International Cooperation for Road Safety

Road traffic accidents kill more than 1.2 million people yearly and injure or disable between 30 and 50 million a year. Most of the victims are young males and vulnerable road users. According to the World Health Organization, road traffic deaths are predicted by 2020 to increase by 83% in low-income and middle countries, and to decrease by 27% in high-income countries.
Road traffic injuries (RTI) must be treated as an important international public health problem and facing it should be considered as a major requirement for sustainable development. The United Nations and its specialized agencies, International Non-Governmental Organizations and many developed countries can be, by far, more effective in facing this challenge however, the strain remains on the health and the economy of most developing countries.
Most developing countries failed to face the growing problem of road traffic injuries due to the following reasons that will be studied in this report:
- Lack of political will because many decision-makers still regard RTI as being due to unfortunate mischance and an inevitable result of modernity;
- The abscence of national long-term plans that are well designed and targeted to involve of cooperation to face this challenge on both regional and international levels.
- Insignificant technical and scientific assistances to the majority of the developing countries from the various United Nations Organizations and from some developed countries, which have been relatively successful in facing the rising challenge of road traffic injuries.
According to the scientific Research Foundation (SRF), Road traffic injuries in the Arab region are a major public health problem, claiming about 40 thousand lives per year and around one million victims. This is equivalent to the entire population of both Qatar and Bahrain. As a result, our societies bear a huge cost that is estimated to be about 2.5% of the Arab National Products including Oil revenues. Although the huge number of injuries caused by wars that are unfortunately continuous in the Middle East, road traffic injuries are the leading cause of death among youth in our region and are predicted to increase in the next decade.
This report prepared by YASA International targets to face the increasing death toll in the majority of developing countries where more than one million are killed annually due to road traffic injuries and more than forty million are severely injured.
YASA International invites all developing countries to study the success of most developed highly motorized countries and then to respond to the rising road trauma levels by analysing plan to reduce casualties through outcome-oriented interventions.

The Mission of YASA International
YASA International, a new International Non-Governmental Organization, seeks through its effort to create a greater level of safety awareness and commitment from all people in order to reduce the global burden of uninternational injuries. It supports strategies to improve international cooperation for safety promotion and injury prevention. The organization launched from Lebanon in 2002 the Middle East Campaign for Accident Prevention (MECAP) which was successful in building effective partnerships with many public and private agencies in the region, especially with media and educational institutions.
The organization works to persuade policy-makers and decision-makers of the immediate necessity to treat Injury Prevention as a major public health issue and to adopt the universal concept of 6Es, based on cross-sectoral collaboration, as a new approach to reduce RTI.
YASA International provides social support to the bereaved families. It counts on their active partipation in the safety promotion movement in Middle East.
The report, prepared by the organization, entitled «International Cooperation to Improve Road Safety» is an important response to the underestimation of road safety by many national and international agencies. The report is directed at all policy-makers in various sectors such as public health, education, transport, media, law and other sectors, and aims to push efforts for better road safety for all.

Introduction
The world is changing day after day, and globalization has been in the making for many years. All people became more interdependent and closer to each other because of globalization. Threats to health and safety are also globalized.1 A major threat to safety is the growing problem of road traffic injuries. Traffic crashes and injuries are rapidly growing around the world and causing a huge economic and social impact on all societies, especially in the developing world.2 The World Health Organization (WHO) stated in 1990 that Road Traffic Injuries (RTI) were the ninth most important cause of years of life lost around the world. Unless all countries take action immediately, by 2020, they will rise to the second place.
Inspite of the fact that the risk of crash is relatively low for most individual journeys, people face risks on roads due to the various travels done on daily and weekly basis. Almost anybody can be involved in a traffic crash. No special time, place, or equipment is necessary. Crashes and related-injuries are not restricted or limited to race, creed, social status, age, or sex. The old and the young, the rich and the poor, men and women all may be involved in a crash.3
The term “accident”, which is widely used worldwide, can give the intended impression that “accidents”, are inevitable and unpredictable events that cannot be managed. Therefore, most new documents related to road safety prefer to disregard the term “accident” and replace it with “crash”. The injury problem has been largely neglected because injuries were viewed as random events. Nowadays, injuries are known to be preventable by the majority of people. The uses of helmets, seat belts, child seats, and pedestrian bridges have all been proven to be effective measures for injury prevention.4
For more than four decades, most of the developed countries have been organizing sustainable national campaigns to decrease RTI. The number of people killed and injured due to traffic crashes had significantly decreased in the developed world with different rates among developed countries. With this clear decrease in numbers, many institutions adopted “Vision Zero” initiated by Sweden that targets a theoretical zero death by road crashes. In June 2003, a new European charter for road safety was launched in a target of reducing the burden of injuries.5 People from all socioeconomic groups suffer fatal injuries, but death rates due to injury tend to be higher in those with lower income groups. The poor are less likely to make a full recovery following an injury due to the lack of the required means.6
In most of the developing countries, no effective traffic safety campaigns have been organized.7 The governments and the citizens of most of the developing world perceive road safety as a low priority issue inspite the fact that victims of road accidents in most developing countries are significantly increasing.8 No sustainable effort has been done to decrease road crashes. International agencies have almost done no successful effort to assist developing countries to combat this burden of injury. Even the last world summit about development organized in South Africa in summer 2002 did not adopt traffic safety as an international issue for sustainable development.
The United Nations Development Program UNDP, an international organization dedicated to help and assist developing countries in their efforts to achieve sustainable human development, had not consider until recently the struggle against road tragedies to be included in their mission and their policy.9
Contrary to most developing countries, many international organizations added road safety to their agendas during the past few years. Among such organizations was the World Bank whose President James D Wolfensohn said: “Road safety is an issue of immense human proportions; it’s an issue of economic and social proportions and also an issue of equity. Road safety very much affects poor people”.
 

Relevance and Objective of the Report
A key purpose of this report is to enhance the efforts targeting the international cooperation for road safety. It communicates information related to road traffic injury prevention to a wider audience especially in the developing countries, where the burden of traffic related injuries is still underestimated. This report may push many institutions (media, specialized non – governmental organizations, governmental agencies, and others) to study seriously the immediate needs to improve road safety and to put more pressure on their citizens and governments to prioritize safety. Very few studies have tried to treat this subject from this perspective.
Moreover, non – governmental organizations in developing countries had not been well supported by their governments compared to the support of similar institutions in developed countries. Most of these associations are disappointed by the carelessness of governmental agencies in dealing with road safety.10

Having reliable data on the numbers of victims and injured under an acceptable transparent registration system will push governmental agencies to formulate and implement national strategies in order to start decreasing the burden of injuries. The loss of productivity due to death and disability from injury represents a significant loss of economic opportunity in all countries. The treatment and rehabilitation of injured persons account for a large proportion of many national health budgets. Personal loss, to the injured and to those close to them, is immeasurable.11 Unfortunately, most developing countries did not realize the various negative impacts of RTI (pain, hospitalization and tourist frustration by unorganized traffic) on their GDP and on their sustainable development.
The main aim of this report is to provide both public and private policy makers in developing countries and cities, with scientific tools and practical experiences to draw strategies, design and implement road safety programs that can be effective in reducing the death toll on roads by taking into consideration that international cooperation was effective in reducing RTI in most developed countries. Learning by sharing is considered a very efficient tool to reduce the impact of road traffic injuries.
 

Fundamentals of Road Safety
Each injury incident is a complex interaction between a number of factors, including the host, agent, and physical and socio cultural environment. Dr. William Haddon, one of the first theorists in injury prevention, developed the Haddon Matrix to describe the inter-action between these elements during three phases: pre-event (before the injury occurs), event (while the injury in occurring), and post event (after the injury has occurred). The matrix helps professionals to assess the different elements of an injury and identifies which ones can be used to prevent injury.
The traditional view of injuries as “accidents”, or random events, has resulted in the historical neglect of this area of public health. During the past few decades, public health officials have recognized that injuries are preventable, and they have established methods of scientific study for the prevention of injuries.12 Road traffic injuries are a worldwide leading cause of injuries.
The most recent estimates show that injuries are among the leading causes of death and disability in the world. They affect all populations, regardless of age, sex, income or geographic region.13 An injury is defined as “a bodily lesion at the organic level, resulting from acute exposure to energy in amounts that exceed the threshold of physiological tolerance. In some cases, the injury results from an insufficiency of a vital element”.14
The WHO estimated that all injuries caused, in 2000, more than 5,5 million deaths that is a mortality of around 87 per 100,000 populations, and injuries caused more than 14 per cent of the global burden of disease. For every person who dies of injuries, several thousand injured persons survive, but many of them are left with permanent disabilities.
Despite the large social and economic costs of unintentional injuries, there has been a relatively negligible amount of investment in injury prevention and safety promotion research, compared with other health issues such as HIV/AIDS, Malaria, and Diarrhoeal diseases.
According to World Health Organization (WHO) press, deaths from Road Traffic Injuries (RTI) account for around 25% of all deaths from all kinds of both intentional and unintentional injuries. There are more than one million and two hundred thousand victims on roads and more than 40 million serious injuries per year that are caused by traffic crashes. YASA International estimates that more than two million people are killed yearly by road traffic crashes, if we consider deaths due to serious injuries in the first year after the crash. According to a study organized by the Scientific Research Foundation (SRF) in the Middle East Region, more than 55% of road traffic victims are from among the economically productive males.
Road crashes form the leading cause of death to people between 1 and 40 years old in most countries. Road traffic injuries are the leading cause of death due to injury15, and according to the global burden of disease study, the ninth leading cause of all deaths.
By 2020, WHO projected that Road Traffic Injuries (RTI) will account for about 2.3 million deaths, with 90% of these occurring in the less motorised countries (LMC)”16 and rise to 3rd most significant burden of diseases.
Although men are more likely to suffer a fatal injury than women (men accounted for two thirds of the total number of deaths due to injury worldwide in 1998), injuries are a leading cause of death for both sexes and in all age groups.17
Combined figures from Australia, the Netherlands, New Zealand, Sweden and the United States indicate that, in these countries at least, for every person killed by injury, around 30 times as many people are hospitalized and 300 times as many people are treated in hospital emergency rooms and then released. Many more are treated in other health care facilities, such as family doctors’ offices and first-aid clinics.18
Unfortunately, injury prevention has been considered seriously only in developed countries. It is estimated that around 75% of the global burden of traffic injuries is in the developing countries, whereas only 25% are occurring in the developed countries. This contrasts the fact that more than 75% of the vehicles of the whole world are circulating in the developed countries (vehicles circulating in low-income developing countries are less safe than those in developed industrialized countries).19
According to YASA International, a Non-governmental Organization specialized in Injury Prevention; the number of road victims will increase during the next two decades in most developing countries especially in the Middle East Region. Many advocacy non-governmental organizations recommended that all governments should face the growing number of road tragedies and work to save people’s lives by reducing mortalities and morbidities caused by road crashes.20
Decreasing the burden of injury is among the main challenges for public health. Many prevention strategies have already shown to be effective such as using seat belts and child seats in cars, and also helmets by motorcyclists. Another lesson is that the approach to injury prevention needs to be multidisciplinary and treated as a major public health issue. In many cases it is only through effective collaboration between physicians, sociologists, psychologists, lawyers, politicians, engineers, designers, human right experts, journalists, and other professionals from the public and private sectors that the right injury prevention strategy can be developed and promoted.

The Multisectoral concept of 6Es
Road traffic deaths and serious injuries are to a great extent preventable, since the risk of incurring injury in a crash is largely predictable and many countermeasures which are proven to be effective do exist. The conventional concept for road safety was the three E s (Education, Engineering, and Enforcement) that was developed by Siddney Williams, of the U.S. National Safety Council. The 3 Es concept has been a corner stone of road safety improvement programs.
The programs of traffic safety throughout the years have undergone a series of developments, but they always had a coordination element built in their structure. YASA International adopted the concept of six Es that is based on a wider coordination compared with the standard 3 Es.The three new Es that the organization proposed are Emergency, Evaluation and Encouragement. The 6Es are: Education, Emergency, Enforcement, Engineering, Evaluation and Encouragement.21 This concept is based on the new understanding that considers RTI prevention a multisectoral issue that requires the engagement and commitment of many actors.
 

Education
Education has been consistently viewed as the method of safety promotion that will lead to the ultimate degree of accident prevention. Education often proceeds with other methods since people must be aware of the traffic safety need before they authorize engineers and personnel to act. In addition, education has the responsibility of informing the public of new equipment or enforcement procedures. Basic principles of road safety have to be continuously promoted by NGOs, schools, universities, clubs, parents, media and many others. Traffic education should be life-long starting from the primary school since behavior change and education on safety needs time and effort.22
The concept of partnership between heavy vehicles, standard vehicles, motorcycles, and the pedestrians, has to be highlighted in order to avoid the aggressive behavior of many road users. All road users should accept sharing roads with others. Since most people are often reluctant to attend safety meetings or take an active part in safety activities, traffic safety education should also be planned to bring its concepts to the individual. The best way that usually accomplishes that target is through the mass media sources and the publicity campaigns. In addition, special handouts, billboards, and bulletin boards can be used to distribute traffic safety information. Effective traffic education should span over a person’s entire lifetime. Elementary and secondary schools are the most important phases of this system. However, traffic education has to compete for space against many other topics that are considered to be important and current.
Increased education is an essential part of improving road safety promotion. Improved methodology of providing such education is equally important. Visualization can be highly effective in providing safety education. With the enhancement in the capability of computers and reduction in price, it is expected that the computer will become an effective tool for education, even in the developing countries. Computer based multimedia can be successful in safety education.23

Mass Media Campaigns
Enforcement of new traffic regulations is more effective when preceded and accompanied by sustainable publicity and media campaigns. These efforts can assist in the struggle to reduce RTI.
 

Engineering
The provision of safe, sustainable and affordable means of travel should be a key objective in the planning, design and maintenance of roads. The vulnerability of the human body should be a limiting parameter for the traffic system.
Common drivers’ errors and common pedestrian behavior should not lead to death and serious injury. A main objective of traffic safety engineering should be to make drivers comply with traffic laws such as blocking the passage of pedestrians under the pedestrian bridges that are especially constructed for the safety of the pedestrians.
When new transport projects are proposed, area-wide safety impact assessments are needed to ensure the proposals do not have an adverse safety impact on the surrounding network. Road safety audits are then required to check that the proposed design and implementation are consistent with safety principles, and to examine whether further design changes are needed to prevent crashes.24
 

A. Better Road Infrastructure
The construction of new roads is not the answer to traffic growth. The emphasis is now on making best use of the existing highway networks, giving priority to treating the places with the worst safety, congestion and environmental records.
For safer infrastructure, the following points and guidelines should be considered;
1- Regular road maintenance.
2- Construction of more pedestrian bridges and proper sidewalks with consideration of the disabled.
3- Lane Width
The design of lane width on highways must take into consideration the speed limit and type of traffic.25
4- Pavement type
It is very crucial that the highway pavement be executed as designed in accordance with international standards. Finish grading of the pavement must also be completed properly to eliminate bumps, and holes in the pavement.26
 

B. Crash cushions
Crash cushions are usually effective in reducing the consequences and damages caused by traffic crashes. They form a cushion for the vehicles before hitting the rigid and dangerous hazards such as barrier terminals, light posts and sign supports. Evaluations done by the Scientific Research Foundation (SRF) in Lebanon found that these crash cushions which are rarely installed in Lebanon, had helped in reducing the fatal and serious injuries at some crash sites for up to 60%.
 

C. Traffic signals
Traffic signals should be used only where lesser forms of control have proven ineffective, since signals almost always create more "overall intersection delay." In fact, minor movements may experience excessive delay, particularly if the signal is improperly timed. As a result, many drivers switch to less desirable alternate routes or to residential streets to avoid the added delay.
 

D. Vehicle Improvement:
Since Charles and Frank Duryea built the first successful gasoline powered car back in 1893, the automobile industry has made phenomenal advances in vehicle reliability, capability and safety. However, despite these impressive achievements, driver judgment has remained one of the key factors in traffic crashess. New vehicles are engineered to reduce or eliminate the risks on the roads. Sensors, infrared detectors, radar systems, and optical imaging may improve visibility and enhance driver sensitivity to impeding dangers. Smart chips may even automatically initiate certain corrective or evasive actions.
The industrialized countries should make vehicles safer, in particular by harmonizing passive safety measures (fitting and compulsory wearing of seat belts, in particular in coaches, widespread use of universal attachment systems for child-restraints devices and development of vehicle design to reduce the impact of accidents) and support for technical progress.27
The development of brake control systems started with the ABS in the late seventies. Brake interventions at the driven wheels emulate the function of an automatic differential lock. In combination with an engine control the first stage of a stability control system became available. Further additional control circuits were introduced to reduce excessive wheel slip at the driven wheels during downshifting of the gearbox or during light braking while cornering close to limit speed. With the development of automatic wheel individual brake control systems, which limit over steering or under steering during extreme driving maneuvers, a further step towards a very efficient improvement of active safety became available.28 With additional driving dynamic sensors, which generate signals for an actual nominal comparison of the driving situation, further functions became possible, which lead to the introduction of Electronic Brake Management.29
 

Enforcement
Road traffic law sets the framework for using the roads safely. It provides clear standards based on experience and analysis. Implementing all traffic rules and regulations on all who share the roads and regular review of these rules. It is crucial to use Technology as a means to help law enforcement (for example, using speed radars and alcohol tests). Traffic offences range from minor, careless errors to extremely serious, deliberate offences with devastating consequences for other road users and the drivers themselves.31
It is a serious problem facing all enforcement agencies in most countries that road traffic offences are not regarded by society with the same degree of condemnation as other crimes. This is partly a question of social attitudes but it is also affected by a lack of understanding. Road traffic laws are usually complex and the reasons for regulation are not always obvious for people. Safety Education can be helpful by raising the knowledge and acceptability of traffic rules and regulations.32
The fine for not using the seat belt is 30 Euros in the Netherlands. The number of fines (about 230,000 in 2001) increased dramatically the last few years, but apparently did not leading to an improved seat belt behavior. There is about 20% of drivers do not use their seat belts in the Netherlands nowadays. Not only in the Netherlands, but also in most countries there is a need of more efforts in both education and enforcement in order to have a higher rate of seat belt use.
 

Emergency
To increase road safety, post-crash care is crucial in preventing deaths and disability through limiting the severity of the injury and the suffering caused by traffic crashes. In order to improve the performance and capacity of the pre- hospital care system and the emergency care in hospitals,33 the following remarks should be considered:
1- New roads should include emergency lanes;
Paved emergency lanes must be provided on all highways on both sides of the pavement, and in each direction of the highway. The emergency lane has several purposes; access for ambulance and emergency vehicles to the accident site in a timely fashion, and also to provide a safe location, to park the vehicle in case of flat tire or a mechanical problem.
2- People, who arrive first at a scene of a crash, should get used to call quickly the emergency institutions or call other sources of help.34
3- Training all people, especially commercial drivers, on basic first aid principles because the majority of road traffic deaths in developing countries occur in the pre-hospital phase. All educational institutions and corporations should train their employees on needed actions in case of an injury or a disaster.35   
4- Teach road users (for example, during training for a driving license) how to secure and signal the area of a traffic crash (i.e. triangle, lights, road flares) in a safe way and to avoid and prevent further complications, pending the arrival of emergency units.36
In April 2001, the economic and social council of the United Nations adopted a new resolution highlighting the role and the importance of Fist Aid training and equipment for road users through specific recommendations, applicable in UN Member states from 2003. These achievements were done in close collaboration with FEVR and Red cross/Red crescent.37 Since September 2003, it is obligatory for all new drivers in the EU to know how to behave in the case of a road crash and have basic knowledge of First Aid and Knowledge of measures to be taken after a road crash or similar occurrence, including emergency actions such as evacuation of passengers.38
 

Yielding for emergency vehicles
Drivers must always yield the-right-of way to fire engines, ambulances, police cars, and other emergency vehicles when those vehicles are using a siren and/or emergence flashing lights. If they see or hear an emergency vehicle coming from any direction, drivers must pull as close as possible to the right side of the road and stop until the vehicle has passed and keep in mind slow rolling is not acceptable.39
Drivers must check their mirrors and find a safe place to pull over to the right. They should not pull their vehicle to the left or slam on brakes and stop suddenly. They should use right turn signal to let those driving behind know what they plan to do.
After the emergency vehicle has passed, use your left turn signal and make sure the lane is clear before merging into traffic. Drivers must also be sure that there are no other emergency vehicles approaching before they enter traffic.
 

Training Human resources
Training for teams specialized in trauma care is crucial to save lives of injured people.
YASA International asks developed countries and the World Health Organization to provide more technical support to train human resources in the developing countries on how to deal with various injuries on the scene of crashes. For example, in Lebanon, the introduction of Trauma Life Support courses for some doctors and for the Lebanese Red Cross and civil defense led to decrease the trauma mortality in the field of traffic crashes.
 

What to do when you come across or face a crash?
There are many things that a passer by or even a person involved in a crash, can do to help limit injury. The first task in the event of a road crash is to secure the scene before trying to get close to the casualty. It is not sufficient to simply switch on the hazard warning lights, you should also use the warning triangle (red triangle), which all drivers are required to have in their vehicle. It must be placed at an appropriate distance before the location of the crash (Ahead of a curve or at least 200 meters before the crash in the traffic direction). After securing the scene, you should inform the concerned parties by calling the emergency institutions. When calling for help, you should identify the exact location of the crash with the approximate number of casualties.
After calling for help, and in case of knowing the basic first aids principles, it is possible to try helping the casualties. The basic and most important thing is that the casualties should not be moved except when there is threat to the casualty’s life such as the car catching fire, or the car on the verge of rolling over to a valley.
Not only is it necessary for every car to be equipped with a basic first aid kit but every person especially drivers should know basic first aid.
 

Evaluation
Evaluation of road safety efforts rely on various uses of injury surveillance and registration. On national basis, good injury surveillance data allow concerned parties to compare losses caused by RTI with past years and to forecast the future. The results should be useful in both policy development and in the implementation of new interventions.40 Good injury surveillance can inform the public of the number of people lost and injured on roads and generate statistics that give an overall picture of the categories of crashes and of RTI. Experiences from many developed countries proved that good surveillance had assisted in planning successful interventions to reduce RTI.
Evaluations should be systematic because they require careful planning and consistent use of the chosen techniques. Evaluations should also be reliable. The findings of an evaluation should be reproducible by a different evaluator with access to the same data and by using the same methods of data analysis. Finally, evaluations should be user-driven.
International cooperation is highly required to establish better injury surveillance systems in developing countries. But, every country and every organization has its own needs and problems that should be considered in building the most suitable RTI surveillance system. A study, organized in 2003 by YASA International in many Arab Countries, proved that many factors unique to a certain developed country may present serious problems in building reliable injury surveillance in many Arab cities and countries. The study recommended taking advantage of developed countries experiences in training staff that build RTI surveillance systems in developing countries and cities.
Evaluation is a cornerstone for the success of road safety interventions. As an example, in the study entitled “A small area study of motor vehicle crash fatalities in Alberta, Canada”, most quantitative analysis achieved in that study are based on the developed injury surveillance system. Through evaluation and comparisons between many variables,interventions to reduce road traffic related injuries could be designed in a better way.

 
Encouragement
The success and improvement of any national campaign for injury and disease prevention is mainly reliant on the evaluation of the campaign and the encouragement of the components that help in the success and progress of the campaign to reach the planned goal. Moreover we should also treat and punish the causes that lead to the distraction of the campaign from achieving its aims.
Encouragement and rewarding can increase the impact of the positive causes on public safety.  Likewise, the punishment of bad behaviors that affects negatively can lead to limiting such behavior and its impacts.
Encouragement could also have many forms such as financial or moral rewards which help in facing tragedies along with the other 5Es which are: Education, Enforcement, Emergency and Engineering.
YASA’s adaptation for the vision of the 6Es and introducing the encouragement as the 6th E, is from its conviction of the benefits of the encouragement and rewarding in relation to the other 5Es.
It is the role of the government and the house of parliament to hold back the money from official bodies such as municipalities, ministries and public organizations that do not follow safety standards in road construction and maintenance. It is also important to provide more financial support for the parties that are meeting safety standards.
The diversification of responsibilities usually leads to conflicts that result from avoiding responsibilities and depending on others. Some conflicts of responsibilities between ministries has at times lead to neglecting responsibilities by the concerned ministries for coordinating work to preserve human life on the roads.
This bitter fact has been lived by most developed countries in the 60s and 70s.  Their remedy was through constituting a Higher Commission for Traffic Safety, which reports directly to either the Prime Minister or one of the ministries of interior or transport. This higher commission has independence to the extent that its annual report can affect the parliament, governmental policies and the public opinion. This is due to the fact that this facilitates the monitoring of the concerned parties in traffic safety.

The Major Actors

   While it is ultimately the responsibility of the individual to drive safely, there is also a role for many groups and organizations both public and private, to provide the tools that will help road safety.
   Transportation is constantly changing and the volume increasing continuously. We believe that road safety, as understood by our association, by the European Federation for Road Victims (FEVR) and by an always-larger part of the public opinion, will follow a new evolution. We think that the responsibilities must be shared. This will include in addition to that of the drivers, that of the car manufacturers, road and highway builders, town planners, lawmakers, judges, police, teachers, insurance companies, first-aid worker, doctors, psychologists, media, motor clubs, as well as victim associations. The objective of the present report is to define the role of the major actors and the kinds of roles they can adopted to prevent road traffic related injuries:
 

Legislators
The influence of legislation has been one of the strongest forces at work for traffic safety in most developed countries. The desires of people for education of young drivers in high school and as expressed by their legislators helped provide compensation for injured people, and made provisions for many more safety measures to protect all persons.  In most developed countries, legislative acts to create safer conditions are a direct result of many other forces such as the safety organizations, universities and media. “Seat belt legislation is one of the most important public health measures of modern times”. This was the conclusion in 1988 in “Strategies for accident prevention” for the U.K. (HMSO, 1988). The seat belt was introduced in 1971 in the Netherlands, in 1975 in Sweden and by 1983 this law was passed in most developed countries.  After around three decades, most developing countries passed the seat belt law under the influence of the road safety movements in these countries.
   Traffic crashes dilemma had created a variety of legal issues, especially in the potential liabilities in activities surrounding the use of automobiles and other motor vehicles. Individuals and organizations are usually aware that the ownership, maintenance, or use of a motor vehicle creates a serious liability exposure, but they often do not appreciate the complexity of magnitude of this exposure. This section will deal briefly with the special factors affecting the finding of negligence and liability in automobile crashes, the financial responsibility requirements that governments have imposed upon drivers to protect innocent victims of their negligent acts.
    The law clauses penalizing negligence still play the most important role in automobile liability. Negligence relating the use of vehicles normally depends upon a jury’s decision as to certain questions of fact: (1) Did the defendant fail to have the vehicle under proper control? (2) Did the defendant fail to exercise proper lookout? (3) Did the defendant operate the vehicle at an excessive speed? An affirmative answer to any one of the three above questions will result in finding the defendant negligent. The owner of a vehicle, however, can not be concerned only about his or her own driving habits and liability to meet the above negligence tests. Liability may also exist under certain conditions in the use of the owned automobile when someone operates it other than the owner.
     
Country Presidents
John F Kennedy, the US President of 1960-1963, said: “Traffic accidents are one of the greatest, perhaps the greatest of the nation’s public health problems.”
    Dr Thomas Klestil, the Federal President of the Republic of Austria, said in welcoming guests to the Seventh World Conference on Injury Prevention and Safety
Promotion:
     As Federal President of the Republic of Austria I have accepted with pleasure the patronage of the “Seventh World Conference on Injury Prevention and Safety Promotion” to be held in 2004 in Vienna.
  For many years I have followed attentively the international scientists in this field, which are reflected in meetings and congresses in Austria. And I am glad that the relevant issue of risk and injury prevention will be discussed in Vienna. Our modern world, which-through communication and technology has made life much easier for us, has unfortunately also lead to a multiplication of the risks and threats with which we have to live, a fact too little noticed and inadequately investigated so far. It has thus also become increasingly necessary to analyze the wide realm that has opened itself in the field of risk prevention. I hope that the result of this World Conference will contribute to making questions of safety and injury prevention a central issue, thus reducing the risks faced by human beings.
 

Regional, Provincial Governments and Local Authorities
The development and implementation of safety programs are the responsibility of the local community. Planning and development of a road safety campaign can often be done on a national basis. The actual program must be implemented by people in the community.  If leadership does not exist at the local level, all educational programs except simple public information announcements will be poorly developed, if at all. In order to have an effective traffic safety program, the community leaders must take an active part in the program.
Community leaders are in a position to determine which programs are most effective and the best time to start them. They will be able to present the program in a manner that will be acceptable to a majority of the people.
 

Police or Internal Security Forces
The Judicial Prosecution Institutions have also a major crucial role in promoting road safety.
Mr. Serge MACKOWIAC, national prosecutor (France), emphasizes a difficulty in getting a simple message across in daily life: road delinquency really is delinquency. The fact is that the messenger is his own target. Policemen, judges and elected officials never identify with thieves or swindlers, but they sometimes identify with drivers violating the regulations. Moreover, he recalls that the weapon of the crime, the car, is a symbol of social success, and that the majority of the violators of traffic regulations, very highly socialized, are utterly unaware of their social danger.
 

Educational Institutions
Formal education in the schools and mass education of the public have both played important roles in the development of the accident prevention movement. Since accidents result from human failures, there is a need for education and training in safe practices in nearly every type of human endeavor.
  Justin Okot, the chairman of the National Road Safety Council of Uganda, said: “If road safety education could be introduced into primary schools in Uganda it would be the single most important contribution to road safety ever seen in this country.” Educational institutions, in the developing countries, should raise the priority of safety education and play their role in changing behavior of the upcoming generations.
Also, in developed countries, colleges and universities prepared and disseminated many safety publications that contributed to the development of safety education. These publications include reviews of doctoral level and other research projects at these institutions in addition to many promotional safety materials that have been used to the advantage of accident prevention work.
In developed countries, universities and research centers work together in joint research and programs that targets to study and analyze accidents and prevention. Many books and researchers from different institutions in different countries join efforts and experiences in their common work.  Many institutions in developing countries fail to work together, because they have a tendency to be attracted by Western Institutions. These institutions should continue learning from the developed countries, but they must share their experiences with their counterparts in the developing countries.
 

Ministry of Education
The planning of safety education experiences into the school curriculum should involve many sectors of the school and community. Many persons can contribute materially to the program. Bringing persons from these sectors into the planning stages of the instructional program will lead to broader, more meaningful experiences and create wider acceptance of the safety curriculum. These groups should include teachers, pupils, and representatives of community agencies and organizations interested in the objectives of safety education.
 

Research
   A major problem of developing countries is the reliance on international research that does not always match with the local and community’s needs. Universities and research centers can help to initiate and assist a cadre of national and local professionals from a variety of fields (public health, medicine, engineering…). Those professionals can study and evaluate the local needs and produce efficient results if they are able to maintain the independence of their research. In most developing countries, there is a major problem that researchers are usually recruited and employed by public agencies, which are usually not willing to support independent research that may criticize the performance of these public agencies.    
 

Vehicle Manufacturers and Importers
The motor industry is highly competitive and operates worldwide. Unless there is a consumer or other demand for a safety feature, safety is unlikely to be offered.  Better information on safety is now available, and as consumers become better informed, they start to choose vehicles with a better safety record, especially in developed countries. If this continues, the motor industry should be encouraged to provide further improvements.
This is an exciting time: modern technology is constantly pushing back the frontiers of vehicle design and offering innovative approaches to age-old problems. These new technologies are already delivering many improvements to new vehicles. In the next few years we expect to see vehicles that are intelligent in their own right, helping to avoid accidents and to protect road users.

Despite all the aforementioned improvements to the design, manufacture and quality of new vehicles, many cars are subject to a safety-related recall by the manufacturer during their lifetime. There seems to be a worrying trend of car recall during the last decade. Most vehicle manufacturers can do more to halt this increasing trend of recalls in order to avoid defects that are causing undesired crashes and casualties before the first recall.
    
Assessment of Safety Features in New Vehicles
    People buying new or used vehicles must be aware of the safety specifications in the vehicle. Most consumers in developing countries are not aware about the safety performance of vehicles, while in developed countries consumers rely on New Car Assessment Programs (NCPAs) that subject new vehicles to crash tests in order to rate their performance in case of traffic crashes. NCPA are considered as an evaluation of the safety performance of the new vehicles and of their manufacturing companies. The first NCPA was set up in 1978 in the United Sates, followed by Australian and European versions in the nineties. Research has shown that NCPAs were relatively successful in estimating safety specifications according to safety stars for each vehicle.
 
Vehicle Inspecting Agency
In most developed countries, the role of the vehicle inspectorate is to prevent road accidents from happening and to protect drivers and passengers when an accident occurs, by checking that vehicles are roadworthy and through other road safety enforcement measures.
Its work should include:
1- Supervising all vehicles (Cars, buses, coaches, trucks and trailers).
2- Checking that the operators of heavy trucks, buses and coaches are meeting their license conditions.
3- Cooperating with the police in a program of spot checks on heavy commercial vehicles and their drivers to check licenses, hours, and roadworthiness and vehicle weights.
4- Checking and certifying the safety standards of imported vehicles
5- Inspecting vehicles as part of accident investigations
6- Considering with manufacturers the reports of safety defects.  

Media
Media should stress that road traffic safety is synonymous with public safety in everyday life.  Control of road danger is trailing behind controls imposed on other sectors where there is a potential danger - i.e. shipping, aviation and railways. Ingrained habits prevent the use of road safety applications of devices used in other transport systems - such as advanced technologies - to enhance safety and codes of good conduct. To change this, a new culture for road safety is required and the media can play a vital part in bringing this about. It should also be emphasised that traffic regulations are instituted for the safety of all and that they are the result of a careful process involving, consultation and consensus.
Together with the media, people are already creating this new culture, which influences lawmakers/enforcers, road designers/builders and car manufacturers.  Road traffic safety and the reporting of crashes should belong to the core curriculum of the schools of journalism and publicity of awards for safe driving, causes of crashes (fog, alcohol, drugs, etc.), crash analysis, enforcement (also technological advances), crash statistics and socio-economic costs of road crashes should be encouraged.
    The awareness of the public to the dangers of road-traffic should be continuously promoted. While other risks of civilization, e.g. nuclear power or other means of transportation, get great attention by politically active people and journalists, this is not so for road-traffic, although clearly more people lose their life on the roads.
The press contributes a lot for the purpose of educating the public on various phases of safety. It is always the first group to be called upon to support safety campaigns. Television and radio channels are considered the most important media communication channel in providing safety education for the public and are required to provide a portion of their broadcast time in the interest of public service. Alfred P. Sloan said, “Radio and television have added a new dynamic to the nationwide effort to curb traffic crashess. Broadcasting has become a potent educational force for informed opinion and constructive safety action throughout the country”.  Radio and television have supported many types of road safety campaigns. For example, in the Arab countries, YASA, the Tunisian Association for Road Safety and many Arab ministries of Interiors, had organized many radio and television programs that are based on road safety themes.
In all countries, publicity campaigns are important, particularly when laws are introduced, in order to inform the vehicle users. This has been the case in most developed countries where it can be assumed that there is a high level of knowledge concerning traffic safety issues. To keep this knowledge, media is a strong partner in the sustainability of road safety campaigns.  Shock as a permanent condition is, however, a contradiction in itself.  With increasing saturation it becomes difficult to attract any attention whatsoever by shock methods.
    
Motoring Associations
Motorcycle instructors and associations have a basic role to do for safety education. One agency in the United Kingdom declared:
We propose to develop the compulsory basic training course for all learner riders and possibly introduce different courses for different types of motorcycles. We shall work closely with motorcycle instructors, safety experts and rider organizations to get the training package right.

Commercial Advertising
Advertising is a powerful tool and this is recognized in most countries. There has been too much speed-dominated car advertising. This kind of commercial advertising is irresponsible and stimulates youth to behave in a dangerous way. Advertisers can do more to encourage responsible, safe and considerate behavior among road users.
Early initiatives to influence vehicle advertising were taken in Germany, Switzerland and Austria. In 1988, the European Conference of Traffic ministers moved in the direction of greater internationality. It pronounced itself against aggressive advertising, which trivialized the actual risks involved. It adopted a resolution, which included the commitment of the ministries of all European participants to initiate steps to limit all advertising, which was detrimental to safety.  
 
The Military
The armed forces represent in most countries one of the largest employers. The individuals involved in various job tasks also make the military a source of numerous RTI with a higher rate of deaths compared to others. Therefore, the various branches of the armed forces must do a lot of efforts to reduce their mortality rate that is caused by traffic crashes. This should start by declaring publicly and in the military magazines the number of killed and injured due to RTI and to set short-term and long-term targets to decrease the burden of RTI.  
     The Norwegian army has decided that they want to decrease the number of crashes where soldiers are involved. The Norwegian Public Roads Administration, Telemark, has on several occasions been visiting the Royal Norwegian Air Force School of Transport to run the video and talk with the guys there. The Royal Norwegian Army’s Transport Officer now works on a concept for the rest of the army.
Unfortunately, most military leaders in developing countries are not aware about their role in purchasing safe vehicles for the military and are rarely engaged in declaring publicly their willingness to reduce RTI.
Religious leaders
Religious Leaders have also a crucial role in Safety Awareness. His Holiness Pope John Paul II said in the World Remembrance Day for Road Traffic Victims in November 17, 2002:
Every year, this Sunday invites us to remember road traffic victims. While especially praying for the Lord to welcome in His love all those who tragically died in a road accident, I entrust to the tenderness of the Madonna the numerous injured people, often permanently disabled, as well as there families and I appeal to the solidarity of all. Finally I fervently demand all drivers to show respect for others, accepting to drive in a careful and responsible way.
Although religious leaders have a major role to do in order to promote safety awareness, very few are aware of this role.  It is greatly needed that road safety experts and practitioners do their best to convince religious leaders in promoting safety awareness.
Driver Training Schools
In most industrialized countries, driver training is seen as a necessary requirement in the quest for a driving license or permit. The normal approach is to follow a syllabus that covers sufficient elements to enable the student to pass the license test. Ideally, the syllabus and the training should aim to prepare learner drivers for all potential hazards and situations and not just those tested by the examiner at the time of the test. But in reality, it cannot. It is evident that most candidates are concerned only about learning enough to pass the test.    
Better driving skills and better driving behavior would make an enormous difference in reducing the number of road casualties. Driving is an acquired and demanding skill that takes years to master.  In addition to the right skills, drivers need the right attitude towards speeding, other road users, alcohol, drugs and fatigue. Learning to drive should be relevant to today’s road conditions. Learning does not and should not stop when the candidate passes the driving test. Safe driving is as much about attitude as about ability to control the car. Driver training should not only introduce safe driving, but should reinforce it throughout training.
 There are number of basic essentials for the safe and efficient operation of a motor vehicle. Among the most salient of these are attitude, skill, and good knowledge of road safety. The driver training schools have a major role to prepare well-trained drivers to know the potential risk faced on roads, install in young people the right attitudes towards road safety and to guide learner drivers to take a more structured approach to learning, to prepare them for their driving career, not just to pass a test.
Driving Instructors
  Governments must ensure that people advertising themselves as driving instructors are qualified to do so. In order to receive a qualification, they must have successfully completed a training course organized by the appropriate authorities and be qualified to drive vehicles of the type in which they wish to instruct. Once qualified, their names should appear on a register of driving instructors and they are then entitled to charge for driving lessons. However, it is not essential that only qualified driving instructor instruct learners.
  Driving instructors should have the ability to impart practical and theoretical knowledge to their students. As well as the obvious skills in driving the vehicles and giving demonstrations of techniques where appropriate, they should be conversant and comfortable with classroom procedures and be good communicators. It should always be remembered that a competent driver does not necessarily make a good driving instructor, but a competent driving instructor must always be a good driver.
Health Care Professionals
   Doctors, nurses, and other medical, emergency, and health care professionals can also add their unique perspective to road safety. They can use their experience, knowledge, and professional reputations to educate state legislators, the media, patients, and the general public about the various dangers traffic such as not buckling up, drinking and driving, and not using child restraints properly.
    To achieve better road safety, the health sector has to integrate its policies with transport and safety policies. This sector has to improve emergency and rescue services especially for the vulnerable and the poor. It has to develop sustainable training programs at regional and national level for improving first aid knowledge and trauma care management. Finally, the health sector should encourage and strengthen partnerships with the transportation sector, NGO’s and the insurance sector.   
Civil Society Organizations
    Groups such as Advocates for Highway and Auto Safety, Colleges of Emergency Physicians, Academies of Pediatrics, Coalitions for Traffic Safety, International Association of Chiefs of Police, and Network of Employers for Safety Products, Parent Teacher Association, Transportation engineers and others can provide valuable technical assistance and resources. They can build constituent efforts and partnerships, advocate strengthened laws and increased enforcement, and provide better road safety education.
     Important key players in road safety are non-governmental organizations. These organizations have emerged to fill in gaps in the response to the increasing number of road traffic deaths and injuries as well as the resultant health, economic and social consequences. There are many voluntary organizations working actively for road safety in many countries.
Business Enterprises
   Many businesses already have made major contributions toward increasing road safety, from local businesses to major international corporations. They should provide more support for safety laws by implementing, for example, seat belt use policies and programs for their employees and their families. Many enterprises communicate road safety messages to their employees and customers. As a group, business is respected by country legislatures, community governments, and private citizens, and wields influence in determining legislative, economic, and commercial priorities. Business can promote the "healthy habit" through a wide variety of strategies and is an essential partner in collective road safety efforts. More business enterprises should join in coalitions with other businesses and national organizations to advance road safety education, legislation, and enforcement. In most developing countries, business enterprises form a cornerstone of the scarce funding available for road safety campaigns.     
The Emergency Units
    In most developed countries, the rescue team may be at the place of the accident within 10 minutes in cities and 20 minutes in suburban areas. The duties of the team of medical or paramedical personnel, is to stabilize the vital functions of the victim for the transport to the hospital (and not performing surgical operations). It is important that the team performs on the spot a preliminary diagnostic in order to direct the patient to the appropriate hospital.
 
CHAPTER FOUR
An International Dilemma
The objective of road safety work throughout the eight decades that follow 1923 is still the same .The whole target is to reduce the number of the casualties, and the diversified impacts of road accidents. But the most important and difficult element of achieving this objective is in the HOW phase of the improvement process. The answer of developed countries is through sustainable planning, programming and implementing of road safety campaigns.
Road Crashes are Causing Huge Losses  
   The road injuries and loss of human lives would be seriously strained if steps were not taken at this time to find conventional solutions to dealing with the traffic problem. We can assure that the context of the aforementioned statement is valid worldwide although major changes had occurred in some developing countries and road safety is considered today as a high priority transport and public health issue in most developed countries.
      Mortality due to road traffic injuries have always existed in the past but their recognition as a public health problem is a phenomenon of the last decades of the twentieth century.  Policy makers and safety professionals in many countries find it very difficult to institute changes that can result in dramatic decrease in fatalities. This is mainly because experience shows that public sectors and individuals do not abide easily by instructions given in order to promote road safety. Attempts to educate people face many problems due to the wide variations between people’s knowledge and their actual behavior. This makes injury prevention and safety promotion a very complex process. Therefore, there is a societal and moral responsibility to design our vehicles and our roads and different domestic traffic laws so that people find it easier and convenient to behave in a safe manner without sacrificing their needs to earn a living or to fulfill their other societal obligations. With better designs, rules and regulations, the probability of people hurting each other or themselves will decrease. Such systems cannot be put in place unless there is a societal and political understanding about the ethical and moral responsibility of the governments and the civil society organizations to ensure the right to life of all its citizens. This right to life includes living in good health.  Once we admit that injury control is a public health problem and that we have ethical responsibility to arrange for the safety of individuals, the worldwide problem of injuries will start to be resolved.   
 Injury control work needs very innovative working techniques. The present collaboration mechanisms for inter disciplinary research, sharing techniques between different states, and structures for interaction between scientists and the public are still somewhat weak. The better structures and methodologies will become apparent only if we consciously evaluate experiences, successes and failures in widely different societies and settings.
  Road safety is an issue of immense human proportions, it is an issue of economic proportions, it is an issue of social proportions and it is also an issue of equity. Road safety very much affects poor people.  Collaboration between individuals and countries had almost succeeded in many environmental issues and it is highly urgent to enhance efforts of international collaboration on all plans to reduce road traffic injuries caused by all types of accidents, especially traffic crashes.
European Commission: Placing Users at the Heart of Transport Policy
     Of all modes of transport, transport by road is the most dangerous and the most costly in terms of human lives. Still viewed as something of a fact of life in most developing countries, it is only recently that road accidents have aroused any particularly strong reaction. Road safety should be placed in the heart of domestic and international transport policies.
     Studies indicate that drivers in Europe (as in most developed countries) expect stricter road safety measures, such as improved road quality, better training of drivers, enforcement of traffic regulations, checks on vehicle safety, and road safety campaigns.  While in most developing countries, the aforementioned recommendations still considered as a low priority.
In the European Union, in the 1990’s, many directives related to technical standardization have been promulgated in order to develop safe motor vehicle equipment and accessories (compulsory use of seatbelts, transport of dangerous goods, use of speed limitation devices in lorries, standardized driving licenses and roadworthiness testing of all vehicles).
   The Maastricht treaty in 1992 finally provided the community with the legal means to establish a framework and introduce measures in the field of road safety.
In the battle for road safety, the European Union set to itself an ambitious goal to reduce the number of people killed between 2000 and 2010 by half. This would be by a series of recommendations such as harmonization of penalties and promotion of new technologies to improve road safety.  While in developing countries, the situation is very different. The sums spent on improving road safety fail to reflect the severity of the situation. Efforts to prevent road accidents are still inadequate.
World Health Organization’s Response (WHO)
    In recent years, indications that road traffic injuries are raising sharply, particularly in developing countries, have given WHO a new impetus to address this major public health concern. The WHO Director General had announced that the annual World Health Day in 2004 will be dedicated to “Road Safety”. During this event they launched the World report on road traffic injury prevention that WHO prepared with the World Bank. Although efforts on road traffic injuries have been rather sporadic since the World Health Assembly called on WHO to act on the problem since 1974, there is no doubt of WHO’s renewed determination to address the issue.
    The first tangible outcome of this renewed commitment was the production of the “Five-year WHO strategy for road traffic injury prevention”. Developed in 2001 in collaboration with experts from health, transport and police, as well from NGO’s and the private sector, the document covers the areas of epidemiology, prevention and advocacy. It outlines a strategy for building capacity at local and national levels to monitor the burden of road traffic injuries; for incorporating road traffic injury prevention and control into national public health agendas; and for promoting action-oriented policies and programs so as to prevent road traffic injuries.
      In order to identify effective and cost-effective strategies for preventing road traffic injuries, WHO has commissioned the Cochrane Injuries Group to conduct a systematic review of existing good practice in this area. The Cochrane Injuries Group, based at the London School of Hygiene and Tropical Medicine, is an international network whose task is to prepare, maintain and promote high-quality, peer-reviewed systematic reviews.
WHO Collaborating Centers
   The Department of Violence and Injury Prevention of the WHO is supported in its work by a network of WHO Collaborating Centers and National institutions designated by the WHO Director General to form part of an international network undertaking activities in support of WHO’s program priorities. Seventeen such bodies have been designated as WHO Collaborating Centers on Injury Prevention and Control. Discussions to create additional six of which five are in developing countries are in progress. In November 2002, VIP hosted the 12th Meeting of WHO Collaborating Centers on Injury Prevention and Control. With the participation of VIP staff and Regional Advisors and representatives of the Collaborating Centers, the meeting was also an opportunity to update participants on the current work of WHO and the Collaborating Centers for Injury Prevention and Control.
The Resolution of the General Assembly of the United Nations 57/309
A turning date in the improvement of road safety, worldwide, was 22 May 2003 when the Fifty-eighth session of the General Assembly of the United Nations took the resolution 57/309. This resolution discussed road traffic injuries and the challenges relating to the prevention of road crashes and their impacts. It emphasizes that road traffic injuries now pose a global public health crisis that requires urgent action at the national and the international level.
      The resolution 57/309 described the magnitude of the problem, the health, social and economic consequences, and the risk factors and determinants that predispose certain groups to vulnerability to road traffic injuries. This resolution calls on member states, particularly developing countries, to stimulate a new level of commitment in tackling the problem of road safety.
    This resolution encouraged each member state to assess its own road traffic safety problem and situation. This includes promoting and facilitating research that will build capacity and improve data collection methods, and encouraging collaboration between various sectors so that effective surveillance, data management and evaluation can be enhanced. Accurate assessment of the road traffic injury problem involves collecting data not only on deaths and morbidity, but also on the economic impact of road traffic injuries, so that this can be compared with other social problems or government priorities.
The World Bank Response
     “It is important to look at the overall picture of what causes road deaths, and take a cross-sectoral approach that can be nested within a country’s development framework, and is therefore capable of being applied nationwide”, says taskforce member Eva Jarawan, AFR Lead Health Specialist.   
    The need to reduce road traffic injuries pushed the World Bank to create recently a Bank taskforce with members drawn from across the health, education, and transport sectors. On the other hand, the World Bank has project work underway in 28 countries on either improving road design and other road systems, or improving road design and other road systems, or improving emergency medical care for people injured in road crashes.
  In his report about “The Role of NGOs in Road Safety” Leif Agnar Ellevset, World Bank Road Safety Consultant, stated that:
  The World Bank support and cooperation with NGOs in road safety should be improved during the next years. The aforementioned successful seminar in Bangladesh is a good example to be replicated in other developing countries and cities, especially because it includes NGOs, which often have proved to play an important role in the work to prevent road crashes.   
 
Gender and Road Traffic Injuries
   Globally, almost three times as many males as compared to females die from road traffic crashess, accounting for the largest sex differentials in mortality rates from unintentional injury.  In Barcelona, Spain, a large 6-hospital study found that 7 of 10 road traffic injury cases above the age 14 years were among males, and the overall death rate was more than three times higher for men than women (Plasencia 1995). Injury and fatality rates for males are higher for every category of road injury victim in several developing countries.
   Higher male risk of road traffic injuries and fatality is associated to a significant extent with greater exposure to driving as well as to patterns of high-risk behavior when driving. On the other hand, higher male pedestrian injury and fatality rates appear to hold irrespective of time spent walking on the road, and are attributable to alcohol use and risky behavior.
Social and Economic Costs
The experiences of the developed world show clearly that “Economic assessment of the costs involved is an essential element in the planning of the implementation phases” of road safety improvement programs. This sort of assessment played a significant role in motivating the political leadership in developed countries to respond energetically towards improving the level of road safety. Such response had helped the declaration of road safety as a national and strategic goal, and the allocation of adequate funding for this purpose. At present, the socio-economic and environmental costs of road accidents worldwide are not known. However, Retting estimated a global economic impact of motor vehicle injuries and property damage being of more than US 300 billion USD annually.
SRF using the same calculation principles as Retting estimated in 2000 the global economic impact at more than US 500 billion USD annually. In the United Kingdom, the estimated economic costs of RTI, despite the decrease in road fatalities, have increased from 230 million pounds in 1961 to 2,820 million pounds in 1985, a percentage increase of 1,126%. In the United States, in 1940, the estimated economic cost of road accidents of 34,501 road fatalities was 1.6 billion USD. In 1950, the cost of 34,763 fatalities increased to 3.1 billion USD. In the 1990’s, it reached 95 billion USD.  It is estimated to be more than 300 billion USD in 2010.
Medical Costs
There is an urgent need to spend more money on improving and upgrading the quality of the pre-hospital care for road traffic victims especially by improving the means of emergency medical transport (medicalized ambulances and helicopters) and by a better preparation of the rescue team in emergency medicine.
In the European Union, according to the present definition of the injured road traffic victim and the evaluation of the total medical expenses, the average cost of an injured victim amounts to 3,000 Euros, this represents a yearly expense of 15 Euros for each European citizen. Thus, the total annual European medical expenses amount to 4.5 billion euros, which represents only 3% of the total annual socio-economic costs of the 150 billion Euros of road, crashes.  Therefore an increase of, for example, 30% of the medical expenses (representing only 1 % of the above total socio-economical costs of road traffic crashess), would permit to decrease drastically the 20% to 40% “avoidable deaths” in hospitals.  
People Disabled
According to WHO, disability is a huge public health problem affecting at least 10% of the world population. From these more than 20 million people are severely disabled because of road traffic crashes. Proper treatment and care of the disabled would represent an enormous burden to the public health problem services, therefore most of the care for these victims is left to its families, self –help groups and charities, or they are simply abandoned and left for themselves.
The most tragic situation is that of the mentally disabled (due to brain trauma) who will need continuous care and assistance for the remainder of his life. Motor disabled people (often due to spinal trauma) may frequently, after rehabilitation, be able to undertake some activities, allowing them certain independence. It is however necessary to provide them the necessary equipment (wheelchairs and artificial limbs) and to adapt the surroundings in order to allow them to practice their mobility (fitting pavements, buses, trains, doors, lifts and toilets). This would give them the access education, professional training and eventually to find a job.
Indirect Effects
    There are also considerable indirect effects of road traffic injuries: members of the public may be affected by road traffic injuries even when they or their family members are not directly involved in road crashes. For example, fear of road traffic injuries can prevent old people from venturing outdoors. In many high-income countries, increasing use of cars has led to a general decline in walking and an increase in sedentary lifestyles, which in turn has had adverse consequences in terms of increasing obesity and cardiovascular health problems.

 
CHAPTER FIVE
The Needs of Developing Countries
 “Estimated annual economic costs of road traffic accidents in most developing countries represent more than one percent of the GNP and sometimes may reach around three per cent of the GNP as in the case of Thailand.”  Although the huge cost caused by road crashes, road safety is still a low priority issue in most developing countries. Road traffic crashess are the most serious but hidden disaster threatening the existence of millions of the world’s population. Road problems are a complex dilemma of a multi-facet and multi-disciplinary characteristic. It has also a continuous and non- ending socioeconomic, environmental and health impacts. Unfortunately, the annual road accident casualties of millions of innocent and productive population in developing countries receive relatively little interest at the international and even at the national levels.
Review of Road Safety in Developing Countries
In developing countries, the road problems in the last decade have reached high levels, despite their relative low motorization rates. According to the Global Road Safety Partnership (GRSP), about 70 million in-patient days are taken up, each year, in the hospitals of the developing countries with road crashes victims. This is due to the lack of:
1. Effective pressure groups
2. Strong political will and support
3. Effective traffic safety organization
4. Sufficient resources
5. Adequate road safety education
The deterioration of road safety has grave implications on development and the protection of environment. Therefore, extensive commitments, planning, and skilled efforts are needed urgently to reduce the complex impacts of road accidents.  However, many governments of the developing world during the last three decades exerted efforts in spite of their inability to effectively solve this highly complex problem. In addition, developing countries with ineffective or no road safety programs, usually have inefficient law enforcement, high crash rates and casualty rates and uncontrollable road user-vehicle – environment system. Therefore, any developing country or city trying to lessen the catastrophic impacts of RTI should examine carefully its road safety situation as a pre condition to any attempt in this respect (wide comparisons with different developed countries can be very helpful).  Improving road safety can only be achieved through good planning and scientific programming. Both public and private sectors must share efforts.
“RTI constitute a grave and growing problem in Syria and in other developing countries.”  It is worth noting that the situation in developing countries is different from other problems in many ways. It is continuous, escalating at a high rate, lacks strong political recognition and support, lacks the wide attention of the public and the media, causes human losses and injuries and affects all age groups, its socio-economic and environmental costs are higher than other national problems, and has no simple, direct, inexpensive, or quick solution. Demographic and technological changes coupled with development in the socio-economic sectors have increasing demand on transport facilities in urban and rural areas. The main objective of the planning and design of road networks and infrastructure in developing countries was, and continues to be, mainly to provide better mobility to aid national economic development. Improved road surfaces and vehicle performance, and the enjoyment of high vehicle speeds gave the motor vehicle its usual predominant role in the motorization process of every developing country.  Sudden changes of this nature coupled with educational and cultural complexities could not be accommodated safely by developing countries. Millions of innocent people (children, youths and the adults) are dead, or crippled for the rest of their lives.
     The diversity of authorities responsible for road safety in the majority of developing countries make it very difficult to put the issue in perspective at the international, national, and local levels. This division of authority has also resulted in many failures of valuable investments and ad-hoc programs aimed at reducing the impacts of road crashes. Most of such programs were based on subjective assessment of causes. Some developing countries and cities realized the desperate need to reduce the escalating casualties of road traffic crashes and took some actions in this respect. Construction of road infrastructure was intensified and expanded, traffic police departments were established and strengthened, national committees and associations on the prevention of road accidents were created at governmental and non- governmental levels, ad-hoc traffic safety campaigns were carried out, road traffic safety journals were published, and some investment in road safety research were committed in very few countries.
 
A Special Council for Road Safety
      The United Nations resolution 57/309 recommends that a leadership role for road safety efforts lie with governments of member states. A single agency or focal point is required to be responsible and accountable for road safety issues, with sufficient authority and resources to fulfill a leadership role. This agency should be responsible for involving other organizations and bodies within government, in order to create an environment that is conducive to road safety promotion. Similarly, the agency should be responsible for encouraging the participation of citizens in road safety efforts. For example, Oman has established a National Committee for Road Safety, an independent institution whose remit includes legislation, promoting the improvement of transportation services and raising awareness of the road safety problem.
     The complexity and development of the road accident phenomenon required more coordination and integration of efforts for the road safety process.  It should be highlighted, as a result of the British Transport and Road Research Laboratory’s road safety experience in developing countries, the “need to bring together all the relevant agencies in some form of National Safety Council”. YASA stressed the importance of the integration concept and elaborated on the benefits of its adoption for developing countries. The German Council for Road Safety (DVR) is also a successful experience of cooperation between public and private agencies working for road safety in Germany.
Funding And Support For Road Safety
    Road safety is only one of the many competing demanding need from the scarce resources of the various countries. With the worldwide growing problem of road crashes and related injuries, more funds are expected to be available in order to face this problem. Many multilateral and bilateral aid agencies had already started to assist with the funding of road safety activities and by providing specialist support.
     In most developed countries, many private companies were committed in funding road safety efforts, especially the insurance and automobile industry. These companies consider themselves funding for their conviction in road safety and for improving their image in serving the community, which may be fruitful as any other advertising.
In addition to the aforementioned funding, other conventional funding sources should be pursued, especially in developing countries:
· Road user charges (from vehicle licensing, taxation and insurance)
· A proportion of traffic fines
· An element of the road maintenance budget
   Unfortunately, most developing countries are facing the deterioration of road safety due to the absence of the adequate funding.   
 
 
CHAPTER SIX
Sharing the Experiences with Developed Countries
 
     During the last five decades vast investments and efforts were implemented in many developed countries, which have almost one fifth of the world road casualties. The results of these efforts, commended by both media and political apprehension of the problem and the application of social and scientific research in the process of reducing the impacts of road crashes, were encouraging. In most developed countries, during the beginning of the seventies the number of road casualties started to decrease, despite the sustainable increase in both the travel rates and the motorization. The relative success was accomplished through the formulation and implementation of comprehensive road safety improvement programs.
Road Safety in developed countries went through three major periods: Before pre-World War II period, the post World War II until 1973 and the post 1973 period. The first two periods witnessed increases in motorization and road traffic crashes and casualties. The third period could be characterized by continued high vehicle ownership with reduced road casualties due to improvement in road safety level. This reduction was the fruit of a long and elaborate planning and programming to reduce RTI.
In the early 1980’s, many developed countries suffered from slight increases in road casualties which required them to review and assess the situation.  In 1983, there were approximately 130,000 people killed by road crashes in OECD countries.
Despite the relative low crash rates and severity indices in these countries in comparison with the developing world, it has been stated, in respect to the aforementioned figures, by many policy makers that “What is at stake is enormous”, and that “presents programs, although comprehensive still suffer from unnecessary redundancies, imbalance, incoherence and unexploited opportunities.” This thinking by many policy makers around OECD countries necessitated the evolution of a new management concept utilizing available techniques, optimizing resources, and improving efficiency. Effective management of the road safety movement distributed horizontally activities demands a high degree of coordination and comprehensive information based on accident causation, impacts, and costs of countermeasures. With the vertical structure of the traditional lead governmental road safety organization, the integration of actions into a coherent program became obvious.
At the national level, developed countries initiated and implemented pilot road safety plans. After their success at the experimental level, these schemes gained national and worldwide acceptance and appreciation. However, extensive planning efforts of industry, academic, governmental and non-governmental organizations have been, and are being, exerted in most of the developed countries in order to achieve the objectives of the road safety programs in the new century (millennium).
 
   
 
Conclusion
    Road traffic injuries are a deadly scourge, claiming the lives of 1.2 million people around the world each year. 30 to 50 million are injured on the roads among which some become permanently disabled. The vast majority of these occur in developing countries, among pedestrians, cyclists, motorcyclists and users of public and scholar transport, many of whom would never be able to afford a private motor vehicle.
    This research focused on the requirements and policies that may be efficient in the struggle against underestimation of road safety on the global scene. There is a need on a number of fronts to prevent these needless deaths and disabilities, and the immense loss and suffering that RTI are causing. During the last five decades, many programs and policies were implemented to prevent road traffic crashes in the developed countries.
Recently, few developing countries started to organize interventions that aim to reduce traffic injuries. Road safety efforts include strategies to address speed and alcohol consumption; promotion of airbags, helmets and seat belts and other restraints; and greater visibility of people walking or cycling. A concerted effort on the part of governments and their partners to improve road safety can make a difference.
    YASA International highlights the concept of 6E as the basic solution to the problem of RTI. Each country need a Higher Committee for Traffic Safety, which is responsible for engaging concerned bodies from the public and private sectors in a national road safety strategy. This committee must have the responsibility, the necessary funding and the authority to make decisions and coordinate efforts of all concerned parties.
     Road crashes can indeed be prevented, although the historical approach that used to place responsibility mainly on the road user is inadequate and confusing. This old approach is now absent in the developed countries, but still exists in the majority of the developing countries. This research advocated an approach that recognizes not only the fallibility of road users, but also the major roles of emergency systems, law enforcement and the infrastructure. The 5E concept, as a summary of major requirements of road safety, is proposed on developing countries for their national campaigns targeting the reduction of road traffic injuries.   
    Public and private organizations, working in the road safety field, should establish a sustainable cooperation on the local, regional and international scenes. They can share experiences to reduce the global burden of road traffic injuries through safety promotion and learning by sharing from other successful and unsuccessful interventions, either in the developed countries or in the developing countries. This cooperation will help for more spreading the word that road traffic injuries are preventable.
  Developing countries should take benefit from the extensive research and studies organized in the industrialized countries about traffic safety measures. Not only the civil society organizations, but also the governmental agencies can take advantage of the successes and failures of road safety campaigns that were organized in the developed countries. International organizations such as the WHO, the World Bank, and the UNICEF started to realize their primordial role for road safety. In early September 2003, the secretary-General of the United Nations Mr. Annan recommended most United Nations agencies to integrate road safety into other policies, such as those related to sustainable development, the environment, gender, children or the elderly. He also said that road safety requires strong political will on the part of the governments.
  Strong political advocacy is required. Road safety is a political issue that frequently involves tensions between various sectors of society. For example, improving the rights of vulnerable road users may involve tensions with those advocating increased motorized travel. Furthermore, there is often a lack of clarity about the exact role and responsibilities of government at the local, national and international levels, which hinders effective and sustained political advocacy.  A change of approach regarding motor vehicle related crashes must take place. All people, including political and religion leaders, should know and understand that road injuries are not natural disasters. Men created them, and therefore mankind has the ability to prevent road traffic injuries.    
     Finally, advocacy non-governmental organizations specialized in road safety issues should share their experiences for creating more pressure and awareness targeting reducing road traffic injuries. Policy makers need to be more aware of the gains to be achieved by implementing policies on issues such us mandatory seat belts, drunk driving and helmets, to be able to save many lives. In most developing countries, these NGOs need to enhance their cooperation with other civil society organizations in order to enhance or even start sustainable road safety campaigns in these countries. They have to carefully review the successful strategies for reducing road traffic injuries in developed countries and especially in other developing countries.    
 
Appendix I - Safety as a Human Right
The Human Rights approach has been used effectively in many arenas, including the rights of the child, the rights of women and the rights of people in development. The Human Rights approach attempts to address issues of accountability at levels that range from that of the individual to those of the larger political and economic systems. The issues which such a document might address include non-discrimination, relationship to other human rights, accountability, the right to organize, the right to appropriate health care, the right to complain, sovereignty over living environments, the right of information and education, the right to participation, the right to environmental monitoring, the right to emergency preparedness, the right to relief and compensation, the right to enforcement of safety laws, the right to effective legal representation, the right to fair procedures, and the right to hold organizations and state accountable.
    
 The attendees of the 5th World Conference on Injury Prevention and Control declared their support for Safety as a Human Right, in the New Delhi declaration in March 2000, based on:
First. Injury is a huge burden as measured by the number of victims, injured and especially the disabled.
Second. It is important to look at safety because of the increase in complexity and interdependence of many related issues that interact with safety, including health, environment, peace promotion and economic well being and development.
The notion of safety as a human right is an important policy tool for injury control and safety promotion. It is a way to bring together the injury control community for collective action that can be more effective than separate communities or individuals acting alone.

 
Appendix II - Youth Association for Social Awareness
Birth and Progress
December 2003

The tragic death of Tarek Assi, a 19 year-old university student, led his friend Ziad M. Akl to establish YASA.  YASA was registered as an NGO in Lebanon in 1996.  YASA works on injury prevention campaigns by means of orientation through education and lobbying.
YASA aims at spreading awareness among all people, especially the youth about safety promotion and injury prevention in order to decrease injuries.  Furthermore, YASA seeks law enforcement concerning public safety issues through lobbying and preparing continuous campaigns.  In addition, YASA aims at providing social assistance and support to the victims of traffic crashes.

Since the death of Tarek in 1994, YASA has participated in and organized:
1. More than 1500 events in educational institutions
2. More than 2700 radio and TV interviews and press coverage,
3. More than 25 radio and TV campaigns,
4. Printing and distribution of around 4 million brochures and posters,
5. Lectures for more than 100 thousand participants in the military service of the Lebanese Army,
6. Training of Traffic Police on better communication skills,
7. Four national conferences under the patronage of the Lebanese President with the participation of many Arab countries, Lebanese public and private sectors.
8. More than 35 international safety promotion events.

YASA has accomplished numerous activities, among them: the Simulation of rescue from crashes which are done with the participation of the Lebanese Red Cross, Lebanese Fire Brigade and the Lebanese Civil Defense.  They aim at introducing the roles of each of the parties in the emergency rescue.
The Traffic Safety Educational Program (TSEP), for children of all ages, educates the students on the safe use of roads and then gives them an enjoyable practical session whereby then can drive mini cars while wearing their seatbelts and a safety helmet.
Another educational program is the Driver Improvement Program (DIP).  The DIP addresses defensive driving.  Among the groups that the DIP targets are: school bus drivers, company drivers and future drivers.
Furthermore, YASA seeks to provide social assistance to victims of road crashes.  YASA has built partnership with many organizations especially the Scientific Research Foundation and the Lebanese Fire Prevention Committee.

In 2002, YASA launched a national campaign for safety in road construction zones.  In November 2002, YASA won the Best Practice Certificate for Dubai International Award to Improve the Living Environment which was given by the United Nations and Dubai Municipality.
 

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تشير تقديرات منظمة الصحة العالمية إلى وفاة ما يزيد عن مليون ومئتي ألف قتيل في العام الواحد من جراء حوادث المرور في العالم، بالإضافة إلى إصابة ما يزيد عن أربعة وعشرين مليون شخص بجروح بليغة.
أصبحت حوادث السير مشكلة كبيرة ومتزايدة في مختلف دول العالم ولاسيما بالنسبة للشريحة العمرية ما بين 16 و27 سنة، حيث تعتبر حوادث السير المسبّب الأول للوفاة أو للإعاقة الدائمة. وتشير معظم دراسات مؤسسة الأبحاث العلمية واليازا إلى احتمال تزايد حوادث السير في معظم الدول النامية وخصوصاً في الدول العربية، إذ تعتبر هذه الدول معرّضة لتزايد سنوي في تلك الحوادث يقارب العشرة بالمائة.
على الصعيد الدولي، ينبغي مطالبة الدول المتقدّمة والمنظّمات الدولية المستقلة والتابعة للأمم المتحدة بأن تعطي المزيد من الاهتمام لقضايا سلامة المرور، وأن تسعى لمساعدة الدول النامية للتصدّي لتزايد المآسي الناتجة عنها.
بعد الدراسة المفصّلة لوضع وتاريخ الوقاية من حوادث السير في دول الإتحاد الأوروبي نستنتج بأنّ تعاون المجتمع الأهلي في الإتحاد الأوروبي على مدى عقود أثمر تبادلاً مستمراً للخبرات والتجارب الناجحة تمثّلت بإنجازات هامة أدّت إلى تخفيض عدد الوفيات بشكل ملفت للنظر، كما نجحت برفع القضية إلى أعلى مستويات الإهتمام في دول الإتحاد الأوروبي من هنا أهمية التأكيد على الدور الفاعل والرئيسي للمجتمع الأهلي في الضغط على سلوك الأفراد بهدف نشر مفاهيم السلامة بالإضافة إلى السعي الدؤوب لرفع قضايا الوقاية من الحوادث على سلّم الأولويات في مختلف الدول العربية.
لذلك نكرر النداء بأنه حان الوقت للتصدّي للوفيات والإصابات البليغة الناتجة عن حوادث السير والتي بلغت ارقاماً قياسية في معظم الدول العربية، كما نأمل بنجاح جميع نشاطات يوم 7 نيسان السنوي للحدّ من حوادث السير في لبنان والعالم، آملين التصدي لهذه المشكلة بشكل مستمر، وليس في هذه المناسبة وحسب.
بيان بإحصاءات ضحايا حوادث المرور في العالم:
(الوفيات والإصابات البليغة)
أكثر من 1.2 مليون وفاة و 24 مليون جريح            كل سنة
أكثر من 100.000 وفاة و 2 مليون جريح كل شهر
أكثر من 3.300 وفاة و 68.00 جريح كل يوم
أكثر من 120 وفاة و 2.700 جريح كل ساعة
أكثر من 2 وفاة و 40 جريح كل دقيقة
المصدر: يازا انترناسيونال ­ نيسان 2004.

 بيان بإحصاءات ضحايا حوادث المرور في العالم العربي:
(الوفيات والإصابات البليغة)
أكثر من 40.000 وفاة و مليون جريح كل سنة
أكثر من 3.300 وفاة و 83.300 جريح كل شهر
أكثر من 111 وفاة و 2770 جريح كل يوم
أكثر من 4 وفاة و 116 جريح كل ساعة
المصدر: منظمة الصحة العالمية ­ نيسان 2004

بيان بإحصاءات ضحايا حوادث المرور في العالم العربي
(الوفيات والإصابات البليغة)
أكثر من 550 وفاة و 9000 جريح كل سنة
أكثر من 54 وفاة و 750 جريح كل شهر
أكثر من 1 وفاة و 25 جريح كل يوم
المصدر: يازا لبنان ­ شباط -2004.