Public Health (2000) 114, 3739 R.I.P.H.H. 2000 www.nature.

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Causes and effects of road trafc accidents in Saudi Arabia

S Ansari*, F Akhdar, M Mandoorah and K Moutaery Department of Neurosciences, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia
In Saudi Arabia the motor vehicle is the main means of transportation. Between 1971 and 1997; 564 762 people died or were injured in road trafc accidents, a gure equivalent to 3.5% of the total population in Saudi Arabia. During this period 66 914 people have died on the roads in Saudi Arabia due to road accidents, amounting to one person killed and four injured every hour. Over 65% of accidents occur because of vehicles travelling at excess speed and=or drivers disobeying trafc signals. Of deaths in Ministry of Health hospitals, 81% are due to road trafc accidents and 20% of their beds are occupied by trafc accidents victims. Also, 79.2% of patients admitted to Riyadh Armed Forces Hospital with spinal injuries has sustained their injuries as a result of a motor vehicle accident. We recommend compulsory use of safety seat belts in vehicles and the setting up of a new database to collect, store and analyse information relating to the road trafc accidents. Public Health (2000) 114, 3739. Keywords: road trafc accidents (RTA); mortality rates; injury rates; vehicle speeding; trafc signal violations; seat belt use; Saudi Arabia

Introduction The problem of road trafc accidents (described by the WHO as a cost of modernisation) is becoming an internationally recognised concern. Road trafc accidents, i.e. accidents involving a motor vehicle with another vehicle, animal or pedestrian are becoming increasingly common in Saudi Arabia.1 They are a major cause of morbidity and mortality at a rate which is on a level with heart diseases and cancer.2,3 There has been a progressive increase in vehicle accidents within Saudi Arabia which corresponds to the increase in the number of registered vehicles over the past two decades (Figure 1). Since 1992, the number of reported trafc accidents has suddenly

Figure 2 Cause of accidents in Saudi Arabia for the decades 1970, 1980, 1990 (by percentage of whole).

Figure 1 Number of accidents recorded by number of vehicles registered (in thousands) for Saudi Arabia for the years 1971 1994 inclusive.

*Correspondence: Dr Sohail Ansari, W-939 Riyadh Armed Forces Hospital, PO Box 7897, Riyadh 11159, Saudi Arabia. Accepted 30 April 1999

increased throughout Saudi Arabia. This is partly due to the change in methods of registering trafc accidents. Previously, some accidents went unreported either to the police or to the Ministry of Health hospitals. Legislation passed at this time, which made it compulsory to report accidents to the police and for the victims to attend the designated Ministry of Health hospital, would be expected to be responsible for the sudden increase in accidents recorded. Computerised information technology is now being used by the trafc engineering department to maintain a national data base for these accidents. This has mostly replaced the previous practice of keeping handwritten records. In 1971, 5483 vehicular accident injuries were recorded: this gure had increased six fold for the year 1994, for which 32 133 injuries were recorded. Recorded deaths from vehicular accidents increased from 570 in 1971 to 4077 in 1994, a seven fold increase. Excess speed and violation of trafc signals are major

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causes of trafc accidents (Figure 2).3 In addition to fatalities, such trafc accidents also cause disability and a drain on the health resources. Causes of trafc accidents The causes of trafc accidents in Saudi Arabia can be divided into: general and specic causes. General causes 1. A large increase in the number of vehicles and expansion of road networks within and between cities. 2. Large national development projects which require the development of supporting transport systems. 3. Increased number of expatriates from different countries with different habits and culture who are unfamiliar with local driving conditions and requirements. Specic causes 1. Most accidents occurred as a result of driver error. 2. Over 50% of the trafc accidents are due to excess speed and violation of signals at intersections (Figure 2). 3. Road safety and vehicle condition contribute to accidents, particularly those on open roads. Therefore errors and negligence of drivers contribute signicantly to trafc accidents throughout Saudi Arabia. Analysis of the spinal cord injury patients admitted to Riyadh Armed Forces Hospital's Spinal Unit showed 79.2% of the patients having been involved in a road accident compared to 47.7% in the USA and 36% in the UK (Figure 3). Studies comparing the causes of the accidents in Saudi Arabia and USA4 showed an estimated 80% of accidents occurred because of the human factor. Safety of the road itself or the vehicle's condition contributed to only 20% of the accidents. The study also showed: 1. Accidents in Saudi Arabia due to excess speed are 3.5 times more common than in the USA.

2. Signal violation accidents are 4.5 times more common than in the USA. 3. Overtaking from the wrong side in Saudi Arabia is eight times more common than in USA. Making an incorrect U turn (turning the vehicle through 180 ) is also much more common in Saudi Arabia.

Effects of trafc accidents Motor vehicle accidents have social, medical and economic effects on an individual. The average estimated cost of accidents in Saudi Arabia every year is SR 21 billion. In industrial countries the gross loss, due to accidents, is 1 2% of the national income. In Saudi Arabia, an estimated loss of between 2.2% and 9% of the national income has been suggested.5 Also loss of a family member leads to change in family dynamics bringing about nancial and emotional problems. Medical effects The total number of beds in 175 Ministry of Health hospitals is 26 737. At any time one third of these beds (9000 beds) are occupied by road trafc accident injury casualties.6 This is in addition to the resources required at the scene of the accident and prehospital care of the victims. Many of these patients have residual disabilities which requires long-term care to be provided in the community. These medical resources are used at the expense of patients with other illnesses. Statistics from Ministry of Health during 1993 and 19957,8 showed the following as the leading causes of death in their hospitals. 1. Road trafc accidents. 2. Tumours. 3. Cardiac diseases.7,8 Over 22% of the cases transported by the Red Crescent Society ambulances during the year 1994 (1415H) were from road accidents. A study from an Eastern Province hospital9 showed that 46% of the total injuries received were due to road accidents and 80% of these patients were below 40 y of age, 69% of those injured were Saudis, and 20% of the victims were children below the age of 12. The male to female ratio was 9 : 1. None of the victims were wearing seat belts at the time of the accident and 49% had head and facial injuries. Half were discharged from hospital before 10 days, 25% stayed more than 30 days, and 33% of long-stay patients were discharged with a disability resulting in a major neurological decit. Head and facial injury were the main effects of road trafc accidents in Riyadh,10 accounting for 30% of injuries and causing 26% of the deaths. Seat belts could have substantially reduced the number of fatalities and injuries. 73.6% of all cases of hemiplegia, paraplegia or tetraplegia in Saudi Arabia are due to road trafc accidents.11 Of deaths in 1982 registered in accident and emergency departments in the Riyadh Medical Centre 70.2% were caused by road accidents. Minor accidents in Saudi Arabia at 82.1% are less than that in USA (91.6%) but this is balanced by major accidents causing injuries and deaths in Saudi Arabia being more than double (17.4%) than those in the USA (8.313%).4 The number of accidents resulting in injuries in Saudi Arabia is

Figure 3 Percentage of all accidents resulting in Spinal Cord Injuries (by cause of injury) for Saudi Arabia compared with the United Kingdom and United States of America.
Public Health

Causes=effects RTA in Saudia Arabia S Ansari et al

twice that in USA but the number of fatalities is more than eight times the USA gure. Therefore the severity of road trafc accidents in Saudi Arabia is much greater than those in USA, and needs special attention due to the human and nancial resources lost in treating these patients. The ratio of accidents to injuries in Saudi Arabia is 8 : 6 compared to the international estimate of 8 : 1. In the USA, the ratio of accidents to deaths was 283 : 1 in 1993; the ratio for Saudi Arabia in 1995 was 32 : 1.4,12 Recommendations The size of the problem of trafc accidents and the size of the human and economic resources lost are enormous. It is necessary to implement a national strategy to face this problem. The human factor (the driver) has a major role. This problem can be overcome by: 1. Control of the poor driving such as violation of trafc rules, for example, driving at excess speed, ignoring crossing signals, unsafe overtaking and unsafe U turns (turning the vehicle through 180 ). This should reduce trafc accidents by more than 50%. Firm punishment for those who violate trafc rules needs to be implemented. 2. The compulsory use of safety seat belts for the driver and the front passengers should be implemented. 3. Improving the method of collecting trafc accident data and improving ways of processing these data in order to get the maximum benet from it. In the era of the Internet, the old ways of manual ling and recording of these data should be made obsolete. Processed data could be linked to advanced systems of data analysis to produce regular reports to improve trafc safety.

References
1 Ministry of Interior. Trafc statistics: Statistical publications from 1391H 1417H. (1971 1997) Ministry of Interior, General Trafc Department: Riyadh. 2 WHO. World Health Statistics. World Health Organisation: Geneva, 1996. 3 Al Ghamdi A. Road trafc accidents in Saudi Arabia: Causes, Effects and Solutions 1418H. General Trafc Department: Saudi Arabia, 1998. 4 National Safety Council. Accident facts, 2nd edn. National Safety Council: USA, 1994. 5 Saudi Arabia Monetary. The 32nd annual report 1417H. The economical and statistical research Ofce: Saudi Arabia, 1997. 6 Al Sheikh M. Analysis of trafc accident and facilities in Riyadh: Epidemiological study. College of Engineering, King Saud University: Riyadh, 1996. 7 Ministry of Health. Annual Health Report. Ministry of Health: Riyadh, 1995. 8 Ministry of Health. Deaths reports for 1995. Ministry of Health: Riyadh, 1995. 9 Al Habdan I. Road trafc accident admission to King Fahad University Hospital in Al Khobar, Records of international conferences about road trafc accidents. 1412H. Security Force Hospital: Riyadh, 1992. 10 Isam S, Al Ghamdi A. Analysis of injuries resulting from road trafc accidents in Riyadh district. King Saud MagazineEngineering Science 1416H Ref. 2; Issue 8, 1996, pp. 235 250. 11 Abdul J, Saif AL, Zacharial S, Nabil W. Study in research about causes of the increase in the rate of road trafc accidents, injuries in Mecca and Eastern Province and measures to avoid it; 1411 H. General Ofce for scholarship programmes, King Abdulaziz City for Sciences and Technology: Riyadh, 1991. 12 Mohamed S et al. Improving the emergency medical services in Saudi Arabia; King Abdulaziz. 1414H Book No. 61, City for Sciences and Technology: Riyadh, 1994.

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