Last reviewed 1 August 2018
Gordon Tranter considers employers’ duties and responsibilities as they apply to the health of employees who are sent to work in a different country to where they usually work.
Travelling overseas is an integral part of many Britons’ jobs, with the Office for National Statistics estimating that the number of UK residents traveling abroad for work was 6.8 million in 2017, either on short-term visits or on longer-term assignments. The duty of care employers owe to their workers continues to exist when they are working abroad.
The criminal law set out in the Health and Safety at Work, etc Act 1974 (the HSWA) and in regulations made under the Act does not apply outside the UK. Employees working overseas are subject to the legislation of the country concerned.
Although UK statute law will not apply abroad, the common law “duty of care” which requires employers to protect their workers from reasonably foreseeable hazards applies while they are working abroad in the course of their employment. This allows workers to claim for injuries or loss incurred while working overseas.
In order to show it has fulfilled its duty of care obligations, an organisation needs to be able to demonstrate that, though not a criminal law requirement, the general duties set out in the HSWA and regulations have been applied. In particular, the organisation should carry out a suitable and sufficient risk assessment of all associated risks. This should be communicated to the employee and incorporated into a risk management strategy.
Employers need to protect employees travelling abroad to work from:
risks to their safety, eg harm from unintended occurrences
security threats, ie threats that normally arise from intentional acts
While there is much onus placed on safety and security, health risks are often overlooked, but health is the greatest risk for any employee travelling overseas. Consequently, this feature considers the use of the risk assessment to identify health risks associated with employees travelling overseas to work, and the use of the assessment to develop a comprehensive travel risk management plan.
The risk assessment
The health risks likely to be encountered depend very much on where the employee is travelling to and the mode of transport. Work further afield than European countries can be complex and difficult to manage. Below are some of the risks that should be considered.
Overseas travel may raise additional health-related risks. In fact, one of the largest health risks is not associated with the destination but rather concerns the individual’s existing health conditions. Consequently, every employee travelling abroad should have a pre-travel health risk assessment to ensure that any pre-existing health conditions are not compounded by the overseas travel or work-related activity. This should allow time for any treatment needed to be completed prior to travel. The pre-travel risk assessment should consider the individual’s “fitness for travel”, his or her previous travel experience, the length of the trip and specific health risks at the destination. In some cases it may be necessary to seek advice from a specialist travel health clinic before travel.
The assessment must check whether he or she is up to date with medical and dental check-ups and his or her vaccination history, particularly tetanus, diphtheria, polio and MMR (mumps, measles and rubella). The MMR jab should not be overlooked, because in Asia and Africa children are not vaccinated. Some countries require visitors to have an International Certificate of Vaccination or Prophylaxis (ICVP) before they enter and consequently employees should keep a record of all mandatory vaccinations with them when travelling.
Before travelling, it should be stressed that good travel health involves not only vaccinations and, for example, anti-malaria tablets but it is also the responsibility of the employee to ensure elements such as hand hygiene and safe sex.
Health risks related to the country being visited
The assessment should consider whether there are any specific and special risks to health in relation to the country being visited. It should consider whether immunisation, vaccinations or other treatments are necessary. According to the country, these might include Hepatitis A, B or C, anti-malaria treatments, rabies and cholera. It is important that the necessary courses of immunisations are completed prior to travelling.
The assessment may need to consider the following.
Whether the local water is safe to drink and if water purification tablets are required or if bottled water is readily available. Warn employees that ice should be avoided unless sure that it is made from treated and chlorinated water.
Whether abnormally high or low temperatures are likely to be experienced and whether acclimatisation and/or special clothing will be required.
Whether there are risks from local food and its preparation and handling. Employees should be advised on the precautions based upon personal hygiene, particularly the strict hand washing techniques, they should take to avoid catching diseases that lead to stomach upsets.
Whether the visit is to a country, particularly China, where there are high levels of air pollution in major urban and industrialised areas. Exposure to polluted air may affect those with pre-existing medical disorders such as bronchial, sinus or asthma conditions.
What is the likelihood of bites by insects, spiders, snakes, etc.
There are a variety of health issues arising from the travel itself. It is essential therefore that travellers are provided with sufficient information to protect their health while en route.
Employees taking east–west or west–east long-haul flights should be informed about the effects of jet lag. They should be told about:
the symptoms, which include trouble falling asleep or waking up; tiredness during the day; confusion; general feeling of not being well; headache; irritability; stomach upset; and sore muscles
how to prevent or minimise its effects by not sleeping unless it matches the bedtime of the destination; getting up walking around a few times while awake; drinking plenty of water and avoiding heavy meals, alcohol and caffeine.
Where there are risks of jet lag, the assessment should consider whether the work schedule allows for recovery times and whether it is necessary to use non-economy flights.
Prolonged immobility on long distance travel by air, and also by train, coach or car, can cause deep-vein thrombosis (DVT), where a blood clot develops in a vein, usually in a leg. There are several things that travellers can do to reduce the risk:
wear clothing, including wearing medical compression stockings, that may help circulation
get up and move around at least once an hour
flex the ankles and move the feet if it is necessary to remain seated
drink plenty of water before and during the flight
limit in-flight alcohol consumption.
Travellers should seek medical advice before travelling if they feel they are at risk, ie if they have ever had a DVT or clots in their lungs, have a family history of clotting, have had major surgery especially a hip or knee replacement in the past three months, suffer from heart disease or cancer, or have ever had a stroke.
Malaria is a serious tropical disease spread by mosquitoes. If it is not diagnosed and treated promptly, it can be fatal. Malaria is found in more than 100 countries, mainly in tropical regions of the world, including large areas of Africa and Asia, Central and South America, Haiti and the Dominican Republic, parts of the Middle East and some Pacific islands. The assessment should identify whether the employee is travelling to an area where there is a risk of malaria. The Fit for Travel website has more information about the risk of malaria in specific countries.
Those travelling to countries where there is a high risk of malaria should be made aware of the risk and the symptoms of malaria. They should consult a medical expert as to whether they need to take malaria prevention tablets and it must be emphasised that they must finish the course. Advice should be given on the steps necessary to avoid mosquito bites including by using insect repellent, covering the arms and legs, and using an insecticide-treated mosquito net.
Any employee who develops malaria symptoms in the period up to a year after he or she has left a malarial region should seek immediate medical advice. More information is available at NHS Choices: Malaria — Prevention.
Rabies is an acute viral infection of the nervous system caused by bites by infected animals, usually dogs. Once its symptoms develop in human beings, the disease is usually fatal. Employees should be told to avoid touching any animal, whether wild, stray or apparently tame. They should be aware that, if they are bitten by an animal while overseas, “post-exposure” treatment given early enough will usually prevent the disease developing. They should wash the wound immediately, using soap or detergent, or flush with clean water, apply alcohol and get medical attention immediately.
More information is available at NHS Choices: Rabies.
Many employees will encounter hot, cold or humid weather extremes. They should be informed about the risks and precautions required, such as the risks from solar radiation and the precautions needed to counter them. Those whose work takes them to cold climates should be advised on suitable clothing. Cold weather puts an extra strain on the heart, so employees who have heart disease or high blood pressure should consult their doctor about their activity level in the cold.
There is a higher incidence of mental health problems and stress among travelling employees than non-travellers. Travelling abroad for work purposes, particularly for long periods, can lead to feelings of isolation and anxiety and affect employees’ emotional wellbeing. Under the stress of travel, pre-existing mental disorders can be exacerbated. Furthermore, for those people with a predisposition towards mental disorders, such a disorder may emerge for the first time during travel.
Factors that can increase the risk of stress include:
separation from family and familiar social support systems
difficulties adjusting to foreign cultures
unfamiliar threats to health and safety
fear of greater workload on return
personal and family concerns
lack of rest upon return.
The risk management strategy should include steps to reduce the risks of stress. These include giving practical tips and advice, eg on the cultural differences they are likely to encounter. Many employers have a maximum number of days per year that their employees travel or work overseas.
Not only should the risk management system for the overseas travel include the actions required to minimise the risks to the employee’s health but it should also include plans for what to do if things go wrong. The plans for emergencies should consider all sensibly feasible situations. There should be assessment of whether a first-aid kit is required, of the adequacy of local healthcare and the accessibility of medical services. There should be comprehensive travel insurance that includes emergency medical repatriation.
Employees should be advised to pack sufficient medication for the duration of their travel. They should take a letter from their doctor or a personal health record card giving details of the drug(s) prescribed in case they are questioned by customs officials or run out of medication while away.
During the air travel disruption in 2010 caused by the ash cloud from the Eyjafjallajokull eruption in Iceland, one of the main issues for people stuck abroad was individuals running out of personal medical supplies and not knowing where or how to obtain more.
Those employees travelling by air should be made aware that there are restrictions concerning what liquids and gels can be taken on planes in carry-on bags. Medicines can be carried in hand luggage and should be placed in a transparent bag, and prescribed medications should be kept in their original packaging with a prescription or supporting letter from the doctor confirming that the medication is prescribed for the particular traveller and bearing his or her signature and a formal letterhead.
The company’s health and safety policy should include the framework for protecting employees’ health while travelling overseas on the organisation’s business. It should cover the duties and responsibilities to employees travelling to and working in countries that are not where they usually work. It should outline the procedure to prevent, protect and mitigate incidents. It should respond to incidents before, during and after travel and not subject staff to a lower standard of safety just because they happen to be working abroad. The policy should also include the employee’s responsibilities.
The assessment should be reviewed if there are any changes in the circumstances of the employee while travelling for the company. It also is good practice to review the assessment upon the traveller’s return to see if there are any lessons for future journeys.
Palfrey v ARC Offshore Ltd
An employee contracted a fatal malarial infection when travelling to work on an oil rig in West Africa. Mr Palfrey was told by his employer that he did not need to be concerned about the risk of malaria because he would be working offshore on an oil rig, where there was no risk of being bitten by a mosquito. As a result, he took no anti-malarial medication before or during his trip. After being bitten by a mosquito during an overnight stay on an island on the way to the oil rig, he contracted malaria, which turned out to be fatal. The High Court found that there was a clear failure on the part of the employer to take reasonable care to ensure the safety of Mr Palfrey during his employment, which included not only his work on the oil rig but also his travel to and from the oil rig.
Cawthorn v Freshfields
Gillian Cawthorne a trainee solicitor with law firm Freshfields, won substantial damages in settlement of a claim for personal injuries after she contracted shigella dysentery while working in Ghana. She successfully claimed that her employer was negligent for not ensuring that she had received the proper vaccinations or providing her with dietary and other preventative health advice.