AsiaLIFE

Crash sightings make for normal conversation topics in Cambodia. Motorcycle parts littered across the road, overturned tuk-tuks and rear-ended cars are the stuff of stories circulated around the dinner table.

You may have heard about Jacqui, the Australian hairstylist who was hit by a motorcycle driver going the wrong way on Phnom Penh’s one-way Street 51 last year. The consequences for Jacqui? A severe concussion, a medical evacuation to Bangkok and six months of recovery, during which stabbing pains and nausea were common symptoms.

There’s also Maarten, a 19-year-old Belgian whose car was sideswiped by a speeding Lexus SUV this past March. His vehicle flipped and landed on its roof. Maarten was left with scratches all over his body, a deep cut on his eyebrow, some muscle injuries in his back and a totalled car. The other driver had failed to obey a stop sign.

Last year, 18,287 road crash casualties were reported in Cambodia. The statistics are distressing, and the relatively low attention and funding given to this public health issue are equally so. Mai Lynn Miller Nguyen examines the growing challenge of road safety in Cambodia. Photography by James Grant.

“I want this exhibition to encourage people to be very careful on the street, and to join together to reduce the death rate,” says Roeun Sokhom, a member of Battambang-based artists collective Trotchaek Pneik. “In Cambodia now, we don’t have war and fighting, but we have deaths because of modern technology.”

Shocked by the high rate of crashes he observed on the streets, Roeun proposed that he and his fellow artists create a series on the theme of road safety. In August, the resulting artwork opened at Phnom Penh’s Meta House in a group exhibition entitled CHO (Khmer for “walk” or “go”). These vivid paintings depict vehicles and mangled victims, as well as more conceptual renderings of anguish and despair.

As Roeun recognises, road safety—or more precisely, the lack of it—is a pressing issue in Cambodia. The number of road crash fatalities has doubled within the past six years. Earlier this year, Prime Minister Hun Sen declared Cambodia’s road situation a national disaster, just as the United Nations announced that 2011 would be the start of a global Decade of Action for Road Safety.

Amongst Southeast Asian countries, Cambodia stands out as one of the most dangerous places to be on the road. With such a high rate of prevalence, crashes are commonly viewed as an inevitability of the road. But that view undermines the possibility and potential for change.

A Call for Action

Handicap International Belgium, a leading NGO in efforts to promote road safety in Cambodia, favours the term “crash” to describe traffic collisions. It’s a tactical choice of word.

“With the term ‘accident,’ people might feel that it’s not preventable,” explains Sann Socheata, road safety programme manager at Handicap International Belgium (HIB). “But the term ‘crash’ clearly says that it’s a collision that people can prevent.”

According to the Cambodia Road Crash and Victim Information System (RCVIS) Annual Report 2010, a comprehensive data collection and review initiative from HIB, the Ministry of Interior, the Ministry of Health, the Ministry of Public Works and Transport, and the National Road Safety Committee, 95 percent of crashes can be attributed to human error—predominantly speeding or drunk driving related—compared to vehicle defects at 2.2 percent and the road environment at around 0.83 percent.

Motorcycle and car drivers in Cambodia are legally required to have a driver’s license, contingent on passing a written test at the Ministry of Public Works and Transport. Yet an informal system of middlemen makes it possible to circumvent the law by paying more—and that means that many of the drivers on the road have little knowledge of road rules.

The future looks even dimmer as Cambodia’s development could have serious ramifications for the road safety issue. As per capita income becomes higher, more Cambodians will have access to motorised vehicles. The number of registered vehicles has risen by 187 percent over the past six years, and is expected to keep increasing over the next few years.

Improvement of roads in Cambodia can actually have adverse effects on road safety, as with paved routes comes greater levels of speeding. This has a direct impact on villages situated along national roads, where the majority of crash fatalities occur. Communities used to a bumpy, dirt road must learn to adjust to a new situation.

Jeroen Stol, International Belgium (HIB) country director, anticipates the rate of casualties will continue to grow at an alarming rate and that a holistic approach—encompassing public awareness raising, legislation and law enforcement—is necessary to turn the tide.

“We don’t see the infrastructure getting rehabilitated and the notions of people changing at the same pace as the number of motorised vehicles,” Stol says. “We really need to increase our intervention in order to at least keep up with that rate of increased fatalities.”

Focus on Helmets

Last year, motorcycle drivers made up 70 percent of road casualties in Cambodia. Because head injuries were the primary cause of death in 73 percent of motorbike fatalities, helmet promotion has become the central point of several campaigns.

The passage of a law in 2009 requiring motorcycle drivers to wear a helmet has raised the rates of helmet usage among drivers in Cambodia. But the law does not require passengers to wear helmets, an omission which undermines the importance of helmet use.

“In Phnom Penh, 78 percent of observed drivers wear helmets while only 8 percent of passengers do,” says Mirjam Sidik, executive director of the Asia Injury Prevention Foundation (AIPF) in Vietnam. “If we do not address the low rates of helmet use and lack of road safety knowledge, the devastating numbers of crashes and resulting fatal head injuries will continue to rise.”

The AIPF, which recently opened an office in Phnom Penh, is a lead NGO of the Global Helmet Vaccine Initiative. An international coalition promoting helmet use in Southeast Asia, the GHVI equates wearing a helmet to a life-saving vaccine. Programmes include public awareness education, with a special emphasis on child protection, helmet provision and technical assistance.

In August, the AIPF, in collaboration with the National Road Safety Committee, the General Commissariat of National Police and the Ministry of Interior, hosted a stakeholder consultative meeting to discuss the passenger helmet use campaign. An amendment to the helmet law to include a stipulation for passengers is currently in the process of being developed.

Participants included representatives from government ministries, NGOs and the private sector. After a series of presentations of data and findings and past campaign outcomes, the workshop broke into working groups to propose approaches and activities for the campaign’s unrolling in Phnom Penh, Kampong Speu and Kandal provinces.

“GHVI has found that although Cambodians are aware that helmets are very important for one’s safety, they do not wear their helmets in situations which they consider to be exceptional,” says Sidik. “Riders are less likely to wear a helmet when driving short distances or on local roads, as opposed to highways, because they believe that their chances of getting into an accident are slighter in these situations.”

Among other reasons reported for failing to wear helmets, Sidik also cites “forgetting one’s helmet, and it being uncomfortable and inconvenient. “Parents also report that their children 'are too young' to be wearing helmets,” she adds.

Cost Versus Investment

Crashes have acute consequences, and not only for the people directly involved. “Most accidents happen in urban areas, so one can assume that those victims are the ones who are economically active,” says Jeroen Stol of HIB. “So what happens when someone gets into a collision or a crash and becomes temporarily or permanently disabled or dies? A whole family can plummet into poverty.”

A recent study entitled How Road Traffic Injuries Affect Household Welfare in Cambodia Using the Millennium Development Goals Benchmarks, co-written by Pagna Kim, country director of AIPF, found that when a member of a household is injured by a road crash, the household experiences an average of 21 percent loss of income.

The annual economic cost of road crashes for the country overall was estimated at US$279 million for 2010, according to RCVIS data. Yet the funding invested in road safety last year is estimated to be only around US$2 million, according to Sann of HIB. A relatively small sum when the death rate due to road crashes is compared to that of the more visible and funded issue of malaria, which caused 279 reported fatalities in 2009.

“Overall lack of funding for road safety activities, as well as limited support and involvement from internal donors, is a significant issue,” says Sidik. “Additionally, the government and development sectors lack the adequate amount of human resources and road safety professionals. This limits the number and effectiveness of road safety interventions.”

Budget constraints have restricted the scope of the Coalition for Road Safety (CRY), a Cambodian NGO that works in awareness raising and lobbying efforts. Together with the HIB, CRY aimed to launch a community-based road safety education programme in 40 communes along National Road 6 from Phnom Penh to Banteay Meanchey. Due to budget limitations, the project was downsized to only eight key communes.

“This work is a charity and can help and save people’s lives. Our programme is only in a small part of Cambodia, so I think we could help the people more,” says Sim Sophal, project coordinator of CRY. “It depends on our funds.”

Who’s Responsibility?

“Road safety doesn’t receive the attention it should,” says Stol of HIB. One problem has been the challenge of viewing road safety as a medical topic. However, Stol notes that an increasing number of health organisations are becoming more focused on road safety intervention. The World Health Organisation (WHO), which has described road safety as a global crisis, is one example.

Sim believes that improving driving practices must be a shared duty. The creation of the National Road Safety Committee in 2005 is a step forward for increased government action, but collaboration remains necessary for greater impact. “Road safety is not only the responsibility of international NGOs, there must be a lot of stakeholders participating together to promote road
safety,” Sim says.

Sann Socheata of HIB points out that citizens must also accept the task of keeping roads safe. “During focus groups, we ask, what should we do in order to reduce road crashes?” she says. “Participants point to the traffic police to enforce, but they don’t say ‘I should respect the speed limit, I should not drink and drive.’ People tend to focus on somebody else.”

Beyond the government and NGOs, attention to road safety is emerging from other sources. Some businesses, as part of a move towards corporate social responsibility, have contributed support to road safety efforts. This year, telecommunications company Smart Mobile donated educational and communications material to the Cambodian Road Cross for a road safety programme. ANZ Royal Bank has provided funding for Global Helmet Vaccine Initiative campaigns. Also making road safety a current focus, Telecom company Emaxx has pledged to donate
helmets for every new subscriber.

As number of government ministries, NGOs, companies and artists highlight Cambodia’s dangerous roads, perhaps the issue of road safety will start to see the attention it deserves. Everyone is at risk, and the responsibility is collective. Then hopefully Cambodia will see fewer accidents on the road and less people having to receive emergency medical treatment that could have been avoided.