Piracy on the high seas-threats to travelers' health.

Piracy has been threatening international sea trade and creating risk for crews and passengers worldwide. The problem is largely confined to the Somalia coast, West Africa, South America, and Southeast Asia. The targets are merchant ships, cruising yachts, and passenger ships with several thousand people on board. Such attacks can result in loss of lives, short- and long-term health problems, and can further be complicated by the consequences of hostage situations on shore. The purpose of this article is to present the problem of piracy, its relevance to the field of travel medicine, and help travel medicine practitioners to deal with its specifics before, during, and after attack. METHODS: Comprehensive literature research was done and published data from 2002 until 2012 from the International Chamber of Commerce specialized division-International Maritime Bureau (IMB)-on 3, 806 attacks and 7, 635 incidents involving human victims are analyzed. Available occupational health data in merchant marine and epidemiological data acquired on board cruise ships were used to estimate the health risks. RESULTS: From 2002 until 2012, 3, 806 ships were attacked including 82 yachts and 13 passenger ships. A number of reported piracy attacks worldwide continued to threaten security and lives on sea. In 2012, 297 incidents of piracy and armed robbery were reported, a total of 585 crew members were taken hostage, 26 kidnapped, and 6 killed as a direct result of the incident.(1) CONCLUSION: The risk of being injured or killed by pirates on board cruise ships is actually very low. Piracy on the world's seas is in decline and remains a reasonably localized issue. While this improvement is a result of continued efforts of international naval forces, that protection is only partial and fails to suppress piracy completely. Piracy still presents significant threat to international travel, and future involvement of travel medicine practitioners in providing advice to travelers to piracy regions or victims of piracy is expected.