The 22 Egyptian soldiers who were killed last month might never have imagined that they would die in a road accident rather than on a battlefield. However, on 8 October 22 soldiers were killed and 27 others were injured in a horrific road crash when their truck overturned in the eastern Sinai Peninsula after the driver lost control on rugged terrain. More and more Egyptians are being killed every year as a result of road traffic accidents, and the country now loses about 12,000 lives due to such accidents every year. Egypt has a road traffic fatality rate of 42 deaths per 100,000 of population, or 1.8 per cent of all deaths from all causes in the country, according to the World Health Organisation (WHO). As a result, the WHO has ranked Egypt among the countries with the highest morbidity rates in the world in its 2009 Global Status Report on Road Safety, which assessed road safety conditions in 178 countries. However, despite these figures road safety has been neglected by the Egyptian public health agenda for many years, and the number of fatalities and injuries on Egypt's roads continues to rise. The fact that road safety is a huge public health problem and a leading cause of death has been largely ignored. Indeed, the number of Egyptians killed in road accidents in 2010 exceeded the number of people who died in last year's revolution, but despite this the numbers have not received the same attention. According to government figures, road accidents claimed over 7,000 lives in Egypt in 2010, a 7.9 per cent increase on the previous year. Meanwhile, the number of people killed during the revolution did not exceed 2,000. These statistics highlight the significant burden that road traffic injuries pose to the health of the population, but little attention has yet been paid to address the problem. THE CRISIS IN PERSPECTIVE: Road accidents are a global public health problem that claims the lives of about 1.3 million people each year. This figure could rise to 1.9 million by 2020 if no action is taken. More alarming still is the fact that road traffic injuries are the leading cause of death among young people aged 15-29 years, who are the youngest and some of the most productive members of society. Though road injuries are a global problem, 90 per cent of road traffic deaths occur in low and middle-income countries, even though these have only 48 per cent of the world's registered vehicles, according to the WHO. Egypt, a middle-income country, has one of the highest fatality rates in the world due to road accidents. “There is a lack of road safety in Egypt,” said Etienne Krug, director of the Violence and Injury Prevention Department at the WHO. “There is a big road safety problem, particularly regarding issues of speeding, the non-use of seat belts, the safety of vehicles and infrastructure.” Krug said that more drivers are going on the roads today than ever and more new roads are being built in Egypt, but these things have not been matched by the necessary safety measures. “The Middle Eastern region and the African region are the two regions with the highest rates of death on the roads,” Krug said in an interview with Al-Ahram Weekly on the sidelines of the 2012 World Safety Conference held in Wellington, New Zealand, last month. The World Safety Conference on Injury Prevention and Safety Promotion is a biennial event that aims at strengthening injury prevention and safety promotion worldwide. It is held under the auspices of the World Health Organisation. According to the WHO Global Status Report on Road Safety (GSRRS) of 2009, the Eastern Mediterranean Region has the highest road traffic injury fatality rates in the world. Egypt, Pakistan and the Islamic Republic of Iran are responsible for almost 60 per cent of all road traffic deaths in the region, which consists of 22 countries, covering over 500 million people. For Marwan Hammad, chair of the Egyptian Society for Road Safety (ESRS), a NGO dedicated to promoting safety on the roads, the problem of road safety in Egypt is due to a combination of factors that include poor road planning, lax enforcement of laws and social factors relating to drivers' attitudes. The majority (48 per cent) of those killed in road accidents in Egypt are the passengers of cars, while pedestrians also constitute a significant proportion (20 per cent) of fatalities. “The deaths of pedestrians on the roads are a big problem in Egypt,” Hammad said, attributing them to the poor state of civil engineering in the country. “You cannot build a ring road around Cairo without pedestrian crossings,” Hammad said, in reference to Cairo's heavily travelled ring road, which does not have adequate pedestrian crossings. Most of Egypt's roads and highways do not have pedestrian crossings, something that is believed to contribute to the deaths of thousands of pedestrians across Egypt each year. Pedestrians usually stand on one side of the road and then try to dodge between the cars to reach the other side. “Crossings require tunnels and bridges, but in Egypt people don't think of these things. They just build the roads,” Hammad added, letting pedestrians fend for themselves. In its bid to promote road safety and save lives, the ESRS itself has built a pedestrian bridge in the Maadi area of Cairo. The bridge, built over a road notorious for its frequent traffic accidents, will be inaugurated on 18 November, which coincides with the World Day of Remembrance for Road Traffic Victims, a global event that mourns people who have lost their lives on the world's roads. It took the ESRS eight years to build the bridge. While Hammad said that the project was a good example of a partnership between the government and civil society, it also showed how bureaucracy could be inefficient or even cruel. The bridge cost LE4.5 million to build, funded mostly by donations from local companies, he said. “The bridge we have built today has helped many people, especially mothers with kids who could not cross the street because it is a highway and the cars don't stop.” The ESRS would continue building more pedestrian bridges, especially since it has been able to design a cheaper kind of bridge, he said. The lack of pedestrian crossings is one indication that road safety and its relationship to urban planning has been widely ignored in Egypt. Roads are planned almost arbitrarily, with minimal concern for safety and often poor signage. Hammad said that when the ESRS was founded in 2004, there were no stop signs in the country. “We noticed that accidents in many areas happened because there were a lot of intersections with no signs,” he said. As a result, the society started a campaign to erect stop signs, installing many of them initially in the Maadi area. These have made a big difference, he said, and have helped decrease road accidents. Another aspect of the road safety problem in Egypt, according to Hammad, is the lax enforcement of the traffic laws. “We have all the laws we need to control road safety, but they are not enforced,” he said. This lack of enforcement got worse after the 25 January Revolution, Hammad ascribing this to changing priorities in the wake of the revolution. The security forces became more concerned with security issues related to kidnapping and car stealing than with road safety, he said. “After the revolution, and in the light of the current circumstances, law enforcement on the roads is the least of the security forces' priorities,” he added. The Global Status Report also highlights the fact that although there are laws on speed, as well as on drink driving and seat belt and helmet wearing in Egypt, these are often poorly enforced. Drivers' attitudes are also a problem that contributes to the lack of road safety in Egypt. According to Hammad, 70 per cent of the country's road accidents are due to driver error, and 20 per cent are due to the condition of the vehicles concerned. The remaining 10 per cent can be put down to the condition of the roads. Driver error could include speeding, going in the wrong direction, the use of mobile phones while driving, and the non-use of seat belts. “This is a social issue that goes back to education, and it reflects how people were educated in schools and at home,” Hammad said. He pointed out that when youngsters see that their parents do not care about the traffic laws, they may grow up and decide to be like them. “To correct this problem, we will need a long period of time,” he added. Drivers' attitudes also got worse after the revolution. Unsafe vehicles contribute to a further 20 per cent of road deaths, and Egypt has many poor quality vehicles that don't have even basic safety features. The many outdated vehicles on the country's roads threaten the lives of its drivers. Hammad is particularly concerned at the state of the tyres on many of the country's vehicles, pointing out that only one car is involved in many of the accidents that take place on the Cairo-Sokhna road. “Ninety-five per cent of these accidents are due to burst tyres,” he told the Weekly. Too many people do not understand that car tyres have technical specifications that should be adhered to, he said. “After 40,000 kilometres driving, tyres should no longer be used because internal failures start happening inside them.” However, many people are not aware of their tyres' manufacture date, indicated by a four-digit number on the tyre. “Anyone buying car tyres should make sure that they are not more than six months old,” advises Hammad. Any tyre that is more than six months old has expired and could fail when a car is driven at speed. This matter also requires action from the government, he said, adding that often tyres imported into Egypt have expired, and there is no law that stipulates that all imported tyres should be not more than six months old. ADDRESSING THE PROBLEM: Despite the increase in road traffic fatalities in Egypt, the issue of road safety has long taken a back seat, and little appropriate action has been taken to prevent further deaths. Etienne Krug of the WHO attributes this to the absence of a single agency dedicated to road safety in Egypt. It is important to establish one entity or agency that can take responsibility and leadership for road safety issues and receive the resources to improve the problem. “Currently, no one is accountable for this problem. Even if there are thousands of deaths, nobody gets the blame,” Krug told the Weekly. Hammad agreed, adding that the problem was due at least in part to the fact that there were too many government agencies involved in road safety and that these were not properly coordinated. There should be an independent board to handle road-safety issues, Hammad said, as there is in the United States in the shape of the National Road Safety Board, an independent body comprising people from the government and from civil society working together to study road safety and make recommendations for action. “It is important for Egypt to have a similarly independent board dedicated to road safety that directly reports to the prime minister,” Hammad said. This board, according to Hammad, would work on collecting data regarding road traffic accidents and make recommendations to the government. It could also feed the People's Assembly, the state legislative authority, with needed road safety laws. Such a model of partnership, in which civil society and government work together, is an efficient way to solve such problems, and it has been proven to be successful worldwide, Hammad said, adding that European and other developed countries have faced similar problems to those faced by Egypt, the only difference being in the way in which they solved them, using the model of a partnership between government and civil society. “The government alone cannot solve the problem,” Hammad said, adding that the ESRS was working on the passage of a draft law, to be presented to the next parliament, that would allow NGOs to be members of advisory boards on road safety. There have been numerous initiatives designed to tackle the issue of road safety since the early 1990s, including the National Conference for Injury Control and Prevention, which released the first-ever report on such injuries in 1993, and the National Road Safety Council (NRSC), a joint initiative between the Egyptian ministries concerned, various NGOs, and the WHO in 2003. Unfortunately, little came out of these initiatives, and Hammad described the NRSC as little more than “window dressing”. The government, he said, has long talked about road safety, but it has shown a reluctance to take concrete steps on the issue. Its attention had been drawn in the wrong direction, he said, and it has not been focussed enough on finding solutions. “There have been too many ideas on road safety, but zero focus on the right path,” he said. However, he is now more hopeful about solving such problems, noting that President Mohamed Morsi has said that one of the things he most wants to resolve is road safety. “This says a lot about his priorities. He must have seen that road accidents are very costly in terms of money and lives lost, and the problem is affecting everyone,” Hammad said. ACCIDENTS ARE PREVENTABLE: Road accidents have proven to be largely preventable worldwide through the implementation of a broad range of strategies based on sound scientific evidence that has been shown to be effective in reducing road fatalities. This comes against the background of the widespread idea in some societies that road accidents are somehow inevitable. Governments have been able to take actions to prevent road accidents and to minimise their consequences, reducing road traffic fatalities. In Australia, France, Sweden and the United Kingdom, for example, the number of road traffic deaths has declined by more than 50 per cent over the past four decades. “When there are a lot of people dying and it is preventable, it is not acceptable if we don't act,” said Dale Hanson of the School of Public Health at James Cook University, Australia. Hanson said that the number of deaths from road accidents, particularly in the developing world, exceeded the number of people dying from diseases like malaria, and that policy-makers need to be proactive when they approach public health. “Get your facts together and start doing things, because you can make a big difference,” Hanson told the Weekly during the World Safety Conference. WHO experts argue that road accidents could be prevented if the reasons behind them were addressed. “If someone dies in an accident because he is driving at 160km an hour, whereas the speed limit is 100km, we cannot blame ‘destiny' for that,” Hammad said. This emphasises the importance of enforcing speed limits as one effective measure in reducing road accidents, something that has had some success in Egypt. In 2012, eight new speed cameras were installed on Cairo's heavily travelled ring road, and preliminary data showed that average speeds had been reduced as a result of the threat of fines being issued to speeding drivers. According to Hammad, the cameras captured about 40,000 traffic violations in only three days. Other scientifically proven measures to reduce road traffic accidents include, according to the WHO, enforcing seat belt, child restraint and helmet wearing laws, developing safer roadway infrastructure, including separating different types of road users, implementing vehicle and safety equipment standards, and introducing a graduated driver-licensing system for novice drivers. To prevent road accidents and minimise injuries in Egypt, these measures would entail assessing the number of traffic deaths, injuries and crashes, as well as understanding which road users are most at risk, which geographical areas are most affected, and which contributing risk factors, such as poor road conditions and non-enforced regulations, are most to be targeted. All this would require a holistic way of addressing road safety with the involvement of multiple authorities, including transport, police, health and education. Besides the huge death toll road accidents exact, they also result in considerable economic losses, turning road deaths and injuries into a development problem as well as a social and human tragedy. According to the World Bank, the costs of road accidents in middle-income countries such as Egypt can account for 1.5 per cent of GDP. “Societies pay huge prices for the lives lost or for people suffering from long-term disabilities as a result of injuries,” Hanson noted. Globally, the cost of road accidents has been estimated at some $518 billion. Road traffic accidents cost many countries between one to two per cent of their GDP, and in some cases this figure can reach up to five per cent, according to the WHO. The Global Status Report on Road Safety states that the direct cost of road deaths for the Eastern Mediterranean Region countries is estimated to be $7.5 billion annually. This is in addition to indirect costs, such as productivity losses caused by a disabled population, together with the costs of their care providers and the loss of property. People who are killed or disabled by road injuries lose their incomes as a result of their losing their productivity. This can be particularly challenging for limited-income family members, who often experience declining living standards as a result of losing the family's main or sole breadwinner. INTERNATIONAL RESPONSES: In March 2010, the United Nations General Assembly proclaimed a Decade of Action for Road Safety during 2011 to 2020. The Decade was launched in May 2011 in over 110 countries, with the aim of saving millions of lives by improving the safety of roads and vehicles, enhancing the behaviour of road users and improving emergency services. For its part, Egypt has also developed a National Decade of Action, a plan developed by the government and NGOs in collaboration with the WHO. The Decade includes five pillars, including road safety management, safer roads and mobility, safer vehicles, safer road users, and improved post-crash responses. Given the country's poor road conditions, Egypt is also one of 10 countries involved in the Road Safety in 10 Countries Project (RS10), which focuses on 10 countries that account for almost half (48 per cent) of all traffic deaths globally — Brazil, Cambodia, China, Egypt, India, Kenya, Mexico, the Russian Federation, Turkey and Vietnam. “We are looking for big countries with big problems with the potential for improvement,” Krug said. The RS10 is funded by Bloomberg Philanthropies, an initiative of New York mayor Mike Bloomberg, and it has been funded to the tune of $125 over five years (2010-2014). The project brings together six consortium partners, including the WHO, and its primary goal is to reduce deaths and serious injuries in the countries concerned by focussing on proven prevention and care interventions. In Egypt, the project is strengthening the enforcement of speed restrictions, increasing seat belt use, and improving road traffic injury and data systems in Cairo and Alexandria, Egypt's two main cities. However, according to Krug, it has been able to achieve little so far. He ascribes this to the fact that the project has been interrupted over the last two years because of the political unrest that has hit the country since the outbreak of last year's revolution. Krug told the Weekly that it was impossible for the project to work without coordination from the government and police to enforce needed measures. The unrest consequent on the revolution has kept the police busy handling protests, however, while the government had changed several times. “We haven't really done much, unfortunately, as activities were suspended and the funding allocated to Egypt has been cut,” Krug said. Nonetheless, he said that the WHO was ready to hold talks with the new government in order to resume the RS10 project in Egypt. In a world where every hour some 150 people die on the roads, addressing road safety has become a more urgent issue than ever.
