Zanzibar Health 2026: Malaria, Emergencies

The ZIC insurance: what it is and what it costs

Since 1 October 2024, non-resident visitors whose first point of entry into Tanzania is Zanzibar (Unguja and Pemba) must hold the ZIC inbound insurance from the Zanzibar Insurance Corporation. It is a statutory entry requirement, not a normal travel policy.

It is valid for up to 92 days. The best way is to buy it before you fly at inbound.visitzanzibar.go.tz. After payment you get a QR code and an emailed policy document. The QR code can be scanned as you leave the plane. Save it offline and keep it for the whole trip. If you arrive without it, you are sent to a separate counter, apply and pay there, then go on to immigration. I have never seen a guest turned back for a missing ZIC, but the counter costs time, so it is better done at home.

Since 1 October 2026 the mainland has its own policy (NIC, inbound.nicinsurance.co.tz). The insurer depends on your first point of entry into Tanzania, and it is one policy per journey. According to the Zanzibar Insurance Corporation’s notice of 28 September 2026, nobody buys two just because the trip includes both Zanzibar and the mainland, and a valid policy within its 92-day period means no new one on a later entry to either side. Qualifying EAC and SADC travellers are exempt from the mainland requirement only; where Zanzibar is their first entry they still need ZIC. Questions go to ZIC at zichq@zic.co.tz or 080 000 8005.

What ZIC does not replace: its medical cover is limited (about USD 50,000), and it sits on top of your own policy, not instead of it. A private or German Auslandskrankenversicherung is not accepted as a substitute for ZIC, and ZIC is not a substitute for your private cover with evacuation and repatriation. You need both. For the entry process, see the Zanzibar entry requirements.

Malaria on Zanzibar

Travel-health authorities rate the malaria risk as high in all areas of Tanzania below 1,800 m, and Zanzibar sits at sea level. Risk on the island is lower and declining compared with the mainland, but it is not zero, so prophylaxis is standard advice for Zanzibar and more so for a safari-and-beach trip. Risk is generally higher in and after the rainy seasons, but because mosquitoes are present all year, do not plan around a “safe” month.

What I do, for what it is worth. I have never taken malaria tablets, not since 2009 and not since I moved here in 2011. On the beach it is usually not a big deal: the sandy ground drains water and there is more wind. The risk is higher inland, in the centre of the island, where there is less wind and more standing water. Long-term residents and expats generally do not take tablets, while many guests coming from a safari do. Guests decide for themselves, and I am not a doctor, so talk to a travel clinic and decide yourself. Staff of ours who travel to the mainland have caught malaria, got pills at the hospital and recovered quickly; nothing serious in all these years.

Mosquitoes are mostly out after sunset. In the evening I would wear long, light trousers and use repellent. At Matlai we put mosquito coils under the tables.

Protection has three layers, and tablets are only one of them:

• Tablets. Ask a travel clinic, not a general practitioner without tropical training, 4 to 6 weeks before you go.
• Repellent. Use 20% or more DEET, long sleeves and trousers in the evening, and permethrin-treated clothing if you want extra cover (CDC advice).
• A bed net or a screened, air-conditioned room. Ask your accommodation if you are unsure.

Prophylaxis timing

The timing catches people out: starting tablets at the airport is already too late.

Doxycycline is not recommended in pregnancy and can make skin sensitive to sun. All three need a prescription, so fill it at home. Do not count on buying prophylaxis on the island.

If you also visit the mainland, note that the mainland carries a higher malaria risk than Zanzibar, so make sure your course covers those days too.

Dengue: the daytime mosquito

Dengue is present on Zanzibar, and unlike malaria it is spread by mosquitoes that bite during the day. CDC lists no vaccine for travellers to Tanzania, although some European travel institutes mention a dengue vaccine for longer stays, so ask your clinic. For a normal holiday the protection is behaviour:

• Put on DEET (20% or more) every morning, not only at dusk.
• Wear long sleeves and trousers early and late in the day.
• Choose accommodation with window screens or air conditioning.

Symptoms are high fever, severe headache, muscle and joint pain and a rash. See a doctor quickly if they appear, and tell a doctor at home you were in a dengue area if they start after you return.

Vaccinations

Yellow fever is the only vaccine tied to entry: required if you arrive from, or spent more than 12 hours in transit through, a risk country. Direct flights from Europe do not trigger it. The certificate is valid for life.

For travel health the German Federal Foreign Office recommends hepatitis A and polio for Tanzania, with hepatitis B, typhoid, rabies, meningococcal ACWY and others depending on how long you stay and what you do. Your travel clinic will fit this to your trip.

Medical facilities

• Mnazi Mmoja Hospital (Kaunda Road, Stone Town): the only government hospital on Zanzibar and its main referral and teaching hospital. Emergency care is possible; capacity for complex cases is limited.
• Aga Khan Polyclinic (Old Dispensary, Stone Town): a private clinic and the better first stop for non-emergency problems.
• Zanzibar Hyperbaric Chamber: managed by DAN, in the Stone Town area, and the only hyperbaric chamber in Tanzania. It is the destination for decompression sickness.
• MedExpress, Paje: a hospital with a pharmacy on the east coast. It accepts foreign travel insurance and can also come out to Michamvi; a new clinic in Michamvi is planned. The owner is Egyptian, the doctors are a mix of expats and locals, and I rate it very good. Make sure your insurance covers the costs. In all these years we have never had to evacuate a guest; MedExpress would tell us what to do and whom to contact.
• Pharmacies: found in Stone Town and Paje, but stock and quality vary. Bring prescription medicines and malaria tablets from home.

For serious illness or injury, expect evacuation to the mainland or abroad. That is the case for medevac cover.

Evacuation cover: AMREF Flying Doctors

AMREF Flying Doctors runs 24-hour air evacuation. It is not health insurance: it assesses the emergency and provides specialised transport and in-flight stabilisation, and it works alongside your travel insurance.

• Extended Regional visitor rate (includes Zanzibar): USD 30 for 14 days, USD 50 for 2 months (Flying Doctors rates page, 2026).
• 24-hour line: +254 20 699 2299 (Kenya), or +255 684 818 071 in Tanzania.
• Keep the card in your wallet, not in your luggage.

Divers: DAN membership alone mainly gives you access to the emergency network. Check whether your cover pays for treatment of a diving accident in Tanzania before you dive.

Which insurance you actually need

Three separate things, often confused:

1. ZIC (mandatory if Zanzibar is your first entry; NIC if you land on the mainland first). USD 44 per adult, bought at inbound.visitzanzibar.go.tz or at a separate counter on arrival. Without a valid policy you cannot continue to immigration.
2. Your own travel health insurance (essential). It should cover treatment, medical evacuation and repatriation. ZIC does not stand in for it, and public health schemes at home generally do not pay for treatment on Zanzibar.
3. AMREF Flying Doctors (strongly advised). An evacuation service on top of your insurance, from USD 30 for 14 days.

Check that your own policy explicitly includes diving if you dive.

Emergency numbers

Several numbers are in circulation and sources do not agree on routing, so also save your insurer’s 24-hour line and your accommodation’s number before you travel.

Everyday risks

• Sun. This is the most common guest problem I see. We are about 6 degrees south of the equator, and the wind hides the heat, so people burn and dehydrate without noticing. Drink a lot, cover your head, use broad-spectrum SPF 30 or higher and reapply every 2 hours, more often after swimming. Quality sunscreen is hard to find and expensive on the island, so bring enough.
• Heat. Rest in the shade or in air conditioning in the hottest part of the day and keep strenuous activity for early morning or evening.
• Water. Do not drink tap water or use it to brush your teeth. Use sealed or boiled water and avoid ice if you do not know its source.
• Stomach upset. Oral rehydration salts are the first-line treatment. See a doctor if the diarrhoea is bloody, you have a high fever, vomiting will not stop, or it lasts more than a few days.
• Animal bites. Do not touch dogs, monkeys or bats. If bitten or scratched, wash the wound with soap and water for at least 15 minutes and get medical care straight away. Rabies is virtually always fatal once symptoms start, and the vaccine may only be available in larger facilities.
• Sea. Wear reef shoes on the east coast at low tide to avoid sea urchins. Low tide leaves a long, shallow reef flat, so plan swimming around high tide; the east coast tides and villages guide has the detail.

Food and drink

Zanzibar’s food is one of the best parts of the trip, and a few habits keep it that way. Treat tap water as unsafe everywhere, including for teeth and ice. Bottled water is sold everywhere. With seafood, eat it fresh and cooked and ask when it was caught. At street stalls, pick food that is cooked in front of you over dishes that sit warm for hours, and be cautious with uncooked salads where you cannot see how they were washed. Peeled fruit is the safe choice.

First-aid kit

Pack from home: your malaria tablets, DEET repellent, oral rehydration salts, paracetamol or ibuprofen, plasters, antiseptic wipes and tweezers for reef cuts, hydrocortisone cream and insect-bite treatment, and sunscreen. If your doctor prescribes an antibiotic for traveller’s diarrhoea, bring it with its prescription.

Before you go: a checklist

1. 4 to 6 weeks out: see a travel clinic about malaria tablets and vaccines.
2. Before you fly: if Zanzibar is your first stop, buy ZIC at inbound.visitzanzibar.go.tz (NIC if you land on the mainland first) and save the QR code offline. If you forget, do not panic; there is a counter at the airport.
3. Before you fly: confirm your own travel insurance covers medical evacuation, and consider AMREF Flying Doctors.
4. 1 to 2 days before arrival: start Malarone or doxycycline if prescribed.
5. In your bag: repellent, rehydration salts, sunscreen, reef shoes and prescription medicines.

Related guides: the Zanzibar packing list, Zanzibar safety, the best time to visit, Zanzibar with children, the diving guide and the Zanzibar hub. If you are planning the east coast, see where to stay on the east coast, including Matlai.