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Avoiding the dangers of altitude sickness when climbing Kilimanjaro

Climbing Kilimanjaro is the adventure of a lifetime. This iconic mountain has captured the imagination of adventurers for decades.

It’s easy to see why it is so popular. Mount Kilimanjaro is the tallest mountain in Africa and at 5,895 meters, its height has earned its place on the seven summits – which are comprised of the highest mountains on each of the 7 continents.

It is also the tallest mountain worldwide that doesn’t require any technical skills to climb, which makes it accessible to anyone in reasonably good health. Technically speaking, Mount Kilimanjaro is also relatively safe compared to other mountains of similar altitude and the risks are low compared to other mountains.

However, this is not to say that it is easy to reach the summit or that there are no risks involved. Mount Kilimanjaro has a summit success rate of only 60% and it is generally reported that ca. 10 climbers die on Kilimanjaro every year, though we believe the actual number to be a multiple thereof.

The main reason why climbers do not reach the summit is altitude sickness, also known as acute mountain sickness (AMS), caused by the high elevation. Altitude sickness is also the main risk that makes Mount Kilimanjaro a potentially dangerous mountain to climb, especially when compared to other popular touristic mountain destinations.

At 5,895 meters Kilimanjaro is in the extreme altitude zone and almost everyone who climbs it will be affected by altitude sickness, in some way. For most climbers, the symptoms of altitude sickness will remain limited to shortness of breath, dizziness, nausea or headaches; neither of which is dangerous.

When you climb Kilimanjaro, you may feel these altitude effects from as low as 1,500 meters (4,921 feet) above sea level. While such mild symptoms of altitude sickness are not comfortable, you generally do not need to worry much about your health and safety when you experience them.

However, when climbers acclimatize poorly, altitude sickness may become more severe and, in extreme cases, lethal. Beware that altitude sickness can strike suddenly and unexpectedly. Young, fit and healthy climbers are as much at risk of altitude sickness as anyone else. When attempting to climb Kilimanjaro, you are always taking a risk.

With the right advance preparation and planning, however, it is possible to minimize the risks and largely mitigate the effects of altitude sickness, so that you can prevent it from becoming more severe and get adequate treatment when you need it.

This includes choosing the right hiking route, climbing with a responsible Kilimanjaro operator who employs experienced and well-trained guides, and following the golden rules of altitude acclimatization.

Another condition with symptoms similar to altitude sickness and equally dangerous, though much less frequent in Kilimanjaro climbers, is hyponatremia. You can learn more on this directly from a personal trainer and marathon runner who shares her experience with severe hyponatremia whilst climbing Kilimanjaro here.

In this blog, we will discuss the risks and symptoms of altitude sickness in detail, as well as how you can prepare for your Kilimanjaro climb to minimize the dangers of altitude sickness.

What is altitude sickness?

Altitude sickness or acute mountain sickness (AMS) is the side effect caused by exposure to high altitudes. As a person reaches higher altitudes, the air contains less oxygen which begins to negatively affect the human body. Symptoms usually develop from around 2,500 meters of altitude.

First signs of altitude sickness include headache, nausea or shortness of breath. More severe symptoms include dry cough, fever, vomiting or retinal haemorrhage. Extreme cases can include fluid build up in the brain characterized by loss of coordination, confusion, inability to walk and even coma. If left untreated, AMS can be lethal.

If any severe symptoms arise, immediate descent assisted by your guide is imperative to avoid more serious and lasting consequences.

How dangerous is altitude sickness on Kilimanjaro?

Altitude sickness is a serious and potentially dangerous risk when climbing Kilimanjaro. It is the most common cause of tourist deaths on Mount Kilimanjaro and needs to be taken seriously.

Beware that young, fit and healthy climbers are as much at risk as anyone else. Even when taking all the recommended and important precautions and implementing all best practice safety measure, altitude sickness can strike suddenly and unexpectedly, so there's always a risk.

There is currently no public information about the number of people who suffer from severe altitude sickness when climbing Kilimanjaro. We expect that it may be significantly higher than common estimates.

So this leads us on to another question: why do incidents not get reported?

Kilimanjaro is a major source of tourist revenue and income for Tanzania. The local government naturally has an incentive to keep a clean safety record in order to attract more climbers. Therefore, local tour operators are encouraged by the government to keep safety incidents on Kilimanjaro confidential.

Moreover, no tour operator would voluntarily want to disclose their own records. Because even if they are much better than any competitor, it would create the perception that they don't have good Kilimanjaro safety practices if they are the only ones disclosing those incidents.

While the risk of altitude sickness cannot be entirely eliminated when climbing Kilimanjaro, there are ways that you can minimize the risks and largely mitigate the impact. We discuss these in more detail below.

How to prevent altitude sickness

Almost everyone who climbs Kilimanjaro will be affected by the high altitude to some extent. However, you can take steps to prevent altitude sickness from becoming more severe. One of the ways you can do this is by following the 3 golden rules of acclimatization.

The so-called 3 golden rules of altitude acclimatization will help you acclimatize naturally in order to reduce the discomforts and risks associated with altitude sickness. The golden rules are:

  1. Take your time: Choose a route that allows you to ascend slowly over multiple days, and walk slowly during the day.
  2. Stay hydrated: Drink at least 2-3 liters of water every day, or more if in combination with dehydrating substances such as diamox or caffeine.
  3. Walk high, sleep low: Sleep at a lower altitude at night than you've climbed during the day. Some routes offers such a beneficial altitude profile.

This means that the best way to prevent severe altitude sickness in advance is by choosing a longer route with a good altitude profile.

Importance of choosing the right route


Budget and time permitting, we recommend that you take 8 days or more to climb Kilimanjaro. This is in the interest of your safety and summit success chance.

Taking your time helps you to acclimatize naturally to the high altitude and therefore reduces discomforts and the risks of altitude sickness. The better you acclimatize, the more likely you will reach the summit (and safely so).

There is statistical evidence that 7 or 8 days lead to a higher summit success rate than 5 or 6 days. The local helicopter evacuation service also sees a significantly higher need for evacuations on routes of 7 days or less compared to 8 days or more.

Shorter routes that last just 5-6 days are only suitable for experienced climbers who are accustomed to high-altitude climbs.

Importance of choosing the right operator

Choosing a good route goes a long way to reduce your risks of developing severe altitude sickness, but the risk always remains. While climbing, it’s easy to forget about walking slowly and staying hydrated. And even if you follow all the rules diligently, you may develop severe altitude sickness.

A good mountain guide will set the right pace and remind you to drink water, continuously. When you fall sick nevertheless, you will rely 100% on your guide to take correct and immediate action to protect your safety.

Therefore, it is important to climb with a well-trained and experienced guide who can monitor your individual altitude acclimatization, watch out for symptoms of altitude sickness, and – if required – insist on and assist with your descent.

One way to increase your chances of finding a good guide is to book your climb with a KPAP Partner company. KPAP is an abbreviation for the Kilimanjaro Porters Assistance Project, an independent organization that monitors porter treatment practices locally.

Although KPAP does not measure safety criteria, we believe that companies who have demonstrated a commitment to treating their porters fairly are also more likely to be committed to your safety, compared to the industry average. Note many budget operators do not even employ duly licensed guides.

You should also choose a company that is very transparent about the safety standards and equipment included in your climb. If possible, spend a little more on a premium tour that includes a Wilderness First Responder certified guide and emergency oxygen; plus a hyperbaric chamber for overnight stays at Crater Camp is a must.

At Fair Voyage, we offer high safety standards for an affordable price and help you easily compare safety standards across climbing packages.

Symptoms of moderate altitude sickness

Moderate altitude sickness is a little more intense than mild short-term altitude sickness. Fatigue, weakness, and shortness of breath gets worse instead of improving over time.

Climbers may start to experience a loss of coordination and although the person may still be able to walk on their own, it will become more difficult for them to do so. Normal activities will also become more difficult.

This may be accompanied by symptoms of nausea, vomiting, tightness, congestion in the chest and severe headaches that are not relieved by pain medication.

The best remedy when experiencing signs of moderate altitude sickness is immediate descent.

Symptoms of severe altitude sickness

Although all Kilimanjaro climbers may experience mild altitude sickness to some degree, in extreme cases, it can develop into more severe forms, which include HAPE (high altitude pulmonary oedema) and HACE (high-altitude cerebral oedema).

HAPE is excess fluid on the lungs, and if altitude sickness has progressed to this stage, a person may experience shortness of breath while they are resting, coupled with fever and coughing.

Another severe form of altitude sickness is HACE, which is fluid on the brain. Symptoms of HACE include clumsiness, confusion and stumbling.

Sometimes a person with severe altitude sickness may have both HAPE and HACE.

A person suffering from severe altitude sickness may also have a bluish, grey or pale skin tone. In all such cases, immediate descent and emergency treatment is imperative.

What is the best action when experiencing symptoms of moderate altitude sickness?

If you are experiencing moderate symptoms of altitude sickness, then in the interest of your own safety, we recommend immediate descent and hospital treatment. Even if symptoms improve with descent, you should get an immediate health check locally and in any case before continuing your onward journey or boarding a plane, as you may still be at risk of developing more severe forms of altitude sickness.

Some guides may encourage climbers to keep going even if they are suffering from altitude sickness.

This is not recommended. If you notice that your symptoms are getting worse, then you should insist on descending.

What is the best action when experiencing symptoms of severe altitude sickness?

When experiencing symptoms of severe altitude sickness, immediate descent and emergency hospital treatment are mandatory. Most likely, the person suffering from severe altitude sickness will no longer be in a position to descend on their own.

To receive the necessary assistance with emergency evacuation, it is important to be accompanied by an experienced guide, and for the guide to have access to satellite or radio phones for making emergency calls. It is also important to be covered by adequate insurance that covers helicopter evacuation for high altitude activities.

When adequately insured and in case of emergencies, local helicopter evacuation service is available thanks to Kilimanjaro Search & Rescue (KSAR). KSAR also operate a high-altitude medical clinic for Kilimanjaro climbers, open 24/7.

What else can you do for your own safety when experiencing symptoms of altitude sickness?

The key thing here is to remember that altitude sickness can be lethal. Therefore, it is important to be honest with your guide and never try to hide the fact that you are feeling ill.

Although some guides may try to persuade you to keep going even when you are feeling very unwell, you have the right and responsibility to stop when you no longer feel in the position to continue your ascend.

Always remember that summiting is optional, but coming down safely is mandatory. There is no shame in making the difficult decision to descend. Instead, your number one priority is your health and well-being, and you should be proud of how far you’ve come.

By taking the decision to climb Kilimanjaro, you have already achieved far more than most people. So by prioritizing your life and knowing when to call it a day, you will not only stay safe, you will also be setting a good example for other climbers.

What can you do for the safety of your group members?

When you observe moderate or severe symptoms of altitude sickness in any of your group members, try to have an open discussion. Make the climber and your guide aware of what you're observing.

Understand that there are different dynamics at play and remember that the affected climber may not always be in a position to act in their own best interests. Both your guide and the climber may be reluctant to agree on descent.

If this is the case, then try to keep calm and stay factual. Make sure the climber understands that you are concerned about their safety. At the same time, understand that the final decision will rest with the guide.

With the necessary training and experience, having led many climbs and observed many different instances of altitude sickness in others, your guide will know best whether it is safe for the affected climber to continue.

How many guides will there be for my group when climbing Kilimanjaro?

When climbing Kilimanjaro, you must have at most 2 climbers per guide, and at least 2 guides for groups of 2 climbers or more.

This ensures that there will always be enough guides to assist climbers who require descent, while at the same time allowing all other climbers to continue their summit ascent safely.

The minimum guide-to-climber ratios are stipulated by Kilimanjaro National Park regulations and they apply to all climbs booked via Fair Voyage. So for every group, there will always be one lead guide, and we have classified all other guides as assistant guides.

Please beware that guides and companies operating illegally on Kilimanjaro may not adhere to these minimum ratios, which can lead to dangerous, life-threatening situations. While it may be tempting to save costs by booking with a low-budget operator, your financial savings may come at the cost of your own safety.

Minimum ratio of Kilimanjaro climbers per guide for all climbs booked via Fair Voyage:
ClimbersGuides
1 climber1 guide
2 climbers2 guides
3 climbers2 guides
4 climbers2 guides
5 climbers3 guides
6 climbers3 guides
7 climbers4 guides
8 climbers4 guides
9 climbers5 guides
10 climbers5 guides
11 climbers6 guides
12 climbers6 guides

How to find the best Kilimanjaro guide

Currently, there are no objective certifications or ratings which can help you find the best Kilimanjaro guides. However, there are ways that you can increase your chances of finding an experienced and well-trained guide.

Firstly, you should book with a responsible climb operator. They tend to have the best guides, because they are better paid, trained properly and given the resources they need to navigate the mountain.

The two things you want to look for are Wilderness First Responder (WFR) training and CPR first aid training, should you fall ill on the mountain.

Who certifies Kilimanjaro guides for Wilderness First Responder (WFR)?

Kilimanjaro guides have to undergo many hours of practical and theoretical training to obtain their Wilderness First Responder (WFR) certification. Certification is not required by the Kilimanjaro National Park, but something the best tour operators invest in voluntarily for their guides, to ensure highest safety standards for their climbers.

The cost of certification is usually paid by the tour operator.

What motivates guides?

Although many Kilimanjaro guides choose their profession out of passion, remember that guides are human beings that have the same pressures as other people. They usually have a family that relies on their income, including children and elders.

In a country without social security and where people are still working to move up to a higher income level, pay is an important motivator.

Tipping is a major component of pay for all guides, particularly for those that are employed by operators who do not treat their staff fairly. With many very low cost budget operators, guides rely solely on a tip. The highest tips are usually paid by happy climbers after they've reached the summit.

Ask yourself: Would you be willing to give your guide a big tip if he forced you to descend before reaching the summit? As long as you have doubts whether that decision was really necessary and whether you could still have reached the summit, you will be unlikely to reward your guide for keeping you from reaching your dream.

Unfortunately, those hard decisions to force climbers to stop often have to be made by guides under uncertain conditions. You might have made it and stayed safe, or you might have suffered severely – perhaps even with your life – if you had continued to push.

This is why it is important for you to understand that guides have a natural incentive to get you to the summit, even if it is risky. However, this is less likely to happen with an ethical company that pays their porters and guides fairly.

Final thoughts

climbing kilimanjaro

The important thing to remember when climbing Kilimanjaro is that preparation is essential when it comes to mitigating the effects of altitude sickness.

Part of that preparation includes choosing a longer route that lasts at least 8 days, which allows you to acclimatize to the high altitude.

Book your trip with an ethical tour company. They pay your crew fairly which means that your guides rely less on tips and have what they need to help you navigate the mountain safely. The most responsible tour operators will have guides trained in Wilderness First Responder (WFR).

To prepare for possible cases of emergencies, make sure to take out adequate travel medical insurance. Amongst others, your insurance should cover helicopter evacuations and high altitude trekking up to 6,000 meters.

Once on the mountain, the key thing to remember is that if you do fall ill and you are experiencing moderate to severe altitude sickness, then immediate descent is mandatory. You must seek emergency treatment, even if you feel better upon descent.

Kilimanjaro Search & Rescue (KSAR) operate helicopter evacuation services and a high-altitude medical clinic for Kilimanjaro climbers, open 24/7. Watch our interview with KSAR Founder Ivan Braun if you’d like to learn directly from arguably the most knowledgeable expert on Kilimanjaro safety.

By following these basic steps, you can maximize the chances that your Kilimanjaro climb is a safe and enjoyable experience.

At Fair Voyage, we offer personal travel advice, craft unique climbing experiences to accommodate the needs of each person traveling with you, and exclusively operate all our climbs according to highest safety standards.

Ask one of our Kilimanjaro experts to also help you organize a safe and enjoyable climb, or let us know your wishes and we’ll connect you with our best advisor for your needs.

About the author

Alex is our Founder, Visionary and Strategist. She writes about ethical & sustainable travel and conscious leadership. As Kilimanjaro expert, Alex is also personally in charge of all our Kilimanjaro content.