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Comoros
Risk:
Moderate
Health Overview
Comoros is Level 2 — ambulance services are limited in Moroni and very limited in rural areas. No permanent US presence (consular via Antananarivo Madagascar). P. falciparum malaria high risk all three islands. Mount Karthala active volcano (Grande Comore). CBD/cannabis illegal even with prescription. Coelacanths found in Comorian waters. Cyclone season Nov-April.
Key Health Risks
High
Healthcare Infrastructure
Ambulance services are limited in Moroni and very limited in rural areas (State Dept, January 2026) — do not count on one arriving. Healthcare limited to Moroni; very limited rural/outer islands. Cash payment before treatment. US Embassy Madagascar cannot provide on-ground help. Any serious condition = medevac.
Moderate
Political Unrest
Protests spontaneous in Moroni; have turned violent. Elections trigger unrest historically. US gov't personnel require prior approval for ALL travel to Comoros.
High
Malaria
P. falciparum all three islands; CQ-resistant. Year-round. Limited ambulance availability means febrile emergencies may require self-transport. Carry RDT and standby Coartem.
Health Risk Callout
Ambulance services are limited in Moroni and very limited elsewhere — that is the defining clinical reality. In a malaria emergency or a cardiac arrest, plan to arrange your own transport. Medevac insurance; malaria RDT; standby Coartem; inter-island evacuation plan all non-negotiable.
Other Health Risks
Mpox (clade Ib confirmed January 2026, travel-linked to Madagascar — see the CDC advisory field; avoid close contact with anyone who has an unexplained rash, and seek evaluation for any new rash illness during or after travel); Cholera (periodic); Schistosomiasis (freshwater); Mount Karthala active volcano (2005/2007); Cyclone season Nov-Apr; inter-island boat safety (capsizings/fatalities); piracy (small craft); non-traditional healer deaths documented; CBD/cannabis illegal (even prescriptions)
Regional Information
Regional Risk Callout
Grande Comore (Moroni; most healthcare; protest frequency). Anjouan (separatist tensions history; more limited care). Mohéli (smallest; most remote; least infrastructure). Inter-island boats: poorly regulated; capsizings; fatalities documented.
Regional Healthcare Callout
Outside Moroni: extremely limited. Anjouan (Mutsamudu): basic only. Mohéli: minimal. No reliable regulated ferry system.
Vaccine and Malaria Prevention
💉 Entry Vaccine Required
No vaccines required for entry. Visa on arrival (30-500 EUR cash). CBD/cannabis/marijuana ILLEGAL even with prescription. Same-sex illegal (5 years). Photography of government/military illegal.
🛡️ Recommended Vaccines
Typhoid; Hep A; Hep B; Malaria prophylaxis (P. falciparum; CQ-resistant; all islands); routine (MMR; Tdap). YF NOT required and NOT recommended (Comoros not on WHO YF list). FAA has NOT assessed Comoros aviation.
🦟 Malaria Information
- Risk Level: High
- Areas: All three islands year-round (Grande Comore; Anjouan; Mohéli)
- Recommended Drug: Atovaquone-proguanil; Doxycycline; Mefloquine; Tafenoquine
- Drug Resistance: Yes
P. falciparum dominant; CQ-resistant. Year-round all islands. Ambulance availability is limited — febrile illness is a potential emergency requiring self-arranged transport. Carry standby Coartem and malaria RDT.
Moderate
Physician Note
Dr. Robert
Emergency Medicine · 25+ Years · 40+ Countries
Comoros: the State Department describes ambulance services as limited in Moroni and very limited in rural areas. Level 2 sounds manageable; that sentence sounds like something else entirely. Malaria prophylaxis; a medevac plan that does not depend on emergency services; complete pharmaceutical self-sufficiency.
CBD prohibition catches travelers who don't read fine print. Coelacanths in Comorian waters — extraordinary marine environment for self-sufficient ecotravelers.
Pre-Departure Checklist
8+ Weeks
- Be sure to consult your Dr. prior to travel to discuss
- CDC recommends Malaria prophylaxis + standby Coartem + RDT
- Typhoid
- Hep A/B
- MMR/Tdap.
- All medications for entire trip.
- Medevac insurance.
- Do NOT carry CBD/cannabis.
2-4 Weeks
- STEP
- Embassy Antananarivo +261-20-23-480-00
- Political calendar research
- Mayotte/Réunion evacuation route.
Day Of
- Police 117
- Fire 113 or 114
- Ambulance services are limited in Moroni and very limited in rural areas — arrange your own transport to a facility
- US Embassy Antananarivo +261-20-23-480-00 (main and after-hours).
Trip Type Guidance
Mission
- Some faith-based (Islamic aid) and NGO operations. Marine/ecotourism: coelacanth encounters
- Pristine reefs
- Sea turtles (experienced self-sufficient ecotravelers only).
Notes
Special Evacuation Notes
No US presence in Comoros — consular via Antananarivo Madagascar. Medevac from Moroni (HAH) to Mayotte (~30 min); Réunion (~1.5 hours); Nairobi (~2.5 hours). Ambulance services are limited in Moroni and very limited in rural areas — plan self-arranged transport for all emergencies.
Safety Notes
Avoid demonstrations (violent history). No photography of govt/military. Same-sex illegal (5 years). CBD/cannabis illegal even with prescription. Inter-island boats: avoid overcrowded/no life jackets. Ambulance availability is limited — know your own transport plan.
partner recommendation
Medical Evacuation & Assistance
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Good For
Mission