Eswatini
Travel Destination – Eswatini
Eswatini, formerly known as Swaziland, is a small landlocked kingdom tucked between South Africa and Mozambique, and one of the world's last remaining absolute monarchies. The country encompasses four distinct landscape zones, each with its own character and wildlife, shifting from misty highlands in the west to hot, wildlife-rich areas in the east.
National parks are home to black and white rhino, elephant, lion, and a remarkable diversity of bird and antelope species. Beyond wildlife, Eswatini is distinguished by the living cultural traditions of its people. The country also produces internationally regarded handcrafted goods, from the famous Swazi Candles to glass art, silk, and woven textiles.
Healthcare in Eswatini is limited. More serious medical cases are typically evacuated to South Africa, making travel insurance with evacuation cover an essential consideration.
Health Risks
Pre-travel preparation
When preparing for travel to Eswatini, book a travel medicine appointment six to eight weeks before departure for vaccination review, safety recommendations, and antimalarial medications. A travel doctor can give you personalised advice based on your planned itinerary and health background. Travellers booking closer to their departure date should still see a travel doctor without delay, as much of the essential preparation can still be completed.
Medical facilities throughout Eswatini are limited, particularly in rural areas, and more serious conditions are generally evacuated to South Africa. Travel insurance that explicitly covers medical evacuation is therefore not optional. There can be shortages of basic medication throughout the country, and all prescription medications should be brought from Australia in sufficient quantity for the full duration of the trip.
Insect avoidance
Malaria risk exists in parts of Eswatini, particularly in the lower-lying eastern lowveld areas including regions surrounding Hlane Royal National Park and the Lubombo area. Malaria-carrying Anopheles mosquitoes are most active from dusk to dawn. Dengue spread by daytime-biting Aedes mosquitoes, is also present. Other insect-borne diseases occur in Eswatini, and accommodation should be insect-proof with air conditioning or a permethrin net.
Apply insect repellent containing DEET or picaridin to exposed skin throughout the day and into the evening, reapplying after swimming or heavy sweating. Long-sleeved clothing and trousers when outdoors, particularly around dusk, add a further physical barrier. Treating outer clothing and equipment with permethrin before travelling provides additional protection for those travelling rurally.
Food and water hygiene
Swazi cooking is hearty with many wildlife lodges offering sishwala, a stiff maize porridge, as well as slow-cooked game meats and seasonal vegetables. Travellers staying in well-resourced lodges will generally find safe food readily available, though consistent hygiene habits throughout the trip help prevent gastroenteritis.
Hands should be washed with soap and water before eating and after using the toilet, and alcohol-based hand sanitiser carried when facilities are unavailable. Travellers should not eat raw or undercooked food, and fruit should be peeled immediately before eating.
Tap water quality varies across the country. Bottled water is the safest option throughout the visit, including for brushing teeth. Ice from unverified sources should be treated with caution.
Rabies prevention
Rabies is a viral disease which is almost always fatal once symptoms develop. It is present in Eswatini and is carried by dogs and various wildlife, including bats. Access to post-exposure treatment may be limited, particularly in rural areas.
Physical contact with any animal throughout the visit should be avoided, whether stray dogs in towns or wildlife encountered in game reserves. Pre-exposure vaccinaiton for rabies is recommended for travellers spending extended time in the country, those visiting rural or wildlife areas, and those whose activities involve an increased likelihood of animal contact, including safari walks and outdoor pursuits.
Any bite, scratch, or lick to broken skin from an animal requires immediate thorough washing of the wound with soap and running water and prompt medical assessment, regardless of prior vaccination status.
Our Travel Doctors
Our fully qualified doctors have an interest in travel medicine and immunisations. And they know travel. Their expert advice will be tailored for you, your travel companions and your trip.
Which shots do I need for Eswatini?
Hepatitis A
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Hepatitis A is a contagious viral infection of the liver that is spread through food, water, or contaminated hands. Infection often causes fever, tiredness, nausea, abdominal discomfort, loss of appetite, dark urine, and jaundice, although some people experience only mild symptoms. Because the virus spreads easily wherever food hygiene or sanitation is inconsistent, vaccination is recommended for almost all Australian travellers visiting Eswatini.
The Hepatitis A vaccine is highly effective and provides long-term protection after two doses. Even after vaccination, sensible food and water precautions remain worthwhile, including drinking safe water, washing hands before eating, and choosing food that is freshly prepared and served hot.
Typhoid
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Typhoid fever is a bacterial infection caused by Salmonella Typhi, usually acquired through contaminated food or drinking water. It often begins gradually with persistent fever, headache, fatigue, abdominal pain, constipation or diarrhoea, and can become life-threatening if left untreated.
Vaccination is recommended for most travellers to Eswatini, particularly those spending extended periods in the country, visiting rural communities, or eating frequently outside established hotels and restaurants. Because no vaccine provides complete protection, reducing risk also depends on drinking safe water, avoiding raw or undercooked foods, and maintaining good hand hygiene throughout your trip.
Rabies
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Rabies is a viral disease which is almost always fatal once symptoms develop. It is present in Eswatini and is carried by dogs and various wildlife, including bats. Access to post-exposure treatment may be limited, particularly in rural areas.
Physical contact with any animal throughout the visit should be avoided, whether stray dogs in towns or wildlife encountered in game reserves. Pre-exposure vaccinaiton against rabies is recommended for travellers spending extended time in the country, those visiting rural or wildlife areas, and those whose activities involve an increased likelihood of animal contact, including safari walks and outdoor pursuits.
Any bite, scratch, or lick to broken skin from an animal requires immediate thorough washing of the wound with soap and running water and urgent medical assessment, regardless of prior vaccination status.
Measles
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Measles is one of the world's most infectious viral diseases and spreads easily through the air when an infected person coughs, sneezes, or even breathes. The virus can remain suspended indoors for up to two hours after an infected person has left the area. Symptoms usually begin with fever, cough, runny nose, and sore eyes before a widespread rash develops several days later.
As measles continues to circulate internationally, Australians travelling overseas who were born during or since 1966 should ensure they are fully vaccinated before departure. Two documented doses of the MMR vaccine provide excellent protection against measles, mumps and rubella. Anyone unsure of their vaccination history should discuss this with their GP or travel doctor before departure.
Hepatitis B
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Hepatitis B is a viral infection that affects the liver and spreads through contact with infected blood or body fluids. This can occur during unprotected sexual activity, sharing needles, receiving medical or dental treatment with inadequately sterilised equipment, or through tattooing and body piercing.
Vaccination is recommended for travellers to Eswatini because hepatitis B remains more common than it is in Australia, and medical care is more unpredictable when travelling. Many Australians received hepatitis B vaccination during childhood, but adults who are uncertain whether they completed the series should check their immunisation history before departure. Completing vaccination before travel provides long-lasting protection.
Yellow Fever
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Yellow fever is not found in Eswatini, so travellers do not need the vaccine for protection while visiting the country.
However, Eswatini follows international health regulations requiring some travellers to show a valid International Certificate of Vaccination or Prophylaxis (ICVP) on arrival. This generally applies if you are arriving from, or have recently transited through, a country where yellow fever transmission occurs. If your itinerary includes a stop in sub-Saharan Africa or South America, even for a connecting flight in some circumstances, check the entry requirements well before departure to avoid delays or refusal of entry.
Routine vaccinations
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Travelling to Eswatini is a good opportunity to make sure your routine vaccinations are fully up to date before leaving Australia. Protection against tetanus, diphtheria, pertussis, hepatitis B, polio, measles, mumps, and rubella is particularly important, as these infections continue to occur in many parts of the world.
If it has been more than ten years since your last tetanus booster, another dose may be recommended, especially if your plans include hiking, wildlife viewing, camping, or other outdoor activities where cuts and scrapes are more likely. Influenza vaccination is also worthwhile because influenza circulates throughout the year in southern Africa. COVID-19 vaccination should remain current according to Australian recommendations, including booster doses for older adults and people with underlying medical conditions. Ensuring these routine vaccinations are current provides protection not only during travel but also after returning home.
Eswatini
Other health risks in Eswatini
Malaria
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Malaria is a potentially life-threatening infection caused by parasites that are spread through the bites of infected mosquitoes, which are most active from dusk until dawn. Symptoms often include fever, chills, headache, muscle aches, and fatigue, and the illness can become severe if not treated promptly.
In Eswatini, malaria occurs in many areas including areas around Hlane Royal National Park, Mhlume, and the Lubombo plateau. Travellers visiting areas with significant malaria transmission should take prescription antimalarial medication. The highland regions, including Mbabane and Manzini, have little or no malaria risk, although anyone combining highland and lowveld travel should plan for the highest-risk part of their itinerary. Plasmodium falciparum, the most serious malaria parasite, is the predominant species, and chloroquine is no longer effective in the region.
A travel doctor can recommend the most appropriate antimalarial based on your itinerary, medical history, and length of stay. Medication should be obtained before leaving Australia. If you develop a fever during your trip or within four weeks of returning from a malaria-risk area, seek urgent medical attention and tell your doctor where you have travelled.
Gastroenteritis
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Gastroenteritis is usually caused by bacteria or viruses picked up through contaminated food, drinking water, or poor hand hygiene, although parasites are occasionally responsible. Symptoms commonly include diarrhoea, nausea, vomiting, stomach cramps, bloating, and sometimes fever, and usually begin within one to three days of exposure.
Healthcare facilities outside Mbabane are more limited, making prevention particularly important. Choosing freshly cooked food, drinking bottled or treated water, avoiding raw or undercooked foods, and washing hands regularly can significantly reduce your risk.
Most people recover within several days with rest and replacement of lost fluids with water or oral rehydration solutions. Medical attention should be sought if symptoms are severe, prolonged or atypical and for the very young and older travellers.
Dengue
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Dengue is a viral infection spread by Aedes mosquitoes, which bite mainly during the day, especially in the early morning and late afternoon. Infection usually causes sudden fever, severe headache, muscle and joint pain, nausea, and a rash, although some people develop only mild symptoms. A small number of cases can progress to severe dengue, which requires urgent medical care.
There is no specific antiviral treatment or routine vaccine recommended for most Australian travellers, so preventing mosquito bites is the best protection. Use insect repellent containing DEET or picaridin during the day, wear long-sleeved clothing where practical, and stay in accommodation with screens or air conditioning whenever possible.
Schistosomiasis
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Schistosomiasis (also called bilharzia) is a parasitic infection that can be acquired by swimming, wading, or bathing in contaminated freshwater. Tiny parasites released by infected freshwater snails are able to pass directly through healthy skin, even after only brief contact with rivers, lakes, dams, or slow-moving streams.
The safest approach is to avoid freshwater activities altogether while visiting Eswatini. Swimming pools that are properly chlorinated and the ocean do not carry this risk.
There is no vaccine or medication that prevents schistosomiasis, but the infection can be diagnosed and treated after travel. Anyone who has had freshwater exposure during their trip should consider arranging testing after returning to Australia, even if they feel well.
Tuberculosis
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Tuberculosis (TB) is a bacterial infection spread through the air when an infected person coughs, talks, or sings, primarily affecting the lungs.
Eswatini has one of the highest tuberculosis burdens in the world relative to its population size, compounded by the very high HIV prevalence in the country, which significantly increases the risk of serious TB disease in co-infected individuals.
The risk to most short-stay travellers is low, but those visiting or working in healthcare settings, prisons, homeless shelters, or hospitals, or those visiting friends and relatives, face a higher level of exposure and should discuss pre and post-travel screening with their travel doctor. A persistent cough or unexplained weight loss developing after travel to Eswatini warrants prompt medical review alongside disclosure of travel history.
Non-infectious conditions
Crime and unrest
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Crime is the most significant day-to-day safety concern for visitors. Both petty crime and violent crime are prevalent throughout the country. Armed robberies and carjackings occur sporadically, and criminals may resort to force if not immediately cooperated with. Jewellery, mobile phones, and expensive items should not be displayed in public. At ATMs, shield the keypad when entering your PIN and remain alert to surroundings. Congested urban areas are particularly risky at night, and walking alone after dark in Mbabane and Manzini should be avoided.
Demonstrations and protests occur sporadically throughout the country and should be avoided, as gatherings can turn violent without much warning. Taking photographs of certain government buildings, events, and sites may also be prohibited. Travellers should check Smartraveller for current advice before and throughout their trip.
Safety on the roads and elsewhere
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Road conditions in Eswatini are generally reasonable on main paved routes, though rural roads can deteriorate significantly, particularly after rainfall. Driving standards vary and road accidents do occur. Travellers should wear seatbelts at all times, avoid driving at night where possible, and use reputable transport. Carjackings have occurred on both main and secondary roads, and doors should be kept locked and windows raised while driving.
When visiting game reserves and national parks, it is essential to follow all ranger and guide instructions at all times. Animals encountered during guided walks, including rhino, elephant, and lion, present genuine safety hazards, and staying within designated areas and following protocols is not optional.
The extreme heat in the lowveld during summer months, which can exceed 40 degrees Celsius, requires travellers to maintain consistent fluid intake, use sunscreen, and avoid strenuous outdoor activity during the hottest part of the day.
Deep vein thrombosis
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Deep vein thrombosis (DVT) is a blood clot that forms in a deep vein, most commonly in the legs, and the risk can increase during long periods of immobility such as long-haul flights. Reaching Eswatini from Australia usually involves extended travel times, often with a connection through Johannesburg or another regional hub.
To lower the risk, travellers should walk around the cabin regularly, perform simple seated exercises such as ankle circles and calf raises, and drink water consistently throughout the journey. Those with additional risk factors, including previous blood clots, recent surgery, pregnancy, hormonal contraception use, or significant overweight, should discuss whether compression stockings or other preventive measures are appropriate with a travel doctor before departure.