Do you need a doctor's note to bring distilled water on flight for medical reasons?

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In the USA there's TSA https://www.tsa.gov/travel/security-screening/whatcanibring/items/medications-liquid

In Canada it's CATSA https://www.catsa-acsta.gc.ca/en/medication-and-medical-items

In Germany, we can look Frankfurt Airport https://www.frankfurt-airport.com/en/faqs/overview-faqs/faq-hand-luggage.html

None of these require a doctor's note. All of them require you to present your stuff to the screening officers. An official label is super helpful, to quote CATSA

You are not required to bring documentation to support your medical needs or condition. However, if you feel that it would help ease your screening, it should be presented to the screening officer along with your medically necessary items.

Prescription medications and essential non-prescription medications are exempted from the 100 ml or 100 g (3.4 oz) limit and do not have to be placed in a plastic bag. However, we recommend that these items be properly labeled (manufacturer's name or pharmaceutical label identifying the medication).

So don't just put your liquid on the belt and begin to explain after rather talk to the officers before. Much as pilots have the "Aviate, Navigate, and Communicate" credo, communication should be high on your priority too. To quote CATSA again

If you need assistance, please inform the screening officer when you arrive at the checkpoint.

Despite the stupid regulations binding their hands , staff at checkpoint are also humans. Treat them with respect and it'll be fine. Allow extra time and be very patient. One little tip: I'd call it "special treated water for medical purposes" or similar. This is not a lie, it's more of an assistance for people who never needed to learn the difference between purified and distilled water.

Since you mentioned the Middle East, let's check Dubai https://www.dubaiairports.ae/before-you-fly/baggage/baggage-regulations

Exemptions will be made for medication, baby milk/foods and special dietary requirements to be used during your trip.

Same everywhere.

Of course, the UK has stricter rules, because it's the UK. https://www.heathrow.com/at-the-airport/security-and-baggage/hand-baggage-and-liquids

Liquid medicines: You are only permitted to carry quantities of liquid medication in excess of your personal liquid allowance where it is needed during the course of your flight. All medication should be accompanied by documentary proof of authenticity, such as a prescription or letter from a medical practitioner confirming that you need them for your journey. Liquid medication that is not required on the flight should be carried as hold luggage

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