International travel and health

Travellers with medical conditions or special needs

Airlines have the right to refuse to carry passengers with conditions that may worsen, or have serious consequences, during the flight. They may require medical clearance from their medical department/adviser if there is an indication that a passenger could be suffering from any disease or physical or mental condition that:

  • may be considered a potential hazard to the safety of the aircraft;
  • adversely affects the welfare and comfort of the other passengers and/or crew members;
  • requires medical attention and/or special equipment during the flight;
  • may be aggravated by the flight.

If cabin crew suspect before departure that a passenger may be ill, the aircraft’s captain will be informed and a decision taken as to whether the passenger is fit to travel, needs medical attention or presents a danger to other passengers and crew or to the safety of the aircraft.

Although this chapter provides some general guidelines on conditions that may require medical clearance in advance, airline policies vary and requirements should always be checked at the time of, or before, booking the flight. A good place to find information is often the airline’s own web site.


A fit and healthy baby can travel by air 48 h after birth, but it is preferable to wait until the age of 7 days. Until their organs have developed properly and stabilized, premature babies should always undergo a medical clearance before travelling by air. Changes in cabin air pressure may upset infants; this can be helped by feeding or giving a pacifier to stimulate swallowing.

Pregnant women

Pregnant women can normally travel safely by air, but most airlines restrict travel in late pregnancy. Typical guidelines for a woman with an uncomplicated pregnancy are:

  • after the 28th week of pregnancy, a letter from a doctor or midwife should be carried, confirming the expected date of delivery and that the pregnancy is normal;
  • for single pregnancies, flying is permitted up to the end of the 36th week;
  • for multiple pregnancies, flying is permitted up to the end of the 32nd week.

Each case of complicated pregnancy requires medical clearance.

Pre-existing illness

Most people with medical conditions are able to travel safely by air, provided that necessary precautions, such as the need for additional oxygen supply, are considered in advance.

Those who have underlying health problems such as cancer, heart or lung disease, anaemia and diabetes, who are on any form of regular medication or treatment, who have recently had surgery or been in hospital, or who are concerned about their fitness to travel for any other reason should consult their doctor or a travel medicine clinic before deciding to travel by air.

Medication that may be required during the journey, or soon after arrival, should be carried in the hand luggage. It is also advisable to carry a copy of the prescription in case the medication is lost, additional supplies are needed or security checks require proof of purpose (Chapter 1).

Frequent travellers with medical conditions

A frequent traveller who has a permanent and stable underlying health problem may obtain a frequent traveller’s medical card (or equivalent) from the medical or reservation department of many airlines. This card is accepted, under specified conditions, as proof of medical clearance and for identification of the holder’s medical condition.

Dental/oral surgery

Recent dental procedures such as fillings are not usually a contraindication to flying. However, unfinished root canal treatment and dental abscesses are reasons for caution, and it is recommended that individuals seek advice with regard to travel plans from the surgeon or dental practitioner most familiar with their case.

Security issues

Security checks can cause concerns for travellers who have been fitted with metal devices such as artificial joints, pacemakers or internal automatic defibrillators. Some pacemakers may be affected by modern security screening equipment and any traveller with a pacemaker should carry a letter from their doctor.


Almost all airlines now ban smoking on board. Some smokers may find this stressful, particularly during long flights, and should discuss the issue with a doctor before travelling. Nicotine replacement patches or chewing gum containing nicotine may be helpful during the flight and the use of other medication or techniques may also be considered.

Travellers with disabilities

A physical disability is not usually a contraindication for travel. A passenger who is unable to look after his or her own needs during the flight (including use of the toilet and transfer from wheelchair to seat and vice versa) will need to be accompanied by an escort able to provide all necessary assistance. The cabin crew are generally not permitted to provide such assistance and a traveller who requires it but does not have a suitable escort may not be permitted to travel. Travellers confined to wheelchairs should be advised against deliberately restricting fluid intake before or during travel as a means of avoiding use of the toilet during flights, as this may be detrimental to overall health.

Airlines have regulations on conditions of travel for passengers with disabilities. Disabled passengers should contact airlines for guidance in advance of travel; the airlines’ own web sites often give useful information.