The Healthcare System in Djibouti: Public, Private, Access to Care and Health Risks

Djiboutian healthcare consists of public facilities and a private sector, concentrated in Djibouti City, for more than a million inhabitants according to the World Bank. World Bank indicators show a system with limited means: very low current health expenditure per capita, fewer than one doctor per 1,000 inhabitants and life expectancy of about 66 years. Households directly finance nearly 30% of health expenditure.

France Diplomatie names no healthcare facility and describes no medical evacuation procedure. The pages of the French embassy in Djibouti refer to the ‘Social – Health’ section for social assistance and to the ‘Coverage of healthcare costs’ page, which reminds readers that the French State does not pay healthcare costs in the event of hospitalisation, medical care abroad or repatriation for health reasons.

Djibouti is not on the list of States linked to France by a social security agreement published by CLEISS (the French liaison centre for social security abroad): the carte Vitale opens no rights there, and there is no coordination between the two schemes. An employee recruited locally comes in principle under the Djiboutian scheme to which the employer contributes; the extent of benefits, the facilities concerned and the conditions of access for a foreign employee should be confirmed with the Djiboutian social security fund and the employer, as the official pages consulted do not detail them.

For self-employed people, retirees, families and tourists, there is no scheme open as of right: cover comes through the CFE (Caisse des Français de l’Étranger, the French expatriate social security fund), international health insurance or, for a seconded employee, continuation of the French scheme. Law No. 201/AN/07 (art. 5 para. 4) requires every foreigner to show means of subsistence and repatriation guarantees. The page on healthcare reimbursement in Djibouti details each situation.

The official pages consulted do not describe a family-doctor system comparable to that of France: a resident chooses a doctor or a facility according to their cover, checking with their insurer the conditions of direct payment. France Diplomatie recommends consulting your family doctor or an international vaccination centre, and possibly your dentist, before departure.

The French embassy in Djibouti publishes the police on 17, the fire brigade on 18 and the coastguard on 1500, as well as a telephone duty line for a French national needing emergency assistance, +253 77 86 32 93, which must in no case be used for visa questions. The France Consulaire service answers Monday to Friday, from 8 a.m. to 4 p.m., Paris time. It is advisable to save as well the number of the assistance provider in your contract and the address of the facility closest to home.

France Diplomatie recommends taking only the medicines strictly needed, in their original packaging, with a prescription written using the international nonproprietary name, and checking that they are authorised in Djibouti. It asks travellers never to take medicines bought on the street, because of the risk of counterfeits.

For a chronic illness, a recent medical report, the insurer’s prior agreement on coverage of treatments and a sufficient supply for the length of the stay make settling in easier. The heat also calls for checking the storage conditions of some medicines.

The French vaccination schedule must be up to date (diphtheria, tetanus, polio, whooping cough, measles). Depending on the profile, France Diplomatie mentions yellow fever (mandatory for travellers coming from endemic areas, preferably ten days before departure), hepatitis A and B, typhoid, tuberculosis for children under 15 on frequent or prolonged stays, rabies, chikungunya, dengue and mpox in the event of risk exposure.

Cases of chikungunya, dengue and malaria are recorded all year round in Djibouti; Zika calls for a consultation before departure for pregnant women or those planning a pregnancy. Added to these are cholera, hepatitis A, mpox, polio, rabies and tuberculosis. Prevention rests on protection against mosquitoes (covering clothing, repellents, mosquito nets, elimination of standing water), food hygiene, safe drinking water, prevention of sexually transmitted infections and caution around animals, swimming, the road, heat and venomous bites or stings.

Before departure, a check-up with the family doctor and the dentist, which France Diplomatie recommends, avoids having to look for scheduled care on the spot. The vaccination record is up to date, usual treatments are taken in sufficient quantity with a prescription using the international nonproprietary name, and the insurance contract is checked on three points: cover for evacuation, handling of pre-existing conditions and conditions of direct payment.

On the spot, it is useful to save the numbers of the embassy and the assistance provider, to register with the Ariane system and to protect yourself from the heat: temperatures often above 40 °C from May to October, caution in sporting activities, hydration, caution around venomous bites or stings and swimming (stingrays, corals, sea urchins). When travelling outside the capital, France Diplomatie advises travelling with a water reserve of eight litres per day per person.

An assistance contract or insurance covering all medical costs (surgery, hospitalisation) and medical repatriation is judged essential by France Diplomatie: the embassy in no case pays them. The contract is compared on the annual ceiling, evacuation to a better-equipped country or to France, the handling of pre-existing conditions and direct payment. As the conditions of stay are tied to proof of repatriation guarantees, an insurance certificate should be kept on you.

The notions of medical evacuation and medical repatriation help to read the offers; the page on expat health insurance presents the solutions, and Expavy helps to compare them against your situation. For settling in, see living in Djibouti.