Assuming that holiday illness complaints are a scam could be a ‘recipe for disaster’, says Professor Rodney Cartwright and Dr Esteban Delgado

“Not another client complaint of stomach upset whilst on holiday. We know it is probably another scam. Let’s ignore it for a while.”

This can be a recipe for disaster. It is true that there has been a major upsurge in unsubstantiated claims for recompense due to a stomach upset whilst on holiday.

This has been particularly true in association with Spanish resorts and has featured in the British press with pictures of vans advertising the services of claims legal firms.

In the 1970s and 1980s some resorts in Spain and Portugal were associated with medically proven high rates of stomach upsets amongst British travellers. Data from tour operators in the 1980s revealed rates of above 50% in some well known resorts.

This data was collected by way of a question regarding health on the Client Satisfaction Questionnaires (CSQ) used by major tour operators. The same question is used by all the participating operators and records stomach upsets on holiday which last for more than 24 hours.

As all major tour operators use the same question, it has made it possible to combine the participating operator’s results to produce a monthly report, by holiday region, for the Abta Health and Safety Committee. This study was started in 1982 and with a few modifications since then continues today.

Although purely subjective and is not medically substantiated, it has and still does provide information on regions worthy of further investigation. Experience has also shown it to be a useful measure to show if remedial actions have been successful. Results have even been used in discussions with Ministers of Tourism and municipality officials.

Following the sharing of information with municipalities in Spain and Portugal, major investment programmes in improving drinking water supplies, sewage disposal systems and in developing and food and general hygiene training were undertaken. There was a rapid and dramatic reduction in stomach upsets among tourists as recorded by the CSQs.

Over the past few years, this study has not shown any increase in reported stomach upsets amongst tourists returning from the Balearics, the Canaries or Mainland Spain. Neither have individual tour operators reported an increase in complaints to resort staff, a very different situation from the years when the CSQ results recorded a high incidence.

The CSQ analysis, developed and run for many years by Professor Rodney Cartwright, is now undertaken by Dr Esteban Delgado of Preverisk. Preverisk has developed a comprehensive health and safety training/monitoring package which is currently used in many countries. Their data doesn’t reveal any increase in reported illness to hoteliers in Spain and the Balearics either.

Abta and Dr Delgado maintains a good working relationship with the Travel and Migrant Health Section of Public Health England. This section correlates reports of known travellers who have returned to England and Wales and from whom a stomach upset causing bug has been isolated.

This has proven very useful in identifying the cause of stomach illness outbreaks in resorts. In the late 1990s and early 2000s, high numbers of stomach upsets amongst tourists returning from Mainland Spain and Majorca, were shown to be due to Salmonella and Cryptosporidium. There has not however, been any such increase in reports of stomach bugs from Mainland Spain and the Balearics over the past few years.

Thus, this evidence from various unrelated sources is consistent and doesn’t show any increase in stomach upsets amongst tourists returning from Mainland Spain, the Canaries or the Balearics that correlates with the rise in numbers of litigation claims.

The reaction to “ignore claims for a bit” does therefore seem very reasonable, so why may it be a recipe for disaster. In spite of all efforts to maintain high hygiene levels and correct food and water practices, whether in this country or abroad, stomach infections and upsets can still occur and be real.

It is essential that they are recognised at the earliest opportunity so that the tourist, now the patient, can receive the appropriate treatment and relevant measures can be put in place to prevent any spread or new cases occurring. This may require action by the hotelier, resort public health departments, external health and hygiene consultants and tour operators.

Failure to react accordingly and take the appropriate action could lead to serious consequences for tourists, hoteliers and tour operators. Real cases may well be hidden amongst the myriad of false claims and the saying “crying wolf” is a very real danger. Every complaint could be real and supportive evidence should always be sought.


Professor Rodney Cartwright, MB, FRCPath, Hon FRSPH, Hon FSoPHE, Hon FCIPHE

Rodney Qualified in medicine from Birmingham University and later specialised in medical microbiology and infectious disease. Most of his working life was in the Public Health Laboratory Service where he developed an interest and expertise in travel associated infections and their prevention, and in water borne diseases. He was appointed a Visiting Professor at the University of Surrey.

Although initially concentrating on the clinical aspects of infections he later recognized the importance of a public health approach to the prevention of infections. His involvement with the Royal Society for Public health emphasized to him the importance of a multidisciplinary approach and he developed working liaisons with both the UK package holiday industry and with water companies.

He introduced the health question in the major tour operators’ Client Satisfaction Questionnaires, the results of which have led to major improvements in the public health infrastructures in many tourist destinations. His work took him to many different countries interfacing with governments and local municipalities. He was awarded Honorary Fellowships of the Royal Society tor Public Health, the Society of Public Health Engineers and the Chartered Institute of Plumbing and Heating Engineering.

Dr Esteban Delgado, PhD, FRSPH, MAE

Esteban holds a Degree and PhD in Biological Sciences from the University of Balearic Islands (Spain). He is a practising member of The Academy of Experts of London, a Fellow of the Royal Society of Public Health (UK) and an International Member of the Worshipful Company of Plumbers, City of London.

Since April 2008 he has been giving advice in Public Health to the FTO/ABTA. He also carries out health data analysis obtained through the CSQs for the main British Tour Operators and ABTA/FTO. He has participated at several conferences / consultations with the WTO and the WHO.

Currently he is mainly involved in Public Health and Tourism, assisting senior managers and board members to plan and implement their own environmental safety programmes, risk management systems and crisis management programmes.