Road safety is no accident
More than 3,200 people — the
equivalent of eight jumbo jets — die in road crashes
every day. What is being done to tackle this global disaster?
And how is the Red Cross and Red Crescent Movement contributing
to saving lives on the world’s roads?
An injured Chinese man waits for medical
treatment at the site of a traffic accident that killed
6 people and injured 22. Rapid development has brought
increased motorization in China but road safety measures
lag far behind. Between 1975 and 1998, some 250,000
people were killed in traffic accidents in China. ©REUTERS
/ China Newsphoto HAN/JJ, Courtesy www.alertnet.org
‘‘I WANT to see road safety taken as seriously
as AIDS,” explained Mary Mwangangi in the New York Times.
Mwangangi is traffic commandant in Kenya’s Police Department
and a vocal advocate of road safety in the country. “It
kills just like AIDS and malaria and tuberculosis.”
Road safety is more than a professional concern for Mwangangi.
She speaks from a wheelchair — a road accident put her
Today, according to the World Health Organization (WHO),
motor vehicle crashes kill about 1.2 million people each year.
That is set to rise to 2 million by 2020 unless new safety
measures are taken, making road traffic injuries the third
largest cause of death and disability.
in the increasingly risk-averse developed world, people accept
road death and injury as part of the price of living in modern
societies. Most road safety experts put this attitude down
to a widespread ignorance of the scope and extent of the problem
and what can be done to address and prevent it.
To change people’s attitude, experts from the WHO and
the World Bank published in 2004 a pioneering new report,
World report on road traffic injury prevention that advocated
road crashes be ranked along with cancer, heart disease and
stroke as a major public health threat.
And nowhere is this threat greater than in developing countries.
Reports, like meetings, are often dismissed as the international
community’s alternative to action. But in the case of
road safety, it is noticeable how the International Federation’s
1998 World Disasters Report published in 1999, helped to build
awareness within the humanitarian and development community
that death and injury on the roads were indeed a global disaster
with the greatest impact on the developing world. As a result
of the 1998 World Disasters Report, the International Federation
was one of the few founding partners of the Global Road Safety
Partnership (GRSP), and continues to host it today.
For international agencies, the imperative for action seemed
clear, according to the 1998 report. On the eve of “massive
growth in developing-world traffic,” it said, “crashes
already cost the South almost as much as all the aid they
receive.” Traffic accidents limit progress by killing
and injuring the economically active, and were forecast to
do more harm through death and disability than many other
health threats given more attention.
The solution? A development strategy that incorporates road
safety as a vital component.
But even as development surges in many countries, especially
in Asia, rapidly pushing up “motorization” levels,
road safety measures do not necessarily follow.
In China, for example, road traffic deaths more than tripled
between 1975 and 1998, according to a study highlighted in
the WHO and the World Bank report. In 2003, more than 250,000
people were killed in traffic accidents there. The government
of Kenya estimates that some 2,600 people die each year in
road crashes. The thousands of Kenyans injured in road accidents
use up limited Medical resources and drain some US$ 76 million
each year from the country’s fragile economy.
In the emerging economies in the western Pacific and South-East
Asia regions, road traffic deaths account for more than half
of all road deaths in the world. In Russia, road crashes are
the second leading cause of death
With poverty directly linked to death and injury on the road,
the WHO and the World Bank report offers a grim prediction
that between 2000 and 2020, motor vehicle deaths will decline
by 30 per cent in high-income countries but increase 80 per
cent in poor ones.
Katherine Sierra, vice president for infrastructure at the
World Bank, points out: “Road safety is a very important
development challenge. It is one that is often overlooked,
and which disproportionately impacts the poor. If we are to
help reduce the very significant social and economic impacts
of road traffic fatalities and injuries, then everyone must
take them much more seriously and take preventative efforts
Dr. Etienne Krug, director of the department for injuries
and violence prevention at WHO, explained it this way in a
recent newspaper article: “All over the world, economic
development is leading to more cars and more roads, but we’ve
forgotten to match that with more safety.”
Three million vehicles in Egypt’s
capital city, Cairo, compete for space on roads designed
for a quarter of that number and drivers make up their
own rules to navigate the constant traffic jams. The
result is traffic chaos and thousands of road deaths
REUTERS / ALADIN ABDEL NABY, COURTESY
Red Cross and Red Crescent business
Road safety is prime territory for the Red Cross and Red Crescent.
The Movement’s expertise in first aid leads naturally
on to road safety and accident prevention.
Of all victims who are killed, 57 per cent die in the first
minutes after the crash, before the arrival of the emergency
services. First aid provided in these vital first minutes
can save lives and help both victims and bystanders cope psychologically.
The Red Cross and Red Crescent has been instrumental in raising
standards in road safety through first-aid courses. Many National
Societies in developing countries, like Ghana for example
(see box), which lack a proper ambulance service, are targeting
first-aid training at drivers — almost by definition
the first people to arrive at the scene of an accident.
safety covers activities which “in one way or another
are the business of all the National Red Cross and Red Crescent
Societies in virtually every country in the world”,
according to Christopher Lamb, special adviser on international
representation at the International Federation.
“An increase in the tragic loss of life resulting from
road accidents is a global problem of great concern to the
Movement,” says Dr. Mohammed al-Hadid, president of
the Jordan Red Crescent Society and chairman of the Standing
Commission. “The most vulnerable are pedestrians, cyclists
and users of non-motorized vehicles. Treatment of the injured
is such a drain on under-funded medical services that in some
countries it is holding back development.”
From Oman to Eritrea to Austria, the Movement is bringing
together its collective resources to tackle this crisis. To
achieve worldwide progress, the International Federation was
a founding partner in a global initiative to raise awareness
of road safety issues.
A man sells vehicle safety tools along
the main highway to Ghana's capital city Accra. ©Michael
Winnett / International Federation
Ghana’s commercial first-aiders
It was only a short international wire story, but last December
it reported to the world one of the worst accidents many Ghanaians
could remember for some time. Twenty-four people, four of
them children, had been killed in a head-on collision on the
road between the second-largest city, Kumasi, and Sunyani.
A bus driver had tried to overtake a taxi and lost control,
smashing into another oncoming bus, according to police.
Traffic accidents “occur frequently in Ghana”,
said the news agency, due to the “poor condition”
of the roads and the “willful ignorance” of most
motorists of traffic laws.
But in Kumasi itself, a bustling, commercial city, with some
of the worst traffic jams in Africa, that has been changing
gradually. The Ghana police have reported some success in
getting taxi drivers to stick to the rules about how many
people they can carry, and the local Red Cross branch has
been providing special training in first aid to drivers of
the city’s commercial vehicles — most of them
The course is designed for the low-tech environment of West
Africa and “long pre-hospital times”, according
to the project outline. The key first-aid actions to be taught
in the course are: the recovery position for keeping an injured
person’s airway clear during prolonged transport with
no medical equipment; safe extraction and simple precautions
to protect the spine; bleeding control and splinting; triage,
mass-casualty and scene management.
In the first year of the project, more than 60 per cent of
the taxi drivers trained had actually used their skills.
Without a proper ambulance service, Kumasi’s commercial
drivers are very often the first at the scene of crashes,
and just over 70 per cent of all casualties are taken to hospital
in some kind of commercial vehicle — usually a taxi.
The Kumasi project was a joint effort by the Ashanti chapter
of the Ghana Red Cross Society, the Kwame Nkrumah University
of Science and Technology, the Ghana Private Road Transport
Union and the University of Washington (UW). Before it began,
only 13 per cent of the city’s commercial drivers had
any kind of formal first-aid training. Now some 500 individuals
“It just bugs me to see people being killed senselessly,
when small things could prevent it,” says Dr. Charles
Mock, a trauma surgeon at UW who has been closely involved
with the Kumasi project. He believes injuries and death from
trauma and especially traffic accidents are “a huge
problem that’s been grossly ignored throughout the world”.
Empirical data shows that by introducing some basic road
safety management, national or local authorities can reduce
crashes and injuries by 80 per cent. If the car industry introduces
more safety measures the reduction could be even greater.
For example, Dr. Krug explains: “We have to persuade
car manufacturers to stop using speed as a selling point.”
He adds: “While the private sector has achieved a great
deal with things like seat belts, air bags and advanced braking
systems, there’s a long way to go before everything
that’s technically possible has actually been done.”
Following the publication of the 1998 World Disasters Report,
the International Federation and the World Bank initiated
an international partnership, the Global Road Safety Partnership
(GRSP), with business, civil society and governments. The
partnership’s mission is to advocate for greater awareness
of road safety and to bring about a sustainable reduction
of road crashes in developing and transition countries.
Currently, some 200 organizations take part in GRSP activities,
and it is active in over ten countries. David Silcock, chief
executive of GRSP, describes it as “part of a growing
coalition of transport and public health professionals who
are pressing for greater priority and resources for road safety”.
GRSP has an “active programme of projects and a growing
pool of knowledge and experience”, he adds.
The latest GRSP initiative is a US$ 10 million programme
funded by seven of the world’s largest oil and auto
companies. It will be implemented by GRSP, and will focus
on key road safety themes, training road safety professionals
in developing countries, and provide seed money to support
pilot programmes to improve road safety in several developing
In Asia, the GRSP concentrates its efforts in a few “focus
countries”. In the last ten years, vehicle populations
in two of the GRSP Asian “focus countries”, India
and Thailand, more than doubled; in the third, Viet Nam (see
box below), it more than tripled, with motorcycles increasing
by nearly 70 per cent in the last two years alone. According
to David Silcock: “Road traffic in Asia’s urban
areas has become a vast mix of pedestrians, animal-drawn carts,
old and modern motor vehicles and two-wheelers.” Helmet
use is low; the proportion of victims who are motorcyclists
is high — as much as 80 per cent in one province of
Thailand. “There are few quick wins in road safety,
but the single actions most likely to have an early and substantial
impact are helmet wearing, use of safety belts, controlling
drink driving and effective speed management. The Red Cross
and Red Crescent Movement has a lot to offer in advocacy and
prevention programmes in the affected communities” says
“The character of the individual GRSP programmes in
Asia is in many ways a reflection of the political culture
in each country,” says Silcock. “There is strong
political pressure for road safety improvements in Thailand
and a GRSP foundation has been registered there.” Progress
Another GRSP focus country, well placed to display the special
problems of transition economies and where, in addition, the
Movement is active in road safety is Poland.
The Colombian Red Cross, through its ambulance
and first-aid services, is a lifesaving component in the country’s
emergency response system to road accidents. ©JAVIER
GALEANO / AP PHOTO
good cars, bad roads
The point of Poland’s “transition” from
a communist to a free-market system can clearly be seen on
a graph of the number of vehicles on the roads. In 1989 the
line turns sharply upwards, reaching a peak two years later
that has yet to be exceeded.
“Our roads are a major disaster,” says Katarzyna
Stepinska, the senior officer in the Polish Red Cross (PRC)
coordinating its efforts in the area. “And you can sum
up the reason quite easily,” she adds. “Good cars
on bad roads.” When you put your foot down in a Polski
Fiat 126, the car people saved for years to buy under socialism,
she explains, nothing much happened. Now, like everywhere
else in the old Soviet bloc, today the vehicles of choice
are powerful German or Japanese cars, any of which will exceed
the urban 50 kilometres per hour speed limit in not much more
than a blink of the driver’s eye.
Everyone agrees: excessive speed is the number-one killer
on Poland’s roads.
Poland’s essentially pre-Second World War road system
has been described as one of the most dangerous of any OECD
(Organisation for Economic Co-operation and Development) country.
“Our roads are fantastic,” Andrzej Grzegorczyk,
head of the government’s National Road Safety Council,
says ironically, “but only if you’re in a tank.”
Grzegorczyk also sees the crisis on Poland’s roads
as being fundamentally a transition issue, pointing to a decade
of liberalization and motorization, and what he calls a new
“king-of-the-road” mentality in, above all, young
men. “In the old days,” he says, “it was
fathers who drove, not sons, and they were very careful with
the car they had worked hard for and could not easily replace.”
But recently, the Polish death toll has fallen while motorization
has continued to rise, implying that preventive measures are
working. “Point number one in our strategy is expanded
first aid,” says Scholastyka Sniegowska, secretary general
of the PRC, whose 16-hour course is now certified to European
Red Cross standards. (It has been estimated 70 per cent of
Poles who die at the scene of a crash could be saved.) The
PRC, which has a written agreement with the fire brigade on
accident and disaster preparedness, has also nagged the government
for years to bring first-aid training in civilian driving
courses up to scratch.
There are also familiar political arguments over restraining
cars and drivers. “In democratic Poland,” says
one expert, “every driver is also a voter.” Three
separate bills to bring in a national speed limit, for example,
died on the floor of the lower house of the National Assembly.
Death on the roads:
the human toll
Road traffic injuries are a huge public health and
• They kill 1.2 million people a year or an average
of 3,242 people every day.
• They injure or disable up to 50 million people a year.
• They rank as the 11th cause of death and account for
2.1 per cent of all deaths globally.
Ninety per cent of road traffic injuries affect people
in low- and middle-income countries, especially in Asia:
• More than half of all road traffic deaths occur among
young adults between 15 and 44 years of age, the most productive
group in any society.
• Seventy-three per cent of all road traffic fatalities
• The most vulnerable road users are pedestrians, cyclists,
users of motorized two-wheelers and passengers on public transport.
Without action the problem will get worse in the developing
• Road traffic injuries are predicted to become the
third-largest contributor to the global burden of disease
• Road traffic deaths are predicted to increase by 83
per cent in low- and middle-income countries, and decrease
by 30 per cent in high-income countries.
It is estimated that every year, road traffic crashes
• US$ 518 billion globally.
• US$ 65 billion in low- and middle-income countries,
more than total development assistance.
• Between 1 and 1.5 per cent of gross national product
in low- and middle-income countries.
• Two per cent of gross national product in high-income
Many countries have shown sharp reductions in the
number of crashes and casualties by:
• Enforcing laws governing speed limits, alcohol, seat-belts,
child restraints and crash helmets.
• Implementing transport and land-use policies that
promote fewer, shorter and safer trips; encouraging safer
modes of travel such as public transport; incorporating injury-prevention
measures into traffic management.
• Making vehicles safer for occupants, pedestrians and
cyclists, and more visible using daytime running lights, high-mounted
brake lights, reflective materials on cycles, carts, rickshaws
and other non-motorized forms of transport.
Source: WHO/World Bank,
World report on road traffic injury prevention,
Few concerted attempts by the Red Cross and Red Crescent
to tackle road safety have been more successful than the campaign
by the National Societies of the European Union, now entering
its third year with the leadership role passing from the German
to the British Red Cross.
Some 9,000 teachers and hundreds of thousands of children
took part directly in campaign activities, which last year
culminated in the publication in 13 different languages of
a Good Practice Guide in CD and printed form. Luc Henskens,
director of the Red Cross/EU Office in Brussels, says the
contribution of the accession states was crucial “in
terms of the volume and quality of activity”.
The 2005 phase of the campaign includes a four-vehicle tour
traveling through each participating country in the summer,
converging on Brussels for a final event in September.
The British Red Cross (BRC), like so many other National
Societies, advocates the inclusion of first aid in the overall
test of proficiency for driving licences. The French Red Cross
has launched an aggressive road safety campaign that combines
graphic television spots of road accidents with the promotion
of first aid as a life-saving technique. BRC first-aid adviser
Anita Kerwin-Nye argues that: “within us all there is
the ability to learn simple life-saving skills, which if administered
at the scene of a road accident, could have such an impact.”
Tackling road safety means taking on some of the most intractable
problems of modern society: alcohol and drug abuse, under-development
and ignorance. The Red Cross and Red Crescent Movement has
some basic tactics to fight this global crisis: prevention
and first aid.
But this is a fight that must be fought on many levels. Governments,
businesses, the media and civil society need to build on joint
initiatives like GRSP. Reversing this worrisome trend, which
could lead to millions more people dying on the road, requires
moving beyond projects like GRSP to making road safety a top
public health emergency. As the WHO and the World Bank report
concludes: “Road traffic injury prevention and mitigation
should be given the same attention and scale of resources
that is currently paid to other prominent health issues if
increasing human loss and injury on the roads, with their
devastating human impact and large economic cost to society,
are to be averted.”
Alex Wynter is a London-based freelance writer and editor.
Mandatory helmet use is the most urgent
government measure currently being considered in Viet
Nam to lower their fast-rising number of road deaths.
©GÉRARD LAUTRÉDOU / French Red Cross
Viet Nam: a tale of two cities
Viet Nam is “poor”, but getting richer fast.
Its average annual gross domestic product growth of 7.5 per
cent between 1991 and 2000 would delight European governments.
But a direct consequence of this is an exponential increase
in road use, and road accidents are by far the greatest cause
of death for people between 18 and 50 years of age —
the country’s most productive.
Viet Nam, in fact, is a classic case of a developing country
paying a high price in death and injury on the roads for the
“motorization” — much of it in the form
of small, inexpensive two-wheeled vehicles — that goes
hand-in-hand with development. In the past decade, road deaths
have increased fourfold from 3,000 to almost 13,000 —
a daily average toll of 36 lives lost on Viet Nam’s
In 1995 there were 4 million vehicles on the road; now there
are 12 million, the overwhelming majority of them motorcycles.
Mandatory helmet use is the most urgent measure the government
can take if the road deaths are to be brought down significantly.
Now, a joint project between the French Red Cross and the
Red Cross Society of Viet Nam worth nearly a quarter of a
million dollars, will adopt a twin-track approach to improving
road safety: first aid at key intersections in the main cities
of Hanoi, the capital, and Ho Chi Minh City, and media campaigns.
The project agreement was signed in October 2004 during the
state visit to Viet Nam by French President Jacques Chirac
and is intended “to reduce the rising mortality rate
on the roads”, according to a joint press release by
the National Societies. Over the past 3 years France has substantially
increased its efforts to reduce the number of road accidents
with significant success. The French Red Cross is one of the
most experienced National Societies in the field.
In Viet Nam, the Red Cross first-aid effort is targeted specifically
at the dangerous urban entry points in neighbourhoods where
the national highways begin. In Hanoi these are on the Thang
Long motorway on the way to the airport, in the Dong Anh suburb
to the north, in Trau Quy in the east and Van Dien to the
south. There will be 500 volunteers equipped with first-aid
kits and a stretcher at each of the four locations.
In Ho Chi Minh City, to start with, 160 volunteers will stand
watch at one of the four entry points regarded as the most
dangerous. In both cities, the Red Cross is also organizing
media and poster campaigns to get people to drive more slowly,
encourage helmet-use among motorcyclists and prevent drink-driving.
Gérard Lautrédou is head of mission with
the French Red Cross in Viet Nam.