More than seven untimely deaths occur on the roads of Nepal every day. In the first half of this fiscal year, there have been more than 1,000 premature deaths, which is a five-year high. Although we commonly use the term road traffic accident to refer to a mishap involving automobiles, the World Health Organisation now calls it 'road traffic crash' instead of 'accident' as it is entirely preventable. Nearly 3,700 people are dying on the world's roads daily. At the same time, tens of millions are injured or disabled with long-lasting ailments. Among the leading causes of death in the world, road traffic crash comes in the eighth position. More people die in road traffic crashes than from tuberculosis or diarrhoea.

Nepal ranks 79th in the world with an age-adjusted death rate of 20.13 per 100,000 population. Road traffic crashes kill a significantly higher number of people than HIV/AIDS in the country. These incidents are not only devastating for individuals and families but are a significant loss for the country in terms of gross domestic product (GDP). Road traffic crashes cost almost 3 percent of the GDP of many countries. Unfortunately, such an alarming problem doesn't attract the attention of the government and key stakeholders as much as it should.

Devastating impact

Stakeholders seem to be either incognizant of or indifferent to its catastrophic effect on the physical, mental and social health of the victims, their families and the entire society. The tragic bus crash in Sindhupalchok that killed 15 people last December so saddened our prime minister that he directed officials to investigate it in a manner similar to an air crash. But, up to this time, no report has been disseminated, and no special intervention has been implemented.

Overall, the causes of road traffic crashes are broadly categorised into driver error, road condition and mechanical error. Among them, driver error is the number one cause. Over-speeding is the most common cause of death and disability in auto crashes; a one percentage point increase in speed results in a four percentage point increase in fatal crashes and a three percentage point increase in serious crashes. Driving under the influence is the most common driver error. Further, distraction while driving has now become a growing concern as drivers using mobile phones while driving is common. Similarly, the incorrect use of helmets or seatbelts also lead to deaths and disability.

In the Nepali context, unsafe road infrastructure makes the situation worse. Even in the capital city of Nepal, we lack footpaths, cycle lanes, safe crossing points and other traffic calming measures. The road condition in the countryside is pathetic, especially the routes in the hilly and mountain regions. Overloading frequently causes crashes in these regions. Old and unsafe vehicles increase the risk of collisions.

We have a national road safety strategy, but funding to implement the policy is not sufficient. Legal provisions, to some extent, are present; but their enforcement is lax. We don't have effective post-crash care. As reported by the World Health Organisation, some of the facilities only have trauma registries; and there is no provision of formal certification for pre-hospital providers. We have laws against driving under the influence, but these are implemented in a fragmented manner.

Underlying causes

Going deeper into the micro-level, it is almost always the driver who gets blamed whenever there is a crash. A report by the Nepal Traffic Police showed that nearly three-quarters of road traffic crashes are due to the negligence of the driver. But we are making no effort to understand the psychological and physiological reasons behind the incident, especially in the case of drivers that ferry the public on long routes. Why do these drivers drive so carelessly or hurriedly? Aren't they worried about their own and their passengers' lives? Is it due to monetary pressure or the vehicle owner's pressure? Or is it due to the age factor (most drivers in such routes tend to be young)? This should be studied at the micro level because many people's lives are under the control of one driver. This issue has somehow not raised enough concern in the key stakeholders. Research needs to be done in this area to create driver-centred interventions.

Whatever be the cause of road traffic crashes, an integrated approach is needed to prevent them and to protect lives. The government alone can't prevent crashes; other key players, including private and public transportation agencies, should act collaboratively. At the same time, pedestrian behaviour is also vital to avoid collisions. Intensive research is needed to analyse the underlying factors behind the soaring number of crashes. It should not be forgotten that halving road traffic deaths and injuries by 2020 is one of the aims of the Sustainable Developing Goals. The need of the hour is urgent, systematic action. Otherwise, every citizen who drives a vehicle or rides in a vehicle or walks on the road remains at severe risk.