Considered a routine vaccination for most travel itineraries. Single adult booster recommended.

See the tables below for more information:

Ethiopia sits in the meningitis belt. This region of Africa is known for it’s meningitis transmission from December through June. Make sure you are vaccinated against all forms of meningitis before your trip.

Mosquito-borne diseases like malaria and dengue are in Ethiopia. Make sure you’re protected with antimalarials, repellents and netting. A travel health specialist will help you determine what protection is right for you.

Visit our vaccinations page to learn more. Travel safely with Passport Health and schedule your appointment today by calling or book online now .

Do I Need a Visa for Ethiopia?

A visa is required in order to visit Ethiopia. The government of Ethiopia sells visas on arrival for those who will be in the country less than 12 hours and to tourists. Only citizens of several different countries, including Canada, may receive a visa upon arrival at Bole International Airport.

Sources: Embassy of Ethiopia and Canadian Travel and Tourism

Proof of yellow fever and polio vaccination may be required at entry.

Visit the Canadian Travel and Tourism website for more information on entry and exit requirements.

What Is the Climate Like in Ethiopia?

Ethiopia’s main climate is tropical monsoon. Weather will vary depending on the region. Here are 3 of the major cities and what you can expect when you travel:

• Addis Ababa – The capital of Ethiopia is on the foothills of Mount Entoto. With an elevation of around 2,400 metres, you can experience a pleasant climate year round. Expect average temperatures in the high-teens to low-20’s. The main wet season is from June to September with higher temperatures.
• Mekele – This city is located in the Tigrayan Highlands in the north of the country. The warmest it gets is mid-20’s and the coolest is in the teens. Be cautious of travelling during the wet months. Many roads can be inaccessible due to flooding.
• Adama – Also known as Nazret or Nazareth, this city is a major weekend destination located near Addis. With a similar elevation of Addis Ababa, the climate is about the same.

Most of the major cities in Ethiopia have a similar elevation to Addis Ababa. If you’re travelling to lower regions, the climate can be hotter and drier depending on the time you travel.

Be sure to take this into account when packing your bags.

Is Ethiopia Safe?

Ethiopia has had some terrorist attacks over the last few years. Travellers should take extra precautions especially in the Oromia and Amhara regions.

Be cautious of areas with large gatherings. If you think a protest may be forming try to leave the area as a precaution.

Remain alert and cautious if travelling near bordering countries of Ethiopia. There is a high threat of landmines along the western border and tensions are high due to ethnic conflicts.

Ethiopia has a low crime rate compared to other African countries. As with any major city, be wary of pick-pocketing and other theft that are common in Addis Ababa. Many of the crimes are petty but some violent robberies have been known to occur.

Stay alert, take your surroundings into consideration, plan your trips ahead of time, and make sure you have everything you need.

Crocodiles at Lake Chomo

Lake Chomo is home to scores of crocodiles lounging around in the sun. If you’re lucky you’ll see other natural wildlife such as hippos and shore birds.

If you’re looking for a great way to be up close and personal with wildlife, you’re able to take a boat tour around the lake. The Rift Valley Boat Service Association is in control of making these trips. It’s best to visit early morning to mid-afternoon to see the crocodiles. The boat ride may only take about half an hour, but the whole trip could take longer. Allow two or more hours for the trip and plan accordingly.

What Should I Pack for Ethiopia?

What you need to take to Ethiopia will depend on when you are travelling. Make sure you bring these items with you:

• Rain Gear – If you’re visiting during the wet season bring protective gear against the rain. Consider bringing waterproof shoes. They can help so you don’t need to pack extra socks in your day bag.
• Comfortable Hiking Shoes – A lot of Ethiopia’s wonders involve varying terrain and activities like hiking or climbing. Pack shoes you’ve already broken in and are comfortable wearing for long periods of time.
• Lightweight Jacket – With varying elevation you may find yourself needing to layer. Higher elevations have a different climate. Ne sure to have a decent jacket you don’t mind carrying around for when it gets warmer.

Canadian Embassy in Ethiopia

The Embassy of Canada in Addis Ababa serves Canadians as well as other citizens for a various number of issues. The embassy also serves those who are visiting the country of Djibouti.

Embassy of Canada to Ethiopia Old Airport Area, Nefas Silk Lafto Sub City Kebele 04, House No. 122 Addis Ababa, Ethiopia Telephone: +251 11 317 00 00

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On This Page: What Vaccines Do I Need for Ethiopia? Do I Need a Visa for Ethiopia? What Is the Climate Like in Ethiopia? Is Ethiopia Safe? Crocodiles at Lake Chomo What Should I Pack for Ethiopia? Canadian Embassy in Ethiopia

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COVID-19: travel health notice for all travellers

Ethiopia travel advice

Latest updates: Health – editorial update

Last updated: April 8, 2024 11:16 ET

On this page

Safety and security, entry and exit requirements, laws and culture, natural disasters and climate, ethiopia - avoid non-essential travel.

This advisory excludes Addis Ababa where you should exercise a high degree of caution.

Additional regional advice and advisories are in effect. Our ability to provide consular assistance is limited in some regions.

Addis Ababa - Exercise a high degree of caution

Exercise a high degree of caution in Addis Ababa due to an increase in robberies and the risk of spontaneous demonstrations becoming violent. Ongoing armed conflict and civil unrest in other parts of the country could spread to major cities without warning.

Northern regions - Avoid all travel

• zones 1, 2 and 4 and the Danakil Depression in the Afar region
• Benishangul-Gumuz
• areas within 30 km from the borders with the regions and zones listed above

Central regions - Avoid all travel

• Wollega zones
• West Shewa zone
• A7 highway between Mojo and Hawassa and A1 highway North-East of (but not including) Welenchiti, in the East Shewa zone
• North Shewa zone
• Southwest Shewa zone
• West Arsi zone
• Haraghe zone
• 30 km from the areas bordering the zones and regions listed above

Somali - Avoid all travel

Avoid all travel to the Somali Region, due to incidences of armed attacks and the risk of terrorism and kidnapping. This includes areas within 30 km from the border with Dire Dawa, Oromia Region, and Afar Region.

Border areas - Avoid all travel

South sudan.

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The situation is volatile and unpredictable in several areas throughout the country due to ethnic conflicts. Violent clashes occur, especially near regional borders. 

Frequent incidents of civil unrest can lead to violence. Sporadic roadblocks, curfews and disruptions to telecommunications services are possible throughout the country.

If you travel to Ethiopia:

• expect a heightened security presence
• ensure that your travel documents are up to date
• carry identification documents at all times
• make sure to stop at all checkpoints and roadblocks, even if they appear unattended
• if you are stopped by security forces, stay calm and follow instructions

Amhara region

The state of emergency, declared by the Ethiopian authorities on August 14, 2023, remains in effect in the Amhara region due to continued clashes between armed groups and security forces.

While a state of emergency is in effect, police and military have the power to:

• restrict freedom of movement and assembly
• enter private properties to conduct searches
• detain persons of interest

There is increasing and spreading violence in the Amhara region. The majority of the instability is taking place in towns and villages along the A2 and B22 highways, as well as along the southern part of the A3 highway. The cities of Lalibela, Bahir Dar and Gondar have also been affected. The safety and security situation is changing rapidly and includes violent clashes between armed groups in and around cities, towns and airports. Road blocks and curfews are also being used to restrict movements.

Due to the potential for violence to increase and spread in this region, you are at high risk of encountering movement restrictions and having no access to communications.

If you are in the Amhara region affected by the armed conflict:

• monitor local media to stay informed on the evolving situation
• follow the instructions of local authorities
• shelter-in-place until the situation stabilizes and until it is safe to leave the region (flights and land transportation may be disrupted)
• register with ROCA ( https://travel.gc.ca/travelling/registration ) to receive important safety updates from the Government of Canada
• contact the Embassy of Canada in Addis Ababa by email if you require consular assistance: [email protected]

Violent clashes between armed groups occur. Inter-ethnic disputes in Amhara have resulted in casualties, including civilians. Although foreigners are   generally not targeted, there is a risk that you could be caught up in violence.

Tigray region

A cessation of hostilities agreement was signed on November 2, 2022 between the Government of Ethiopia and the Tigray People's Liberation Front (TPLF), after two years of armed conflict. The agreement has yet to be fully implemented and there remains uncertainty regarding its implications for security in the region.

Travel in and out of the Tigray region can be restricted without notice and food insecurity remains a major concern. Heightened security measures are in place.

Danakil Depression (Afar region)

Foreigners have been the target of violent crimes, including armed assaults and kidnappings by bandit groups in this area. Cross border tensions and landmines are also a concern. 

Border areas

Border areas, including regional borders, often see higher criminal activity and violence, including in rural areas. Confrontations between organized criminal groups, ethnic groups, and Ethiopian authorities pose a risk.

The border with Eritrea is still a heavily militarized security corridor despite the peace agreement signed in 2018. Armed conflict could erupt without notice. Due to the conflict in Tigray, border roads and border crossings with Eritrea are closed. Conditions at the border may change without notice. Landmines pose a risk.

Inter-ethnic conflicts and banditry are frequent near the border with Kenya. Security forces regularly carry out military operations, which periodically raises tensions.

Cross-border violence also occurs. Armed groups hostile to the Government of Ethiopia operate in several areas near the border.

Terrorists maintain a presence in this area, and ethnic conflict has been reported. This includes but is not limited to the Konso Zone and surrounding areas. Kidnapping also poses a risk in this area.

Sporadic armed clashes over disputed land occur. The risk of terrorism and kidnapping is high in this area.  Landmines pose a threat to safety.

Ethnic tensions and sporadic violence are common. Ethnic militias from South Sudan have crossed into Ethiopia to attack rival communities. The security situation is extremely unstable. The threat of violent crime, civil unrest and tribal clashes is high. Kidnapping and landmines pose a threat to safety.

Gambella region

Ethnic conflict, violent crime and sporadic violence are of concern in the city of Gambella and its surrounding areas. Armed clashes have caused casualties and damage to foreign companies’ installations in the area.

Somali region

Terrorist groups maintain a presence in Somali towns near the Ethiopian border, presenting a risk for cross-border attacks and kidnappings. Violent crime, including armed robbery, occurs. Violent clashes between armed groups and security forces, as well as ethnic violent, are common. Landmines pose a threat to safety.

Oromia region

Demonstrations, civil unrest, violent crime, armed conflicts, and clashes between security forces and armed groups occur in Oromia, including in areas bordering Amhara. Roadside attacks have also taken place.  These incidents are particularly prevalent in the following zones:

• West Wellega and the main Addis Ababa to Gambella road (A4 highway)
• East Wellega
• Kellem Wellega
• Horro-Guduru Wellega

Airstrikes targeting rebel groups in the West Shewa, East Shewa and West Wollega zones have killed hundreds of civilians.

The security situation could deteriorate without warning. A heightened security presence remains throughout these areas. Local authorities may impose curfews without notice. Internet and cellular data outages could occur.

• avoid military, police and security installations
• exercise extreme caution
• follow the advice of local authorities

There is a threat of kidnapping, particularly in Western Oromia region.

Benishangul Gumuz region

Civil unrest, including armed conflicts, has resulted in deaths. Violent clashes can occur without warning due to local ethnic tensions.

Southern Nations, Nationalities, and Peoples region

Armed conflicts and civil unrest have occurred sporadically across the region.  These have led to casualties and mass arrests. Residents have also randomly attacked cars and disrupted road travel. Militia attacks have also occurred. 

The security situation could deteriorate without warning. A heightened security presence remains throughout these areas. Local authorities may impose curfews without notice. Internet and cellular data outages could occur. 

Kidnapping occurs, especially in the Somali, Gambella and Oromia regions (Kellem, East and West Wellega zones), as well as in the border areas with Kenya, Somalia, South Sudan and Eritrea (Danakil Depression).

If you are travelling in a region prone to kidnapping:

• get professional security advice
• arrange for personal security
• change your travel patterns regularly
• be aware of your surroundings
• avoid displaying signs of affluence
• don’t travel alone

Petty crime

Petty crime, such as pickpocketing, purse snatching and mugging, occurs, especially in Addis Ababa. Incidents are mostly opportunistic. However, they have been increasingly reported in the following areas:

• the Bole Medhanealem
• the Bole Atlas
• the Meskel Square
• the Merkato

Theft from parked cars and burglaries in vacant residences also occur, especially in rural areas, where the police response is limited.

Crime significantly increases after dark.

• Be aware of your surroundings at all times, especially in crowded areas
• Avoid displaying any signs of affluence in public
• Avoid walking alone after sundown
• Choose living accommodations that have good security measures
• Keep car doors locked while you’re in your vehicle
• Park your car in a well-lit and guarded area
• Be vigilant if approached by strangers seeking assistance
• If threatened, hand over valuables without resistance
• Ensure that your belongings, including your passport and other travel documents, are secure at all times

Violent crime

Violent crime is rare in Addis Ababa, but happens. Westerners have been victims of armed assaults and muggings.

If threatened:

• stay calm and don’t resist
• comply with the robbers’ requests

Demonstrations and civil unrest

Demonstrations take place regularly, especially across the Oromia region and Addis Ababa. They can occur without warning. Ethnic tensions and territorial disputes in this area have led to demonstrations and civil unrest near the regional state borders.

Even peaceful demonstrations can turn violent at any time. They can also lead to disruptions to traffic and public transportation.

• Avoid areas where demonstrations and large gatherings are taking place
• Follow the instructions of local authorities
• Monitor local media for information on ongoing demonstrations

Mass gatherings (large-scale events)

There is a threat of terrorism.   Regional terror groups continue to threaten Western interests and other potential targets in Ethiopia, including in Addis Ababa.  Domestic terror groups also pose an increased threat in some regions, like the Somali region.

Targets could include:

• government buildings, including schools
• places of worship
• airports and other transportation hubs and networks
• public areas such as tourist attractions, restaurants, bars, coffee shops, shopping centres, markets, hotels and other sites frequented by foreigners

Always be aware of your surroundings when in public places.

Ethiopia is primarily a cash-based economy but credit card and ATM fraud may sometimes occur, especially in large cities. There have been reports of unauthorized charges. Connectivity issues may also be a problem.

Be cautious when using debit or credit cards:

• pay careful attention when your cards are being handled by others
• use ATMs located in well-lit public areas or inside a bank or business
• avoid using card readers with an irregular or unusual feature
• cover the keypad with one hand when entering your PIN
• check for any unauthorized transactions on your account statements

Overseas fraud

Outages and shortages

Power outages are frequent nationwide, particularly during the dry season from November to June. Local authorities may impose power rationing.

Not all buildings have generators. Outages can result in lack of street lighting, restaurants and supermarkets without adequate refrigeration, and gas stations unable to supply fuel.

Communications

Although there are some plans to improve the network, cellular coverage is unreliable and connectivity remains an issue in several parts of the country.

Local authorities also control telecommunications and may shut down both cell phone and internet systems during periods of civil unrest or ahead of a large planned protest.

You should not rely on your cell phone in case of emergency, especially outside major cities.

• Avoid travelling alone
• Inform relatives of your itinerary

Fuel and food

Periodic fuel and food shortages occur. This may create social tensions and increase food prices.

• Carry flashlights
• Plan to have adequate water, food and fuel supplies

Road safety

Driving standards, vehicle maintenance and road conditions are often poor throughout the country. Traffic accidents are a regular occurrence, especially in Addis Ababa and on the Addis Ababa–Djibouti road.

Apart from major arteries, roads are generally unpaved. They often lack markings and signage, reflectors and shoulders, even in urban areas. They are poorly lit and maintained.

Drivers often drive at excessive speed and don’t respect traffic laws. They may be reckless. Poorly maintained vehicles, roaming animals and pedestrians pose further hazards. Armed robbery, carjacking and landmines also pose a threat, especially in border areas

There is no road assistance and emergency services are limited to nonexistent in several areas. Although improving, the cellular coverage remains unstable outside main cities.

• Avoid driving after dark
• Always keep your gas tank full when in remote areas
• Always carry a first-aid kit, as medical facilities are often undersupplied
• Advise a relative of your anticipated itinerary and route
• If you encounter a roadblock, turn around and don’t attempt to pass it
• Don’t rely on your phone for navigation or emergency contacts

Traffic accidents occur regularly throughout Ethiopia. Traffic often moves unpredictably.

Under Ethiopian law, it is illegal to move your vehicle before a police officer arrives if an accident occurs. Large crowd may gather and could become hostile and aggressive.

If involved in an accident:

• avoid confrontation
• call the local police and remain at the scene of the accident until they arrive
• should you feel unsafe, leave immediately and report the incident to the nearest police station

Public transportation

Most public transport is unregulated and unsafe. Hire private transport from a reliable source or use transportation provided by your hotel.

Minibuses and large buses are often old, poorly maintained and overcrowded.

Some buses have been attacked on their way from one region to another.

Only use buses from the airport that have been organised by your hotel or your tour operator.

Rail services are limited and trains are poorly maintained. Avoid travelling by train.

Taxis are generally unsafe.

If travelling by taxi:

• only use metered taxis
• choose yellow taxis rather than white or blue ones
• make sure you are the only passenger in the vehicle

Hiking in the Danakil Depression

Weather conditions in the Danakil depression area can be fairly arid. Facilities are basic. There is no running water and medical options are very limited.

You should prepare for excessive heat and difficult terrain, namely around the Erta Ale Volcano.

If you intend on hiking in this area despite the advisory in place:

• never do so alone and always hire an experienced guide from a reputable company
• buy travel insurance that includes helicopter rescue and medical evacuation
• ensure that your physical condition is good enough to meet the challenges of your activity
• ensure that you’re properly equipped and well informed about weather and other conditions that may pose a hazard
• inform a family member or friend of your itinerary, including when you expect to be back to camp
• know the symptoms of acute altitude sickness, which can be fatal
• obtain detailed information on trekking routes before setting out and do not venture off marked trails

Women’s safety

Women travelling alone may be subject to harassment and verbal abuse.

We do not make assessments on the compliance of foreign domestic airlines with international safety standards.

Information about foreign domestic airlines

Every country or territory decides who can enter or exit through its borders. The Government of Canada cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements.

We have obtained the information on this page from Ethiopian authorities. It can, however, change at any time.

Verify this information with the  Foreign Representatives in Canada .

Entry requirements vary depending on the type of passport you use for travel.

Before you travel, check with your transportation company about passport requirements. Its rules on passport validity may be more stringent than the country’s entry rules.

Regular Canadian passport

Your passport must be valid for at least 6 months beyond the date you expect to leave Ethiopia.

Passport for official travel

Different entry rules may apply.

Official travel

Passport with “X” gender identifier

While the Government of Canada issues passports with an “X” gender identifier, it cannot guarantee your entry or transit through other countries. You might face entry restrictions in countries that do not recognize the “X” gender identifier. Before you leave, check with the closest foreign representative for your destination.

Other travel documents

Different entry rules may apply when travelling with a temporary passport or an emergency travel document. Before you leave, check with the closest foreign representative for your destination.

Useful links

• Foreign Representatives in Canada
• Canadian passports

Tourist visa: required Business visa: required Transit visa: required

Canadians must have a valid visa to enter the country. You may obtain a visa online. If you overstay your visa, you may face daily fines and imprisonment.

You need the proper visa if you want to conduct a business or volunteering activity. If you fail to do so, you may be fined or detained.

• Obtain a visa online before arrival
• Verify carefully that your visa is valid
• Ensure that your activities in the country adhere to the type of visa you have obtained

Ethiopian e-Visa  – Federal Democratic Republic of Ethiopia

Other entry requirements

Authorities may request additional documents if you attempt to enter Ethiopia by vehicle at certain border crossings.

Contact the Embassy of Canada to Ethiopia, in Addis Ababa, to determine specific entry requirements at land borders.

Children and travel

Learn more about travelling with children .

Yellow fever

Learn about potential entry requirements related to yellow fever (vaccines section).

Relevant Travel Health Notices

• Global Measles Notice - 13 March, 2024
• Zika virus: Advice for travellers - 31 August, 2023
• COVID-19 and International Travel - 13 March, 2024
• Dengue: Advice for travellers - 8 April, 2024

This section contains information on possible health risks and restrictions regularly found or ongoing in the destination. Follow this advice to lower your risk of becoming ill while travelling. Not all risks are listed below.

Consult a health care professional or visit a travel health clinic preferably 6 weeks before you travel to get personalized health advice and recommendations.

Routine vaccines

Be sure that your  routine vaccinations , as per your province or territory , are up-to-date before travelling, regardless of your destination.

Some of these vaccinations include measles-mumps-rubella (MMR), diphtheria, tetanus, pertussis, polio, varicella (chickenpox), influenza and others.

Pre-travel vaccines and medications

You may be at risk for preventable diseases while travelling in this destination. Talk to a travel health professional about which medications or vaccines may be right for you, based on your destination and itinerary. 

Yellow fever   is a disease caused by a flavivirus from the bite of an infected mosquito.

Travellers get vaccinated either because it is required to enter a country or because it is recommended for their protection.

• There is a risk of yellow fever in this country.

Country Entry Requirement*

• Proof of vaccination is required if you are arriving from Brazil, Bolivia, Peru, or Venezuela or have transited through an airport in one of these countries.

Recommendation

• Vaccination is recommended depending on your itinerary.
• Contact a designated  Yellow Fever Vaccination Centre  well in advance of your trip to arrange for vaccination.
• Discuss travel plans, activities, and destinations with a health care professional.
• Protect yourself from mosquito bites .

About Yellow Fever

Yellow Fever Vaccination Centres in Canada * It is important to note that  country entry requirements  may not reflect your risk of yellow fever at your destination. It is recommended that you contact the nearest  diplomatic or consular office  of the destination(s) you will be visiting to verify any additional entry requirements.

There is a risk of hepatitis A in this destination. It is a disease of the liver. People can get hepatitis A if they ingest contaminated food or water, eat foods prepared by an infectious person, or if they have close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.

Practise  safe food and water precautions and wash your hands often. Vaccination is recommended for all travellers to areas where hepatitis A is present.

Measles is a highly contagious viral disease. It can spread quickly from person to person by direct contact and through droplets in the air.

Anyone who is not protected against measles is at risk of being infected with it when travelling internationally.

Regardless of where you are going, talk to a health care professional before travelling to make sure you are fully protected against measles.

  Hepatitis B is a risk in every destination. It is a viral liver disease that is easily transmitted from one person to another through exposure to blood and body fluids containing the hepatitis B virus.  Travellers who may be exposed to blood or other bodily fluids (e.g., through sexual contact, medical treatment, sharing needles, tattooing, acupuncture or occupational exposure) are at higher risk of getting hepatitis B.

Hepatitis B vaccination is recommended for all travellers. Prevent hepatitis B infection by practicing safe sex, only using new and sterile drug equipment, and only getting tattoos and piercings in settings that follow public health regulations and standards.

Coronavirus disease (COVID-19) is an infectious viral disease. It can spread from person to person by direct contact and through droplets in the air.

It is recommended that all eligible travellers complete a COVID-19 vaccine series along with any additional recommended doses in Canada before travelling. Evidence shows that vaccines are very effective at preventing severe illness, hospitalization and death from COVID-19. While vaccination provides better protection against serious illness, you may still be at risk of infection from the virus that causes COVID-19. Anyone who has not completed a vaccine series is at increased risk of being infected with the virus that causes COVID-19 and is at greater risk for severe disease when travelling internationally.

Before travelling, verify your destination’s COVID-19 vaccination entry/exit requirements. Regardless of where you are going, talk to a health care professional before travelling to make sure you are adequately protected against COVID-19.

 The best way to protect yourself from seasonal influenza (flu) is to get vaccinated every year. Get the flu shot at least 2 weeks before travelling.  

 The flu occurs worldwide. 

•  In the Northern Hemisphere, the flu season usually runs from November to   April.
•  In the Southern Hemisphere, the flu season usually runs between April and   October.
•  In the tropics, there is flu activity year round. 

The flu vaccine available in one hemisphere may only offer partial protection against the flu in the other hemisphere.

The flu virus spreads from person to person when they cough or sneeze or by touching objects and surfaces that have been contaminated with the virus. Clean your hands often and wear a mask if you have a fever or respiratory symptoms.

This destination is in the African Meningitis Belt, an area which has the highest rates of meningococcal disease in the world. Meningococcal disease is a serious and sometimes fatal infection. 

Travellers who are at higher risk should discuss vaccination with a health care provider. High-risk travellers include those living or working with the local population (e.g., health care workers) or those travelling to crowded areas or taking part in large gatherings.

Malaria  is a serious and sometimes fatal disease that is caused by parasites spread through the bites of mosquitoes.   There is a risk of malaria in certain areas and/or during a certain time of year in this destination. 

Antimalarial medication may be recommended depending on your itinerary and the time of year you are travelling. Consult a health care professional or visit a travel health clinic before travelling to discuss your options. It is recommended to do this 6 weeks before travel, however, it is still a good idea any time before leaving.    Protect yourself from mosquito bites at all times:  • Cover your skin and use an approved insect repellent on uncovered skin.  • Exclude mosquitoes from your living area with screening and/or closed, well-sealed doors and windows. • Use insecticide-treated bed nets if mosquitoes cannot be excluded from your living area.  • Wear permethrin-treated clothing.    If you develop symptoms similar to malaria when you are travelling or up to a year after you return home, see a health care professional immediately. Tell them where you have been travelling or living. 

In this destination, rabies is commonly carried by dogs and some wildlife, including bats. Rabies is a deadly disease that spreads to humans primarily through bites or scratches from an infected animal. While travelling, take precautions , including keeping your distance from animals (including free-roaming dogs), and closely supervising children.

If you are bitten or scratched by a dog or other animal while travelling, immediately wash the wound with soap and clean water and see a health care professional. In this destination, rabies treatment may be limited or may not be available, therefore you may need to return to Canada for treatment.  

Before travel, discuss rabies vaccination with a health care professional. It may be recommended for travellers who are at high risk of exposure (e.g., occupational risk such as veterinarians and wildlife workers, children, adventure travellers and spelunkers, and others in close contact with animals). 

The World Health Organization (WHO) has identified this country as no longer poliovirus-infected but at high risk of an outbreak . Polio can be prevented by vaccination.

Recommendations:

• Be sure that your polio vaccinations are up to date before travelling. Polio is part of the routine vaccine schedule for children in Canada.
• One booster dose of the polio vaccine is recommended as an adult .

Safe food and water precautions

Many illnesses can be caused by eating food or drinking beverages contaminated by bacteria, parasites, toxins, or viruses, or by swimming or bathing in contaminated water.

• Learn more about food and water precautions to take to avoid getting sick by visiting our eat and drink safely abroad page. Remember: Boil it, cook it, peel it, or leave it!
• Avoid getting water into your eyes, mouth or nose when swimming or participating in activities in freshwater (streams, canals, lakes), particularly after flooding or heavy rain. Water may look clean but could still be polluted or contaminated.
• Avoid inhaling or swallowing water while bathing, showering, or swimming in pools or hot tubs. 

Cholera is a risk in parts of this country. Most travellers are at very low risk.

To protect against cholera, all travellers should practise safe food and water precautions .

Travellers at higher risk of getting cholera include those:

• visiting, working or living in areas with limited access to safe food, water and proper sanitation
• visiting areas where outbreaks are occurring

Vaccination may be recommended for high-risk travellers, and should be discussed with a health care professional.

Travellers' diarrhea is the most common illness affecting travellers. It is spread from eating or drinking contaminated food or water.

Risk of developing travellers' diarrhea increases when travelling in regions with poor standards of hygiene and sanitation. Practise safe food and water precautions.

The most important treatment for travellers' diarrhea is rehydration (drinking lots of fluids). Carry oral rehydration salts when travelling.

Typhoid   is a bacterial infection spread by contaminated food or water. Risk is higher among children, travellers going to rural areas, travellers visiting friends and relatives or those travelling for a long period of time.

Travellers visiting regions with a risk of typhoid, especially those exposed to places with poor sanitation, should speak to a health care professional about vaccination.  

There is a risk of schistosomiasis in this destination. Schistosomiasis is a parasitic disease caused by tiny worms (blood flukes) which can be found in freshwater (lakes, rivers, ponds, and wetlands). The worms can break the skin, and their eggs can cause stomach pain, diarrhea, flu-like symptoms, or urinary problems. Schistosomiasis mostly affects underdeveloped and r ural communities, particularly agricultural and fishing communities.

Most travellers are at low risk. Travellers should avoid contact with untreated freshwater such as lakes, rivers, and ponds (e.g., swimming, bathing, wading, ingesting). There is no vaccine or medication available to prevent infection.

Insect bite prevention

Many diseases are spread by the bites of infected insects such as mosquitoes, ticks, fleas or flies. When travelling to areas where infected insects may be present:

• Use insect repellent (bug spray) on exposed skin
• Cover up with light-coloured, loose clothes made of tightly woven materials such as nylon or polyester
• Minimize exposure to insects
• Use mosquito netting when sleeping outdoors or in buildings that are not fully enclosed

To learn more about how you can reduce your risk of infection and disease caused by bites, both at home and abroad, visit our insect bite prevention page.

Find out what types of insects are present where you’re travelling, when they’re most active, and the symptoms of the diseases they spread.

There is a risk of chikungunya in this country.  The risk may vary between regions of a country.  Chikungunya is a virus spread through the bite of an infected mosquito. Chikungunya can cause a viral disease that typically causes fever and pain in the joints. In some cases, the joint pain can be severe and last for months or years.

Protect yourself from mosquito bites at all times. There is no vaccine available for chikungunya.

Cutaneous and mucosal   leishmaniasis   causes skin sores and ulcers. It is caused by a parasite spread through the bite of a female sandfly.

Risk is generally low for most travellers. Protect yourself from sandfly bites, which typically occur after sunset in rural and forested areas and in some urban centres. There is no vaccine or medication to protect against leishmaniasis.

Visceral  leishmaniasis   (or kala azar) affects the bone marrow and internal organs. It is caused by a parasite spread through the bite of a female sandfly. It can also be transmitted by blood transfusion or sharing contaminated needles. If left untreated it can cause death. Risk is generally low for most travellers. Protect yourself from sandfly bites, which typically occur after sunset in rural and forested areas and in some urban centres. There is no vaccine or medication to protect against leishmaniasis.

Onchocerciasis (river blindness)   is an eye and skin disease caused by a parasite spread through the bite of an infected female blackfly.  Onchocerciasis often leads to blindness if left untreated. Risk is generally low for most travellers. Protect yourself from blackfly bites, which are most common close to fast-flowing rivers and streams. There is no vaccine available for onchocerciasis although drug treatments exist.

• In this country,   dengue  is a risk to travellers. It is a viral disease spread to humans by mosquito bites.
• Dengue can cause flu-like symptoms. In some cases, it can lead to severe dengue, which can be fatal.
• The level of risk of dengue changes seasonally, and varies from year to year. The level of risk also varies between regions in a country and can depend on the elevation in the region.
• Mosquitoes carrying dengue typically bite during the daytime, particularly around sunrise and sunset.
• Protect yourself from mosquito bites . There is no vaccine or medication that protects against dengue.

Rift Valley fever is a viral disease that can cause severe flu-like symptoms. In some cases, it can be fatal. It is spread to humans through contact with infected animal blood or tissues, from the bite of an infected mosquito, or eating or drinking unpasteurized dairy. Risk is generally low for most travellers. Protect yourself from insect bites and avoid animals, particularly livestock, and unpasteurized dairy. There is no vaccine available for Rift Valley fever.

Zika virus is a risk in this country. 

Zika virus is primarily spread through the bite of an infected mosquito. It can also be sexually transmitted. Zika virus can cause serious birth defects.

During your trip:

• Prevent mosquito bites at all times.
• Use condoms correctly or avoid sexual contact, particularly if you are pregnant.

If you are pregnant or planning a pregnancy, you should discuss the potential risks of travelling to this destination with your health care provider. You may choose to avoid or postpone travel. 

For more information, see Zika virus: Pregnant or planning a pregnancy.

Animal precautions

Some infections, such as rabies and influenza, can be shared between humans and animals. Certain types of activities may increase your chance of contact with animals, such as travelling in rural or forested areas, camping, hiking, and visiting wet markets (places where live animals are slaughtered and sold) or caves.

Travellers are cautioned to avoid contact with animals, including dogs, livestock (pigs, cows), monkeys, snakes, rodents, birds, and bats, and to avoid eating undercooked wild game.

Closely supervise children, as they are more likely to come in contact with animals.

Anthrax is a serious infectious disease caused by bacteria. People can get sick with anthrax if they come into contact with infected animals or contaminated animal products. Anthrax can cause severe illness in both humans and animals. Travellers to areas where anthrax is common or where an outbreak is occurring in animals can get sick with anthrax if:

• they have contact with infected animal carcasses or eat meat from animals that were sick when slaughtered
• they handle animal parts, such as hides, wool or hair, or products made from those animal parts, such as animal hide drums.

If you are visiting these areas, do not eat raw or undercooked meat and avoid contact with livestock, wildlife, animal products, and animal carcasses.

Person-to-person infections

Stay home if you’re sick and practise proper cough and sneeze etiquette , which includes coughing or sneezing into a tissue or the bend of your arm, not your hand. Reduce your risk of colds, the flu and other illnesses by:

•   washing your hands often
• avoiding or limiting the amount of time spent in closed spaces, crowded places, or at large-scale events (concerts, sporting events, rallies)
• avoiding close physical contact with people who may be showing symptoms of illness 

Sexually transmitted infections (STIs) , HIV , and mpox are spread through blood and bodily fluids; use condoms, practise safe sex, and limit your number of sexual partners. Check with your local public health authority pre-travel to determine your eligibility for mpox vaccine.  

Tuberculosis is an infection caused by bacteria and usually affects the lungs.

For most travellers the risk of tuberculosis is low.

Travellers who may be at high risk while travelling in regions with risk of tuberculosis should discuss pre- and post-travel options with a health care professional.

High-risk travellers include those visiting or working in prisons, refugee camps, homeless shelters, or hospitals, or travellers visiting friends and relatives.

HIV (Human Immunodeficiency Virus)   is a virus that attacks and impairs the immune system, resulting in a chronic, progressive illness known as AIDS (Acquired Immunodeficiency Syndrome). 

High risk activities include anything which puts you in contact with blood or body fluids, such as unprotected sex and exposure to unsterilized needles for medications or other substances (for example, steroids and drugs), tattooing, body-piercing or acupuncture.

Medical services and facilities

Health care is inadequate, except in private hospitals of Addis Ababa where you can expect reasonable standard of basic care for minor health problems. Otherwise, health facilities are not up to Canadian standards. They lack of personnel, equipment, supplies and medications.

Ambulance services are extremely limited and unreliable.

Ensure that you always carry a comprehensive medical pack when travelling.

You will likely need medical evacuation in case of serious illness or injury.

Make sure you get travel insurance that includes coverage for medical evacuation and hospital stays.

Travel health and safety

Altitude sickness

Addis Ababa is located about 2500 metres above sea level. Acute mountain sickness may occur at high altitudes.

Be well informed about the potential health hazards at high altitudes.

Keep in Mind...

The decision to travel is the sole responsibility of the traveller. The traveller is also responsible for his or her own personal safety.

Be prepared. Do not expect medical services to be the same as in Canada. Pack a   travel health kit , especially if you will be travelling away from major city centres.

You must abide by local laws.

Learn about what you should do and how we can help if you are arrested or detained abroad .

Death penalty

Ethiopian authorities may apply the death penalty for serious offences.

All illicit drugs are illegal except khat, a local stimulant. Khat is illegal in several countries. Don’t attempt to export it.

Penalties for possession, use or trafficking of illegal drugs are severe. Convicted offenders can expect lengthy jail sentences and heavy fines.

Ethiopia is used as a drug trafficking hub between Western markets and southern Asia for heroin.

• Carry only your personal belongings, and don’t leave them unattended
• Don’t agree to carry packages that are not your own

Drugs, alcohol and travel

2SLGBTQI+ travellers

Ethiopian law prohibits sexual acts between individuals of the same sex. Those convicted can face up to 15 years in prison.

2SLGBTQI+ travellers should carefully consider the risks of travelling to Ethiopia.

Travel and your sexual orientation, gender identity, gender expression and sex characteristics

Dual citizenship

Dual citizenship is not legally recognized in Ethiopia.

If local authorities consider you a citizen of Ethiopia, they may refuse to grant you access to Canadian consular services. This will prevent us from providing you with those services.

Travellers with dual citizenship

International Child Abduction

The Hague Convention on the Civil Aspects of International Child Abduction is an international treaty. It can help parents with the return of children who have been removed to or retained in certain countries in violation of custody rights. It does not apply between Canada and Ethiopia.

If your child was wrongfully taken to, or is being held in Ethiopia by an abducting parent:

• act as quickly as you can
• consult a lawyer in Canada and in Ethiopia to explore all the legal options for the return of your child
• report the situation to the nearest Canadian government office abroad or to the Vulnerable Children’s Consular Unit at Global Affairs Canada by calling the Emergency Watch and Response Centre.

If your child was removed from a country other than Canada, consult a lawyer to determine if The Hague Convention applies.

Be aware that Canadian consular officials cannot interfere in private legal matters or in another country’s judicial affairs.

• International Child Abduction: A Guidebook for Left-Behind Parents
• Travelling with children
• Canadian embassies and consulates by destination
• Emergency Watch and Response Centre

Identification

You must carry photo ID with you at all times, as local authorities can ask you to prove your identity.

Keep a photocopy of your passport in a safe place, in case it is lost or confiscated.

It’s illegal to carry a firearm in Ethiopia.

It’s illegal to own any quantity of ivory, including in jewellery.

Antiques or religious paraphernalia

You may not export real antiques or religious items.

Tourist souvenirs are often copies of Ethiopian antiques or religious paraphernalia.

If buying such items, ensure that you have a receipt, clearly indicating that it’s a souvenir and not authentic. However, be aware that authorities may confiscate items purchased for export or for personal use, especially ceremonial knives, even if you present a receipt.

Photography

It’s strictly prohibited to photograph:

• military installations
• police and military personnel
• industrial facilities
• government buildings and infrastructure, including roads, bridges, dams and airfields

Never stop near a restricted area, no matter the reason, on foot or in a vehicle.

Street vendors

It is illegal to give money to, or purchase something from, people who approach vehicles stopped in traffic, including children.

If caught, both the beggar/vendor and the vehicle operator face fines.

Social media

Writing on blogs or social media about political subjects could lead to detention and arrest.

Cell phones

You can use one cell phone or tablet on the network of the sole, state-owned telecommunications provider, Ethio Telecom.

Additional devices are subject to a customs fee of 10% of the total cost of the device, as well as the activation fee.

Other electronic devices

You must declare all laptop computers and video equipment other than those for personal use upon arrival and departure. Some recording devices may require special customs permits.

If you will be using these items for work, obtain permission to bring them into the country from the Embassy of Ethiopia in Ottawa or the Consulate of Ethiopia in Toronto.

Foreign representatives in Canada

In 2024, the lunar month of Ramadan is expected to begin on or around March 10.

In public, between sunrise and sunset, be discreet when:

Orthodox Christian

The Ethiopian highlands population is predominantly Orthodox Christian. There is fasting in this region every Wednesday and Friday, and during Lent.

• Always obtain permission from religious authorities before visiting churches
• Dress conservatively, behave discreetly, and respect religious traditions to avoid offending local sensitivities

Time of day

Many people in Ethiopia use the Ethiopian clock.

According to the Ethiopian clock, unlike the convention in most countries, the start of the day is dawn rather than midnight. As a result, daytime hours are counted beginning from what would be 6 a.m. For instance, the time at one hour after dawn – 7 a.m. –  would be 1 a.m. on the Ethiopian clock.

Most hotels and larger organisations, including all airlines, use the global clock. However, many individuals or smaller organisations continue to use the Ethiopian clock.

Check with your host if you are unsure which clock is being used for a meeting or an event.

You must have a local driver’s licence to drive in Ethiopia. You must present your valid Canadian driver’s licence or an International Driving Permit to obtain one.

If you're involved in an accident, don’t move your vehicle before a police officer arrives. It's illegal to do so.

International Driving Permit

The currency of Ethiopia is the birr (ETB).

Credit cards are not widely accepted except by large hotels, travel agencies and a few shops and restaurants in Addis Ababa. ATMs are very limited outside urban areas and may run out of cash without notice.

Make sure you have access to hard-currency cash in case of emergency.

It is illegal to enter or exit Ethiopia with more than 1,000 birr.

You may enter or exit Ethiopia with up to US$3,000 or its equivalent in any convertible foreign currency. This doesn’t include birr. However:

• if you enter with more, you must declare the funds upon arrival
• a bank document certifying the purchase of the foreign currency and approving travel with the funds or
• a customs declaration form made upon entry

Be aware that even the provision of such documents may not safeguard you against confiscation of the extra funds, imprisonment or fines. Policies may change at any time without notice.

Exchanging money on the black market is illegal. Exchange foreign currency at banks or official foreign exchange offices only as you may face heavy fines or detention.

Due to below-average rainfall for several years in a row, Ethiopia is experiencing severe drought.

Local services and the availability of water and basic food may be affected.

You may encounter difficulties travelling overland.

Rainy season

The rainy season normally extends from June to September. Seasonal flooding can hamper overland travel and reduce the provision of essential services. Roads may become impassable due to mudslides and landslides. 

• Monitor local media for the latest updates, including road conditions
• Stay away from flooded areas
• Follow instructions from local authorities, including evacuation orders

Earthquakes

Ethiopia is located in an active seismic zone. Earthquakes may occur.

Earthquakes - What to Do?  

Local services

In case of emergency, dial 991.

Consular assistance

For emergency consular assistance, call the Embassy of Canada to Ethiopia, in Addis Ababa, and follow the instructions. At any time, you may also contact the Emergency Watch and Response Centre in Ottawa.

The decision to travel is your choice and you are responsible for your personal safety abroad. We take the safety and security of Canadians abroad very seriously and provide credible and timely information in our Travel Advice to enable you to make well-informed decisions regarding your travel abroad.

The content on this page is provided for information only. While we make every effort to give you correct information, it is provided on an "as is" basis without warranty of any kind, expressed or implied. The Government of Canada does not assume responsibility and will not be liable for any damages in connection to the information provided.

If you need consular assistance while abroad, we will make every effort to help you. However, there may be constraints that will limit the ability of the Government of Canada to provide services.

Learn more about consular services .

Risk Levels

  take normal security precautions.

Take similar precautions to those you would take in Canada.

  Exercise a high degree of caution

There are certain safety and security concerns or the situation could change quickly. Be very cautious at all times, monitor local media and follow the instructions of local authorities.

IMPORTANT: The two levels below are official Government of Canada Travel Advisories and are issued when the safety and security of Canadians travelling or living in the country or region may be at risk.

  Avoid non-essential travel

Your safety and security could be at risk. You should think about your need to travel to this country, territory or region based on family or business requirements, knowledge of or familiarity with the region, and other factors. If you are already there, think about whether you really need to be there. If you do not need to be there, you should think about leaving.

  Avoid all travel

You should not travel to this country, territory or region. Your personal safety and security are at great risk. If you are already there, you should think about leaving if it is safe to do so.

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• Passports, travel and living abroad
• Travel abroad
• Foreign travel advice

Before you travel check that: 

• your destination can provide the healthcare you may need 
• you have appropriate travel insurance for local treatment or unexpected medical evacuation 

This is particularly important if you have a health condition or are pregnant. 

Emergency medical number 

Dial 907 and ask for an ambulance. 

Contact your insurance company promptly if you’re referred to a medical facility for treatment. 

Vaccinations and health risks 

At least 8 weeks before your trip check: 

• the latest information on health risks and what vaccinations you need in TravelHealthPro’s Ethiopia guide
• where to get vaccines and whether you have to pay on the NHS travel vaccinations page   

Altitude sickness is a risk in parts of Ethiopia, including Addis Ababa. TravelHealthPro’s altitude sickness guidance has more information. 

Other health risks 

UK health authorities have classified Ethiopia as having a risk of Zika virus transmission.  

Malaria is common in areas of the country below 2,000 metres above sea level. Addis Ababa sits at 2,400 metres but a number of sites popular with tourists are below 2,000. 

Bilharzia is present in the vast majority of lakes in Ethiopia – check before swimming. 

Water-borne diseases are common. Drink or use only boiled or bottled water and avoid ice in drinks. 

There is an ongoing outbreak of cholera in the south of Ethiopia, and new cases have been reported in the north west of the country.  

For more information and advice on health risks in Ethiopia, visit the National Travel Health Network and Centre .

Medication 

The legal status and regulation of some medicines prescribed or bought in the UK can be different in other countries. 

Read best practice when travelling with medicines on TravelHealthPro . 

The NHS has information on whether you can take your medicine abroad . 

Healthcare facilities in Ethiopia 

Only private hospitals in Addis Ababa offer a reasonable standard of basic care for minor health problems. Dentistry is especially scarce. Ambulance services are also limited. Outside the capital, medical facilities are extremely poor. Carry a comprehensive medical pack when travelling out of Addis Ababa.  

FCDO has a list of English-speaking doctors in Ethiopia.   

COVID-19 healthcare in Ethiopia 

There are private healthcare facilities used by the international community with the capability to respond to COVID-19, but capacity is limited.  

Travel and mental health 

Read FCDO guidance on travel and mental health . There is also mental health guidance on TravelHealthPro . 

Related content

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Travelfornoobs

Ethiopia Packing List | Things you should not forget

Ethiopia packing list – all the things you should not forget, what to take in your bag for ethiopia.

You’ve booked your plane ticket and the time of departure is fast approaching? After the joys of such a decision, comes the question of knowing what to put in your suitcase to go to Ethiopia. No need to panic, we have prepared a very complete list of the essential things to bring to make sure you don’t miss anything once you are there.

In order to leave no room for unforeseen events, it’s of course preferable to go through this list a few days before leaving rather than the day before departure, as you might miss some items.

Take the time to read and download it in order to identify the things that you absolutely must pack and that you might miss and that could make you lose time and money if you forget them.

You will also need to think about packing according to the type of accommodation you will be staying in, the different modes of transportation you will use during your trip, the climate and the season, as well as the activities you plan to do.

In order to help you prepare your suitcase, this checklist of the essential things to bring in Ethiopia gathers several categories: clothes, accessories, various objects… It will allow you to have a concrete vision of a typical suitcase for Ethiopia.

An advice, think of keeping some space in your luggage if you wish to bring back souvenirs or to make some clothing shopping on the spot.

Thanks to this travel list, preparing your bag for Ethiopia will be a real child’s play and you will just have to enjoy your adventure!

Note : This article contains affiliate links to Amazon.

• Important hings to do before you go
• Essential documents
• Transport essentials
• Backpack & luggage
• Clothing and shoes
• Hygiene & Toiletries
• Photo, Video & High Tech
• Useful accessories
• Medication and first aid kit
• Activities and Useful Links (+ Printable checklist PDF)

1/ Important things to do before you go

 Prepare your travel itinerary  Apply for a visa (if necessary)  Make your vaccinations (if necessary)  Check-up at the doctor / dentist  Take out a travel insurance  Photocopy or scan important documents (passport)  Write down e-mail and useful phone numbers in your address book  Warn your bank about your trip abroad (if necessary)  Book accomodation for your first night ( Do it now before everything is fully booked! Check the best hotels on Booking )  Download offline applications and maps for Maps.me  Download movies offline   Prepare your favorite music playlist  Turn off or turn down the heat of your house  Empty garbage cans  Water the plants   Give a copy of your house/car keys to a family member or friend  Close doors and windows

2/ Essential documents

Even before you buy your plane ticket, remember to check the validity of your passport : it must be valid for at least six months after your return date (for some countries) and have a blank page. Another tip: send your important documents to a secondary email in case you lose them.

   Passport   ID card    Plane or train ticket (have a paper copy just in case)   Reservation documents (e-ticket, train ticket, hotel reservation)   Visa (if necessary)   International driver’s license, if you wish to rent a car   Health insurance card   Travel insurance   Credit card   Cash   Useful numbers in case of emergency   Itinerary and address of your accommodation (hotel / AirBnB / camping)   Vaccination certificate   Diving license, sailing license, etc.   Some business cards with your contact information, email, blog, website

3/ Transport essentials

The little things to have with you at all times during the flight or the trip by train or bus:

 Phone and charger  Book / Magazine / Kindle / Travel Guide  MP3 player   Chewing gum   Pen + notepad  Travel pillow ( my favorite )  Sleep mask ( my favorite )   Earplugs   Snacks / sandwich   Small water bottle  Nasal ointment for dry nose  Sunglasses   Glasses case   Watch   Hand sanitizer   Disposable face mask   Tissues   Motion sickness medication

4/ Backpack & luggage

 Waterproof dry bag ( my favorite )  Handbag   Travel laundry bag ( my favorite )  Carry-on suitcase ( my favorite )  Travel bag ( my favorite )   Luggage tag ( my favorite )   Travel Packing Organizers ( my favorite )   Rain cover for backpack ( my favorite )   Zippered carry-on bag   Shoe bag ( my favorite )   Fanny pack   Lightweight foldable backpack ( my favorite )

5/ Clothing and shoes

  Socks  Underwear (panties, thongs, bras, briefs, boxers…)  Tank tops  Skirt ♀  Dress ♀  Pajamas  T-shirts  Long sleeve shirt ( for her , for him )  Short sleeve shirt ( for her , for him )  Polo shirt ( for her , for him )   Sweatshirt / pullover ( for her , for him )   Jeans   Lightweight pants ( for her , for him )   Money belt ( my favorite )   Shorts   Jogging suit   Jacket / coat   K-way ( for her , for him )   Windbreaker ( for her , for him )  Hat / cap / beanie   Scarf / bandana   Swimsuit   Buff scarf ( my favorite )

For shoes, you will have to choose according to the activities you plan to do:

 Comfortable walking shoes   Shoes for going out (restaurants, bars, clubs…)  Flip-flops (for the beach, showers…) ( for her , for him )  Hiking shoes ( for her , for him )  Sandals ( for her , for him )   Water shoes for walking in water (beaches, waterfalls, rivers…) ( for her , for him )  Light trekking shoes ( for her , for him )  Crocs

6/ Hygiene & Toiletries

 Microfiber towel ( my favorite )   Toilet bag   Portable Travel Bottles ( my favorite )  Toothbrush & toothpaste  Dental floss  Soap   Shampoo   Facial cleanser   Nail clippers   Cotton buds (biodegradable)   Tweezers   Make-up   Deodorant   Comb / Hairbrush   Razor & shaving foam ♂   Biodegradable wipes ( my favorite )   Toilet paper roll   Perfume   Makeup ♀   Contact Lenses   Contact lens product   Pocket mirror

7/ Photo, Video & High Tech

For photographers and videographers:

 Camera  Lens  Memory card  Polarizing filters   ND filter   Extra battery   Charger + cable + plug adapter   Cleaning kit   External hard drive   USB key   Stabilizer   Drone ( my favorite )    Waterproof phone case   Flash   Solar charger ( my favorite )    Gopro ( my favorite )   Waterproof case   Selfie Pole  External battery / Powerbank ( my favorite ) 

Don’t forget:

 Portable speaker  Ipad / Tablet  Laptop PC  External battery  Headphones or noise cancelling headphones ( my favorite )

Useful apps to download before you go to Ethiopia:

 AirBnB  Booking  Couchsurfing  Flush – Public Toilet Finder (Useful for finding toilets!)  Google Maps  Google Translator  Google Trips  Lonely Planet Guide  LoungeBuddy  Maps.me  Meetup  Tripadvisor  Uber  Whatsapp  XE Currency

8/ Useful accessories

The accessories you will take in your bag for Ethiopia will depend on your travel style:

  TSA lock ( my favorite )  Headlamp ( my favorite )  Sleeping bag ( my favorite )  Sheets ( my favorite )  Swiss Army knife (not in the hand luggage!) ( my favorite )  Travel clothesline ( my favorite )  Powdered or liquid detergent  Clothes pegs  Spork ( my favorite )  Ziploc bags  Lighter  Folding umbrella ( my favorite )  Toilet paper  Mosquito repellent ( my favorite )   Mosquito net ( my favorite )   Sunscreen cream  Aloe vera gel   Waterproof pouch for smartphone    For hikers : GPS, map, compass, water bottle   Walking stick ( my favorite )   Anti-sweat talcum powder ( my favorite )   Beach towel ( my favorite )   Sawyer water filter ( must-have !)  Pills to purify non-drinking water   Mask, snorkel, fins   Diving accessories (gloves, dive computer, lamp, knife…)

9/ Medication and first aid kit

I suggest that you consult your doctor and dentist before leaving. Beware of unauthorized medication and remember to keep your vaccinations up to date!

If you have a treatment don’t forget to take your personal medication and your prescription if necessary (or medical certificate).

You can buy a first aid kit already prepared ( my favorite ).

  Cotton buds   Tweezers   Round-tipped scissors   Pairs of single-use latex gloves  Bandages   Paracetamol or ibuprofen for pain   Sterile compresses   Disinfectant spray for wounds   Physiological saline solution in pods (wound cleaning)   Condoms and other contraceptives

For longer trips and higher risk locations, we can also add:

  Sterile adhesive skin sutures (steristrips)   Rehydration solutions (in case of dehydration)   Water purification tablets   Water decontamination tablets (Aquatabs or Micropur)   Medication for altitude   Medication for sore throat    Anti-malarial medication   Survival blanket   Tick tweezers   Ointment against itching (antihistamine)   Probiotics for the stomach   Corticosteroid pills and cream   Analgesics (painkillers)   Survival blanket   Cold medicine (decongestant)   Biafine (in case of burns or sunburns)   Broad-spectrum antibiotics without a prescription   Anti-diarrhea tablets (immodium, smecta)

10/ Activities and Useful Links + Printable checklist

You can download the complete travel list in PDF format and print it by clicking here.

Book your hotel in Ethiopia now on Booking.com

AirBnb : Get a discount for your first booking!

Book now your activities in Ethiopia on Getyourguide:

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Travel to Ethiopia: Everything you need to know

By Joan Torres 30 Comments Last updated on March 27, 2024

From visiting the most epic Christian sites to meeting ancient tribes with animistic beliefs, and from roaming around the thickest jungle to crossing the most inhospitable desert; traveling in Ethiopia is the most diverse African experience and this travel guide contains everything you need to know about it

I seriously thought that Ethiopia was a touristic, well-known country in the West but, when I came back from my trip, I was surprised to find out that many people had absolutely no clue about it, like they didn’t even know about its geographical location.

The truth is that traveling can be extremely subjective and, while Ethiopia may be a relatively touristic country as per Against the Compass standards – meaning that this is one of the most visited countries I talk about in this blog – compared to other average destinations, it is a real off the beaten track destination.

Little is known about this African country and, when people ask me what it is like to travel in Ethiopia, I always begin the conversation with the following:

The main reason to visit Ethiopia is that it is an exceptionally diverse experience.

On the one hand, the cultural diversity is huge. In Ethiopia alone, you have 80 distinct ethnic groups who speak more than 80 languages and practice different religions, from different branches of Christianity to Islam and animistic beliefs.

On the other hand, this is a historically rich country and the one with the most impressive historical and archeological sites in sub-Saharan Africa, once the capital of the Aksumite Empire – one of the most powerful ancient empires in the continent that ruled for more than 800 years – and home to endless jaw-dropping millennial rock-hewn churches and European-like medieval castles.

Furthermore, contrary to any Western cliché, Ethiopia is also a land of natural contrasts, composed of fertile tropical forests in the south and vast flat deserts in the east, the Danakil Depression being home to lava pools and the hottest settlement in the world. In the north, Lake Tana is the source of the Blue Nile and Simien Mountains is one of the very few places in Africa with regular snowfall, the highest peak being at 4500m.

And by the way, the scenery in Ethiopia is unconditionally hair-raising, a real blessing to your eyeballs.

And if that wasn’t enough, Ethiopia was recently rebranded the Land of Origins by the Ministry of Tourism because these lands are the origin of humankind – where the oldest hominid was found – the first place to ever produce coffee and they practice one of the rawest and most ancient ways of Christianity.

Trust me, after traveling to so many countries, I am rarely impressed but still, Ethiopia definitely wowed me.

This guide contains everything you need to know to travel to Ethiopia (literally, everything), from how to get a visa to getting in, top experiences, cultural facts, budget and loads of personal travel tips.

In this Ethiopia travel guide you will find:

Table of Contents

• COVID-19 Travel Restrictions
• Overlanding
• Best time to visit
• Travel insurance
• Top experiences
• Books on Ethiopia
• Cultural facts
• The country
• People & Language
• Money, budget & costs
• Is it safe?
• Solo female travel
• Moving around
• Where to stay

😷 COVID-19 Travel restrictions for Ethiopia

COVID-19 entry regulations for visiting Ethiopia have been lifted in 2022.

For more information, check Ethiopian Travel Update .

Travel Insurance for Ethiopia

IATI Insurance  is one of the few providers that offers full Coronavirus coverage, not only when it comes to treatment, but also cancellation costs in case you tested positive before departure.

Moreover, Ethiopia is an adventure destination, so traveling with proper travel insurance is a must.

Readers of Against the Compass can get an exclusive 5% discount .

🪪 How to get a visa for Ethiopia

How to get an e-visa for ethiopia.

Everybody needs a visa for Ethiopia but today, pretty much any nationality can get a tourist e-visa.

And you can easily apply through the official website .

Make sure you do it through the above URL because there are many non-official websites which, even though they do issue valid visas, charge much more money.

Typically, there are 2 types of tourist e-visa:

• 30-day visa, which costs 82USD
• 90-day visa, which costs 102USD

And it takes up to 3 days to process. Mine took less than 24 hours.

It’s a very easy process which has absolutely no secret and very little requirements.

Is the Ethiopian e-visa valid at land borders?

Officially, the tourist e-visa is only valid for those entering via Bole International Airport in Addis Ababa .

My trip to Ethiopia was part of a 3-month journey through the Horn of Africa, traveling from Eritrea to Djibouti, Soma liland and then entering Ethiopia overland, so I intended to apply for it at the embassy in Djibouti.

However, once I got there, they told me that they had run out of visa stickers and that they would not receive more after a couple of weeks at least.

Then, I tried my luck in Hargeisa, the capital of Somaliland but, unfortunately they weren’t issuing visas anymore, so I was in a situation in which, according to the official information, the only thing I could do was booking a flight from Hargeisa to Addis Ababa, which kind of sucked.

However, I contacted a few travelers who said that in Africa, anything can happen and proof of that is that they managed to travel to Ethiopia overland with an e-visa, so I decided to try my luck as well and successfully managed to cross the border from Somaliland , no questions asked.

Visa on arrival for Ethiopia

If you don’t have time to apply for an e-visa because your flight to Addis Ababa is less than 3 days ahead, you can also get a VOA at Bole International Airport.

Otherwise, I don’t see any good reason why you should get a VOA instead of an e-visa.

How to apply for an Ethiopian tourist visa via embassy

The only reason for applying for your Ethiopia tourist visa at the embassy is because you are entering overland and don’t want to risk a potential denial because you are only in possession of an e-visa.

You can find Ethiopian embassies and consulates in many cities across Europe and North America. Just contact your nearest one to ask about the process, which tends to be very easy.

🛫 How to get to Ethiopia

Ethiopia is an adventurous destination, get travel insurance I strongly recommend IATI Insurance : adventure activities, COVID-19 coverage Get 5% discount if purchasing via this link

How to travel to Ethiopia by plane

Bole International Airport in Addis Ababa is one of the most transited airports in the African continent.

I had actually been there twice even before visiting Ethiopia, as Addis Ababa is a common stop for many flights going to other African destinations and the Middle East .

The main airline operating in the country is Ethiopian Airlines , a modern company that flies all over the world , including to and from the American continent.

Moreover, there are many other international airlines that fly to Addis. I actually flew out of the country with Emirates.

Remember that, if you fly in with Ethiopian Airlines, you get a 50% discount on all domestic flights . Check the how to move around section of this post for more information.

How to travel to Ethiopia overland

Ethiopia shares a border with so many countries :

Traveling to Ethiopia from Sudan

Completely open to foreigners. There are regular minivans running from a Sudanese city named Qadarif to the border, and the border formalities are not very complicated.

Read my Sudan travel guide.

Traveling to Ethiopia from Djibouti

An easy border to cross from a bureaucratic point of view but difficult from a logistic point of view, as you need to cross the desert on a 4×4.

Moreover, an easier option would be taking the train that goes from Addis to Djibouti City, but it is a bit unreliable. For more information, check the moving around section.

Traveling to Ethiopia from Kenya

Crossing from the Kenyan town named Moyale should be a simple process.

Traveling to Ethiopia from South Sudan

Not possible. You would have to go through the jungle and go across the most dangerous part of South Sudan, so forget it. There are daily flights connecting both countries though.

Traveling to Ethiopia from Eritrea

This border is closed for foreigners and more often than not, also for locals. The only way of traveling between both countries is by flying in, from Asmara to Addis.

Read my Eritrea travel guide .

Traveling to Ethiopia from Somalia

The one I used. As you may know (or not), Somalia is divided into two regions, actual Somalia and Somaliland.

You can travel to Ethiopia from Somaliland, using the border near the city of Harar. It was very easy and quick to cross. There are normal roads and plenty of public transportation.

Read my Somaliland travel guide

⛅ Best time to visit Ethiopia

Ethiopia is a big country composed of several geographical regions, each having a different optimal season to visit, so it’s a bit difficult to guess the ideal time to come.

Rainy season

Typically, most travelers avoid the rainy season running from mid-June to mid-September, especially because the northern highlands is where it rains the most, the region with the highest concentration of popular destinations, including Gonder, Axum, Tigray churches, Simien Mountains and Lalibela .

In the south, however, which includes the famous Omo Valley , the rainy season runs from March to June, and it’s highly advisable to avoid these months, for the simple reason that the remotest villages, which are only accessible along muddy roads, will be unreachable.

November to January is high season

The weather is ideal and, up to January, the landscapes are beautifully green still. Expect to find big crowds and high prices though.

February and March is a good time too

As the weather is pleasant and most crowds are gone but the main downside is that it is already dry season, so the northern landscapes won’t be as pretty. I visited Ethiopia from February 1st to mid-March.

Therefore, in order to avoid the crowds and still get pretty landscapes, I believe that mid-September and October would be the best time to go backpacking in Ethiopia.

However, bear in mind that the Danakil Depression , one of the country’s highlights, is also one of the hottest places on Earth, and September and October’s heat will be unbearable; it is advised to visit here from mid-November to February.

And last, you may also want to organize your visit so you come during one of their most important cultural festivals :

• Genna – Ethiopian Christmas that takes places on January 7th
• Timkat – Ethiopia’s Orthodox Christian celebration that takes place on January 20th
• Meskel – Ethiopian religious holiday that takes places at the end of September

As you can see, telling you the right time is a bit tricky!

🚑 Travel insurance for Ethiopia

Ethiopia is an adventurous region, so make sure to choose a proper backpacking insurance with good adventure coverage. I recommend IATI Insurance .

• It covers the largest number of adventure activities, including trekking
• Covers both short-term trips and 1-year long trips.
• Covers senior citizens too.
• Readers of this blog get an exclusive 5% discount

🛖 Top experiences in your trip to Ethiopia

Trekking among tens of thousands of baboons.

A rugged, mountain range composed of insanely vertiginous cliffs and several peaks above 4000 meters and inhabited by, literally, thousands and thousands of an endemic species of baboon, trekking the Simien Mountains is one of the highlights of any trip to Ethiopia.

Read my experience trekking in the Simien Mountains of Ethiopia

Visiting the hottest (inhabited) place on Earth

Danakil is a vast depression popularly known for being one of the most inhospitable places on Earth, an arid, unwelcoming land filled with volcanoes and insane geological formations, colors and absolutely crazy landscapes, inhabited by a distinct ethnic group named Afar.

Read my experience visiting the Danakil Depression

Exploring ancient churches built over cliffs

Ethiopia was one of the first countries to adopt Christianity and its churches are not only some of the most ancient churches in the world, but they have been carved out from rocks located in the most unbelievable and vertiginous locations, and what is even more incredible is that they are still as functional as they used to be 1200 years ago.

Feeding wild hyenas with your mouth

In the eastern city of Harar, there is a man who has dedicated every day of his life to feeding hyenas. Those hyenas aren’t domestic but they are free, live in the wild and everyday, at around 6-7pm, a bunch of them come nearby his house to get feed some fresh, raw meet. It is possible to assist the peculiar ceremony and feed them with your own mouth.

Assisting an actual bull-jumping ceremony

A traditional ceremony celebrated by the Hamar tribe (one of the many tribes in the Omo Valley) in which a young boy jumps naked over 10 bulls in order to prove that he is ready to be married.

Before the actual ceremony, there is a party in which people from all the nearby settlements gather to drink, dance and do some other cultural stuff.

Read my experience visiting the Omo Valley on a budget

📚 Best books for planning your trip to Ethiopia

If you don’t have one yet, remember to get a Kindle for your journey, so you don’t have to carry along all your books! CLICK HERE TO GET YOURS

Ethiopia travel guide by Bradt

This is the Ethiopian Bible, definitely, the best book guide available for Ethiopia, and probably, the most complete book Bradt has ever written. A complete travel guide filled with endless insights, cultural facts and history. A must-have.

Ethiopia travel guide by Lonely Planet

It is not as complete as Bradt’s but it’s not that bad, it’s easier to read and they have a special chapter dedicated to the tiny, neighboring country of Djibouti.

🕌 Facts about the country, the people and religion

10 facts about ethiopia as a country.

1 – The Federal Democratic Republic of Ethiopia – It is a landlocked country in the Horn of Africa, one of the largest countries in the continent and with a population of 108,000,000.

2 – The capital of Ethiopia – The capital is Addis Ababa, often referred as the political capital of Africa, as this is the African Union Headquarters and has a strong political and diplomatic influence in all the continent.

3 – It’s a very poor country as per Western Standards – Nearly 50% of their total GDP is based on agriculture, mainly coffee. It is however, one of the most powerful and influential countries in Africa. A curious fact is that I met many Somalis from Somaliland and Eritreans whose short-term objective was migrating to Ethiopia and getting an Ethiopian passport, which is apparently better than other African passports.

4 – It’s never been colonized – Italy tried to take it over twice, at the end of the 19th century and in 1936, but they were defeated so, along with Liberia, Ethiopia is the only African country which has never been colonized, one of the reasons why it is so unique and barely has any foreign influence.

5 – Ethiopia has close ties with Eritrea – Neighboring Eritrea is Ethiopia’s little brother, a country with practically the same culture. They have the same food, religion and share a big bunch of ethnic groups. The dominant ethnic group in Eritrea are the Tigrinya, which also turn out to be one of the most influential groups also in Ethiopia, inhabiting the Tigray region, the most touristic destination in Ethiopia. Moreover, they used to be the same country until 1991. For more information, read my Eritrea travel guide .

6 – They are 6 hours ahead of anyone – The funniest fact about Ethiopia is that their time is different than ours, but they are 6 hours ahead. This means that if someone from Ethiopia tells you to meet at 18h, you need to be there at 12h. Well-educated people from Addis Ababa will talk to you in rest-of-the-world-time, so will those in the countryside who are used to dealing with tourists. But the rest of the country will not and, more often than not, if you ask them: are you talking in Ethiopian time, or faranji time? they will not know what you are talking about. You are likely to meet many travelers who missed a certain bus because of this particular fact.

7 – Ethiopia is the origin of mankind – Lucy , the oldest and most complete hominid ever discovered, dating back from more than 3 million years ago, was found in Ethiopia, in the Afar Depression.

8 – Ethiopia is an ethnic Federal state – Given the ethnic complexity, in 1994, Ethiopia was divided into 9 separate autonomous regions, each one ruled by one of the largest and most influential ethnic groups.

9 – Ethiopia was once one of the most powerful Empires – The Aksumite Empire, whose center was in today’s Tigray region and Eritrea and which ruled from 80BC to 825AD, was one of the most important empires in the Ancient World, along with Rome, Persia, and China.

10 – This is former Abyssinia – A few hundred years after the fall of the Aksumite Empire, there was a man who claimed to be a direct descendent from the last Aksumite King and managed to establish a feudalist state that lasted until 1974, when the famous Emperor Haile Selassie was overthrown and modern Ethiopia started to develop.

9 Facts about Ethiopians and their language

1 – There are two types of Ethiopian – On the one hand, you meet lovely, kind-hearted people who are always willing to help, or simply have a chat with you. And on the other hand, there are the people who try to rip you off continuously. During your Ethiopian trip, you will be meeting both types all the time and, by experience, you will be able to differentiate them easily.

(But most people are good 😉 )

Faranji , hey you, you you, faranji , you! Something I found extremely irritating (and most travelers do as well) is that, when you get into a new city or place, many people will start yelling: hey you, faranji, faranji, come here, come here! This also can happen with people you bump into in the street. In response, something very funny you can do is looking at them and say: hey you, habesha, habesha, come here, come here! Habesha means local , or Ethiopian , so you are basically telling them the same thing. Because they don’t expect such a reply from a faranji , in most occasions they will freeze, while others will laugh and probably shake your hand, turning an annoying person into a pleasant one.

2 – There are 80 distinct ethnic groups – The major groups being Oromo, Amhara, Tigray, Sidamo and Somali, which make up nearly 80% of the total population.

3 – The rest of the groups are minorities – And 45 of them live in a region named Southern Nations, Nationalities and People’s region, the vast majority being tribal people.

4 – Amharic is the official language – The lingua franca, the one used by the Government and the one used by the dominant ethnic group, the Amhara people, is Amharic.

5 – It comes from Ge’ez – Which is the language spoken in Ancient Axum and is still used today by the Ethiopian Orthodox Church.

6 – The alphabet is so cool – It’s called a syllable alphabet.

7 – But more than 80 languages are spoken – Or 70, depending on the source. Each ethnic group has a distinct language.

8 – And not everybody speaks Amharic – Especially in the tribal areas. It’s funny to think that, if certain tribal people from the south travel to Addis Ababa, they would feel more foreign and different than you do. You would certainly be more able to speak to the people than them.

9 – English is just OK – Not everybody speaks good English but in most towns, it is enough to get by.

6 Facts about religion in Ethiopia

1 – Ethiopia was the second state to officially adopt Christianity – After Armenia, in 330AD.

2 – Many Ethiopians belong to the Ethiopian Orthodox Church – Around 44% of the total population.

3 – They have a very raw way of practicing Christianity – Scholars claim that Christianity evolved directly from Judaism but, while it kept evolving to other forms of Christianity such as Catholicism or Protestantism, the Ethiopian Orthodox Church didn’t, hence it is one of the earliest forms of Christianity that clearly has some Judaic influences.

4 – People in white robes – If you see locals in traditional white robes is because they went to Church on that day. On Sunday, you will see wearing them more than usual.

5 – There are Catholics and Protestants too – Around 20%, and they mainly live in the south.

6 – Muslims make up one third of the total population – Differently to what most travelers who have already been to Ethiopia believe, more than 30% of Ethiopians are Muslim, and many foreign people don’t notice them because they inhabit regions that don’t receive many tourists, Ethiopian Somalia for example.

🍲 Ethiopian food and drinks

I have a love and hate relationship with the food in Ethiopia.

On the one hand, traditional food is healthy, mainly composed of stewed vegetables and a protein bread named injera .

On the other hand, despite the unbelievable geographical and cultural diversity, there isn’t much food variety across the country.

Anyways, injera is the cornerstone of any Ethiopian meal, a flat bread made from a local grain named tef . It is sour and has a peculiar crêpe texture and, basically, an average Ethiopian eats injera 3 times a day.

Some travelers don’t like it at all. I did like it but after 6 weeks of traveling in Ethiopia, I got particularly sick of it.

Fasting days in Ethiopia Ethiopians are very religious and besides the 40 days of Lent, the Ethiopian Orthodox Church also recognizes every Wednesday and Friday as fasting days, meaning that most restaurants will only serve vegetarian dishes.

Most popular food in Ethiopia

This is the most available and traditional dish, consisting of different kinds of stewed vegetables and curries that vary from restaurant to restaurant, but typically being spinach, potatoes, carrots and lentils.

It is very cheap, usually less than a $1, and this is what most Ethiopians eat each and every day.

Also very traditional but not as available as beyanet because this is meat-based, usually goat or sheep, hence more expensive, and many Ethiopians can’t afford to eat meat every day.

Tibs is roasted meat with beriberi, a chilly powder sauce, served, of course, along with injera .

This was my favorite dish, the Ethiopian hummus, I would say. Shiro is chickpea paste mixed with onions, garlic and bean flour. Energetic, healthy and delicious.

Shiro Tegamino

Same as shiro wat but much, much thicker and what I liked about it is that, for some reason, it was always served with normal bread, instead of injera .

This was a pretty fancy dish, typically available in expensive restaurants and consisting of a chicken stew cooked in a complex gravy.

Kita fir fir

Kita fir fir is injera with spices and chilli and it’s typically eaten for breakfast. I didn’t like really like it because it’s 95% just injera .

By the way, for breakfast, besides kita fir fir and its different varieties, ful is also very easy to find, which is small beans in tomato sauce and garlic. In the south, you may get some really tasty avocado as well.

Western food in Ethiopia

Many restaurants will serve pasta, pizza and burgers but don’t expect much of it.

In Addis Ababa, however, you can find good international food. Expensive as per Ethiopian standards, but good.

Pizza with cheese, tuna, chocolate and strawberries One day in Mekele, we went to one of the fanciest restaurants in town, a Western-style café typically frequented by the upper Ethiopian class. I ordered a pizza, one that was called calazori, just because it had tuna in it but, to my surprise, they brought me kind of a crêpe covered with chocolate and strawberries. No, I didn’t order this, but I ordered a calazori pizza . He opened the crêpe, which was made of pizza bread, to show me that the actual pizza ingredients were inside. By default, I don’t like chocolate, but that mix was disgusting anyways, so I told her to just change it for a normal pizza without chocolate. Anyways, my point is that, outside of Addis Ababa, don’t have big expectations of Western food.

Beer in Ethiopia

Beer is a big deal in Ethiopia and they have a lot of brands.

The best part is that Ethiopian beer is so cheap, one bottle never costing more than 17 birr in local places, which is less than 50 cents.

Coffee in Ethiopia

Ethiopia is coffee’s birthplace and, today, it is a very important part of their economy and exports.

Traditional style coffee is called buna and pretty much on any corner all around the country, you will see a lady preparing it in a clay pot named a jebena , and serving it in small cups. It’s good, and so cheap, around 5 birr (like 15 cents), but they may charge you double in touristic areas.

💻 Internet and connectivity in Ethiopia

Wi-Fi is really, really bad all over the country.

Even when hotel owners try to sell you the beautiful idea that their hotel prices include Wi-Fi and breakfast, just assume that most likely, Wi-Fi won’t work and, if it does, it’s terribly slow.

If you want to connect to the internet, you must get a SIM Card and telecommunications in Ethiopia is a monopoly controlled by Ethio Telecom .

Their mobile internet isn’t the fastest ever but it’s decent and if, like me, you have to work online while on the road, it’s good enough for creating a hotspot and do regular browsing.

It wasn’t very expensive but it wasn’t cheap at all as per Ethiopian standards.

Get a VPN for traveling in Ethiopia

You should always use a VPN when you travel, especially when you connect to public Wi-Fi networks.

Your connection will be much safer. 

Moreover, you will be able to access content which is typically censored in Ethiopia. 

I recommend ExpressVPN – Extremely easy to use, fast and cheap. 

If you want to learn more about VPN, check: Why you need a VPN for traveling .

💰 Backpacking in Ethiopia: need to know about money, budget & costs

In Ethiopia, they use the Ethiopian Birr (ETB) and, approximately:

1 USD = 53 ETB

Something I remember is that Ethiopian bank notes are some of the dirtiest I have ever seen, to the extent that when I got back home and finally touched some clean ones, it was a real reverse cultural shock.

Always have some hand sanitizer handy with you. In fact, in Ethiopia I got a small eye infection and I suspect it was because of rubbing my eye after touching some of those notes.

Black market rate in Ethiopia

In Ethiopia, there is a black market rate, which can be sometimes double the bank rate .

This means that, at the bank, if the exchange rate is 53, in the black market you can get it for up to 100, but only in Addis Ababa.

That’s why, in order to take advantage of this rate, it is recommended to come to Ethiopia with all your money in cash.

There is black market all over the country but in Addis Ababa you will get the best rate, especially near Meskel Square.

Just ask around where can you exchange your foreign currency.

However, bear in mind that, at first, they will tell you a very shitty rate, so remember to bargain.

ATMs in Ethiopia

In big cities, you can find ATMs, no problem, and they always accepted my foreign credit card. Sometimes they run out of cash though.

Nonetheless, remember that when withdrawing money, you will always get the bank rate.

Faranji and habesha price

In Ethiopia, there is a dual pricing, like I had never seen before: faranji and habesha .

Faranji means foreigner and habesha local .

In restaurants for example, food and drinks in the English menu may cost up to 3 times the habesha price and, if you believe you can grab the local menu and point out any meal marked with the original price, then you are wrong because they will always charge you the faranji price.

Moving around by local bus is also very frustrating because you know they will charge you double, or triple if they can, and negotiating is always a pain because you need to get angry, or even yelling at them, something they don’t usually expect.

I found this extremely frustrating and one of the worst things about traveling in Ethiopia.

And if you think, however, that this is how things work in their culture, I think you are wrong because I talked about this subject with many Ethiopians and they also agreed that it isn’t the right way to treat foreign tourists.

I can understand they charge double in touristic places but why do you have to pay a faranji price if you take the local bus or eat in a local restaurant?

Independent travel in Ethiopia. How much does it cost?

Traveling in Ethiopia on a backpacking budget is cheap and below is a list of the price of the most typical things.

How much does food & drink cost in Ethiopia?

Please note that, in very touristic areas such as Lalibela, paying these amounts can be very challenging but those are the prices assuming you pay the local price, so take it as a base reference.

• Vegetarian local meal like beyanet or shiro : 30 to 50 birr
• Non-vegetarian local meal like tibs : 50-70 birr
• Meal in a nice restaurant: main dishes from 100 birr
• Beer: 15-20 birr
• 1kg of pretty much any fruit (mango, avocado, etc): 30 birr
• Local coffee (buna): 5 birr
• Coffee (machiato, espresso): 15 birr
• 2l mineral water plastic bottle: 15 birr

How much does accommodation cost in Ethiopia?

• Local hotels (creepy ones): 100 birr
• Nice, decent accommodation: 300-600 birr
• Mid-range hotels: from 700 birr

How much does transportation cost in Ethiopia?

• Short local bus ride: 20 to 40 birr
• Long distance bus ticket (Addis Ababa to Gonder): 300 birr
• Domestic flight: $50-$100 one-way
• Local shared taxi (Lalibela to Mekele): 600 birr (This will highly depend on your negotiations skills. For example, two tourists who were traveling in the same car paid 1500 birr).

How much does a tour cost in Ethiopia?

• Danakil Depression 2-day tour: $250
• Omo Valley: $100-$150 a day
• Simien Mountains 3-day trek: $170
• Entrance fee to Lalibela: $50

Average daily budget for backpacking in Ethiopia (independent travel)

Assuming you don’t take any domestic flights and travel by local bus, the minimum a budget backpacker will spend is:

$35-40 a day

⚠️ Is it safe to travel to Ethiopia?

That’s a complicated question.

Overall, I feel Ethiopia is a safe country to visit, but let’s go by parts.

The conflict with the Tigray

The Tigray war was a conflict between the Ethiopian Federal Government and the Tigray People’s Liberation, which lasted from November 2020 to November 2022, causing thousands of casualties and displaced people.

The war isolated completely the whole region of Tigray in the north, home to highlights like Axum, Mekele ( Danakil getaway ) and hundreds of rock-hewn churches.

Today, the war is over and the Tigray region is once again accessible.

Pickpocketing is real

Not bluffing, if you are not careful, you are likely to be pickpocketed in Ethiopia.

I have only been pickpocketed in two countries: in Mexico, and in Ethiopia.

Actually, in Ethiopia it happened to me twice, in 2 different areas of Tigray region. On one occasion they stole my brand-new GoPro, and on the second time they took my wallet with my credit card in it.

This can happen anywhere but in here chances are way higher, so be careful of your belongings.

I strongly recommend you get a money belt ! CLICK HERE TO LEARN MORE!

By the way, in big cities, especially in Addis Ababa, never walk alone at night. Your physical integrity is unlikely to be threatened but there is a high chance of being mugged.

Terrorism in Ethiopia

According to the FCO, the Ethiopian travel advice is that you should avoid the Somali province and the area or Gambella, which borders a conflict area of South Sudan.

There is an existing terrorism threat in Ethiopia but it is limited to the Ethiopian Somalia region, the province that borders Somalia.

Since I traveled to Ethiopia from Somaliland by land, I did cross that region and you could really feel the tension and threat I am talking about.

The security measures were insane. Every X km, there was a police checkpoint in which everybody from the bus had to get off and the police would check every single bag, one by one. It was very annoying.

Outside of Ethiopian Somalia, however, I never had or saw any issue.

Danakil Depression

You may have heard that Danakil Depression comes with its own issues and for that, I recommend you read my travel guide .

💃 Solo female travel in Ethiopia

Here’s the deal.

I traveled in Ethiopia as a solo man, so I can’t really speak for women, but I’ll just give you a small summary of what some kick-ass female travelers told me.

Most women said that Ethiopia was safe but the level of verbal harassment was insane, to the extent that some claim they’ll never go back to Ethiopia.

Many local men believe Western girls are easy and you may have to deal with occasional sex offers and creepy compliments. In fact, I was once with a girl from London and witnessed how a very disgusting man would just stare at her and do some creepy movements with his tongue.

Despite being predominantly a Christian country, Ethiopia is a conservative, patriarchal society in which men tend to be sexist.

Nevertheless, all women said that harassment was always verbal and, other than that, they had great fun in Ethiopia.

If you are female traveler who has been to Ethiopia and wants to write a guest post for Against the Compass, please get in touch.

Here you can see more solo female travel articles .

🛺 Transportation tips: how to travel around Ethiopia

Ethiopia is a big country and as such, moving around can prove challenging. Here are some travel tips:

Traveling around Ethiopia by coach (long-distance bus)

From Addis Ababa, you can always take a long distance bus to major destinations such as Arba Minch, Harar, Gonder or Meskel. Most buses are quite comfortable, some more than others; it doesn’t depend on the company but on the type of bus.

Selam for example, good reputable company.

Buses leave from Meskel Square and typically, they all leave at 4am, which is very annoying but given the long distances, it does make sense.

Book your tickets one or two days before. Unfortunately, you can’t book them online but you need to go to Meskel Square itself, where all company stalls are.

There is a way of booking them over the phone, but it’s a real headache.

Basically, you need to call the bus company and tell them which coach you want to take. They will give you a bank account number in which you need to deposit the respective amount. For that, you need to go to the bank but, when I got there, it was so crowded and such a mess that I thought it would be easier to take a taxi to the square.

Ethiopia travel tip: At Meskel Square, you will be approached by local men who claim they work for a specific bus company, saying they can take you to the respective office. Well, they don’t actually work for the company but they want to get a tip for helping you book your ticket, so just ignore them.

Traveling around Ethiopia by local bus

If you are backpacking in Ethiopia on a budget, you will take the local bus.

Taking the local bus in Ethiopia isn’t very different from other developing countries, but just bear in mind that distances here are huge. I personally got really tired and decided not to take any during the last 2 weeks of my trip.

Moreover, you will always have to battle to get a decent price, which will never be great because they always end up saying that you have to pay extra for the luggage, which is completely bullshit.

In the end, they always win.

Traveling around Ethiopia by plane

If you are not on backpacking on a budget, I recommend you take a few domestic flights.

From Addis, there are direct flights connecting any major touristic city, including Lalibela, Gonder, Axum, Harar and even the Omo Valley .

There are direct flights between secondary cities too but maybe not everyday and, worst case scenario, you will have to make quick layover in Addis.

Traveling around Ethiopia by air will save you a lot of time and energy.

All flight are operated by Ethiopian Airlines, a modern, reliable company, and any one-way flight ticket averages $100.

One of the best travel tips for Ethiopia is that, If you fly in with Ethiopian Airlines, you get a 50% discount in all domestic flights and, if you only have a few weeks to travel in Ethiopia, you may want to get 1 or 2 at least. However, I didn’t fly in with Ethiopian Airlines but, when I booked my domestic flight via their website, there was a tick box which you could mark claiming you actually did fly with them, so the discount was applied anyways. At the check-in counter, no questions were asked. Nonetheless, I just checked their website, and the tick box is gone (it comes and goes) so in that case, if you still want to get your discount, most people book their tickets directly at the Ethiopian Airlines office, which you can find everywhere.

Traveling around Ethiopia by train

There is one train line connecting Addis Ababa with Djibouti country via Dire Dawa (the closest big city to Harar). It runs every other day, one day towards Addis Ababa and one day towards Djibouti.

A one-way ticket from Dire Dawa to Addis Ababa costs 600 birr (price for foreigners).

The train has been built by the Chinese and it’s funny that, at every station, you see Chinese people telling Ethiopian employees what to do.

Traveling by train is always great but I will never catch the Ethiopian train again, for the following reasons:

• It’s very unreliable. We stopped for around 3 hours due to a bus breakdown. Also, the day I was supposed to catch it, the train never arrived because of another breakdown, so had to wait for one additional day.
• The train station is very far away from the city. Good luck negotiating the price of a taxi ride. When I arrived in Addis, they wanted to charge me 500 birr, and I ended up paying 300.
• Very long queues for getting in and out, as the authorities check each and every bag and, since they don’t have x-ray machines, they basically make everyone empty their bags.
• The train itself isn’t very comfortable, plus they don’t sell any food, only sodas.
• It’s an extremely busy train with loads of kids roaming around.

🏨 Accommodation: where to stay in Ethiopia

Ethiopia is well-sorted for hotels, some of them being very good value for money options.

You can check them all on booking.com .

Most hotels owners will ask you to pay in USD but, as I told you in the money section, better to exchange those USD in the black market, get 20% extra, and then pay your hotel in birr.

Creepy hotels – When I was passing through a city, I had to stay on 1 or 2 occasions in one of those creepy hotels which are OK for 6 hours and cost less than 4USD. They are all over the country

Backpacking Hostels – You can find some in Addis Ababa and also in cities like Gonder.

Guest Houses, nicer hotels – Decent accommodation costs from 400 to 600 birr for a double room, and you can find them everywhere, all over the country.

Mid-range hotels – There is also a wide range of relatively good hotels, all of them starting at 900 birr or so.

❗ More resources for traveling in Ethiopia

📢 In my Travel Resources Page you can find the list of all the sites and services I use to book hotels, tours, travel insurance and more.

Useful websites for more Ethiopia travel tips

All Addis Around – For everything related to events, restaurants and bars in the capital.

Migrationology – For anything related to Ethiopian food.

All guides and articles for traveling in Ethiopia destination

• Omo Valley Travel Guide
• A City Guide to Lalibela
• Danakil Depression Travel Guide
• Trekking Guide in Simien Mountains

Travel guides to other countries in Africa

• Eritrea Travel Guide
• Somaliland Travel Guide
• Travel Guide to Sudan
• Travel Guide to Egypt
• Libya Travel Guide
• Mali Travel Guide
• Travel Guide to Mauritania
• Tunisia Travel Guide

This Ethiopia travel blog was a long one, a post in which I put so much effort, and time! I hope you find it useful and if you have any questions or suggestions, leave a comment in the ”comments” section.

30 comments

Hello! Thank you for all of this wonderfully detailed information! I have a few questions: Are toiletries easy to find? Things like shampoo, body soap, sunscreen, mosquito repellant, etc? Are over the counter medicines available? Like Ibuprofen, Pepto-Bismol, etc. What kind of converter for electronics should be used? Thank you in advance!

Hello Maree! Yes, toiletries are very easy to find. Outside of main cities, you may no be able to find international brands but they do have local brands. Counter medicines are available everywhere. About mosquito repellant, is better to bring it from your home country. In my experience in Africa, I have always found it expensive and not the best quality. For electronics, they use regular EU connector.

What was your experience, i intend to go there this december

I’ve travelled to Ethiopia six times or so over the last ten years. The first time I carefully brought along a crisp US20 dollar note for my visa on arrival. As more tourists have come, the price has risen, but it’s become even easier to get the visa. I really wouldn’t bother getting the Evisa as very often the queue for the Evisa is longer than the visa on arrival. And no need for pristine US dollars, they take pounds, euros and card as well.

Hello Joan,

Thanks for sharing your vast travel experience in Ethiopia. Would you know if there is any buses going from Lamu in Kenya, all the way to Lalibali? And if crossing that frontier is a hassle? The alternative is flying to Addis but with the layover there I think a bus would be faster. Any tips would be greatly appreciated.

I dont think there aren’t direct buses from Kenya to Lalibela. It’s just too remote.

Im interested in traveling to Lilabela but concerned about the current of civil war in Ethiopia. Is it safe for senior age Black Americans to visit? If so could you recommend a tour guy?

Hi there, as far as I know, Lalibela is still within the safe area, but the city is out of electricity and there are no tourists.

correction of email below

Speaking to my in laws who live in Addis, who have relatives in the North- NOT a good idea to be travelling as a tourist outside of AA.

so sorry to bother you but would you please elaborate a little? I am currently in addis ababa and i’ve asked around and have received conflicting answers. (I think also due to language barriers but) some say it is totally fine. Others say I’m crazy to go around.

Would love some first hand info from people who are currently here. Thank you in advance.

Hello, well not being in Addis right now it seems like you’re in a better place to find out:) The UK Foreign Office has got some very detailed advice on its website- says Lalibella is ok. I would read that carefully. And whatever you do, don’t go to Tigray. Good luck.

We will be near Ethiopia in late March 2023 and would love to visit Lalibela holy land churches for 3-4 days. Could you advise how to tour them if we fly from Addis Ababa? We are Black Americans and do not know the local language. Thank you.

hi, there’s a tourist office in Lalibela, in the center of the town, where you can buy the tickets

Actually one and half day is enough to visit all the 11 rock cut churches. You could visit some county side churches combining hike to the highlander farmer village where you see their way of life, even take part in their daily activities… Lalibela based tour agent “Highland Eco trekking tours” is known for organizing authentic experience in the area

To Dr King: We went a couple years ago and used a guide named Alex Aregaw( +251 92 019 0138 on Whatsapp or [email protected] by email). He’s also on TripAdvisor: https://en.tripadvisor.com.hk/ShowUserReviews-g480193-d7033629-r793913298-Lalibela_Local_Tour-Lalibela_Amhara_Region.html he is the guy in the mask and white shawl in the first photo. His English is good and he’s very polite and nice to deal with. I occasionally keep touch with him on Instagram, and apparently a few tourists are trickling back now, and water and electricity are back, after they were destroyed when the TPLF invaded last Christmas.

For the author of the article: I’m amazed you got pickpocketed twice in Tigray! We spent like 15 days in various parts of Tigray and never encountered any crowds or groups of people, even in Axum and Mekele. We even had not been locking our car — I realized after we had been driving it for like 10 days that when closing the driver’s side door, it automatically unlocked the car — and no one ever stole the GoPro out of our windshield. But, I was always parking in hotel parking lots or I had been paying a local guy to watch the car if I parked in the street.

Thanks for your advice EG. Truly appreciate it. Peace

Hi, thanks for the useful information. How long do you suggest for a trip in Ethiopia ? I’m planning to cross the border from Sudan and after Ethiopia move on to the next bordering country. Regards, Suné from South Africa 🇿🇦

difficult to say! I spent there 6 weeks, the country is huge! but from crossing from north to south save at least 3 weeks for all the highlights!

Hello, This is very informative. What about getting sick from drinking the water or eating food, for someone who has not been there before? What precautions should one take?

I’d only drink mineral bottled water and be careful on where to eat meat

We just returned from Ethiopia. We travelled as a family with a 8 y.o. child. We’ve been in the Omo Valley with Lalo Tours. They gave the best price from the beginning. 400 USD for 2 days 2 nights everything included. It was the best part of Ethiopia trip. After this we went in Danakil with ETT after long negotiations we have obtained 900 USD for 3 days 2 nights tour. This part was very adventurous. 2 nights sleeping under the sky. You can have mosquitos, wind and dust. Beautiful and incredible sceneries. Don’t expect more than basic conditions for food and accommodation. You should come preprepared. After this it followed Lalibela where we had the best accommodation in all Ethiopia at Ben Abbeba local guide for 40 USD payable in in Birr.

Some tips and tricks:

1. Don’t use ATMs or official exchange offices. Come with USD in cash and change it in Addis on black market. We managed to change it for 99.5 for 1 USD (We heard about 110 for 1 USD). Go to Meskele sq pick up a restaurant and ask discreetly about changing money. Like this all the prices will drop to almost 50% for you.

2. In Addis specially look up for pickpocketing, snatching of the phone from hand, etc. We didn’t experience but we met people who did. So be very aware. We used money belt for USD transportation. For birr it is impossible because you will get a lot of birrs for your USD. Use a backpack.

3. In Addis use Ride app for ridesharing. Select pay in cash and you will have dirt cheap rides.

4. Everywhere it said that if you use international flight with Ethiopian Airlines you will have almost 50% discount for internal flight. Is nobody checking this. So, I believe if you tick on their website that you have am international ticket with them, it will work even if don’t have in reality. More than this if you want to be sure and you don’t have luggage you can make online check-in and you will not face any question from anyone. Another trick is that if you have international flight with them, once in Addis change your USD in birr on black market and after this go to Ethiopian Airlines Office and buy your domestic tickets with cash. Like this you will have the smallest prices.

5. Political situation. It can become quite instable sudden. During our stay in Amhara started some violent demonstrations, especially Gondar. In Lalibela was peaceful, but we didn’t have mobile internet, and, in some parts, we heard a lot of gun shots, the locals said that people buy weapons and test them… Keep an eye on BBC section for Ethiopia and western embassies. Local guides we will tend to minimize the danger, but it is there.

6. If travelling with children, be aware of the sanitation conditions. Ours got food poisoned and for 3 days it was a nightmare with continuously vomiting, diarrhea, high fever, fatigue In Addis we didn’t find any antidiarrheic medicine, just antibiotics that worked finally. We also faced another problem, that by our mistake, we had all the medications in the luggage and Ethiopian Airlines lost them for 10 days. So, travelling with small children can become difficult.

7. Erta Ale volcano activity. It is totally different from the lava lake that you can see it on YouTube. Now there are 2 small volcanic cones like 3-4m in diameter that spit lava. Guides said that the situation is changing each day. You can see the lava or if unlucky only smoke. Be prepared because the smoke can be quite irritating. A face musk can help but not too much. Especially with children in Dallol area you will fill incredibly hot. Drink plenty of water, otherwise there are chances to faint from heat. The guides and agencies are totally unprepared for something like this. You will not have somebody with you permanently to take care. You must handle it on your own.

I will be happy to answer to other questions if there are any. Safe travel for everybody!

Buf! this is one the best travel report/feedback we’ve ever got in ATC. Thanks a lot Vladimir!

I’ve just been researching the visa situation for Ethiopia, and came across your site. The fees are currently vastly different to what you have here ($82 for a 30 day visa, $202 for 90 days, extension $102 and $302 respectively). Your site is very interesting. I am planning an overland trip from Cairo to Cape Town early 2024. 😀

It seems they increased prices, thanks a lot for the update!

I’ll be a black American solo female traveler in 2024 to AA and this detailed info has me excited and informed instead of intimidated and uncomfortable. Fortunately, I currently live in Washington, DC in an Ethiopian community where these beautiful people are my neighbors and small business owners. Daily I interact with them, learn a word or two of Amharic, and eat their food (which I also have a love/hate relationship with ;)) Safe travels, everyone!

Have a lovely trip Chelsea!

You are out of date on. VISAS. Embassies no longer do them VOA no longer available unless you are from an AU country. So you must use e visa..where prices now 82 and 202 dollars…for 1/3 months.

thanks for the update!

You really are amazing. Thanks for the very interesting and comprehensive info. I have 2 friends who have just come back from travelling in Ethiopia and I am planning a trip there myself.

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• Open access
• Published: 05 July 2021

Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology

• Mekonnen Sisay   ORCID: orcid.org/0000-0001-6611-1174 1 ,
• Firehiwot Amare 2 ,
• Bisrat Hagos 3 &
• Dumessa Edessa 2  

Journal of Pharmaceutical Policy and Practice volume  14 , Article number:  57 ( 2021 ) Cite this article

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Access to essential medicines is a universal human right and availability and affordability are the preconditions for it. In line with the sustainable development goals, World Health Organization (WHO) has outlined a framework that assists the policy makers to improve access to essential medicines for universal health coverage by 2030. However, the availability and affordability of essential medicines remains suboptimal in several low-income countries. Therefore, this study was designed to investigate the availability, pricing and affordability of essential medicines in eastern Ethiopia.

A cross-sectional study design was employed to conduct this study. Public and private health facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/Health Action International (HAI) guideline and essential medicines listed on WHO/HAI guideline and essential medicine list of Ethiopia were included. Accordingly, 60 medicine outlets were selected based on the WHO/HAI standardized sampling methodology. A standardized data collection tools developed by WHO/HAI, with necessary modifications, was employed to collect the data. Median Price Ratio (MPR) was computed as a ratio of median local buyers’ price to international buyers’ reference price. The Mann–Whitney U test was employed to compare the median buyers’ price between public and private health facilities. Kruskal–Wallis test was also run to explore the median price difference among all facilities. Treatment affordability was calculated based on the number of days of wage of the lowest-paid government employee of Ethiopia required to purchase the prescribed regimen.

The overall percent availability of originator brand (OB) versions of essential medicines was found to be 3.6% (range: 0.0–31.7%), with the public and private sectors contributing 1.43% and 5.50%, respectively. The overall percent availability of lowest price generics (LPGs) was 46.97% (range: 1.7–93.3%) (Public: 42.5%; private: 50.8%). Only eight LPGs (16.0%) met the WHO target of 80%. The Mann–Whitney U test indicated that 64% drugs showed statistically significant median price difference between public and private settings ( p  < 0.05). The MPR value indicated that the median buyers’ price of drugs in private sector were more than four times the international reference price in 30% of drugs. The percentage of unaffordable medicine were 72.09 and 91.84% for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings were combined.

Only 16% of the surveyed medicines surpassed the WHO cut-off point of 80%. Nearly one-third of drugs in the private sector had a price of more than four times compared to the international reference prices. Moreover, four out of five drugs were found unaffordable when both settings were combined, demanded several days of wage of lowest paid government employee. This finding calls a prompt action from stakeholders to devise a strategy that help promote the access of essential medicines and rescue the struggling healthcare system of Ethiopia.

Health is a fundamental human right while access to health care is a way of ensuring the fulfillment of this right [ 1 ]. Universal health coverage (UHC) as the main target of sustainable development goal strives to achieve access to quality health services according to the need, while ensuring imposition of less financial hardship on the users of the services [ 2 ]. The realization of UHC have the access of essential medicines (EMs) at its core as they are an indispensable element for delivery of services and a requirement for high-quality care [ 3 ].

Availability and affordability are dimensions of measures of access to medicines in health systems [ 4 ]. Access to affordable, quality-assured EMs is crucial to reducing the financial burden of care, preventing greater pain and suffering, shortening the duration of illness, and averting needless disabilities and deaths worldwide [ 5 ]. However, one third of the world’s population lacks regular access to EMs, resulting a cascade of preventable misery and suffering [ 6 , 7 ]. This estimate rises to over 40% in low-income countries and over 50% in poorest countries of Asia and Africa despite the issuance of legislations supporting the implementation of UHC by the countries [ 8 ].

EMs satisfy the priority health care needs of the population. They are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price, the individual and the community can afford [ 9 , 10 ]. In many developing countries, lack of financial resources or information can create barriers to accessing essential medicines and contributing for the increased rate of morbidity and mortality [ 11 , 12 ]. On top of unavailability of EMs, high price of medicines is posing a problem in the provision of health services [ 13 ]. Price of medicines is a concern in low- and middle-income countries where up to 90% of the population purchases medicines through out-of-pocket payments [ 14 ]. This has a huge impact on the affordability of medicines and treatment outcome of diseases [ 15 ].

In the mid-1990s, civil society organizations in developed and developing countries started drawing attention to the need for increased access to essential medicines as part of the fight against poverty. Later, the World Health Organization/Health Action International (WHO/HAI) project was established in 2001 to deal with medicine prices and availability. The main focus of this project was to develop a reliable methodology for collecting and analyzing availability, affordability and medicine price component data across healthcare sectors and regions; to publish survey data to improve price transparency; and to advocate for appropriate national policies and strategies. Through series of improvements, this guideline has been used to measure medicine prices, availability, and affordability throughout the globe [ 16 , 17 , 18 ].

Ethiopia is one of the developing nations facing the dire consequences of unavailability and unaffordability of medicines [ 19 ]. To this end, studies conducted in the country are limited in the provision of region-specific price, availability and affordability data on EMs. Therefore, this study was designed to assess the price, availability and affordability of EMs in Eastern Ethiopia by using WHO/HAI survey methodology.

Study area, design and period

The study was conducted at public and private healthcare facilities in the major cities of Eastern Ethiopia including Dire Dawa, Harar, Haramaya, Chiro, Degahabour and Jigjiga. Dire Dawa is located 515 km east of Addis Ababa with a total area of 1288.02 km 2 . The area is dominated by dry, windy and hot climatic condition. According to the projections made based on the 2015 census, the total population of the administration is 383,529 of whom 283,773 (74%) live in urban part of the city. Harar is located 526 km away from Addis Ababa to the East. Harari Region is one of the nine National Regional States of Ethiopia, with the town of Harar as its capital. Based on the 2015 census, Harari had a total population of 183,344, of whom 92,258 were males and 99,321 or 54.17% of the population were urban inhabitants. Jigjiga is another major city in eastern Ethiopia, mainly inhabited by different Somali clans. Based on figures from the central statistics agency (CSA) in 2015, Jigjiga has an estimated total population of 250,000 of whom 126,578 were females. Haramaya is also one of the administrative centers in eastern Ethiopia located at a distance of 508 km from the capital, Addis Ababa. The 2015 national census reported a total population of 271,018, of whom 138,282 were males and 18.46% of its population were urban dwellers. Chiro, the capital of West Hararghe zone, is another major city in the eastern part of Ethiopia located at 373 km from Addis Ababa. The 2015 national census reported a total population for this town of 33,670, of whom 18,118 were males. Another city included in the study is Degehabur which is located in the Somali region of Ethiopia. Based on figures from the CSA in 2007, it had an estimated total population of 30,027 of whom 16,474 were males. A cross-sectional study was conducted from March 01- March 31, 2020.

All public and private healthcare facilities of Eastern Ethiopia were considered as a source population. Public and private healthcare facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/HAI guideline as well as essential medicines listed on WHO/HAI guideline and essential medicine list (EML) of Ethiopia were included for the study. Non-governmental health facilities, health facilities that provide medications free of cost and programmed essential medicines were excluded from this study.

Sample size determination

Sixty medicine outlets were selected based on the WHO/HAI standardized sampling methodology [ 16 ]. Besides, WHO/HAI recommended that such price-based studies should include at least 14 global core medicines, and where possible 16 regional core medicines. Based on this, 30 drugs from global/regional core lists [ 16 , 17 ] plus 20 other essential medicines from EML of Ethiopia [ 20 ] were included, making a total of 50 essential medicines per site, from different therapeutic classes for this study. This will enable the price and availability dynamics of the therapeutic group of medicines to be compared to those of other essential medicines which may be very meaningful in the interpretation of the findings and development of recommendation and strategies. It will also enable the publicly accessible global database of prices and availability to expand.

Sampling procedure and technique

Based on the WHO/HAI standard sampling technique, six survey areas which cover a population of about 100,000 to 250,000, reachable within one day’s travel from the main urban center, large enough to represent the survey region and containing the requisite number of health facilities were selected [ 16 , 17 ]. Based on this: Dire Dawa, Harar, Haramaya, Chiro, Degahabour and Jigjiga were selected as a survey area. In order to select the medicine outlets for the study based on WHO/HAI standard sampling technique, one main public hospital (referral, district or regional hospital) was selected from each survey area. Then, other four public health facilities, and five private medicine outlets, which are within 3-h travel from the main public hospital, were selected by using simple random sampling. In addition to the global and regional core list of essential medicines, 20 more essential medicines were randomly selected from EML of Ethiopia. The summary of generic name of essential medicines, strengths and unit of measurements, originator brands (OBs) and their respective manufacturers was presented in Table 1 .

Data collection methods

A standardized data collection tool developed by WHO/HAI, with necessary modifications was employed to collect the data from both public and private facilities. The data were collected by twelve pharmacists who were recruited as data collectors. The data regarding price and availability of essential medicines were collected from each selected drug retail outlet.

Study variables

The availability, price and affordability of essential medicines were considered as the outcome variables. Type of sector, source of drugs (local or imported), the nature of facilities, duration of therapy, monthly income of lowest paid government worker (to be converted to daily wage), the type of medicines (OBs and LPGs) were treated as independent variables.

Data processing and analysis

After data collection, data were entered and analyzed using Excel® WHO/HAI Medicine Pricing Workbook and the results were summarized and presented in tables and graphs. Medicine availability was calculated as percent availability of individual medicines; mean (average) percent (%) availability across a group of medicines; and variations between product types (OBs vs LPGs) and sectors. For further statistical analysis, the data were transferred to SPSS version 20. Normality distribution of the price data was checked using Kolmogorov–Smirnov and Shapiro–Wilk tests. Accordingly, the Wilcoxon–Mann–Whitney U test was employed to compare the median buyers’ price (customers’ out-of-pocket expenditure for drugs) between public and private health facilities. Kruskal–Wallis test was also run to explore the median price difference among four facilities (hospital, health center, pharmacy and drug store). Medicine prices were calculated as median prices of individual medicines in United States Dollar (USD). The exchange rate of Ethiopian birr to USD equivalent was considered by taking the monthly average of March, 2020 (1 USD = 35.70 Ethiopian birr).; median price ratio (MPR) was computed as ratios of median local price to international (WHO/HAI) buyers’ reference price for public, private and overall facilities as follows.

Treatment affordability was calculated based on the daily wage of the lowest-paid government employee; and components of the prices of medicines paid by consumers. Daily wage of the lowest paid government worker of Ethiopia was about 0.44 USD ( https://mywage.org/ethiopia/labour-law/wages ). Accordingly, the affordability was also computed for public and private sectors for ease of comparison. Affordability (in terms of the number of daily wages) was computed as follows:

Availability of essential medicines

In 60 health facilities surveyed, nearly half ( n  = 26) of the OB versions of essential medicines were not available at all during the study. From which, 6 OB medicines out of 14 WHO/HAI core drugs were not available at all. Besides, only four OB essential medicines (glibenclamide 5 mg, paracetamol 500 mg, carbamazepine 200 mg and acetyl salicylic acid (ASA) 100 mg tablets) were available in more than 10% of the settings surveyed. The overall (pooled) percent availability of OB versions of these essential medicines in all facilities (both public and private) was about 3.6% (range: 0–31.7%). Observing the public medicine outlets alone, 39 OB medicines (78%) were not available in all facilities during the study period. Moreover, except carbamazepine/Tegretol ( n  = 7) and azithromycin/Zithromax ( n  = 4), the rest drugs were available in only one of the 28 public medicine outlets surveyed. The overall percent availability of OB medicines in surveyed public sectors was 1.43%. Regarding the private sector, 30 OB medicines (60%) were not available at all. Only 6 OB versions of drugs (metformin 500 mg, diclofenac 50 mg, glibenclamide 5 mg, paracetamol 500 mg, ASA 100, and carbamazepine 200 mg tabs) were available in more than 10% of the private facilities surveyed. What is more, the OB versions of drugs like paracetamol suspension, diclofenac 50 tab, glibenclamide 5 mg tab, salbutamol inhaler, ibuprofen 400 tab and ASA 100 tab were available in private sectors only. The overall availability of OB versions of 50 essential medicines in private sector was about 5.50% with pharmacy and drug store contributing 6.1% and 4.5%, respectively (Table 2 ).

Regarding the LPG versions of these essential medicines, all the LPG versions of selected essential medicines were available at least in one of the surveyed health facilities. The overall percent availability of LPGs in all settings was 46.97%, ranging from 1.7% (bisoprolol 5 mg and amiodarone 200 mg tabs) to 93.3% (amoxicillin 500 mg cap). The LPG versions of six drugs (bisoprolol, simvastatin, loperamide, amiodarone, ASA 100 mg, and carbamazepine) were not available at all in public facilities and one of which was from the WHO/HAI core drug category. In general, 26 LPG versions (52%) of the surveyed medicines were available in 50% or more of the facilities included in the study. Only eight LPG versions were available in 80% or more of the facilities surveyed. In descending order, amoxicillin 500 mg caps (93.3%), omeprazole 20 mg cap (90%), ceftriaxone 1 g inj. vial (88.3%), doxycycline 100 mg cap (88.3%), metformin 500 mg tab (83.3%), ciprofloxacin 500 mg tab (83.3%), metronidazole 250 mg cap (83.3%), and diclofenac 50 mg tab (80.0%) were the top eight drugs available during the study. The overall percent availability of LPGs in surveyed public sectors was 42.5% (hospital = 53.11% and health center = 37.47%) whereas that of the private counterparts were 50.8% (pharmacy = 55.7% and drug store = 42.83%) (Table 2 ).

Regarding the source of available drugs, 17 LPGs (34%) were totally imported. From which, four drugs (diazepam, ceftriaxone, simvastatin and captopril) were among the WHO/HAI core list. Except ceftriaxone ( n  = 53), TTC ( n  = 34) and hydrocortisone ( n  = 31), all other imported drugs (LPG versions) were available in less than 50% of the surveyed facilities. Two drugs (metronidazole and fluoxetine) were from local source only. The rest 31 drugs were from both sources with certain domination from imported ones (Fig.  1 ).

Availability based on the source of drugs

Regarding the therapeutic classes, the study included chemotherapeutic agents ( n  = 17), cardiovascular drugs (CVS) ( n  = 8), central nervous system (CNS) drugs ( n  = 7), gastrointestinal drugs ( n  = 6), non-steroidal anti-inflammatory drugs (NSAIDs) ( n  = 5), respiratory agents ( n  = 2) and two more from miscellaneous agents. Comparing the overall availability, the LPG versions of these drugs were obtained from private settings in almost all therapeutic classes. OB medicines obtained from public facilities were primarily from CNS (40%) and chemotherapeutic drugs (35%) whereas those obtained from private counterparts were from NSAIDs (29.5%) and endocrine agents (26.1%). Generally, the average percent availability per class indicated that the top three available (for any LPG versions) were chemotherapeutic drugs (public: 53.78%; private: 68.93%), CNS drugs (public: 48.47%; private: 49.11%) and GI agents (public: 48.21%; private: 58.33%) (Fig.  2 ).

Availability by therapeutic class of LPG versions of essential medicines

Based on the duration of therapeutic regimen, majority of the drugs available in both public and private settings were those agents being used for acute conditions (for less than 2 weeks). The average percent availability of drugs used for acute and chronic conditions was 51.26% (public: 46.77%; private: 55.75%) and 39.23% (public: 35.53%; private: 42.93%), respectively (Fig.  3 ).

Availability based on the duration of therapy of LPG versions of essential medicines

Cost analysis of essential medicines

Drugs like adrenaline, ASA 300, and ibuprofen had comparable median buyers’ price between public and private medicine outlets. On the other hand, the median buyers’ price of drugs in private settings were higher than the public counterparts for 94% ( n  = 47) of LPGs analyzed. From these, the Mann–Whitney U test indicated that 64% ( n  = 32) drugs showed statistically significant median price difference between public and private settings ( p  < 0.05) (Table 3 ). Specifically, the private median prices of LPG versions were more than three times that of the public sector for drugs such as ampicillin, azithromycin, ceftazidime, diazepam, fluconazole, hydrocortisone, metoclopramide and ORS. Likewise, Kruskal–Wallis test indicated that 50% of drugs showed statistically significant median price difference across facilities (Table 4 ).

Regarding the WHO/MSH median buyers’ price, the MPR indicated that the median prices of drugs in public facilities were more than three times the reference price in 8 LPG versions of essential medicines including atenolol, captopril, fluoxetine, furosemide, cotrimoxazole suspension, paracetamol suspension, salbutamol inhaler, and risperidone tablets. Drugs like metronidazole, propylthiouracil, ibuprofen, and hyoscine had local buyers’ price of more than two times the international median price. Looking at the private sectors, the MPR value indicated that the median buyers’ price of drugs were more than four times the international reference price in 30% of drugs. Overall, drugs with top ten MPR were salbutamol inhaler, cotrimoxazole suspension, paracetamol suspension, loperamide tab, ASA 100, simvastatin, fluoxetine, risperidone, atenolol and furosemide (Table 5 ).

Affordability of essential medicines

Majority of the medicines were found to be unaffordable, costing more than one day wage in both private and public facilities. The percentage of unaffordable medicine were 72.09 and 91.84 for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings are combined. The result of the overall affordability calculation revealed that ceftazidime, risperidone, and ampicillin injection were the top three unaffordable medications requiring 171.33, 73.43 and 58.74 days wage of the lowest paid government employee, respectively. The top three unaffordable medications in the private facilities were ceftazidime, risperidone and valproate requiring 186.01, 95.45 and 62.89 days wage of the lowest paid government employee, respectively. While in the public facilities risperidone takes the lead with 70.91 days wage followed by ceftazidime and valproate with 53.84- and 39.88-days wage, respectively (Table 6 ).

Access to essential medicines is a universal human right and availability and affordability are the preconditions for it [ 21 , 22 ]. In line with the sustainable development goals, WHO has outlined a framework that assists the policy makers to improve access to essential medicine for universal health coverage by 2030. The four major components of access are rational selection and use of medicines, availability and affordability, sustainable healthcare financing, and reliable supply system of quality products [ 22 , 23 , 24 ]. In this regard, essential medicines should be systematically selected using evidence-based approach with due consideration on public health priority, comparative cost-effectiveness, efficacy, safety, and generic versions, among others. The provision of complete healthcare is realized when essential medicines are available in the required quality, quantity, and at all times and in a way that patients can easily afford [ 22 , 23 , 25 ].

However, the availability of essential medicines is still suboptimal in several low-income countries. In particular, the availability of pediatric formulations and key medicines for chronic diseases is still suboptimal even in middle-income countries [ 26 ]. As per the global action plan of WHO, the proposed 80% target for access to essential medicines is the key to attain the overall target of 25% relative reduction in premature mortality from chronic non-communicable diseases (NCDs) by 2025 [ 27 ]. Besides, improving the availability and affordability of essential medicines is likely to enhance their use and help towards in achieving WHO targets of 50% use of key medicines by 2025 [ 28 ].

In this regard, this study has addressed the availability, price and affordability of 50 essential medicines in public and private health facilities of eastern Ethiopia. Generally, nearly half of OB medicines, 42.85% OBs from WHO/HAI core drugs, were totally absent in all health facilities included in the survey. The overall availability of OB medicines was lower in public facilities. Besides, nearly half (52%) of surveyed essential medicines were available in only 50% or more of the facilities studied. Only eight LPG versions (16.0%) were available in 80% or so of the facilities surveyed. The overall availability of LPG versions was higher in private drug retail outlets. Except ceftriaxone and hydrocortisone, all imported LPG versions were available in less than 50% of the facilities included. Chemotherapeutic agents were the most commonly available class in both public and private settings. The availability index for drugs for chronic diseases was lower than that used for acute conditions.

The median buyers’ prices for 94% LPG versions were significantly higher in private drug retail outlets. Moreover, the private median price of LPGs were more than three times that of the public sector for 16% of drugs. The MPR value indicated that median price of LPGs in the private sector was more than four times the IRP in 30% of drugs. In public sector, about 16% of LPGs had a median price of more than three times than that of IRP. With reference to the lowest paid government employee, majority of LPG medicines were found unaffordable, costing more than one day wage in both public and private facilities. Generally, four out of five essential medicines were found unaffordable in Ethiopian healthcare settings with the worst price escalation being observed in private settings (nine drugs out of ten essential medicines). In low-income countries like Ethiopia, low availability with high buyers’ price and low affordability vividly reflects a failure of implementing national drug policy on essential medicines.

Unlike this study, the availability of OBs exceeded the WHO target of 80% and found affordable in Qatar public health facilities, although 30% of surveyed medicines were beyond the acceptable threshold of 4.0 in private sector [ 29 ]. Compared with this study, study conducted in the northern Ethiopia indicated that there was lower overall availability (34.1%) but better affordability of LPGs 30% and 50% of LPGs demanded more than a single daily wages to purchase these drugs in public and private sectors, respectively [ 30 ]. In Jordan, much better availability of LPGs was observed in both public (72%) and private (76%) sectors for chronic diseases and the prices of medicines in public sectors were generally affordable but not in private settings [ 31 ]. Likewise, in upper-middle income countries like Malaysia, the affordability of all generic versions of essential medicines was below 2-day wages of the lowest paid government employees in the public sector [ 32 ].

In our study, eight drugs (16.0%) met the WHO target of 80%. It was in trajectory with the study in which 15.2% and 18.9% of LPGs met WHO target in the public and private sectors of low-income countries, respectively. This value was 7 to 8% higher in lower-middle income countries [ 33 ]. Besides, a study conducted in Tanzania and central Ethiopia indicated that locally produced products had greater mean availability (48%) than that of imported ones (19%) [ 34 ] indicating the need of more local manufacturing plants for better access of essential medicines.

In a study conducted on six low-and middle-income countries, less than 10% surveyed medicines were available in public sector in four of the countries surveyed [ 35 ]. Unlike high-income countries, low- and middle-income countries usually have poor regulation of pharmaceutical markets and often lack feasible purchasing and pricing strategies [ 36 ]. Country specific studies indicated that better availability and more affordable generic versions were reported from Rwanda [ 37 ] and Nepal [ 38 ]. Relatively higher availability of OBs in both public (6.8%) and private (55.0%) facilities were also observed in Pakistan whereas the availability of generic versions was lower in public (35.3%) and private (20.3%) facilities [ 39 ]. In a study conducted in China, higher availability of pediatric OBs were observed in public (7.5%) and private (8.9%) sectors although the overall availability of generic versions in both public (34.2%) and private (29.4%) sectors were by far lower but more affordable compared to our study [ 40 ]. What is more, in the primary care settings of Vietnam, the availability of essential medicines was higher (56.4%) than our study. Likewise, the study conducted in eleven countries of the Asian Pacific region demonstrated that there was slightly higher availability (56.7%) of generic versions of essential medicine in the private sector though it was found lower (35.5%) in the public sector [ 41 ]. In the upper middle-income and high income-countries, the availability of OBs and LPGs was by far higher in both public and private sectors with less price variation and more affordability compared to our study [ 42 , 43 , 44 , 45 ]

Regarding chronic diseases in particular, a significant proportion of patients in low- and middle-income countries do not have access (low availability and/or low affordability) to generic versions of essential medicines for the treatment of hypertension [ 46 ], diabetes [ 47 , 48 , 49 ], chronic respiratory diseases including bronchial asthma [ 27 ], diabetes and hypertension combined [ 50 ], several non-specific NCDs [ 51 , 52 , 53 ]. Multilevel analysis also indicated that the availability and affordability of essential diabetes medicines were significantly associated with their use [ 47 ]. Likewise, a study conducted in China indicated that high cost medications were more likely to be prescribed than lower cost alternatives and only one-third of facilities stocked high value (essential) medicines [ 54 ]. To this end, medicines take a large proportion of household expenditure on health in low-and middle-income countries. According to WHO survey, up to 9.5% of the total expenditure was spent on medicines and is almost three times higher than the one spent in high-income countries [ 21 , 22 , 55 ]. Inadequate healthcare financing and inefficient and unreliable supply system is attributable to high out-of-pocket expenditure in such resource poor settings. The PURE study also indicated that secondary prevention medicines for cardiovascular diseases were found unavailable and unaffordable in large proportion of customers in low- and middle-income countries [ 28 ].

With regard to AWaRe (Access, Watch and Reserve) classification of antibiotics, there has been a declining trend of at least 60% total consumption of antibiotics (WHO-national level target) in the access category from 76% in 2000 to 55% in 2015. Without policy intervention affecting the availability of such essential antibiotics, it is difficult to attain at least 60% consumption of antibiotics from ‘Access’ category by 2023 [ 56 ]. In our study, all the included essential antibiotics were from both Access and Watch categories with the former accounting nearly two-thirds of the total agents.

Even in countries where there is drug pricing information, the availability of medicines in public sectors is about one-third while that of the private sector is about two-thirds, and the buyers’ prices for LPGs vary from 2.5 to 6.5 MPRs in these two sectors [ 21 ]. In this regard, a multitude of strategies including managerial, regulatory, economic, and educational approaches shall be devised to increase the access of essential medicines in the public sector [ 21 , 35 , 41 , 57 ]. Economic strategies including competitive or pooled procurement policies for multisource products, price negotiation for sole source products, reducing taxes and tariffs and regulating mark-ups, provision of community-based health insurance, and sustainable health care financing shall be taken as the prior agenda for Ethiopia to address all segments of the population. In addition, regulation of the pharmaceutical market, strict implementation of generic procurement policies, efficient and evidence-based procurement, provision of vivid pricing and procurement information, as well as installation of local manufacturing plants shall also be considered to increase the access of essential medicines.

Strength and limitations

Using validated WHO/HAI methodology allows for the measurement of medicine availability and prices in a reliable and standardized way. Utilization of international reference prices can also allow for valid international comparisons between Ethiopia and other countries. Besides, we considered global core, regional and national essential medicines for international comparison. However, being a single point cross-sectional study, it is unable to reflect the average monthly or annually availability of medicines at individual outlets. The affordability section is also heavily dependent on the economic status, public salary scale, and exchange power of Ethiopian birr and subject to change over time.

The overall availability of generic versions of essential medicines was by far lower than the WHO target of 80% with 16% of the surveyed medicines surpassing the cut-off point. The overall availability of OBs was also less than 5%. About 30% of drugs in the private sector had a price of more than four times (MPR threshold) than that of the international references. Moreover, four out of five drugs were found unaffordable when both settings were combined. Looking at the private sector, about nine from ten drugs demanded several days of wages of lowest paid government employees. There is a higher tendency of prescribing generics than the OB versions of essential medicines as the OB versions are much more expensive in such resource limited settings. However, much is yet to be invested in controlling the price of drugs. Ensuring access of essential medicines is one of the general objectives of Ethiopian National Drug Policy. In this regard, the current regional study indicates the availability and affordability is suboptimal which calls the responsible stakeholders to devise a strategy that help increase the access of essential medicines and rescue the struggling healthcare system.

Availability of data and materials

All the data used for the study are contained within the manuscript.

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The authors thank data collectors and staff of all healthcare settings for their substantial help to realize this research work. The authors also extend their thank to Haramaya University for granting this research work.

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Sisay, M., Amare, F., Hagos, B. et al. Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology. J of Pharm Policy and Pract 14 , 57 (2021). https://doi.org/10.1186/s40545-021-00339-2

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Medical Tourism

Ethiopian medical tourism: proven techniques for success.

In the realm of medical tourism, Ethiopia is emerging as a promising target market. With its unique characteristics, abundant resources, and growing demand for quality healthcare services, Ethiopia presents significant opportunities for healthcare providers. Understanding the distinct features of this market, meeting patient expectations, and accommodating the culture are essential to tap into its potential. In this comprehensive article, we will explore proven techniques for success in Ethiopian medical tourism.

Unique Aspects of the Ethiopian Market

Ethiopia stands out as a unique medical tourism market due to several factors. The country boasts a rich cultural heritage, diverse landscapes, and a rapidly growing economy. The healthcare sector is experiencing significant development, with the government investing in infrastructure and modern healthcare facilities. Ethiopian patients seeking medical treatment abroad are often driven by a desire for specialized care, advanced treatments, and access to world-class healthcare services. Recognizing these distinctive aspects is crucial for healthcare providers aiming to attract Ethiopian medical tourists.

Market Opportunity

Ethiopia's large population of over 110 million people presents a substantial market opportunity for healthcare providers. The demand for high-quality healthcare services in Ethiopia continues to rise, driven by an expanding middle class and increasing awareness of advanced medical treatments. Many Ethiopian patients currently travel abroad for specialized procedures, seeking better healthcare options and timely access to medical services. This creates a favorable environment for healthcare providers in other countries to offer comprehensive and advanced treatments to Ethiopian medical tourists.

Expectations of Ethiopian Patients

Ethiopian medical tourists have specific expectations when it comes to healthcare services. They value access to internationally recognized medical expertise, state-of-the-art facilities, and advanced technologies. Ethiopian patients expect personalized care, clear communication, and empathy from healthcare providers. They appreciate culturally sensitive approaches that respect their traditions, beliefs, and language. Meeting these expectations is essential for attracting and retaining Ethiopian medical tourists.

Accommodating Culture and Enhancing Patient Experience

Accommodating the Ethiopian culture and ensuring an exceptional patient experience are critical components of a successful medical tourism strategy.

Cultural Accommodation

Ethiopian culture is rich and diverse, with various ethnic groups and traditions. Healthcare providers should invest in cultural competency training for their staff to understand Ethiopian customs, traditions, and communication styles. Showing respect for cultural norms and values builds trust and strengthens the patient-provider relationship. Healthcare providers can also consider employing Ethiopian staff members who can serve as cultural liaisons, providing personalized assistance and bridging any cultural gaps.

Enhancing the Patient Experience

Creating a positive and memorable patient experience is vital for attracting Ethiopian medical tourists. This involves streamlining administrative processes, offering efficient appointment scheduling, and providing comprehensive information about treatments and procedures in a clear and culturally sensitive manner. Ensuring effective communication channels, including interpretation services if necessary, facilitates smooth interactions and helps Ethiopian patients feel comfortable and valued throughout their healthcare journey.

Strategies to Tap into the Ethiopian Market

To effectively tap into the Ethiopian medical tourism market, healthcare providers should consider implementing the following strategies:

• Establish Partnerships : Collaborate with Ethiopian healthcare institutions, medical associations, and local partners to enhance your visibility and credibility within the Ethiopian market. Establishing strong relationships can help facilitate patient referrals and build trust among Ethiopian patients.
• Targeted Marketing Campaigns : Develop targeted marketing campaigns tailored specifically to Ethiopian patients. Use localized content, translated materials in local languages, and culturally relevant visuals to resonate with the Ethiopian audience. Leverage social media platforms and online channels that are popular among Ethiopian users.
• Medical Conferences and Events : Participate in medical conferences and events held in Ethiopia to showcase your expertise and services. Engage with key stakeholders, healthcare professionals, and potential patients to establish valuable connections and create awareness about your offerings.
• Quality Assurance and Accreditation : Seek accreditation from internationally recognized organizations such as Global Healthcare Accreditation . Accreditation demonstrates your commitment to quality and patient safety, providing reassurance to Ethiopian medical tourists. Accreditation can also help build trust and differentiate your services in the market.

Global Healthcare Accreditation (GHA)

Healthcare providers aiming to enter the Ethiopian medical tourism market should strongly consider working with Global Healthcare Accreditation (GHA). GHA specializes in providing accreditation, training, and gap analysis services to hospitals and healthcare organizations worldwide.

By collaborating with GHA, healthcare providers can undergo a Gap Analysis to identify areas that require improvement to cater to the specific needs and expectations of Ethiopian patients. GHA accreditation ensures that healthcare providers have met international standards for patient care and services. Ethiopian medical tourists are recommended to choose GHA-accredited healthcare providers due to their cultural training and competency in delivering exceptional patient experiences. GHA-accredited facilities are well-prepared to manage Ethiopian patients, providing a great patient experience that may lead to positive testimonials shared with friends and family.

Having an accreditation like Global Healthcare Accreditation can also help build trust with healthcare consumers. Trust is a critical factor in patients determining which hospital and country they will travel to for medical care.

Medical Tourism Association and Global Healthcare Resources

To further optimize efforts in penetrating the Ethiopian medical tourism market, healthcare providers should consider collaborating with the Medical Tourism Association (MTA). The MTA is a leading organization in the medical tourism industry, providing valuable insights and resources to support medical tourism initiatives.

For expert guidance and support in market penetration, healthcare providers should contact Global Healthcare Resources . With the largest network and audience of consumers and buyers globally, Global Healthcare Resources is well-equipped to facilitate both B2C medical tourist referrals and B2B referrals, including facilitators, insurance companies, and government agencies. Their extensive expertise and experience in market penetration can greatly enhance your efforts to attract Ethiopian patients.

In conclusion, the Ethiopian medical tourism market holds immense potential for healthcare providers. By understanding the unique aspects of the market, accommodating Ethiopian culture, and delivering exceptional patient experiences, healthcare providers can successfully tap into this market. Collaboration with organizations like Global Healthcare Accreditation and the Medical Tourism Association can further optimize efforts, ensuring success in attracting Ethiopian medical tourists and providing them with outstanding care and experiences.

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Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology

Mekonnen sisay.

1 Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia

Firehiwot Amare

2 Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia

Bisrat Hagos

3 Department of Social Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia

Dumessa Edessa

Associated data.

All the data used for the study are contained within the manuscript.

Access to essential medicines is a universal human right and availability and affordability are the preconditions for it. In line with the sustainable development goals, World Health Organization (WHO) has outlined a framework that assists the policy makers to improve access to essential medicines for universal health coverage by 2030. However, the availability and affordability of essential medicines remains suboptimal in several low-income countries. Therefore, this study was designed to investigate the availability, pricing and affordability of essential medicines in eastern Ethiopia.

A cross-sectional study design was employed to conduct this study. Public and private health facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/Health Action International (HAI) guideline and essential medicines listed on WHO/HAI guideline and essential medicine list of Ethiopia were included. Accordingly, 60 medicine outlets were selected based on the WHO/HAI standardized sampling methodology. A standardized data collection tools developed by WHO/HAI, with necessary modifications, was employed to collect the data. Median Price Ratio (MPR) was computed as a ratio of median local buyers’ price to international buyers’ reference price. The Mann–Whitney U test was employed to compare the median buyers’ price between public and private health facilities. Kruskal–Wallis test was also run to explore the median price difference among all facilities. Treatment affordability was calculated based on the number of days of wage of the lowest-paid government employee of Ethiopia required to purchase the prescribed regimen.

The overall percent availability of originator brand (OB) versions of essential medicines was found to be 3.6% (range: 0.0–31.7%), with the public and private sectors contributing 1.43% and 5.50%, respectively. The overall percent availability of lowest price generics (LPGs) was 46.97% (range: 1.7–93.3%) (Public: 42.5%; private: 50.8%). Only eight LPGs (16.0%) met the WHO target of 80%. The Mann–Whitney U test indicated that 64% drugs showed statistically significant median price difference between public and private settings ( p  < 0.05). The MPR value indicated that the median buyers’ price of drugs in private sector were more than four times the international reference price in 30% of drugs. The percentage of unaffordable medicine were 72.09 and 91.84% for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings were combined.

Only 16% of the surveyed medicines surpassed the WHO cut-off point of 80%. Nearly one-third of drugs in the private sector had a price of more than four times compared to the international reference prices. Moreover, four out of five drugs were found unaffordable when both settings were combined, demanded several days of wage of lowest paid government employee. This finding calls a prompt action from stakeholders to devise a strategy that help promote the access of essential medicines and rescue the struggling healthcare system of Ethiopia.

Health is a fundamental human right while access to health care is a way of ensuring the fulfillment of this right [ 1 ]. Universal health coverage (UHC) as the main target of sustainable development goal strives to achieve access to quality health services according to the need, while ensuring imposition of less financial hardship on the users of the services [ 2 ]. The realization of UHC have the access of essential medicines (EMs) at its core as they are an indispensable element for delivery of services and a requirement for high-quality care [ 3 ].

Availability and affordability are dimensions of measures of access to medicines in health systems [ 4 ]. Access to affordable, quality-assured EMs is crucial to reducing the financial burden of care, preventing greater pain and suffering, shortening the duration of illness, and averting needless disabilities and deaths worldwide [ 5 ]. However, one third of the world’s population lacks regular access to EMs, resulting a cascade of preventable misery and suffering [ 6 , 7 ]. This estimate rises to over 40% in low-income countries and over 50% in poorest countries of Asia and Africa despite the issuance of legislations supporting the implementation of UHC by the countries [ 8 ].

EMs satisfy the priority health care needs of the population. They are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price, the individual and the community can afford [ 9 , 10 ]. In many developing countries, lack of financial resources or information can create barriers to accessing essential medicines and contributing for the increased rate of morbidity and mortality [ 11 , 12 ]. On top of unavailability of EMs, high price of medicines is posing a problem in the provision of health services [ 13 ]. Price of medicines is a concern in low- and middle-income countries where up to 90% of the population purchases medicines through out-of-pocket payments [ 14 ]. This has a huge impact on the affordability of medicines and treatment outcome of diseases [ 15 ].

In the mid-1990s, civil society organizations in developed and developing countries started drawing attention to the need for increased access to essential medicines as part of the fight against poverty. Later, the World Health Organization/Health Action International (WHO/HAI) project was established in 2001 to deal with medicine prices and availability. The main focus of this project was to develop a reliable methodology for collecting and analyzing availability, affordability and medicine price component data across healthcare sectors and regions; to publish survey data to improve price transparency; and to advocate for appropriate national policies and strategies. Through series of improvements, this guideline has been used to measure medicine prices, availability, and affordability throughout the globe [ 16 – 18 ].

Ethiopia is one of the developing nations facing the dire consequences of unavailability and unaffordability of medicines [ 19 ]. To this end, studies conducted in the country are limited in the provision of region-specific price, availability and affordability data on EMs. Therefore, this study was designed to assess the price, availability and affordability of EMs in Eastern Ethiopia by using WHO/HAI survey methodology.

Study area, design and period

The study was conducted at public and private healthcare facilities in the major cities of Eastern Ethiopia including Dire Dawa, Harar, Haramaya, Chiro, Degahabour and Jigjiga. Dire Dawa is located 515 km east of Addis Ababa with a total area of 1288.02 km 2 . The area is dominated by dry, windy and hot climatic condition. According to the projections made based on the 2015 census, the total population of the administration is 383,529 of whom 283,773 (74%) live in urban part of the city. Harar is located 526 km away from Addis Ababa to the East. Harari Region is one of the nine National Regional States of Ethiopia, with the town of Harar as its capital. Based on the 2015 census, Harari had a total population of 183,344, of whom 92,258 were males and 99,321 or 54.17% of the population were urban inhabitants. Jigjiga is another major city in eastern Ethiopia, mainly inhabited by different Somali clans. Based on figures from the central statistics agency (CSA) in 2015, Jigjiga has an estimated total population of 250,000 of whom 126,578 were females. Haramaya is also one of the administrative centers in eastern Ethiopia located at a distance of 508 km from the capital, Addis Ababa. The 2015 national census reported a total population of 271,018, of whom 138,282 were males and 18.46% of its population were urban dwellers. Chiro, the capital of West Hararghe zone, is another major city in the eastern part of Ethiopia located at 373 km from Addis Ababa. The 2015 national census reported a total population for this town of 33,670, of whom 18,118 were males. Another city included in the study is Degehabur which is located in the Somali region of Ethiopia. Based on figures from the CSA in 2007, it had an estimated total population of 30,027 of whom 16,474 were males. A cross-sectional study was conducted from March 01- March 31, 2020.

All public and private healthcare facilities of Eastern Ethiopia were considered as a source population. Public and private healthcare facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/HAI guideline as well as essential medicines listed on WHO/HAI guideline and essential medicine list (EML) of Ethiopia were included for the study. Non-governmental health facilities, health facilities that provide medications free of cost and programmed essential medicines were excluded from this study.

Sample size determination

Sixty medicine outlets were selected based on the WHO/HAI standardized sampling methodology [ 16 ]. Besides, WHO/HAI recommended that such price-based studies should include at least 14 global core medicines, and where possible 16 regional core medicines. Based on this, 30 drugs from global/regional core lists [ 16 , 17 ] plus 20 other essential medicines from EML of Ethiopia [ 20 ] were included, making a total of 50 essential medicines per site, from different therapeutic classes for this study. This will enable the price and availability dynamics of the therapeutic group of medicines to be compared to those of other essential medicines which may be very meaningful in the interpretation of the findings and development of recommendation and strategies. It will also enable the publicly accessible global database of prices and availability to expand.

Sampling procedure and technique

Based on the WHO/HAI standard sampling technique, six survey areas which cover a population of about 100,000 to 250,000, reachable within one day’s travel from the main urban center, large enough to represent the survey region and containing the requisite number of health facilities were selected [ 16 , 17 ]. Based on this: Dire Dawa, Harar, Haramaya, Chiro, Degahabour and Jigjiga were selected as a survey area. In order to select the medicine outlets for the study based on WHO/HAI standard sampling technique, one main public hospital (referral, district or regional hospital) was selected from each survey area. Then, other four public health facilities, and five private medicine outlets, which are within 3-h travel from the main public hospital, were selected by using simple random sampling. In addition to the global and regional core list of essential medicines, 20 more essential medicines were randomly selected from EML of Ethiopia. The summary of generic name of essential medicines, strengths and unit of measurements, originator brands (OBs) and their respective manufacturers was presented in Table ​ Table1 1 .

List of essential medicines included in the analysis

Data collection methods

A standardized data collection tool developed by WHO/HAI, with necessary modifications was employed to collect the data from both public and private facilities. The data were collected by twelve pharmacists who were recruited as data collectors. The data regarding price and availability of essential medicines were collected from each selected drug retail outlet.

Study variables

The availability, price and affordability of essential medicines were considered as the outcome variables. Type of sector, source of drugs (local or imported), the nature of facilities, duration of therapy, monthly income of lowest paid government worker (to be converted to daily wage), the type of medicines (OBs and LPGs) were treated as independent variables.

Data processing and analysis

After data collection, data were entered and analyzed using Excel® WHO/HAI Medicine Pricing Workbook and the results were summarized and presented in tables and graphs. Medicine availability was calculated as percent availability of individual medicines; mean (average) percent (%) availability across a group of medicines; and variations between product types (OBs vs LPGs) and sectors. For further statistical analysis, the data were transferred to SPSS version 20. Normality distribution of the price data was checked using Kolmogorov–Smirnov and Shapiro–Wilk tests. Accordingly, the Wilcoxon–Mann–Whitney U test was employed to compare the median buyers’ price (customers’ out-of-pocket expenditure for drugs) between public and private health facilities. Kruskal–Wallis test was also run to explore the median price difference among four facilities (hospital, health center, pharmacy and drug store). Medicine prices were calculated as median prices of individual medicines in United States Dollar (USD). The exchange rate of Ethiopian birr to USD equivalent was considered by taking the monthly average of March, 2020 (1 USD = 35.70 Ethiopian birr).; median price ratio (MPR) was computed as ratios of median local price to international (WHO/HAI) buyers’ reference price for public, private and overall facilities as follows.

Treatment affordability was calculated based on the daily wage of the lowest-paid government employee; and components of the prices of medicines paid by consumers. Daily wage of the lowest paid government worker of Ethiopia was about 0.44 USD ( https://mywage.org/ethiopia/labour-law/wages ). Accordingly, the affordability was also computed for public and private sectors for ease of comparison. Affordability (in terms of the number of daily wages) was computed as follows:

Availability of essential medicines

In 60 health facilities surveyed, nearly half ( n  = 26) of the OB versions of essential medicines were not available at all during the study. From which, 6 OB medicines out of 14 WHO/HAI core drugs were not available at all. Besides, only four OB essential medicines (glibenclamide 5 mg, paracetamol 500 mg, carbamazepine 200 mg and acetyl salicylic acid (ASA) 100 mg tablets) were available in more than 10% of the settings surveyed. The overall (pooled) percent availability of OB versions of these essential medicines in all facilities (both public and private) was about 3.6% (range: 0–31.7%). Observing the public medicine outlets alone, 39 OB medicines (78%) were not available in all facilities during the study period. Moreover, except carbamazepine/Tegretol ( n  = 7) and azithromycin/Zithromax ( n  = 4), the rest drugs were available in only one of the 28 public medicine outlets surveyed. The overall percent availability of OB medicines in surveyed public sectors was 1.43%. Regarding the private sector, 30 OB medicines (60%) were not available at all. Only 6 OB versions of drugs (metformin 500 mg, diclofenac 50 mg, glibenclamide 5 mg, paracetamol 500 mg, ASA 100, and carbamazepine 200 mg tabs) were available in more than 10% of the private facilities surveyed. What is more, the OB versions of drugs like paracetamol suspension, diclofenac 50 tab, glibenclamide 5 mg tab, salbutamol inhaler, ibuprofen 400 tab and ASA 100 tab were available in private sectors only. The overall availability of OB versions of 50 essential medicines in private sector was about 5.50% with pharmacy and drug store contributing 6.1% and 4.5%, respectively (Table ​ (Table2 2 ).

Availability of essential medicine (OB and LPGs) based on WHO/HAI methodology

Regarding the LPG versions of these essential medicines, all the LPG versions of selected essential medicines were available at least in one of the surveyed health facilities. The overall percent availability of LPGs in all settings was 46.97%, ranging from 1.7% (bisoprolol 5 mg and amiodarone 200 mg tabs) to 93.3% (amoxicillin 500 mg cap). The LPG versions of six drugs (bisoprolol, simvastatin, loperamide, amiodarone, ASA 100 mg, and carbamazepine) were not available at all in public facilities and one of which was from the WHO/HAI core drug category. In general, 26 LPG versions (52%) of the surveyed medicines were available in 50% or more of the facilities included in the study. Only eight LPG versions were available in 80% or more of the facilities surveyed. In descending order, amoxicillin 500 mg caps (93.3%), omeprazole 20 mg cap (90%), ceftriaxone 1 g inj. vial (88.3%), doxycycline 100 mg cap (88.3%), metformin 500 mg tab (83.3%), ciprofloxacin 500 mg tab (83.3%), metronidazole 250 mg cap (83.3%), and diclofenac 50 mg tab (80.0%) were the top eight drugs available during the study. The overall percent availability of LPGs in surveyed public sectors was 42.5% (hospital = 53.11% and health center = 37.47%) whereas that of the private counterparts were 50.8% (pharmacy = 55.7% and drug store = 42.83%) (Table ​ (Table2 2 ).

Regarding the source of available drugs, 17 LPGs (34%) were totally imported. From which, four drugs (diazepam, ceftriaxone, simvastatin and captopril) were among the WHO/HAI core list. Except ceftriaxone ( n  = 53), TTC ( n  = 34) and hydrocortisone ( n  = 31), all other imported drugs (LPG versions) were available in less than 50% of the surveyed facilities. Two drugs (metronidazole and fluoxetine) were from local source only. The rest 31 drugs were from both sources with certain domination from imported ones (Fig.  1 ).

Availability based on the source of drugs

Regarding the therapeutic classes, the study included chemotherapeutic agents ( n  = 17), cardiovascular drugs (CVS) ( n  = 8), central nervous system (CNS) drugs ( n  = 7), gastrointestinal drugs ( n  = 6), non-steroidal anti-inflammatory drugs (NSAIDs) ( n  = 5), respiratory agents ( n  = 2) and two more from miscellaneous agents. Comparing the overall availability, the LPG versions of these drugs were obtained from private settings in almost all therapeutic classes. OB medicines obtained from public facilities were primarily from CNS (40%) and chemotherapeutic drugs (35%) whereas those obtained from private counterparts were from NSAIDs (29.5%) and endocrine agents (26.1%). Generally, the average percent availability per class indicated that the top three available (for any LPG versions) were chemotherapeutic drugs (public: 53.78%; private: 68.93%), CNS drugs (public: 48.47%; private: 49.11%) and GI agents (public: 48.21%; private: 58.33%) (Fig.  2 ).

Availability by therapeutic class of LPG versions of essential medicines

Based on the duration of therapeutic regimen, majority of the drugs available in both public and private settings were those agents being used for acute conditions (for less than 2 weeks). The average percent availability of drugs used for acute and chronic conditions was 51.26% (public: 46.77%; private: 55.75%) and 39.23% (public: 35.53%; private: 42.93%), respectively (Fig.  3 ).

Availability based on the duration of therapy of LPG versions of essential medicines

Cost analysis of essential medicines

Drugs like adrenaline, ASA 300, and ibuprofen had comparable median buyers’ price between public and private medicine outlets. On the other hand, the median buyers’ price of drugs in private settings were higher than the public counterparts for 94% ( n  = 47) of LPGs analyzed. From these, the Mann–Whitney U test indicated that 64% ( n  = 32) drugs showed statistically significant median price difference between public and private settings ( p  < 0.05) (Table ​ (Table3). 3 ). Specifically, the private median prices of LPG versions were more than three times that of the public sector for drugs such as ampicillin, azithromycin, ceftazidime, diazepam, fluconazole, hydrocortisone, metoclopramide and ORS. Likewise, Kruskal–Wallis test indicated that 50% of drugs showed statistically significant median price difference across facilities (Table ​ (Table4 4 ).

Median price of LPG versions of essential medicines (USD) by ownership

Wilcoxon–Mann–Whitney U test for two independent groups (public and private settings) with skewed price distribution

Median price of LPGs (USD) by facilities (Kruskal–Wallis Test)

Regarding the WHO/MSH median buyers’ price, the MPR indicated that the median prices of drugs in public facilities were more than three times the reference price in 8 LPG versions of essential medicines including atenolol, captopril, fluoxetine, furosemide, cotrimoxazole suspension, paracetamol suspension, salbutamol inhaler, and risperidone tablets. Drugs like metronidazole, propylthiouracil, ibuprofen, and hyoscine had local buyers’ price of more than two times the international median price. Looking at the private sectors, the MPR value indicated that the median buyers’ price of drugs were more than four times the international reference price in 30% of drugs. Overall, drugs with top ten MPR were salbutamol inhaler, cotrimoxazole suspension, paracetamol suspension, loperamide tab, ASA 100, simvastatin, fluoxetine, risperidone, atenolol and furosemide (Table ​ (Table5 5 ).

Overall median price, median price ratios (MPR) and affordability of LPGs based on WHO/MSH reference guide (buyers’ price)

Affordability of essential medicines

Majority of the medicines were found to be unaffordable, costing more than one day wage in both private and public facilities. The percentage of unaffordable medicine were 72.09 and 91.84 for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings are combined. The result of the overall affordability calculation revealed that ceftazidime, risperidone, and ampicillin injection were the top three unaffordable medications requiring 171.33, 73.43 and 58.74 days wage of the lowest paid government employee, respectively. The top three unaffordable medications in the private facilities were ceftazidime, risperidone and valproate requiring 186.01, 95.45 and 62.89 days wage of the lowest paid government employee, respectively. While in the public facilities risperidone takes the lead with 70.91 days wage followed by ceftazidime and valproate with 53.84- and 39.88-days wage, respectively (Table ​ (Table6 6 ).

Affordability of essential medicines in eastern Ethiopia

DDD defined daily dose, MP median price, afford affordability

Access to essential medicines is a universal human right and availability and affordability are the preconditions for it [ 21 , 22 ]. In line with the sustainable development goals, WHO has outlined a framework that assists the policy makers to improve access to essential medicine for universal health coverage by 2030. The four major components of access are rational selection and use of medicines, availability and affordability, sustainable healthcare financing, and reliable supply system of quality products [ 22 – 24 ]. In this regard, essential medicines should be systematically selected using evidence-based approach with due consideration on public health priority, comparative cost-effectiveness, efficacy, safety, and generic versions, among others. The provision of complete healthcare is realized when essential medicines are available in the required quality, quantity, and at all times and in a way that patients can easily afford [ 22 , 23 , 25 ].

However, the availability of essential medicines is still suboptimal in several low-income countries. In particular, the availability of pediatric formulations and key medicines for chronic diseases is still suboptimal even in middle-income countries [ 26 ]. As per the global action plan of WHO, the proposed 80% target for access to essential medicines is the key to attain the overall target of 25% relative reduction in premature mortality from chronic non-communicable diseases (NCDs) by 2025 [ 27 ]. Besides, improving the availability and affordability of essential medicines is likely to enhance their use and help towards in achieving WHO targets of 50% use of key medicines by 2025 [ 28 ].

In this regard, this study has addressed the availability, price and affordability of 50 essential medicines in public and private health facilities of eastern Ethiopia. Generally, nearly half of OB medicines, 42.85% OBs from WHO/HAI core drugs, were totally absent in all health facilities included in the survey. The overall availability of OB medicines was lower in public facilities. Besides, nearly half (52%) of surveyed essential medicines were available in only 50% or more of the facilities studied. Only eight LPG versions (16.0%) were available in 80% or so of the facilities surveyed. The overall availability of LPG versions was higher in private drug retail outlets. Except ceftriaxone and hydrocortisone, all imported LPG versions were available in less than 50% of the facilities included. Chemotherapeutic agents were the most commonly available class in both public and private settings. The availability index for drugs for chronic diseases was lower than that used for acute conditions.

The median buyers’ prices for 94% LPG versions were significantly higher in private drug retail outlets. Moreover, the private median price of LPGs were more than three times that of the public sector for 16% of drugs. The MPR value indicated that median price of LPGs in the private sector was more than four times the IRP in 30% of drugs. In public sector, about 16% of LPGs had a median price of more than three times than that of IRP. With reference to the lowest paid government employee, majority of LPG medicines were found unaffordable, costing more than one day wage in both public and private facilities. Generally, four out of five essential medicines were found unaffordable in Ethiopian healthcare settings with the worst price escalation being observed in private settings (nine drugs out of ten essential medicines). In low-income countries like Ethiopia, low availability with high buyers’ price and low affordability vividly reflects a failure of implementing national drug policy on essential medicines.

Unlike this study, the availability of OBs exceeded the WHO target of 80% and found affordable in Qatar public health facilities, although 30% of surveyed medicines were beyond the acceptable threshold of 4.0 in private sector [ 29 ]. Compared with this study, study conducted in the northern Ethiopia indicated that there was lower overall availability (34.1%) but better affordability of LPGs 30% and 50% of LPGs demanded more than a single daily wages to purchase these drugs in public and private sectors, respectively [ 30 ]. In Jordan, much better availability of LPGs was observed in both public (72%) and private (76%) sectors for chronic diseases and the prices of medicines in public sectors were generally affordable but not in private settings [ 31 ]. Likewise, in upper-middle income countries like Malaysia, the affordability of all generic versions of essential medicines was below 2-day wages of the lowest paid government employees in the public sector [ 32 ].

In our study, eight drugs (16.0%) met the WHO target of 80%. It was in trajectory with the study in which 15.2% and 18.9% of LPGs met WHO target in the public and private sectors of low-income countries, respectively. This value was 7 to 8% higher in lower-middle income countries [ 33 ]. Besides, a study conducted in Tanzania and central Ethiopia indicated that locally produced products had greater mean availability (48%) than that of imported ones (19%) [ 34 ] indicating the need of more local manufacturing plants for better access of essential medicines.

In a study conducted on six low-and middle-income countries, less than 10% surveyed medicines were available in public sector in four of the countries surveyed [ 35 ]. Unlike high-income countries, low- and middle-income countries usually have poor regulation of pharmaceutical markets and often lack feasible purchasing and pricing strategies [ 36 ]. Country specific studies indicated that better availability and more affordable generic versions were reported from Rwanda [ 37 ] and Nepal [ 38 ]. Relatively higher availability of OBs in both public (6.8%) and private (55.0%) facilities were also observed in Pakistan whereas the availability of generic versions was lower in public (35.3%) and private (20.3%) facilities [ 39 ]. In a study conducted in China, higher availability of pediatric OBs were observed in public (7.5%) and private (8.9%) sectors although the overall availability of generic versions in both public (34.2%) and private (29.4%) sectors were by far lower but more affordable compared to our study [ 40 ]. What is more, in the primary care settings of Vietnam, the availability of essential medicines was higher (56.4%) than our study. Likewise, the study conducted in eleven countries of the Asian Pacific region demonstrated that there was slightly higher availability (56.7%) of generic versions of essential medicine in the private sector though it was found lower (35.5%) in the public sector [ 41 ]. In the upper middle-income and high income-countries, the availability of OBs and LPGs was by far higher in both public and private sectors with less price variation and more affordability compared to our study [ 42 – 45 ]

Regarding chronic diseases in particular, a significant proportion of patients in low- and middle-income countries do not have access (low availability and/or low affordability) to generic versions of essential medicines for the treatment of hypertension [ 46 ], diabetes [ 47 – 49 ], chronic respiratory diseases including bronchial asthma [ 27 ], diabetes and hypertension combined [ 50 ], several non-specific NCDs [ 51 – 53 ]. Multilevel analysis also indicated that the availability and affordability of essential diabetes medicines were significantly associated with their use [ 47 ]. Likewise, a study conducted in China indicated that high cost medications were more likely to be prescribed than lower cost alternatives and only one-third of facilities stocked high value (essential) medicines [ 54 ]. To this end, medicines take a large proportion of household expenditure on health in low-and middle-income countries. According to WHO survey, up to 9.5% of the total expenditure was spent on medicines and is almost three times higher than the one spent in high-income countries [ 21 , 22 , 55 ]. Inadequate healthcare financing and inefficient and unreliable supply system is attributable to high out-of-pocket expenditure in such resource poor settings. The PURE study also indicated that secondary prevention medicines for cardiovascular diseases were found unavailable and unaffordable in large proportion of customers in low- and middle-income countries [ 28 ].

With regard to AWaRe (Access, Watch and Reserve) classification of antibiotics, there has been a declining trend of at least 60% total consumption of antibiotics (WHO-national level target) in the access category from 76% in 2000 to 55% in 2015. Without policy intervention affecting the availability of such essential antibiotics, it is difficult to attain at least 60% consumption of antibiotics from ‘Access’ category by 2023 [ 56 ]. In our study, all the included essential antibiotics were from both Access and Watch categories with the former accounting nearly two-thirds of the total agents.

Even in countries where there is drug pricing information, the availability of medicines in public sectors is about one-third while that of the private sector is about two-thirds, and the buyers’ prices for LPGs vary from 2.5 to 6.5 MPRs in these two sectors [ 21 ]. In this regard, a multitude of strategies including managerial, regulatory, economic, and educational approaches shall be devised to increase the access of essential medicines in the public sector [ 21 , 35 , 41 , 57 ]. Economic strategies including competitive or pooled procurement policies for multisource products, price negotiation for sole source products, reducing taxes and tariffs and regulating mark-ups, provision of community-based health insurance, and sustainable health care financing shall be taken as the prior agenda for Ethiopia to address all segments of the population. In addition, regulation of the pharmaceutical market, strict implementation of generic procurement policies, efficient and evidence-based procurement, provision of vivid pricing and procurement information, as well as installation of local manufacturing plants shall also be considered to increase the access of essential medicines.

Strength and limitations

Using validated WHO/HAI methodology allows for the measurement of medicine availability and prices in a reliable and standardized way. Utilization of international reference prices can also allow for valid international comparisons between Ethiopia and other countries. Besides, we considered global core, regional and national essential medicines for international comparison. However, being a single point cross-sectional study, it is unable to reflect the average monthly or annually availability of medicines at individual outlets. The affordability section is also heavily dependent on the economic status, public salary scale, and exchange power of Ethiopian birr and subject to change over time.

The overall availability of generic versions of essential medicines was by far lower than the WHO target of 80% with 16% of the surveyed medicines surpassing the cut-off point. The overall availability of OBs was also less than 5%. About 30% of drugs in the private sector had a price of more than four times (MPR threshold) than that of the international references. Moreover, four out of five drugs were found unaffordable when both settings were combined. Looking at the private sector, about nine from ten drugs demanded several days of wages of lowest paid government employees. There is a higher tendency of prescribing generics than the OB versions of essential medicines as the OB versions are much more expensive in such resource limited settings. However, much is yet to be invested in controlling the price of drugs. Ensuring access of essential medicines is one of the general objectives of Ethiopian National Drug Policy. In this regard, the current regional study indicates the availability and affordability is suboptimal which calls the responsible stakeholders to devise a strategy that help increase the access of essential medicines and rescue the struggling healthcare system.

Acknowledgements

The authors thank data collectors and staff of all healthcare settings for their substantial help to realize this research work. The authors also extend their thank to Haramaya University for granting this research work.

Authors' contributions

All authors have contributed to the conception of the original idea, study design and data collection. MS analyzed the data; MS and FA drafted the manuscript. BH and DE critically revised it. All authors have read and approved the final manuscript.

The authors disclosed reception of financial support from Haramaya University for conducting this research work.

Availability of data and materials

Declarations.

The authors have declared that there is no competing interests exist.

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CBP Announces Next Phase in Fight Targeting Criminals Funneling Fentanyl into American Communities

NOGALES , AZ – U.S. Customs and Border Protection (CBP) today announced that it will lead an expanded, multi-agency effort to target the transnational criminals funneling fentanyl from Mexico into American communities. Operation Plaza Spike targets the cartels that facilitate the flow of deadly fentanyl, as well as its analogs and precursors and tools to make the drugs. It is designed to disrupt operations in the “plazas,” cartel territories located directly south of the United States that are natural logistical chokepoints within the cartels’ operations. This is the next phase in CBP’s Strategy to Combat Fentanyl and Other Synthetic Drugs , a whole-of-government and international effort to anticipate, identify, mitigate, and disrupt illicit synthetic drug producers, suppliers, and traffickers.

Operation Plaza Spike will employ multiple tactics, including seizing illicit proceeds and scrutinizing related cross-border business entities and cross-border trade. Operation Plaza Spike includes releasing the name of the plazas’ senior ranking cartel officials, the “plaza bosses,” to increase public and law enforcement pressure on them. Plaza bosses control and profit from all illicit activity through the plaza – extortion, kidnapping, as well as the smuggling of humans, dangerous drugs, and firearms. CBP will leverage partnerships, authorities, and resources of other government agencies in our efforts to gather intelligence, disrupt and degrade illicit operations, and deliver legal consequences.

“So long as fentanyl and other illicit opioids wreak tragedy across American communities, the men and women of the Department of Homeland Security will remain unrelenting in their work stopping these deadly drugs from hitting our streets and taking lives,” said Secretary of Homeland Security Alejandro N. Mayorkas. “Operation Plaza Spike is a critical step in our ongoing whole-of-Department campaign to directly attack the transnational criminal organizations that peddle narcotics, death, and destruction for profit. We are sparing no effort to dismantle cartels and ensure everyone from kingpins to plaza bosses are brought to justice.”

CBP’s first target is the Nogales Plaza, located directly south of the border crossing at Nogales, Arizona. Sergio Valenzuela Valenzuela, aka Gio, the Nogales Plaza boss, was indicted by a federal grand jury in 2018 for his role as a Sinaloa Cartel Plaza Boss .

“We are entering the next phase in our fight against fentanyl: one where we are going after the plaza bosses, whose organizations are responsible for virtually everything that is smuggled into the United States. By targeting them for enforcement action, we can directly impact their operations and ability to traffic fentanyl into the United States, which makes its way into communities all across the country,” said Troy A. Miller, CBP Senior Official Performing the Duties of the Commissioner. “Sergio Valenzuela Valenzuela is the first plaza boss that we target, but he won’t be the last. Just as the men and women of CBP are steadfast in the fight against fentanyl - will be unrelenting in our pursuit of those people and organizations that threaten the safety and security of our people and our country.”

Valenzuela Valenzuela and his organization allegedly are responsible for moving thousands of pounds of fentanyl to the U.S. border. Nearly every day, CBP officers intercept fentanyl headed from Valenzuela Valenzuela’s plaza northbound through CBP ports of entry onward to cities across the United States.

Operation Plaza Spike is just the latest effort by CBP, an agency of the Department of Homeland Security (DHS), as part of this Administration’s efforts to stem the flow illicit opioids, including fentanyl, and cracking down on the Transnational Criminal Organizations (TCOs) that traffic them. Through a whole-of-government effort, the Department has stopped more illicit fentanyl and arrested more individuals for fentanyl-related crimes in the last two fiscal years than in the previous five years combined.

CBP is also in the midst of Operation Apollo, and announced today that it will expand into Arizona to continue gathering and utilizing intelligence, and focusing on state and local partnerships to interdict fentanyl. Operation Apollo was launched by CBP in Southern California in October 2023 as a counter-fentanyl joint operation. CBP has evaluated the successes and lessons learned from Operation Apollo, and Operation Apollo – Arizona is now replicating it within the Arizona corridor, integrating all local law enforcement resources in Arizona to interdict finished fentanyl products, illicit precursor chemicals, adulterants, pill press equipment, illicit proceeds, and weapons.

In addition to CBP’s efforts to target operations that move fentanyl north, as well as guns south, CBP will be leveraging partnerships, authorities, and resources of other government agencies.

In 2023, DEA seized a record 79.5 million fentanyl pills and nearly 12,000 pounds of fentanyl powder. Throughout Arizona the DEA Phoenix Field Division seized more than 42 million fentanyl pills last year.

“Fentanyl is the deadliest drug threat our nation has ever faced. The men and women of DEA are relentlessly focused on saving lives by defeating the two cartels responsible for the majority of fentanyl and methamphetamine poisoning our communities – the Sinaloa and Jalisco cartels.” said DEA Administrator Anne Milgram . “DEA proactively investigates cartel members and associates, like Sergio Valenzuela Valenzuela, who allegedly oversee the transportation and distribution of these deadly drugs while interagency partners, like U.S. Customs and Border Protection, interdict shipments at the border before they enter our country. These partnerships ensure those responsible face justice for their crimes.”

As a collaborative partner, HSI will leverage its abilities, ample customs authorities, and investigative capabilities to continue to look at the TCOs supply and distribution chains, while taking dangerous, destructive, and deadly drugs off our streets together with the violence that comes with the illicit activities of these criminal enterprises. HSI Arizona has dedicated groups of special agents assigned to combat drug and human smuggling as well as southbound weapons and bulk cash smuggling.

“HSI stands at the ready to continue dedicating our resources, unique customs authorities and investigative capabilities toward joining our federal partners in not only disrupting the trafficking of lethal drugs into our country but capturing and prosecuting the plaza bosses who profit from poisoning our communities,” said HSI Countering Transnational Organized Crime Assistant Director Ricardo Mayoral . “We will leverage the combined strength of our partnered efforts to relentlessly pursue, disrupt and dismantle one of the most prolific and violent cartels in the world.”

With the launch of its updated Fentanyl Strategy CBP Strategy to Combat Fentanyl and Other Synthetic Drugs Report in fall 2023, CBP has continued to look at innovative ways to stop fentanyl trafficking. The agency continues to utilize its unique authorities and resources as the nation’s border security agency to lead the whole-of-government approach to dismantling the means and methods of the production and distribution of fentanyl and other synthetic opioids, in addition to its historic target of interdicting narcotics at the border of the United States.

CBP officials have previously targeted fentanyl interdictions along the southwest border of the United States during Operation Blue Lotus, Four Horsemen, and Rolling Wave as well as precursors and production materials used to make fentanyl during Operation Artemis . With this latest operation, CBP is utilizing another avenue to disrupt the networks that create and distribute these drugs.

CBP and DEA are also calling on the public to provide any relevant information they may have about Sergio Valenzuela Valenzuela, his movements, his associates, and his operation. Tips can be provided anonymously by calling or texting 619-540-6912 via phone, Telegram, WhatsApp and Signal. Information can also be submitted through Snapchat at narcos_tips or by using the Threema ID: 2VBZFZTY.

For more information about CBP’s efforts to combat fentanyl and other synthetic drugs, visit CBP Strategy to Combat Fentanyl and Other Synthetic Drugs Report .

Operation Plaza Spike press conference: https://www.dvidshub.net/video/918681/operation-plaza-spike-press-conference

U.S. Customs and Border Protection is the unified border agency within the Department of Homeland Security charged with the comprehensive management, control, and protection of our nation’s borders, combining customs, immigration, border security, and agricultural protection at and between official ports of entry.

How to cope with restless legs while traveling

The twitchy, achy condition doesn’t just affect people during sleep.

Through the windows of an express train from Kyoto, Japan, to a whisky distillery on Mount Kaikoma, my colleagues admired the views and calmly discussed the agenda for the day. Distracted and annoyed, I punched my quads while counting down the minutes until we could get off the train. I envied anyone in a state of calm.

My decades-long problem with restless legs interrupted what should have been an unparalleled experience. Every time I traveled, I found myself squished into a confined space or restricted with prolonged stillness — both triggers for my twitchy limbs.

Eventually I was diagnosed with restless legs syndrome (RLS), but the treatment plan for mitigating symptoms while traveling was not clear. On trips, I implemented my own treatments to assuage the annoying twitching in my legs — meditation, marijuana , stretching and taking muscle relaxers. My remedies didn’t reliably work, and the struggle left me feeling distracted, frustrated and helpless.

I’m not alone in the journey to mitigate symptoms. According to Karla Dzienkowski, executive director of the Restless Legs Syndrome Foundation , nearly 12 million adults and children in the United States deal with the condition. And travel in particular is known to exacerbate RLS.

What causes restless legs syndrome?

“The hallmark symptom of RLS is the uncontrollable urge to move the legs. Individuals often describe the accompanying RLS sensations as throbbing, aching, twitching, bubbling in the legs, or insects crawling under the skin,” Dzienkowski explained in an email. It’s also known as Willis-Ekbom disease, and my doctor identified genetics as the leading cause.

RLS is notoriously difficult to treat. Andy Berkowski, a physician and founder of ReLACS Health , says that RLS is unfortunately marginalized in the medical community, as the condition lacks a diagnostic treatment protocol. Berkowski said that RLS is the third-most-common sleep disorder, “but it doesn’t get the attention it deserves.”

According to the Restless Legs Syndrome Foundation, a single unifying cause of RLS has not been identified. The group says RLS often runs in families, and it’s more common in people with Type 2 diabetes. Also, up to 25 percent of women develop the syndrome during pregnancy, but symptoms often disappear after giving birth. Many experts say RLS is neurological.

“RLS is not a leg condition; it’s a brain condition,” Berkowski said.

How can restless legs syndrome affect you while traveling?

Traveling creates conditions that make it more difficult to mitigate RLS symptoms — particularly, the inability to move freely. In a confined space with limited mobility, the legs can twitch with aggression. “People call the airplane a torture chamber for restless legs,” Berkowski says.

For me, RLS flares up in the evening, especially if I’m traveling. If I am sleep-deprived or otherwise anxious, the symptoms dominate with increased intensity. And, as someone who is on and off planes frequently for work, my symptoms are exacerbated by sleep deprivation, limited mobility, and increased alcohol and caffeine intake.

During an overnight flight from Chicago to Paris , my sleep was interrupted by jarring kicks seemingly from deep inside my legs. Unfortunately, moving around the cabin, massaging my legs and flexing my toes did not offer relief.

Experts say anxiety also plays a role when traveling with RLS. “There’s the psychological effect that makes things worse. As with any sensation condition, the more you draw your attention to RLS, the more you will notice it,” Berkowski said.

How to mitigate RLS when traveling

Brian Koo, associate professor of neurology at Yale and director of Yale Medicine’s Restless Legs Syndrome center, recommends avoiding evening or overnight travel altogether if possible. Koo explains that sleep and RLS are intrinsically linked. “Try to get a good night’s sleep in the days leading up to travel,” Koo said. “If you’re changing time zones, adjust your schedule several days before the trip.” Koo warns patients that if they don’t get quality sleep, they are likely to have a bad bout with RLS during the trip.

Koo also voices a strict warning for patients who plan to use over-the-counter sleep aids. “The OTC sleep aids that contain antihistamines will make RLS worse,” he says. He recommends managing your sleep schedule before a trip and has seen improvement in people who avoid alcohol and sugar while traveling.

Berkowski agrees: “You’re not on the same schedule. You’re up early, and may grab that high-sugar mocha latte at the airport before your flight.” He warns that caffeine, sugar and alcohol are culprits of RLS, especially when combined with sleep deprivation.

Berkowski tells his patients that while traveling, mobility is key. “Mild to moderate activity throughout a trip is essential,” he advises. “Simple choices will mitigate symptoms: choose an aisle seat on a flight, avoid the moving walkway at the airport and walk beside it instead, board the flight or train as late as possible, stay standing in the airport before your flight, and on road trips, get out and walk briskly as often as needed.”

An important accompaniment to movement is ensuring proper blood flow to the legs while traveling. Sarah Hans, a physician at United Vein and Vascular Centers , treats patients with RLS. She advises wearing compression socks or stockings while traveling to help with blood flow. She says that “simple exercises such as calf raises with your feet on the ground and pulling your knees toward your chest can help.” Hans also recommends staying well hydrated.

Over the last 20 years, I’ve learned that punching my quads and obsessing over the sensation are not productive coping mechanisms. For me, pre-adjusting my schedule to the destination, avoiding caffeine and wearing compression stockings have helped the most.

Andrea Javor is a Chicago-based writer. Follow her on X or Instagram: @AndreaEJavor.

More travel tips

Vacation planning: Start with a strategy to maximize days off by taking PTO around holidays. Experts recommend taking multiple short trips for peak happiness . Want to take an ambitious trip? Here are 12 destinations to try this year — without crowds.

Cheap flights: Follow our best advice for scoring low airfare , including setting flight price alerts and subscribing to deal newsletters. If you’re set on an expensive getaway, here’s a plan to save up without straining your credit limit.

Airport chaos: We’ve got advice for every scenario , from canceled flights to lost luggage . Stuck at the rental car counter? These tips can speed up the process. And following these 52 rules of flying should make the experience better for everyone.

Expert advice: Our By The Way Concierge solves readers’ dilemmas , including whether it’s okay to ditch a partner at security, or what happens if you get caught flying with weed . Submit your question here . Or you could look to the gurus: Lonely Planet and Rick Steves .

I've traveled to 9 out of 10 countries in Southeast Asia. Here are the 5 biggest mistakes I made along the way.

• I've traveled solo to nine countries in Southeast Asia.
• I've made many mistakes, from traveling during monsoon season to forgetting to bring enough cash.
• Travelers should make sure they plan ahead and research each country's culture.

Over the last two years, my journey as a travel enthusiast and Business Insider's travel reporter in Singapore has brought me to almost every country in Southeast Asia.

In total, there are 10 countries in Southeast Asia , and I've traveled to nine of them — Singapore, Philippines, Malaysia, Vietnam, Thailand, Indonesia, Cambodia, Laos, and Brunei. Myanmar remains the only country in the region I have not visited, and while I am keen to explore it, I have held off on visiting because of the country's ongoing civil war.

I've watched the sun rise in Angkor Wat in Cambodia and cared for elephants in Chiang Mai, Thailand. I've explored the Bornean jungle in Brunei and crawled the Cu Chi Tunnels in southern Vietnam.

But it hasn't always been easy. I've made several mistakes traveling across the region , especially as a solo traveler. Here are five mistakes I made and how to avoid them.

1. Going during monsoon season and not planning for the weather.

In July, I traveled to Thailand on a reporting trip to cover the budding cannabis industry . There, I was met with heavy rain nearly every day. In Bangkok, I was staying in a hostel in Chakkrawat , a district with narrow, meandering streets, which made it difficult to walk anywhere in the pouring rain.

I didn't plan for the weather, so I didn't have an umbrella or poncho with me and had to rush to get one at the last minute. I also had a packed itinerary with a lot of travel between meetings, which was a hassle in the constant downpour.

Before traveling to Southeast Asia, make sure to avoid two seasons — the monsoon season, which often comes with strong typhoons in countries like the Philippines, and the burning season, where farmers burn land for fertile soil. This is a common occurrence in countries like Laos, Thailand, and the island of Borneo, which is shared between Brunei, Indonesia, and Malaysia.

When I traveled to Laos in April last year during the burning season , most of my plans — including a hot air balloon ride — were canceled because of the thick smog. I also didn't have an N95 mask with me, and I ended up with a sore throat.

If you do plan to come during these seasons, make sure to pack accordingly and plan a flexible schedule.

2. Traveling during Ramadan and expecting the same practices everywhere.

Having grown up in Singapore, I'm familiar with the practices during Ramadan , the holy month for Muslims, where they fast for most of the day. I studied Malay for seven years, and in school, I often fasted with my Muslim classmates and ate only in private.

Still, in many cities in Singapore, Malaysia, and Indonesia , non-Muslims are free to dine in public, so long as they do so respectfully. But on my trip to Brunei in April — at the height of the burning season and in the middle of Ramadan — there were more practices I needed to observe.

Most restaurants were closed, and diners weren't allowed to eat there even if they were open — only take-out was allowed. Eating in public was a major faux pas even for non-Muslims, and if you want to drink some water, you can only do so when nobody is around.

It wasn't easy, especially as Brunei was sweltering at 100 degrees Fahrenheit on some days. I made do by returning to the hotel for lunch and grabbing a big dinner with the locals at the night market after they had broken their fast.

3. Not packing enough modest outfits when visiting temples and mosques.

Southeast Asia is pretty liberal, and you can wear whatever you want in many places. In popular destinations like Phuket, Thailand, and Bali, Indonesia, lots of tourists walk around in bikini tops and shorts, and locals mostly tolerate it.

But there are certain places you do need to cover up, like places of worship, which include temples and mosques. When I visited Angkor Wat — the famed temple complex in Cambodia — in February last year, I found some tourists being told off by the local tour guides for wearing shorts and tank tops — "Tomb Raider" style.

I've learned to err on the right side of caution and bring a sarong wherever I go. It's an easy way to cover up and make an outfit more modest when you need to.

4. Forgetting to pack medication, especially when I plan to eat street food.

Southeast Asia has some of the world's most flavorful food. In every country, you can find food that is cheap and delicious, and that includes Singapore , the world's most expensive city. In countries like Malaysia and Vietnam, street food dishes can cost as little as a dollar.

I eat mostly street food when I travel in Southeast Asia, so medicine for tummy-related illnesses is a must. I've only gotten sick twice from eating street food — and it was the same dish both times— and unfortunately, those were the few times I didn't have medicine with me.

I'm a pretty adventurous eater. I've eaten everything from pufferfish stew to frog porridge and dishes made with intestines off the street. I've learned to wash the utensils provided before digging in and make sure the food is cooked to order and heated up before being served.

5. Relying on my card and not bringing enough cash with me.

In Singapore, I don't really use cash and often use Apple Pay, mobile payments, and cards. But I've found that many stores in other countries in Southeast Asia only accept cash.

For example, on my third trip to Vietnam, I spent an hour trying to make payment via bank transfer after the staff at a luxury perfume shop — which was selling items priced upwards of $200 — informed me at the last minute that they didn't accept card or contactless payment.

I've also found the majority of street vendors in the region only accept mobile payment — which is limited to local banks — or cash. I've learned to change a considerable amount of money before leaving the airport and keep whatever I didn't use for my next trip.

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