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Cambodia Travel Information

Cambodia has a lot of things to offer to the visitors as must-see sights. Once the preserve of trailblazing backpackers, this formerly war-torn nation is now firmly established on the Asia travel circuit. That luxury yachts ply their trade on Tonle Sap, Southeast Asia’s largest freshwater lake, is a mark of just how far Cambodia has come.
Carving the country in two is the mighty Mekong River, which remains the lifeblood of Cambodia, running as it does from the bustling capital, Phnom Penh, to Vietnam’s Mekong Delta. A journey down this iconic waterway is one of the great pleasures of Southeast Asia – boats of all shapes and sizes drift, chug and spray their way along the Mekong, carrying piglets, clay pots, bananas, motorcycles, and many more.

Away from the water, the ravages of war have become unlikely tourist attractions in Phnom Penh and other cities. Crowds gather at former prison camps and the notorious Killing Fields to contemplate Cambodia’s darkest hour, a period of unimaginable suffering that took place under the brutal regime of Pol Pot.
The crumbling remains of the Khmer Empire are the biggest draw in Cambodia, though. After building up a kingdom that stretched into neighboring Thailand and China, the Khmers fell, leaving behind an extraordinary collection of temple complexes, most notably Angkor Wat, which owns the bragging rights to being the largest religious monument in the world.
Then there are more typical Southeast Asian attractions – frenetic cities crammed with rickshaws, strange and exotic food, blissful beaches, tropical jungles teeming with wildlife, and a densely-forested hinterland full of tribal villages.
There are few places that have been through as much as Cambodia, but this optimistic nation has belied its tumultuous history and emerged as one of the warmest, most welcoming destinations in Southeast Asia.

Geography
Cambodia is bordered by Thailand to the west, by Laos to the north and by Vietnam to the east. It is almost a circular country with a southern coastline giving onto the Gulf of Thailand. The landscape comprises tropical rain forest and fertile cultivated land, with lush highlands rising in both the northeast and southeast. The capital city, Phnom Penh, is situated at the confluence of the Bassac, the Tonle Sap and the mighty Mekong rivers, rivers are one of the beautiful natural gifts given to this country. A large inland lake, also called Tonle Sap, sits close to the Angkor Temple Complex in the north. There are numerous beaches and offshore islands along the southwest coast.

However, Cambodia’s main landscape is its jewel, comprising tropical rain forest and fertile cultivated land, with lush highlands rising in both the north east and south east. This rich, nutritious land also includes a wealth of nature, including rare and endangered species such as Indochinese tigers, Asian elephants and freshwater Irrawaddy dolphins.
Unfortunately Cambodia suffers from high rates of illegal trading in endangered wildlife and logging, and man is fast wiping out these incredible creatures and their habitat. Around Cambodia visitors can find various eco-camps and rain forest preservation trips offering excursions, education and an alternative form of income to locals previously involved in illegal trade.

History
Little is known of the early history of Cambodia, although there is evidence of habitation in parts of the country as far back as 4000BC. It is also known that Chinese and Indian traders exchanged goods with people living on the coasts of present-day Cambodia and Vietnam in the early AD centuries.
According to Chinese chroniclers, a kingdom known as ‘Funan’ flourished between AD300–600. A dynasty founded by the prince Jayavarman – possibly descended from the rulers of Funan – ruled from settlements in the eastern part of the country between around AD790 and the 11th century. During this period Cambodian power spread westwards into parts of Thailand. The golden era of the Khmer dynasty, from the 9th to the 15th centuries, made the kingdom of Kambuja (from where modern-day Cambodia gets its name) one of the most powerful in Asia.
A long period of decline followed, before the country fell under French colonial clutches in the 1800s. Independence was finally achieved in 1953, after which Norodom Sihanouk was appointed king. His first reign lasted until the 1970s, when a coup d’etat and the Khmer Rouge led to four years of repression and the execution of tens of thousands.

Under the leadership of Pol Pot, the Khmer Rouge committed genocide, masquerading it under a policy of social engineering. They executed academics, the wealthy, and even those who wore glasses. In 1979 the Vietnamese army captured Phnom Penh and occupied Cambodia. Sihanouk returned to the throne in 1993. His son, the current monarch, took over, following his father’s abdication in 2004. Politically, Hun Sen and the extreme-left Cambodian People’s Party recently won the 2012 election, with 77% of the votes, and have been in power since a disputed election in 1998.

Cambodia Culture
Religion:
95% of the population are classified Buddhist (Theravada), the remainder are Muslim and Christian. Buddhism was reinstated as the national religion in 1989 after a ban on religious activity in 1975.

Social conventions:
Sensitivity to politically-related subjects in conversation is advisable. Avoid pointing your foot at a person or touching someone on the head, as it’s considered insulting. Women should keep their shoulders covered and should not wear shorts when visiting pagodas.

Photography: Permitted, with certain restrictions such as the photography of military installations, airports and railway stations. It is considered polite to ask permission before photographing Cambodian people, especially monks.

Language in Cambodia
Khmer is the official language and spoken by 95% of the population. Chinese and Vietnamese are also spoken. French was widely spoken until the arrival of the Pol Pot regime and is still taught in schools. English is commonly spoken in Cambodia. It’s estimated that over 50% of the population are conversational in English, but travellers in rural areas may find in hard to communicate in smaller villages. Learning a few basic Khmer words will get you far, and earn you respects from the locals.

Health Precaution and Vaccination
All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.
Medications
Travelers’ diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

Most cases of travelers’ diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

Malaria in Cambodia: prophylaxis is recommended for all areas except the temple complex at Angkor Wat, Phnom Penh, and around Lake Tonle Sap. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given, except for the western provinces of Banteay Meanchey, Battambang, Koh Kong, Odder Meanchey, Pailin, Kampot, Preah Vihear, Pursat, and Siemreap, where mefloquine should not be used because of the presence of mefloquine-resistant malaria in the forested areas near the Thai border. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.
Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.
Insect protection measures are essential.
For further information concerning malaria in Cambodia, including maps showing the risk of malaria in different parts of the country, go to the World Health Organization – Western Pacific Region.

Immunizations
The following are the recommended vaccinations for Cambodia:
Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.
Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Japanese encephalitis vaccine is recommended for those who expect to spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors or engage in extensive outdoor activities in rural or agricultural areas, especially in the evening. Japanese encephalitis is believed to occur throughout Cambodia. The disease is transmitted by mosquito bites, probably from May through October. The recommended vaccine is IXIARO , given 0.5 cc intramuscularly, followed by a second dose 28 days later. The series should be completed at least one week before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children under the age of two months. In addition to vaccination, strict attention to insect protection measures is essential for anyone at risk.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. In Cambodia, the chief risk is from dog bites. Monkeys and other wildlife may also carry rabies and should be avoided. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.
Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

Cholera vaccine is not generally recommended, even though cholera occurs in Cambodia, because most travelers are at low risk of infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.
Outbreaks were reported from Paoy Pet Commune, Banteay Manchey Province in the northwest of the country in June and July of 1998, and from the Rottanakiri province in the northeast in April and May of 1999.
Polio vaccine is not recommended for any adult traveler who completed the recommended childhood immunizations. In October 2000, the World Health Organization certified that polio had been eradicated from the Western Pacific region.

Yellow fever vaccine is required for all travelers arriving from a yellow-fever-infected country in Africa or the Americas and for travelers who have been in transit more than 12 hours in an airport located in a country with risk of yellow fever transmission, but is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccine a fully validated International Certificate of Vaccination. Yellow fever vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs. It should also not be given to those with a history of thymus disease or thymectomy.

Medical information sourced from mdtravelhealth.com

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