Albania US Consular Information Sheet November 04, 2008
Albania is a parliamentary democracy that is transforming its economy into a market-oriented system. Albania's per capita income is among the lowest in Eu
A passport is required. All travelers entering or exiting Albania must have six months or more validity on their passport. Customs officers strictly enforce this law. U.S. citizens do not require a visa prior to entering Albania, but those traveling without a visa will be charged a fee for an entry stamp at the point of entry, which is valid for a stay of up to 90 days. This fee is currently 10 Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Travelers without a visa who intend to stay in Albania for more than 90 days should be aware that Albanian law allows a traveler without a visa to remain in Albania for 90 days only within a specific 180-day period. That 180-day period is defined from the first day of entry. For example, a traveler entering without a visa on January 1 may remain in Albania for 90 days total during the period of time between January 1 and June 28. Departing Albania during this time period does not "restart the clock." Travelers attempting to reenter Albania without a visa and within 180 days of a previous entry and after an aggregate stay of 90 days may be denied entry. For stays exceeding 90 days within a 180-day period, those interested must apply for a Residency Permit at the police station with jurisdiction over the city of residence. Information on how to apply for a residency permit is available on the Embassy of Albania web site at http://www.embassyofalbania.org/. There is also a departure fee of ten Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Visit the Embassy of Albania web site at http://www.embassyofalbania.org/consular.html#visa for the most current visa information. Dual Nationality: The Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. If such persons are found guilty of draft evasion in Albania, they are subject to prosecution by the Albanian court. Those who might be affected should inquire at an Albanian Embassy or Consulate outside Albania regarding their status before traveling. In some instances, dual nationality may hamper U.S. Government efforts to provide protection abroad. Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY
Although the overall security situation in Albania has improved in recent years, organized criminal activity continues to operate in all regions, and corruption is pervasive. US Government employees need permission to travel to the northern administrative districts of Shkoder, Malesi E Madhe and Tropoje (with the exception of the route along the national road to Montenegro and the city of Shkoder) and to the southern town of Lazarat, with such travel restricted to secure vehicles with escort. Travel restrictions for U.S. Government employees have been lifted for overnight stays in the city of Shkoder. In most cases, police assistance and protection is limited. A high level of security awareness should be maintained at all times. Photographing anything that authorities regard as being of military or security interest may cause travelers problems. All gatherings of large crowds should be avoided, particularly those involving political causes or striking workers. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.
In the latest State Department assessment, Albania’s crime rating is “medium.” Crime against foreigners is rare in Albania, as targeting foreigners is often viewed as too risky. Visitors should maintain the same personal security awareness that they would in any metropolitan U.S. city. Caution should be exercised in bars in Tirana where violent incidents, some involving the use of firearms, have occurred in the past, particularly in the early morning hours. Within the last years there have been fewer cases of carjacking compared with previous years. Anyone who is carjacked should surrender the vehicle without resistance. Armed crime continues to be more common in northern and northwestern Albania than in the rest of the country. Street crime is fairly common in Albania, particularly at night. Criminals do not seem to deliberately target U.S. citizens or other foreigners, but do seek targets of opportunity, and select those who appear to have anything of value. Vehicle theft is still one of the biggest problems in Albania. Pick-pocketing is widespread; U.S. citizens have reported the theft of their passports by pick-pockets. INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The local equivalent to the “911” emergency line is 129, though coverage is inconsistent at best. See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION
Medical facilities and capabilities in Albania are limited beyond rudimentary first aid treatment. Emergency and major medical care requiring surgery and hospital care is inadequate due to lack of specialists, diagnostic aids, medical supplies, and prescription drugs. Travelers with previously diagnosed medical conditions may wish to consult their physicians before travel. As prescription drugs may be unavailable locally, travelers may also wish to bring extra supplies of required medications. Recent electricity shortages have resulted in sporadic blackouts throughout the country, which can affect food storage capabilities of restaurants and shops. While some restaurants and food stores have generators to properly store food, travelers should take care that food is cooked thoroughly to reduce the risk of food-borne illness. Water in Albania is not potable. Visitors should plan to purchase bottled water or drinks while in country. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Albania. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Albania is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Major roads in Albania are often in very poor condition. Traveling by road throughout Albania is the most dangerous activity for locals and tourists. Vehicle accidents are the major cause of death, according to police statistics. Electricity shortages have resulted in sporadic blackouts throughout the country that can happen any hour of the day or night. Such outages affect traffic signals and street lights, making driving increasingly treacherous at any time of day. Travel at night outside the main urban areas is dangerous and should be avoided due to deplorable road conditions. During the winter months, travelers may encounter dangerous snow and icy conditions on the roads throughout mountainous regions in northern Albania. Buses travel between most major cities almost exclusively during the day, but they are often unreliable and uncomfortable. Many travelers looking for public transport prefer to use privately owned vans, which function as an alternate system of bus routes and operate almost entirely without schedules or set fares. Please note that many of these privately owned vans may not have official permission to operate a bus service and may not adhere to accepted safety and maintenance standards. Persons wishing to use privately owned vans should exercise caution. There are no commercial domestic flights and few rail connections. Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office at www.albaniantourism.com.
AVIATION SAFETY OVERSIGHT
As there is no direct commercial air service to the United States by carriers registered in Albania, the U.S. Federal Aviation Administration (FAA) has not assessed Albania's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For further information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa SPECIAL CIRCUMSTANCES: Albania's customs authorities may enforce strict regulations concerning temporary importation into or export from Albania of some items. It is advisable to contact the Embassy of Albania in Washington, D.C. or one of Albania's Consulates in the United States for specific information regarding customs requirements. As noted previously, the Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. See our information pertaining to dual nationality. Albania is a cash economy. Credit cards and travelers checks are not generally accepted, except at the major new hotels in Tirana and some international airline offices. Travelers' checks can be changed at banks in larger towns. Automated Teller Machines (ATMs) are available in most cities. Please see our Customs Information CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Albania’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Albania are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties. Under Albanian law, police can detain any individual for up to 10 hours without filing formal charges. U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times to show proof of identity and U.S. citizenship if questioned by local officials.
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION
Americans living or traveling in Albania are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within Albania. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Rruga Elbasanit 103, tel. (355)(4) 2247285; fax (355)(4) 2232222. The U.S. Embassy web site is http://tirana.usembassy.gov/ * * * This replaces the Consular Information Sheet dated June 10, 2008, to update sections on Entry and Exit Requirements, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.
Travel News Headlines WORLD NEWS
Tirana, March 9, 2018 (AFP) - The military has been deployed in northern Albania to help hundreds of people trapped by floods following heavy rainfall, authorities said on Friday. More than 9,230 hectares (22,800 acres) of agricultural land is underwater in the Shkodra region, including villages where the only means of transport is by boat, the defence ministry said.
Army personnel are evacuating residents and securing food supplies in the affected areas, 100 kilometres (60 miles) north of the capital, Tirana. The torrential rain in recent days has caused landslides damaging dozens of homes and flooding roads, said the transport ministry. The rain has also forced the Albanian authorities to release excess water from a hydroelectric plant, which has added to the flooding in northern areas of the country. Weather forecasters say the rain is likely to ease from Saturday.
Tirana, Dec 3, 2017 (AFP) - Thousands of police and soldiers have been deployed in Albania to rescue stranded residents after heavy rainfall triggered major flooding, and caused the death of a utility worker, officials and the power company said Sunday. The victim, Sabri Vlinga, died while he was working on a electricity pole at Roskovec in the flooded south of the country, the power company said in statement. Two other people were injured in similar accidents. it added. Some 6,400 police and soldiers have been sent to help rescue people stranded by the floods, Prime MInister Edi Rama said Saturday, calling the situation "very critical".
Around 1,500 people in the affected areas have been rescued, while several thousand homes were without electricity as many utility poles have been swept away by mudslides, said Shemsi Prenci, head of civil protection. More than 7,874 hectares (19,450 acres) of farm land as well as 3,193 homes are under water and several roads in the south remained impassable.
Army forces have built a temporary bridge at Darezeze, about 70 kilometres (44 miles) from the capital Tirana, to come to the aid of 2,000 residents stranded by the floods, the defence ministry said. In neighbouring Macedonia, the heavy rains have also caused flooding as several rivers include the main Vardar river have burst their banks, the MIA news agency reported.
By Briseida MEMA
Tirana, Feb 6, 2017 (AFP) - Emira Sela covers her face with her hand to hide a disfiguring abscess, the traumatic result of unregulated cosmetic treatments now rampant across Albania. The 31-year-old began to worry when wrinkles appeared on her face. Sela's hairdresser told her that a simple injection, costing around 60 euros ($65), would banish the signs of ageing. "She assured me that I would not risk anything. She even listed well-known names" of women who had undergone such treatment, said Sela. "I did not think twice, I trusted her without asking questions," said the blonde woman with green eyes, her voice trembling.
Albanian hair and beauty salons lacking expertise and medical supervision are offering such cosmetic treatments, unregulated in a legal vacuum, much to the alarm of qualified doctors. A single injection of a product whose content and dosage Sela knew nothing about was enough to ruin her life in late August. Despite antibiotics she has permanent pain, fever and nausea, while the abscess on her right cheek forces her eye to half-close and her face is nearly paralysed. "I am so disfigured that I tried to commit suicide," said Sela, who lost her job in a bank. Her only hope now is corrective surgery at an Italian hospital, scheduled for this month.
- Desiring Kardashian look -
"There are more and more impostors with syringes," said Panajot Papa, a plastic surgeon at a private clinic in Tirana. "The problem is also the products... Forbidden in Europe, they enter illegally from Turkey or China." Eriona Shehu, a dermatologist at Tirana's university hospital, said these unregulated synthetic products, such as injected liquid silicone and acrylamide, were being offered at temptingly low prices.
"Cosmetic interventions have become a lucrative industry. The patient is only a customer, exposed to a number of risks." Shehu said the desire to look like voluptuous US reality television star Kim Kardashian was "destroying the lives of young Albanian girls looking for beauty". Albanian doctors say the typical age of clients for such procedures is between 16 and 28. In the country of about three million people, the demand for cosmetic interventions rose more than 50 percent in 2015, according to a study published by Albania's economic magazine Monitor.
Promotional offers can be seen everywhere, such as a beauty salon advertising 20 percent reductions for three people coming together for treatment during the holiday season. Papa says he has treated a dozen young women aged between 20 and 27 who suffered complications after having their lips and cheekbones swollen with injected liquid silicone for 40 to 50 euros. The product has been banned for cosmetic use in countries such as Italy and France for more than 15 years. Papa said such botched interventions left these women prone to particularly bad swellings during their menstrual period, requiring further treatment -- and he warned they may suffer such symptoms for life.
- Closing legal gap -
Albanian doctors are worried about foreign practitioners who come from Italy, Turkey and Greece to work just for a weekend. "They may not have a diploma, qualification or licence for these kind of interventions or for assuming the responsibility of a patient's medical follow-up," said Besim Boci, head of the otolaryngology department at Tirana's university hospital. Due to legal loopholes, the judiciary cannot step in. A spokesman at Tirana's tribunal, Alba Nikolla, admits that it is currently impossible to "open investigations and prosecute based only on complaints" against practitioners.
But authorities are set to tackle this with a draft law to control cosmetic products and beauty salons, which is due to be introduced in parliament in the next few months. The law complies with the requirements of the European Union, which Albania aspires to join, and will enable authorities to shut down rogue establishments using synthetic products. When health is adversely affected, practitioners could be imprisoned for three to 10 years. Such regulations could go some way to easing the trauma of women like Elisa Lura, a 22-year-old economics student. She underwent a laser treatment to restore her natural look after paying 50 euros to a neighbourhood salon for permanent eyebrow tattoos, which went wrong. But the laser made things much worse. "Everything is spoiled!" she said of her face now covered with painful scars.
By Briseida MEMA
Tirana, Albania, Jan 13, 2016 (AFP) - With her sick daughter in the arms, Mira Lela pushes her way through the hallway of the doctor's clinic, crowded with patients ailing from heavy pollution in Albania's capital. "This is an emergency, she has difficulty breathing," said the tearful woman, forcing open the door to the office of Bardhyl Vaqari, who has worked in the specialist Tirana clinic for more than 20 years. "An acute asthma attack," said the doctor on seeing the child. "The number of people with respiratory allergies and cardiovascular problems has greatly increased," he told AFP, adding that the number of patients on the clinic's books has more than doubled to 8,000 in the last four years.
On the noisy and congested streets outside, clapped-out bangers and Hummer trucks cross paths with Mercedes, BMWs and overloaded buses that leave a trail of black smoke and heavy odour. Having been cut off from the world under a strict communist regime until 1991, the Western Balkan city had just a few hundred cars on its roads in the 1990s.
But today, through a mixture of pride, luxury-seeking and necessity, given the lack of public transport, there are more than 190,000 cars circulating in a city of about one million people. "Albanians take the car even when going to buy bread in a nearby store. That's why the traffic is overloaded all day and this increases pollution levels," said Altin Duka, a despairing 65-year-old shopkeeper.
The average age of vehicles on Tirana's roads is around 16 years, twice the European average, according to Gani Cupi, deputy manager of Albania's Road Transport Services. Many of the vehicles do not meet the standards of the European Union, which Albania hopes to join. "The traffic load, the age of vehicles, their technical condition but also the poor quality of fuel are all factors contributing to the capital's pollution," said Cupi.
- Taxing dilemmas -
In a bid to clean up the air, Albanian authorities considered doubling taxes on ageing vehicles but then dropped such plans. Analysts suggested the cost would weigh too heavily on citizens in one of the poorest countries in Europe. New cars are already exempt from paying annual tax for the first three years, but authorities in 2012 lifted a levy on the import of old vehicles as the EU considered it a "fiscal discrimination".
Tirana's Mayor Erion Veliaj has pledged to battle against the fumes by increasing the number of green spaces, introducing hybrid buses and improving infrastructure in the city, which is crammed with mostly illegal constructions. "The number of vehicles does not stop growing," he told AFP, pointing out that about 500 people die in the city each year "because of respiratory or cardiovascular problems related to pollution".
A report this year from the European Environment Agency noted a 20 to 30 percent decrease in Tirana's concentration levels of PM10 and PM2.5 -- damaging particulate matter -- according to data assessment from 2011 to 2013. But Laureta Dibra, head of the air and climate change department at Albania's Environment Ministry, told AFP that PM10 levels had actually been rising in areas of heavy traffic in recent years. Tirana remains "among the most polluted cities in Europe", added the director of the National Environment Agency, Julian Beqiri. "The level of the population's exposure to pollutants is still a problem," he said.
- On your bikes -
In an effort to improve air quality in the capital and educate residents, Tirana organised two car-free days in 2015, when the air was said to be at least four times less polluted than usual. Worried activists are campaigning to promote the bicycle as a means of transport and a way of life. Ecovolis, a bike sharing system, rents out at least 200 bicycles from different tations around Tirana, at 60 leke (44 euro cents, $0.47) per bike per hour -- but many people still prefer getting behind the wheel.
Although Albania's energy minister claims that 95 percent of fuel meets the required standards, even Prime Minister Edi Rama attacked its quality in May last year. "It is so bad that even a strong car like a Mercedes ends up being bad for Albanians' lungs," he said, calling for urgent measures to improve fuel controls. The government says restrictions have since been tightened, but those at the frontline of the fumes remain unhappy. "I come home in the evening with a completely dry throat and a bitter taste my mouth," said Bequir Veseli, 37, a traffic policeman who spends eight hours a day at the centre of a chaotic roundabout. "I have trouble breathing but what can I do? The next day I have to go back to my post".
March 29, 2007
COUNTRY DESCRIPTION: Chad is a developing country in north central Africa with one of the lowest per capita incomes in the world. Chad faces challenges in the areas of political stability and
ENTRY/EXIT REQUIREMENTS: A valid passport and visa are required. Visitors must check in with the National Police and obtain a registration stamp within 72 hours of arrival. Further entry information may be obtained from the Embassy of the Republic of Chad, 2002 R St. N.W., Washington D.C. 20009, telephone (202) 462-4009. Overseas, inquiries should be made at the nearest Chadian embassy or consulate. Some travelers originating in countries with no Chadian embassy or consulate can arrange for airport entry visas. This process is generally limited to business or official travelers, and arrangements must be made by the traveler’s local contact in Chad several days in advance of arrival. The U.S. Embassy is not in a position to assist private U.S. citizens with their visa application for travel to Chad.
See our Foreign Entry Requirements brochure for more information on Chad and other countries.
See Entry and Exit Requirements for more information pertaining to dual nationality and the prevention of international child abduction. Please refer to our Customs Information to learn more about customs regulations.
SAFETY AND SECURITY: See the Department of State’s Travel Warning for Chad.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s website where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: Americans and Europeans are perceived to be wealthy and certain precautions should be taken. Travelers are advised not to leave cash or valuables unsecured in their hotel room and not to wear expensive jewelry or show large amounts of cash. Travelers are also advised to dress modestly, not to walk outside after dark, and to lock their car doors. Petty crimes such as purse snatching, pick-pocketing and theft from vehicles do occur, particularly in areas frequented by expatriates. Violent crime is somewhat rare, but does occur. Burglary and vehicle thefts increase during times of political instability. Expatriate residences have been targeted for armed robbery, and some foreigners have been assaulted in the process. Travelers to northern Cameroon should contact the U.S. Embassy’s Regional Security Officer in N'Djamena prior to crossing the Chad/Cameroon border because of a high incidence of road attacks there.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Chad are extremely limited. Medicines are in short supply or unavailable, including many over-the-counter preparations sold in the United States. Travelers should carry any needed, properly labeled, medicines with them. In the event of major injury or illness, visitors generally will require medical evacuation.
There are two medical clinics in the capital of N’Djamena, International SOS and the Centre Medico-social de l’Ambassade de France. Advance membership is required to access these two clinics.
Malaria is a serious and sometimes fatal disease.
Plasmodium falciparum malaria, the type that predominates in Chad, is resistant to the antimalarial drug chloroquine.
Because travelers to Chad are at high risk for contracting malaria, the Centers for Disease Control and Prevention (CDC) advises that travelers should take one of the following antimalarial drugs: mefloquine (Lariam - TM), doxycycline, or atovaquone/proguanil (Malarone -TM).
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking.
For additional information on malaria, including protective measures, visit the CDC Travelers’ Health web site at http://www.cdc.gov/travel/malinfo.htm.
Other widespread diseases in Chad include diarrhea and upper respiratory infections. AIDS is becoming an increasingly serious problem as infection rates have risen to alarming levels (up to 25 percent in high-risk groups). Meningitis outbreaks usually occur annually and several other diseases (cholera, diphtheria, chicken pox, typhoid) periodically appear.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s internet site at http://www.cdc.gov/travel. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Chad is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Roads are in poor condition and dangerous. In the capital city of N'Djamena, only the main roads are paved; the rest of the roads are either hard-packed dirt or looser dirt and sand. During the summer rainy season (mid-June to mid-September) many roads become impassable or are restricted by rain barriers, while during the drier season, clouds of dust rising from the roads reduce visibility.
Visitors should take great care while driving. Both paved and unpaved roads are poorly maintained, and often have large ruts and potholes. All drivers should adjust their speed accordingly. At night, streets are not lit; it is imperative to watch for pedestrians, bicyclists, motorcyclists, and livestock, as they may not become visible until they are in very close proximity.
Driving in Chad tends to be erratic both in cities and in rural areas. In cities, particularly N'Djamena, motorists share the roads with bicycles, motor scooters, pedestrians, and non-motorized wheelchairs. Lanes are not marked, and it is not uncommon for a normally two-lane thoroughfare to become a four-lane road during rush hours (generally 7:00 a.m.-9:00 a.m. and 3:00 p.m.-6:00 p.m. Monday-Thursday; 7:00 a.m.-9:00 a.m. and 11:00 a.m.-12:30 p.m. on Friday). Drivers are urged to be particularly observant at these times because motorists often attempt to overtake slower traffic by moving into oncoming lanes, usually at high speeds.There are only a few traffic lights in N'Djamena, and these are often out of service. Drivers yield to traffic on their right, particularly when entering the many traffic circles.
In rural areas, drivers should watch for livestock crossing the roads, and for large hawks that rest on the roads. These birds can be fearless, and cause damage by smashing into drivers' windshields; drivers may avoid this by slowing down when approaching the hawks, and allowing them sufficient time to fly away. Finally, drivers should be alert to older transport trucks traveling between cities, which do not always have functioning headlights.
No emergency services exist, so drivers should exercise extreme caution. Travelers should always wear seat belts. When traveling by car, be sure to carry a spare tire. Roadside service is limited to good Samaritans and children who will help push cars to the side or out of holes. When traveling outside the capital, it is imperative to carry sufficient quantities of drinking water. Drivers should ensure that their gas tanks are at least half-full at all times, as gas stations are not widely available. Gas may be purchased in an emergency in bottles from roadside stands, but it is generally of poor quality.
Travelers on roads in all areas of the country are subject to attack by armed bandits.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Chad, the U.S. Federal Aviation Administration (FAA) has not assessed Chad’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: All photography requires a government permit. Taking photos of military sites, official buildings, and airports is strictly prohibited, even with a permit. Such sites are not always clearly marked. Film and cameras may be confiscated, often by undercover police.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Chadian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Chad are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information onCriminal Penalties.
CHILDREN'S ISSUES: Embassy N’Djamena does not issue immigrant visas. Therefore, American citizens who adopt children in Chad are required to travel to the U.S. Embassy in Yaounde, Cameroon, or another Embassy for visa processing before return to the United States.
For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues website.
REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Chad are encouraged to register with the U.S. Embassy in Chad through the State Department’s travel registration website , Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy in Chad is located in N'Djamena on Avenue Felix Eboue; mailing address is B.P. 413; telephone (235) 51-62-11, 51-70-09, 51-77-59, 51-90-52, 51-92-18 and 51-92-33, fax (235) 51-56-54.
* * *
This replaces the Country Specific Information dated July 10, 2006 with no updates.
Travel News Headlines WORLD NEWS
By Amaury HAUCHARD
Adré, Chad, April 11, 2019 (AFP) - Dinar Tchere is fighting time and the sun, and he fears he may be losing. This morning, the health worker is expected in a remote village of eastern Chad, where he will administer the measles, mumps and rubella vaccine to poor children. But he's behind schedule -- and there is limited time before his enemy, the blistering Sahelian heat, will destroy his precious drugs. Tchere takes his gear and the ice-packed cooler that shields the vaccines, puts them in an NGO pickup and heads out from his clinic in Hilouta, in Ouaddai province, on the dusty untarmacked road.
Twenty minutes later he is in Agang, a village of 400 people, and there, another private dread has turned to reality. No-one is there to be vaccinated. "It's just what I feared -- most of the mums have gone off to the market to do their shopping," groans Tchere, a stocky, shaven-headed man in his fifties. There is nothing to do but hope that the mothers and their children will return. He stretches out a mat on the soil, under a mango tree. His luck starts to turn. One by one, mothers with their children make their way to the spot, and soon there is no room on his mat for youngsters waiting for their jab.
- Cold chain -
Always worried by the heat -- the thermometer now reads 40 degrees Celsius (104 degrees Fahrenheit) -- Tchere dips his finger into the cooler to check that the ice has not melted, and starts the vaccination. "Our biggest headache is ensuring that the vaccines are always kept cold," says Tchere, who heads one of 21 health centres in the region. "Since the troubles of 2007, we no longer have a solar panel or fridge." The "troubles" refer to years-long violence by armed groups on the tense border between Sudan and Chad. Hilouta, which lies less than two kilometres (one mile) from the border, became a combat zone. With no power, how does Tchere keep his vaccines cool? "I stock them in Sudan, in a clinic on the other side of the border. They've got a fridge," he explains.
But there's a problem: because of security concerns, Sudan refuses to let people cross the border by motorbike -- Tchere's only form of transport when he cannot use the pickup. So on the eve of every immunisation session, Tchere walks into Sudan, carrying his cooler, fills it up with vaccines, and walks back into Chad. His clinic administers to about 60 villages. He says e does four vaccination sessions per month -- two in the clinic, and two in the villages. Most often, he does the outside trips on his motorbike, always taking care never to take the same route back home, in order to avoid holdups.
The state no longer pays the running costs of his health centre -- a French NGO, Premiere Urgence Internationale (PUI), has stepped in, using financial help provided by the European Union. In Arkoum, about 50 kilometres (30 miles) from Hilouta, Felix Djembonoudji, a nurse who runs the health centre, says that the stockpile of vaccines -- held in the district's main town of Adre, several hours away by road -- has run out. "The people (in Adre) sometimes don't receive any -- we've been without MMR (vaccine) for five days," he says.
- Measles threat -
Measles is often dismissed by so-called anti-vaxxers who oppose immunisation as a disease of the past or non-threatening. Experts say that it is neither -- measles is on the comeback trail. And out of every 20 children who catch measles, as many as one will suffer from pneumonia, according to the US Centers of Disease Control (CDC). Blindness, encephalitis and severe diarrhoea are also serious complications. Only one child in five in Chad is fully vaccinated against measles, according to a 2017 survey. "Measles can also cause malnutrition in non-vaccinated children, which in itself is a cause of premature death," said PUI's mission chief in Chad, Fabienne Mially.
According to UN figures, more than one child in 10 in Chad will die before their fifth birthday. In Agang, the measles vaccination session comes to an end, and Tchere is packing up his gear when a horse appears on the horizon, its hooves kicking up dust, bearing a man and his six-month-old baby. The infant needs his second MMR vaccine. "It's important!" pleads the father. The child will get his jab. Tchere returns to his clinic in Hilouta. There is no water or electricity. Two local people are awaiting him in the gloom, desperate for a medical consultation. "The working day is long," he sighs, as he welcomes them in.
By Amaury HAUCHARD
Hadjer Hadid, Chad, April 9, 2019 (AFP) - "I've already earmarked a customer for this drum -- I need to get a move on!" Ali Ahmat,12, flicks his whip to persuade a hard-driven horse to press on with his cart, laden with 200 litres (44 imperial gallons) of freshly-fetched water. The young entrepreneur is one of the informal but indispensable links in a chain to supply people in Ouaddai, eastern Chad, with water, the stuff of life.
Scorching temperatures, an open sky, a shortage of deep wells and lack of water purification system make this a thirsty part of the world indeed. "After the rainy season, water becomes scarce," says Mahamat Adoum Doutoum, chief of the Guerri region, where only two deep wells exist for 86,000 inhabitants. "So people go to look for water in the wadi." Wadis -- "riverbeds" in Arabic -- are watercourses that run strong and fast during the rains and are often dangerous to cross, but largely dry up for the rest of the year. When there is no more rain, people dig wells in the wadis and install pumps to extract groundwater.
Ali and dozens of other water carriers flock to the pumps to collect supplies they plan to sell to people who have no access to the source, often in dusty settlements. Each refill of his 200-litre drum costs Ali 100 CFA francs (0.15 euros / $0.17), but he can sell the water for five times as much in town. "We do between seven or eight return trips each day, roughly," he says. Towards the end of a hot Sunday, the blazing sun has set and Ali's cart is heading towards Hadjer Hadid.
The town harbours a refugee camp for people who fled conflict and mass killings in the Darfur region of western Sudan, the far side of the border. Pascal, a Sudanese refugee and father of five in his 50s, is also used to the return trips between the town, the bed of the wadi and the muddy wells. He first came to Chad about 15 years ago and says that he "suffered" to be able to buy his own donkey. The beast of burden was an investment that has paid off, however, enabling Pascal to deliver water to the townsfolk over the past two years and bring a small sum home to his family.
- Add bleach -
But he remains concerned about the quality of the water. "To drink the water, you also have to add bleach," Pascal says. While water has become as rare as it is valuable, the kind to be found around wadis is unsafe. Traditional wells dug into the earth at the wadis provide water that is often the same colour as the soil. "The water can be contaminated at various points, either at the source, which may be unprotected, or during transport, using receptacles which are inappropriate, dirty or uncovered, and during storage and distribution," says Fabienne Mially, mission chief in Chad for the French aid group Premiere Urgence Internationale (PUI).
The NGO supports 11 health centres in the Ouaddai region, where awareness sessions on the importance of proper drinking water are regularly organised. In Borota, a village several hours' drive from Hadjer Hadid, the head of the local health centre has no illusions. Of the six standpipes in the village, none is working any more. "They were installed by NGOs," says the official, Koditog Bokassa, who says that wadi water is the only available source of water locally. He hands out sachets of bleach to dilute in untreated water. But Bokassa lacks the means to satisfy everybody and PUI has become the sole supplier of bleach in central parts. The state used to deliver some, but has not done so for more than a year, he says. It is quite common to see young people at the wadis drink directly from their cans.
- 'Barely enough' -
The town has holding basins and water towers designed to retain water during the rainy season. "But the holding basins are insufficient and the two water towers broke down several years ago," says local resident Hassan. One trader has bought two barrels of 200 litres apiece, which he leaves in the courtyard of his house. "It's barely enough for the children, but it's better than nothing." The water deliverer Pascal does not have the money to buy a drum of such munificence. For the seven members of his household, there are seven 20-litre cans on the stoop. "I haul water every day, but I have the same problem as everyone else," he said.
By Amaury HAUCHARD
Abeche, Chad, April 7, 2019 (AFP) - The chief medical officer at Adre hospital takes a routine phone call: a patient has been admitted with gunshot wounds and needs emergency surgery. A dusty town in eastern Chad, once part of the proud Ouaddai empire, Adre is caught up in a mounting conflict between local farmers and nomadic camel herders from the north of the sprawling country. Last year, the hospital treated more than 100 patients with bullet wounds.
In a territory where almost everyone seems to have a gun -- a legacy of rebellions launched from eastern Chad and of the brutal conflict in Sudan's Darfur -- squabbles over grazing land and trampled crops swiftly lead to violence. Such disputes are tragically familiar in many parts of Africa. But in arid eastern Chad, near the border with Sudan, the bloodshed is particularly acute, rooted in a bitter drought and population pressure sharpening rivalry over access to land. The vicious circle of attack and retribution is running full tilt.
- Seasonal -
Admissions in Adre rise sharply during "times of tension", a source at the local hospital said. Those times mirror the seasons. At the end of the rainy season, in December and January, herders drive their beasts northwards into the Sahel. When water sources start running low, they return south, from about the end of June. Local chief Abderahim Dahab, who supervises 136 villages in his traditional leadership role, said the modern-day bloodshed contrasted with long-established cohabitation. "Movement of livestock has always happened peacefully, for decades," he said. Migratory herders benefit from pasture on which to feed their animals, and farmers benefit from the animals, whose droppings fertilise the soil. And farmers and herders mutually benefit from trading with each other for food.
Historian Mahamat Saleh Yacoub said two factors explained the breakdown between the two communities. The first is a drought that has gripped the Sahel since the 1970s and seems to be worsening. Everyone who spoke to AFP agreed that the key issue is a lack of water. "The herders are now coming earlier in the year and going back later. The established ways have broken down," said another district chief. Saleh Yacoub, who is head of the ENS college of higher education in Abeche, near Adre, said the second cause was a population increase -- "as much among people as among livestock". Herds are getting larger, straining the fragile ecological resources of the Ouaddai.
- Ethnic friction -
The rivalry has "become intertwined with ethnic problems", added Yacoub. "The herds all belong to the same people: colonels, generals, people in politics," explained a village elder sitting on his mat with a glass of tea. "We have had meetings, we write letters to the deputy prefect (district administrator), the prefect himself, but get nothing back," he protested. "The population has no power against them."
Many cattlemen are members of the Zaghawa ethnic group, who come from the northeast of the giant country. The Zaghawa include President Idriss Deby Itno, who came to power in 1990. Members of their ethnicity have entered every rank of the Chadian state, although Ouaddai's governor, Ramadan Erdebou, dismisses any suggestion that tribalism is to blame for the region's problems. "This ethnic question is a false debate. There are Chadian women and Chadian men and one single unity, Chad," said Erdebou, who was formerly the chief of the regime's powerful intelligence services.
- Disarmament -
Erdebou's predecessor was sacked after an explosion of communal violence last October claimed eight lives. One of his first moves in office was to announce a massive disarmament campaign among the population. He also warned that a mission would be coming from the capital N'Djamena to chase away "those farmers who have cultivated crops along the corridors (set aside) for livestock movement."
These designated corridors were established by law in 1959, to give nomads and their herds passage of up to one kilometre (more than half a mile) wide for their seasonal migrations. "But Zaghawa herders feel they can do what they like and don't respect them," said a farmer, who maintains he lost his entire peanut crop in 2016 when hundreds of dromedaries trampled his field. "How do you expect Ouaddians to agree to be disarmed when you see that the herdsmen have more and more weapons?" asked a local official.
In 2015, the National Assembly in the distant western capital passed a Pastoral Code that led to an outcry from people who found it heavily biased in favour of the cattle breeders. Deby overturned the law. "It's hard to want national unity when those in power only favour their own," said the local official, who asked not to be named, saying he feared reprisals. But, Saleh Yacoub observed, when quarrels turn violent, "the Zaghawa become the target for all the grievances, regardless of whether they are legitimate or not." In a visit to Abeche in February, Deby named no names but acknowledged there was a "serious problem." He vowed to "take matters in hand". "The hour for vendettas is past," he declared.
N'Djamena, May 29, 2018 (AFP) - Hospitals and schools were shut in Chad Monday as civil servants went on strike over pay cuts imposed by the cash-strapped government which is under pressure to cut public funding to meet the demands of international donors. Public sector workers are demanding payment of their "full salary" after bonuses and allowances were slashed by 50 percent in January as part of a package of austerity measures to improve state finances. They had already seen a similar 50 percent cut in 2016. President Idriss Deby, who has been in power since 1990, had asked them to wait until the end of the year to regularise their salaries. The unions on Saturday refused his request and called for an indefinite strike. Primary and secondary schools in the capital and the University of N'Djamena were closed on Monday while the main ministries were functioning at a slow pace, with many offices shut. "This strike is jeopardising thefuture of our children who are in exam class," said parent Joseph Issa. Schools in other major cities were also closed.
At the general hospital in N'Djamena, staff nurse Ali Soumaine said they were providing "a minimal service for surgery, resuscitation and other sensitive services". The government was "surprised" at the strike call, spokeswoman Madeleine Alinque said in a statement. "We question the headlong rush of unions that do not honour our country or workers," she said. "The government is inviting all workers to go about their daily business normally, and efforts are under way for a sustainable recovery of the social situation," she added. Magistrates on Monday also began a three-day strike in protest at a police attack on lawyers in Doba last week. According to trade union leader Michel Barka, the situation of civil servants "is more and more unacceptable, and it gives the workers no pleasure every time they have to close the schools, the hospitals, the public administration". Barka accused the government of not "making an effort" to deal with the situation.
Chad, a poverty-stricken landlocked country of nearly 15 million people, has about 92,000 civil servants. The austerity measures imposed in January led to a seven-week strike by civil servants. The government and trade unions in March reached an agreement to end the paralysis of the public sector. The government proposed ending the cuts to bonuses and allowances at the end of May. N'Djamena obtained a three-year $312 million (254 million euro) credit line from the International Monetary Fund last June. It has received two tranches of $99.8 million but has to make progress on improving state finances to access further funds. The economy of Chad, where 40 percent of the population live in poverty, has been badly hit by a downturn in the price of oil exports since 2015.
World Travel News Headlines
By Nazeer al-Khatib with Hashem Osseiran in Beirut
Maaret al-Numan, Syria, May 22, 2019 (AFP) - Syrian government air strikes killed 18 civilians, including a dozen people at a busy market, as fierce fighting raged for the jihadist-held northwest, a war monitor said on Wednesday. Regime forces battled to repel a jihadist counteroffensive around the town of Kafr Nabuda that has left 70 combatants dead in 24 hours, the Syrian Observatory for Human Rights said. The Hayat Tahrir al-Sham alliance, led by Syria's former Al-Qaeda affiliate, controls a large part of Idlib province as well as adjacent slivers of Aleppo, Hama and Latakia provinces. The jihadist-dominated region is nominally protected by a buffer zone deal, but the government and its ally Russia have escalated their bombardment in recent weeks, seizing several towns on its southern flank. At least 12 people were killed and another 18 wounded when regime warplanes hit the jihadist-held Idlib province town of Maarat al-Numan around midnight (2100 GMT) on Tuesday, the Observatory said.
The market was crowded with people out and about after breaking the daytime fast observed by Muslims during the holy month of Ramadan. The bombardment blew in the facades of surrounding buildings, and ripped through the flimsy frames and canvas of stalls in the market square, an AFP photographer reported. The bodies of market-goers were torn apart. "Residents are still scared," stallholder Khaled Ahmad told AFP. Three more civilians were killed on Wednesday by air strikes in the nearby town of Saraqib, the Observatory said. Two others were killed in strikes on the town of Maaret Hermeh, it added. Another civilian was killed in air raids on the town of Jisr al-Shughur, the monitor said. The Britain-based Observatory relies on a network of sources inside Syria and says it determines whose planes carried out strikes according to type, location, flight patterns and munitions.
- 'Worst fears'-
The strikes came as heavy clashes raged in neighbouring Hama province after the jihadists launched a counterattack on Tuesday. Fresh fighting on Wednesday took the death toll to 70 -- 36 regime forces and militia and 34 jihadists, the Observatory said. It said the jihadists had recaptured most of Kafr Nabuda from government forces, who had taken control of the town on May 8. State news agency SANA on Wednesday however said the army repelled a jihadist attack in the area, killing dozens of insurgents.
Russia and rebel ally Turkey inked the buffer zone deal in September to avert a government offensive on the region and protect its three million residents. But President Bashar al-Assad's government upped its bombardment of the region after HTS took control in January. Russia too has stepped up its air strikes in recent weeks. The Observatory says nearly 200 civilians have been killed in the flare-up since April 30. The United Nations said Wednesday that Idlib's civilian population once again faced the threat of an all-out offensive. "A full military incursion threatens to trigger a humanitarian catastrophe for over 3 million civilians caught in the crossfire, as well as overwhelm our ability to respond," said David Swanson, a spokesman for the UN humanitarian office. Swanson said more than 200,000 people have been displaced by the upsurge of violence since April 28. A total of 20 health facilities have been hit by the escalation -- 19 of which remain out of service, Swanson said. Collectively they served at least 200,000 people, he added.
- 'Break the status quo' -
The September deal was never fully implemented as jihadists refused to withdraw from a planned buffer zone around the Idlib region. But it ushered in a relative drop in violence until earlier this year, with Turkish troops deploying to observation points around the region. The Syrian government has accused Turkey of failing to secure implementation of the truce deal by the jihadists. But Turkish Defence Minister Hulusi Akar accused the Syrian regime late Tuesday of threatening the ceasefire deal. "The regime is doing all that it can to break the status quo including using barrel bombs, land and air offensives," Akar told reporters. "Turkish armed forces will not take a step back from wherever they may be", he however added. Earlier, the US State Department said it was assessing indications that the government had used chemical weapons on Sunday during its offensive in Idlib. HTS accused government forces of launching a chlorine gas attack on its fighters in the northern mountains of Latakia. But the Observatory said Wednesday it had "no proof at all of the attack".
By Amelie BARON
Port-au-Prince, May 22, 2019 (AFP) - With no oxygen in intensive care or gloves in the emergency room, residents at Haiti's largest hospital have gone on strike to protest the filthy environment and demand six months of back pay. "We have almost nothing when we talk about emergency services," said Emmanuel Desrosiers, 24, one of the doctors-in-training at the State University of Haiti Hospital (HUEH) that began the work stoppage Monday. "When a patient arrives, when we should immediately take charge, we start by listing the things they or their family need to go buy." The HUEH, known as the "general hospital," is where the most disadvantaged families in this impoverished Caribbean country crowd. Buying the medical supplies themselves is a financial headache, but private clinics are far too expensive. In crumbling buildings in the center of Port-au-Prince, male and female patients are crowded together in tiny rooms, while trash cans overflow. "We feel ridiculous when we give hygienic advice to patients," one resident said of the situation.
The residents' selflessness as they work in an unsanitary environment is compounded by the fact that they have not been paid since the start of their residency, nearly six months ago. After five years of medical studies, the state is required to pay them 9,000 Haitian gourdes (HTG) per month -- only about $100, due to the devaluation of the national currency. Nothing is being done about the hospital's disrepair, with those in charge waiting for a new building to be completed, according to resident Yveline Michel. The new HUEH will have two floors and more than 530 beds once it's finished -- but it's unclear when that will be. The project began after the January 2010 earthquake, which destroyed more than half the hospital. The United States, France and Haiti invested $83 million in a new hospital, which should have been completed by 2016. Instead, there is little visible activity on the construction site, which can be seen through the windows of the current building.
Due to the heat, the windows are always open, letting in noise and dust from the street. There are only a few fans in the hospital rooms, which do little to combat the humidity or the flies. "At any moment we could lose patients, but the state isn't doing anything to save their lives," said Michel, 25. "We're striking for the population, since it should make these demands." But some locals question the residents' position because the strike prevents the already struggling hospital from functioning. Since the strike began, the poorest families in the area no longer know where to go for medical emergencies, as the residents are in charge of admitting patients. "Due to the lack of resources and the unsanitary environment, there are always people dying in the hospital, so it's not the strike causing that," said Michel in response.
For a description of Hwange national park, go to
Hwange is in the western part of the country bordering Botswana and Zambia
(<https://en.wikipedia.org/wiki/Hwange>). - ProMED Mod.MHJ]
One has to ask: Why are we seeing it in the USA?" is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations among their midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations. - ProMED Mod.LL]