UKC

I was intrigued by a guided tour up Mount Toubkal in Morocco, but I’m a backpacker, so no expert on altitude sickness.

Is 1466m of ascent reasonable after what they call three days acclimatisation -
Day 1&2 Marrakech 466m
Day 3 Transfer to Imi Oughlad 1350m then walking - Tizi n’Tacht Pass 2100m - Tizi Oussem 1800m

Day 4 Imlil 1740m - Refuge Toubkal 3206m (+1466m)

I see that the NHS suggest no more than 500m once above 2500m.

I saw a video of it on YouTube and they got altitude sickness.

TIA

Effectively you are going straight to overnight at 3200m after one day at 1800m.  That's probably on the limit and will cause a range of problems from mild headache, breathlessness, sleeplessness to pounding headaches and nausea.  Or, possibly AMS (acute mountain sickness).

If you haven't been to altitude before, then it's not possible to predict how bad you'll feel overnight and on the summit day (which I assume follows).

I think it's very unlikely, although certainly not impossible, that you would get seriously ill from this plan. But a headache and difficulty sleeping wouldn't surprise me.

Very hard to say Toubkal is just over 4000m and alot of people manage ascents on day two/three with little acclimatisation to that elevation with only one night at height +3000m, on Toubkal, in the alps and elsewhere.

Equally people can feel shit, and a few have serious problems. 

For a guided group it’s a bit gung-ho, also its generally considered better to nip up and down (assuming cardiovascular fit and healthy) to reduce risks, but that is unlikely with a guided party whom will have a mixed range of fitness.  I don’t know your age but the German alpine club did some accident stats and middle aged men pushing hard at altitude thinking they were still young predominated the heart attack tables.

If the guided party has contingency in place so that you can, or other party members can easily loose height if feeling unwell, without turning the whole party around (or having to have a whole party conflab/agreement) then it might be worth considering. Otherwise a couple of extra days acclimatisation would significantly improve your chances and pleasure.

I once did the Dom> 4600m ish on day two of an alpine trip and felt shit. But previously had done low 4000m peaks other trips on day two/three without issue.
 

Best case you'll hardly notice. Worst case you could die. Probably somewhere in between. No way of knowing if you don't have experience with altitude. Good chance you'll just feel crap and have to descend without going to the summit.

It's an odd schedule isn't it, just adding one day in would make a vast difference to group safety, well being and success. The extra cost could easily be justified by what should be near 100% happy customers. 

It simply cannot be predicted.  I had been climbing >4000 metres for over 40 years with nothing more than a headache and no acclimatisation then one year it floored me completely.  Having said that most people benefit from spending at least one night above 3000 metres beforehand.

People vary. Your day walking to 2100m will help a little.

I walked from Imlil to the Neltner one day and went up Toubkal the next. At some point above the hut, I don't recall the altitude, I slowed down and it was 5 steps and rest, 5 steps and rest all the way to the top. I didn't feel ill, but then you're up and down in a few hours. You do have to be patient and be aware of feeling unwell as opposed to just knackered. FWIW I don't do altitude well, I really notice the effects at over c.2500m which is quite low for it to become debilitating.

Enjoy the trip anyway, stunningly beautiful and the people are nice.  

Surely it depends on the exertion to gain the height, I've been from drinking beer at 400m to 2962m (by train) in 2 hours and the only difference was the price of the beer.

One of my climbing partners did Mont Blanc after 5 days around the world so 46 hrs flying then just went up the mountain. The NHS is possibly not the most reliable source of information!

I think the NHS information is pretty sound and your partner rather unusual!

46 hours in aircraft cabins pressurized at 8000 feet must have helped a bit!

That was my thinking, combined with 48hrs rest. 

I once went from Bristol to the refuge in a day. Was absolutely fine as was the rest of the group I was with.

One year we stayed in Imlil for one night straight from the airport and left very early in the morning, again no problems. 

Both times were in February so it was cold and de-hydration wasn't a problem.

Interesting to see how A/S affects people differently. Tourists passing out in the queue to the midi lift comes to mind.

Completely unpredictable. Only one night of proper acclimatisation is not very much. HAPE or HACE would be very unlikely but personally I would feel really rough. I climbed Toubkal as a solo walker a few years ago. I played it safe as I was on my own and walked from Imlil up to the refuge day one, spent a day acclimatising. Then on the third I climbed the mountain and descended all the way to Imlil. Have a great trip, its an interesting place.

I did Imlil to the summit and back in one single 12 hour push, made it back to the hotel just as a lovely terrine was being put out on the table. I was in my late 20s and quite fit at the time, it was fine but did feel a little light headed at the top, breathing was nothing out of the ordinary for the work done.

I have found in the past that I acclimatise quite slowly but what you describe is a bit like going from Grindelwald to the Monchsjochshutte or Arolla to the Dix or Vignettes huts, both of which I’ve done on day 2 of a trip with no more than a slight headache and some Cheyne-Stokes breathlessness. I was very slow ascending Mont Blanc du Cheilon on day 3, mind, at just under 3900 m. My guess would be no major health risk but equally a limited ability to actually enjoy the climb. 
(After the Vignettes, we were snowed off Mont Blanc and had to go back a week later after another few ascents at 4000m+ and I actually enjoyed the ascent at the time as well as in retrospect!)

Fascinating to hear all of your experiences, many thanks !

There will be several here who've done 'matterhorn madness', exit work pm friday, return by monday am, summit matterhorn in between. You just need an ability or willingness to suffer, plus ideally a driver for between the airports. 

And probably several who had to abandon the attempt because of lack of acclimatisation.

Altitude sickness should be taken seriously.  Worst case is you could die, but this is probably unlikely, especially if you or your companions recognise the symptoms and you are able to descend.. The more likely outcome of inadequate acclimatisation is that you will struggle for breath and not enjoy the experience very much.

A few years ago I attempted Mt Blanc.  We'd had time for only one acclimatisation climb, but in order to catch a weather window we went for it anyway.  I really struggled once we left the Gouter hut, I was really slow and by the time we reached the Vallot Hut (4362m) my feet were moving but I wasn't making any forward progress.  I baled out there, but my companions carried on and summited.  I guess all this shows is that different people respond differently, and it's unpredictable. 

I did this as well as some other mountaineering bits in the winter some years ago. It was a great trip and my first time at real altitude. I got sick after walking from Imlil to the refuge. We carried all of our heavy kit, had no guides, and to be honest I think we just pushed a bit too hard on that first day / didn’t drink enough. I actually felt fine until I got to the refuge and then it hit me hard. Spent maybe 5 hours dry heaving and feeling unable to keep my eyes open. Had a sleep, woke up and felt fine… no problems for the rest of the week up there 

Of course, people who aim at this challenge aren't novices, so usually have some fitness in reserve etc.. 

But, how many have died from AMS in the alps, yeah you'll suffer if you rush your plans, you might need to retreat, but it's not like being at 6000m and having to descend quickly at the warning signs, or be rushed down later if ignored. 

Being fit doesn't provide protection against altitude, although it might help you push through. 

It's very rare, but it happens.  This study showed 3 fatalities over the period 2009-2020, and there were others which required rescue but weren't life-threatening.  However AMS can be a contributory factor in other accidents.  It is nevertheless a concern, but most alpinists are aware and it is usually possible to descent rapidly if they get symptoms. 

https://pubmed.ncbi.nlm.nih.gov/35055685/

Years ago a young and fit friend died on Mt Kenya at about only 3500m. Perhaps that's why I take AMS seriously even at lower altitudes.

That's my main point, this itinerary seems a bit rushed and the most likely effect of altitude is that they will suffer and won't enjoy the trip much. 

It'll be much better going more slowly. That's a large ascent alone and that won't be as enjoyable most likely. Fitness will help in the exercise portion of the trek but your body will respond to it as it will, sometimes at random and sometimes purely in response to other issues.

Recently I had the unfortunate luck of developing a couple of infections on a trek (or likely immediately before) which likely resulted in what doctors thought was a massively fast development from no AMS symptoms (really - no headache, no nausea etc) to a temperature and serious levels of HAPE and needing a helivac. The highest I got to was around 3900m and our largest gain on the trip by then was around 900m (but we had gone up/down for it). The same day I got to that high point, I knew something was very wrong as my heart rate and ability to breathe did not line up, and by late that evening as I tried to sleep I went south pretty quick.

I really want to return and re-try but now I have to be ultra careful, likely take additional medication, and will have to go independently to plan several days of rest at specific spots. 

In my very unprofessional opinion: you might be fine going quickly for one day (given fitness as that's a large ascent in one go) if you descend pretty quickly after. You can get altitude tablets online or from very specific travel pharmacies in the UK. And if you have very specific medical needs - even minor at sea level, check whether these could have an impact so you can plan accordingly.

Key is to listen to yourself. And should you start drowning in your lung fluids, stay sitting up and tell someone.