Yes, it can, though for most healthy travellers the effects are mild. Addis Ababa is one of the highest capital cities in the world, and the altitude can be the first thing you notice after landing: a slight shortness of breath on the stairs, or a restless first night's sleep. It's worth understanding, especially if you have a health condition or plan to head straight up to Entoto.

It's also a good reason to make your arrival easy. Rather than dragging bags to a taxi rank after a long flight, you can have one of our Ethiopia Driver team meet you in the Bole arrivals hall and take you straight to your hotel to rest.

How high is Addis Ababa?

You'll see several figures quoted, because the city spreads across hilly ground. The most commonly cited elevation is about 2,355 m (7,726 ft), and rounded figures of 2,400 m or 2,500 m also appear. All describe the same thing: a high plateau city.

• Bole International Airport: about 2,330 m, around the city's lowest point on its southern edge. You land at altitude with no gradual climb.
• Central Addis: roughly 2,300–2,400 m.
• Entoto Mountains, on the northern edge: rising to over 3,000 m.
• World ranking: usually listed as the fourth-highest capital in the world, after La Paz, Quito and Bogotá, and the highest in Africa.

Can you get altitude sickness in Addis Ababa?

It's possible, but serious problems are uncommon at this height. Altitude sickness usually happens above about 2,450–2,500 m (around 8,000 ft), but susceptible people can be affected lower down. Addis sits just under that line, and the Entoto heights are above it.

That's why altitude sickness is listed as a risk in parts of Ethiopia, including Addis Ababa, and why travellers are told to know the symptoms before they arrive.

One point surprises people: training and physical fitness do not affect your risk. It's hard to predict who will feel it, so plan an easy start whatever shape you are in.

What does altitude feel like?

Mild effects are common and usually fade as your body adjusts. The main symptoms of altitude sickness are:

• A headache.
• Loss of appetite, or feeling or being sick.
• Feeling tired or exhausted, or dizzy.
• Difficulty sleeping.

Acute mountain sickness (AMS) is the medical name for this. Symptoms usually begin within hours of arriving at altitude, anywhere from about 2 to 12 hours. An estimated 9–25% of unacclimatised people going to 2,000–3,000 m develop AMS, so a minority of arrivals may feel unwell for a day. Symptoms usually get better within one to three days of resting at the same altitude.

How can you reduce the effects of altitude?

1. Take the first day or two gently. Avoid alcohol and heavy exercise for the first 48 hours at altitude. Addis is a little lower than the usual threshold, but the same approach is sensible: walk, don't run, and save the gym and long hikes for later.
2. Drink enough water. Drink enough to avoid getting dehydrated, and stick to safe drinking water in Ethiopia.
3. Don't go straight up to Entoto. Avoid going higher on your first day. The Entoto heights rise above 3,000 m, so save them for your second or third day.
4. Go lower if you are struggling. If symptoms get worse or don't improve after a day, go 300–1,000 m lower if you can. Much of Ethiopia is lower than Addis, but lower areas can carry malaria risk, so ask a travel clinic before you go.
5. Protect yourself from the sun. UV levels rise by about 10% for every 1,000 m of altitude. The cool air can hide how strong the sun is.
6. Ask your doctor about medication. Some travellers who know they are susceptible use preventive medicine such as acetazolamide. That is a decision for your doctor, not a travel blog.

A private car helps you pace yourself in those first days. Instead of walking between sights in thin air, a driver by the day drops you at the door of each stop and picks you up again, and when you're ready for Entoto on day two or three, the car takes you up the hill and waits while you explore.

Who should talk to a doctor before travelling?

Talk to a doctor familiar with high-altitude medicine before the trip if you have heart or lung disease, diabetes, obstructive sleep apnoea or sickle cell trait, or if you are pregnant. People with sickle cell anaemia or severe pulmonary hypertension should not travel to high elevations. If that sounds like you, ask specifically about flying straight to around 2,300 m, since there is no gradual ascent when you land in Addis.

Make sure your travel insurance covers the whole itinerary and activities, which matters if you plan to hike in highland areas.

Does altitude affect anything else?

If you come to Addis to run or plan to hike in the hills around the city, expect your pace to drop at first. Altitude is also why the city stays mild all year despite being near the equator: in the dry season daytime highs are usually no more than about 23 °C, while nights can fall to 5–10 °C. Pack a warm layer, and see our guide to what to wear in Ethiopia.

The bottom line: most healthy travellers settle into Addis within a few days, often with nothing worse than a few puffed-out moments on the stairs. Plan an easy first day and you give your body the best start.