Traffic Accidents

International Aid, Traffic Accidents

Coups and Contrecoups

~Written by Sarah Khalid Khan (Contact:

Back while I was doing my house job, what most people would call a clinical internship, I worked for six months in the surgical ward of a government hospital in Lahore. Working in the surgical emergency meant witnessing, receiving, and managing patients with surgical injuries, ranging from minor wounds, to firearm injuries (FAI) and road traffic accidents (RTAs) besides other conditions requiring a clinical diagnosis. Indeed studies indicate that most of the cases presented in the emergency department are due to RTAs (Khalid et al., 2015).

Some of the worst cases I remember seeing were RTAs. Most of these patients ended up in neurosurgery as a consequence of head trauma. If one were to take a tour of the neurosurgery ward and go through case files or talk to the attendants, one would discover that most of the cases have a history of RTA. If you were on call and were awakened during the night by women crying, you would speculate that it is probably a life lost on the neurosurgery floor. Patients often stayed in the ward for long periods with an uncertain prognosis.

With urbanization of an exploding population and motorization, the world has also witnessed an increase in RTAs (Atubi, 2012). In Pakistan, the number of motor vehicles on the roads is high and the implementation of traffic rules is low. Road safety is not a prevalent concept and in some places it appears to be completely non-existent. Road injuries rank 9th among the top Disability Adjusted Life Years (DALYs) per 100,000 in Pakistan. Since men are the primary bread-winners, the proportion of male to female casualties is disproportionate; more males suffer disability and death than females (Abdul & Tehreem, 2012). Therefore disability, hospital bills, death and funeral expenses often leave families in bankruptcy.

The situation of road traffic injuries is not very hopeful worldwide either. According to WHO 1.25 million people lose their lives as a result of road injuries and most of these casualties are in low and middle-income countries. Sufficient to say that road traffic injuries are a rather neglected area of global health. Recently there have been efforts to rectify this oversight as RTAs have now been identified as a major cause of death and disability besides communicable and non-communicable diseases. The Sustainable Development Goals (SDGs) presented in September 2015 show an advance towards recognition of the dilemma of RTAs and aims to decrease the number of deaths by 2020 (Cossio et al., 2015). Steps will hopefully be taken towards creating policies that make roads and vehicles safer for people across the world. One can hope that these policies will ultimately rub off in low and middle-income countries where the most lives are lost due to RTAs.


Abdul, M. K., & Tehreem, A. (2012). Causes of Road Accidents in Pakistan. J. Asian Dev. Stud, 1(1), 22–29. Retrieved from ISSN 2304-375X

Atubi, A. (2012). Determinants of Road Traffic Accident Occurrences in Lagos State : Some Lessons for Nigeria. International Journal of Humanities and Social Science, 2(6), 252–259

Cossio, M. L. T., Giesen, L. F., Araya, G., Pérez-Cotapos, M. L. S., VERGARA, R. L., Manca, M., … Héritier, F. (2015). Global Status Report on Road Safety 2015. World Health Organization (Vol. XXXIII). doi:10.1007/s13398-014-0173-7.2

Khalid, S., Bhatti, A. A., & Burhanulhuq. (2015). Audit of surgical emergency at Lahore General Hospital. Journal of Ayub Medical College, Abbottabad : JAMC, 27(1), 74–7. Retrieved from

Economic Burden, Traffic Accidents, Government Policy

Motor Vehicle Accidents - A Growing Public Health Burden

~ Written by Mike Emmerich, Specialist Emergency Med & ERT Africa consultant (Contact:

“Road Traffic Crashes do not just happen! They are caused by Fatal Moves (actions) by a driver. The message is simple - DON'T DO FATAL MOVES!”@FatalMoves* 1990 to 2010: Deaths from road traffic injuries increased by almost half.*

The largest category of fatal events are transport related. In 1990, according to Global Burden figures, these were the 10^th leading global killer. By 2013, they were fifth! Ahead of malaria, diabetes, chronic obstructive pulmonary disease, cirrhosis or any kind of cancer. In part, this is because of progress against these diseases. But it also because as incomes have risen worldwide, more people are buying, and crashing, motorbikes and cars.

Most global road traffic deaths occur in low and middle-income countries and are rapidly increasing because of the growth in motorisation. Mortality rates caused by traffic related injuries are increasing in low and middle-income countries and they account for 48 percent of the world’s vehicles but more than 90 percent of the world’s road traffic fatalities. Pedestrians are most often affected, followed by car occupants and motorcyclists. Alcohol plays a key factor in the drivers and pedestrians, notably in South Africa, where as many as 65% of all pedestrians have increased blood alcohol levels. Conversely, traffic deaths are decreasing in high-income countries, Sweden is an excellent case study that we will review further on in this article.

10 countries are responsible for 600,000 road traffic deaths annually (see this link to see if your country is on the list). Each year, 1.3 million people die in car accidents, so these 10 countries are responsible for nearly half of all road deaths! India tops the list for the highest overall number of road deaths, followed by China and the U.S. If public health leaders are to catch up on accident prevention, the Global Burden of Disease study (Lancet links below) findings can help them see where and how. “Now that somebody’s done the work and we recognize that there’s a difference we may not have seen before, we can go to work and ask why,” said Dr. Schauben

Besides the rapidly rising fatalities we must also take cognisance of the rising number of injured persons and their cost on the (Global) health burden. Road-traffic crashes were the number one killer of young people and accounted for nearly a third of the world injury burden, a total of 76 million DALYs (Disability Adjusted Life Years) in 2010, up from 57 million in 1990. Most of the victims were young, and many had families that depended on them, who know have to rely on other sources of support, in most instances, the state.

What does the current research then tell us about this rapidly rising burden on global public health; transport injury prevention shows that collective action is as important as individual efforts. Motorcycle helmets, car seatbelts and sober drivers are important, but so are safe vehicles, consistent law enforcement and a reliable infrastructure. Thanks to a combination of insufficient, nonexistent or poorly enforced safety laws, poor infrastructure and a lack of enforcement and corrupt enforcers, the bulk of the countries globally keep aiding and abetting in the deaths of over 1.3 million persons annually! Only 28 countries, representing 449 million people (7% of the world’s population), have adequate laws that address all five risk factors (speed, drunk driving, helmets, seat-belts and child restraints). Over a third of road traffic deaths in low and middle-income countries are among pedestrians and cyclists. However, less than 35% of these countries have policies in place to protect their road users.

India has the dubious distinction of registering the highest number of road fatalities in the world (250,000), despite the fact that its population is much smaller than neighboring China and there are more vehicles on the roads in the USA than in India. "A large proportion of these deaths can be prevented by simple measures. The most important of these is strict enforcement of traffic rules, which is conspicuous by its absence in our cities as well as on highways," says the Times of India, and this would be true of the top 10, and also of the country where I reside, South Africa, where 47 persons die each day!

Further compounding the cost of the traffic fatalities is the actual real cost impacting on the affected countries economies; many who cannot afford to have the extra burden on their already strained public health budgets. The economic cost of road collisions to low and middle income countries is at least $100 billion a year! The risk of dying as a result of a road traffic injury is highest in the African Region (24.1 per 100 000 population) It's such a big problem, in fact, that the U.N. feels it needs an entire decade to fix it. In 2011, the U.N. launched a "Decade of Action" that aims to “stabilize and then reduce” global road traffic fatalities by 2020.

Is there any good news? Sweden is one success story, in 2013 only 264 people died in road crashes, a record low. How have they done this? Planning has played the biggest part in reducing accidents. Roads in Sweden are built with safety prioritised over speed or convenience. Low urban speed-limits, pedestrian zones and barriers that separate cars from bikes and oncoming traffic have helped. Globally we need to reduce human error, or eliminate the opportunity for drivers to make fatal moves; human error can even further be reduced, for instance through cars that warn against drunk drivers via built-in breathalysers and making the implementation of safety systems, such as warning alerts for speeding or unbuckled seatbelts/child-seats, compulsory on all new vehicles, built in any factories across the globe.

Individually we need to be aggressive in safe and sober driving habits and not allow our friends and family to place themselves, their passengers and fellow pedestrians at risk by not looking kindly on their unsafe driving practises. Bad and drunk driving should become as unpopular as using a cellphone while driving.