‫املجلد التاسع عرش‬3 ‫العدد اإلضايف‬‫املجلة الصحية لرشق املتوسط‬Road traffic crashes in Ramadan: an observational
study
M.N. Tahir,1 G. Macassa,2 A.H. Akbar,3 R. Naseer,1 A. Zia 1 and S. Khan 1‫ دراسة رصد‬:‫التصادمات عىل الطرق يف شهر رمضان‬‫ شهزاد خان‬،‫ أرشد ضياء‬،‫ رضوان نصري‬،‫ عيل محاد أكرب‬،‫ غلوريا مقاصة‬،‫حممد نويد طاهر‬،‫ يف والية البنجاب‬1122 ‫ وخدمة اإلنقاذ‬،‫ هتدف هذه الدراسة إىل بحث اجتاهات التصادمات عىل الطرق التي تعاجلها خدمة الطوارئ‬:‫اخلالصة‬‫ وكشف حتليل‬.‫ مقاطعة بوالية البنجاب وجرت مراجعتها استعادي ًا‬35 ‫وجِعت البيانات اخلاصة بالتصادمات عىل الطرق من‬ُ‫ م‬.2011 ‫باكستان يف العام‬،)‫ (الذي وافق شهر رمضان‬2012 ‫أغسطس‬/‫ من طوارئ التصادمات عىل الطرق خالل شهر آب‬12969 ‫البيانات أن خدمة الطوارئ استجابت إىل‬‫ من التصادمات عىل الطرق؛‬%29 ‫ سنة) هم الضحايا يف‬27 ‫ إىل‬11 ‫ وكان أفراد الفئة العمرية األصغر سن ًا (من‬.‫ يف الشهر‬11573 ‫مقارنة بمتوسط طوارئ‬‫ وأظهرت نتائج‬.‫) قبل موعد اإلفطار‬18:00 – 14:00( ‫ بسبب القيادة يف ساعات الذروة‬%43‫ من هذه التصادمات بسبب زيادة الرسعة و‬%39 ‫وكانت‬‫ وتعترب السالمة عىل‬.‫ واجهت مزيد ًا من التصادمات عىل الطرق خالل شهر رمضان مقارنة بالشهور السابقة عليه‬1122 ‫الدراسة أن خدمة اإلنقاذ‬‫ وعىل الرغم من التحسينات الكبرية يف الطرق التي شهدهتا باكستان يف السنوات القليلة‬.‫الطريق إحدى قضايا الصحة العمومية اهلامة يف باكستان‬‫ وال خيفى أن الوعي اجلامهريي واإلرادة‬.‫ هناك حاجة إىل القيام بمزيد من العمل للتعاطي مع االجتاهات املتزايدة يف التصادمات عىل الطرق‬،‫املاضية‬.‫السياسية واإلنفاذ الصارم للقانون كلها عوامل بالغة األمهية يف هذا املجال‬ABSTRACT The aim of this study was to investigate trends in road traffic crashes (RTCs) managed by an emergency
service, Rescue 1122, in 2011 in Punjab, Pakistan. RTC data were collected from 35 districts of Punjab and reviewed
retrospectively. Data analysis revealed that the service responded to 12 969 RTC emergencies during August
2011 (Ramadan), compared with an average of 11 573 RTCs per month from January to August 2011. The younger
age group (11–27 years) was victims in 29% of RTCs; 39% were due to speeding and 43% occurred in peak rush
hours (14:00–18:00) before iftar (breakfast).Results of the study showed that Rescue 1122 faced more RTCs during
Ramadan compared with the preceding months. Road safety is an important public health issue in Pakistan.
Although there have been great improvements in roads in the past few years, much work needs to be done todeal with mounting trends in RTCs. Public awareness, political will and stringent law enforcement are key factors.

Accidents de la circulation pendant le Ramadan : étude d'observation

RÉSUMÉ L'objectif de la présente étude était de connaître les tendances en matière d'accidents de la circulation
pris en charge par le service d'urgence « Rescue 1122 » au Pendjab (Pakistan) en 2011. Les données sur ces
accidents ont été recueillies dans 35 districts du Pendjab et examinées rétrospectivement. L'analyse des données
a révélé que le service était intervenu dans 12 969 urgences routières pendant le mois d'août 2011 (Ramadan),par rapport à une moyenne mensuelle de 11 573 urgences routières entre janvier et août 2011. Le groupe d'âge leplus jeune (11–27 ans) représentait 29 % des victimes d'accidents de la circulation ; 39 % étaient dus à la vitesseet 43 % ont eu lieu pendant les heures de pointe de la circulation (entre 14 et 18 heures) avant la rupture dujeûne (iftar). Les résultats de l'étude ont souligné que le service d'urgence « Rescue 1122 » a dû prendre en charge
un plus grand nombre d'accidents de la circulation pendant le Ramadan que pendant les mois précédents. La
sécurité routière est une question de santé publique importante au Pakistan. Si des améliorations majeures ont
été observées sur les routes ces dernières années, il reste beaucoup à faire pour s'attaquer à l'augmentation
croissante des accidents de la circulation. Les facteurs clés sont la sensibilisation du public, une volonté politiqueet une stricte application de la loi.
Punjab Emergency Service (Rescue 1122), Punjab, Pakistan (Correspondence to M.N. Tahir: navidtahir1122@gmail.com).
University of Gävle, Gävle, Sweden.
3
University of Engineering & Technology, Lahore, Pakistan.
1

2

Received: 16/09/12; accepted: 10/01/13

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EMHJ • Vol. 19

Introduction
Road traffic crashes (RTCs) are one of
the most pressing international healthand development concerns in the world.
Every year, nearly 1.3 million people die
as a result of a road traffic collision –more than 3000 deaths each day – andmore than half of these people are nottravelling in a car [1,2].
In Pakistan, half of all major incidents and two thirds of all deaths in major incidents are due to RTCs [3]. Two
independent population-based surveys
estimated the incidence of road traffic
injuries to be around 15–17 per 1000
persons per year in Pakistan [4–6].
It is estimated that approximately
40 000 people die on the roads every
year in Pakistan and many more sustain
serious injuries [6]. In addition to thesuffering, these injuries contribute significantly to the workload in hospitals,
leading to direct costs to the Pakistanieconomy of over US$ 1 billion [4,7,8].
Various studies in many countries
have raised the issue of the increased
number of RTCs during holidays andfestive periods such as Christmas and
New Year [9–11]. In the United Statesof America for instance, the numbersof motor vehicle fatalities were usuallyhigher in six holiday periods: New Year,
Memorial Day, 4th of July, Labour Day,
Thanksgiving and Christmas. Between
1978 and 2002, the three deadliest days
for pedestrians were 1 January, 23 December and 31 October (Hallowe’en)[12–14].
In countries that celebrate Ramadan, Eid al-Fitr and Eid al-Adha, anincreasing trend of RTCs has also been
documented [15–18]. Ramadan is theninth month of the Islamic calendar
and lasts 29 or 30 days. It is the Islamic
month of fasting, in which participating Muslims refrain from eating, drinking, smoking and sex during daylight
hours. It is intended to teach Muslims
about patience, spirituality, humility
and submissiveness to God. The dates
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Supplement 3 2013of Ramadan vary, moving backwards
by about 11 days each year dependingon the moon. In 2011, Ramadan wascelebrated between 1 August and 30
August [19].
This study aims to investigate thetrends of RTCs that were managed bya rescue service, Rescue 1122 in 2011 in
Punjab, Pakistan.

Methods
Study setting

The study was conducted at the Lahore
headquarters of Rescue 1122. Rescue
1122 is an emergency service that offers
ambulance, fire, emergency response
teams, water rescue and safer community programme to over 80 million people in the Punjab [20,21]. The Punjab
is the largest province of Pakistan, with
36 districts. Rescue 1122 is operationalin all 36 districts. The service operates
in urban settings and works through a
toll-free number 1122. It is state funded
and operates over 24 hours, 7 days aweek [20,21].
Study design

In this retrospective study, RTC data forthe period January–August 2011 wereretrieved and examined. The data werecollected by the emergency medical
technicians from the scene of the crash.
The emergency medical technicians
are the first responders of the Rescue
1122 ambulance service. They fill out anemergency response form at the sceneof the RTC and during the journey tohospital. The emergency response form
includes basic first-hand information
regarding the crash (e.g. demographics of victims, type and cause of crash,vehicles involved).
The data included all RTCs reported to the service during the study period
from 35 districts of Punjab. Final data
analysis was carried out using statisticalsoftware SPSS version 16.

Results
Rescue 1122 attended 92 587 RTC
emergencies during the 8 months (January–August 2011) of the study period.
The breakdown of monthly RTCs datashows that the service responded to
10 334 RTCs calls in January, 10 351
in February, 11 957 in March, 11 394
in April, 11 885 in May, 11 708 in June,
11 989 in July and 12 969 in August (theIslamic month of Ramadan) (Figure 1).
No. of RTCs

August12 969July

11 989June

11 708May

11 885April

11 394March

11 957

February

10 351January

10 334
0

5000

10000

15000

Figure 1 Road traffic crashes (RTCs) managed by Rescue 1122 from January toAugust 2011

‫املجلد التاسع عرش‬3 ‫العدد اإلضايف‬Detailed analysis of Ramadan 2011
RTCs data showed that the service
rescued 14 788 victims while responding to 12 969 RTC emergencies. The
highest number of RTCs were reported
in Lahore District (3263), followed by
Faisalabad (1205) and Multan (864)(Table 1).
Males were involved in 11 633(79%) and females in 3155 (21%) of
the total crashes. The younger age groupaged 18–27 years were victims in 4325
(29%), the group aged 28–37 years in
3038 (21%) and the group aged 11–17
years in 2565 (17%) of the total reported RTCs (Table 1).
Motorcycles were the most frequently colliding vehicle, being involvedin 9101 (57%) crashes, followed by carsin 2118 (13%) crashes. Speeding was
found to be the major cause in 4893
(39%) of RTCs and motorcycling one
wheeling was reported in 117 (1%)
crashes. The majority of RTCs (5516;
43%) occurred between 14:00 and
18:00. Fractured bones (3102; 22%)and head injuries (1328; 9%) were themajor injury outcomes of the RTCs
(Table 1).

‫املجلة الصحية لرشق املتوسط‬

Table 1 Epidemiology of road traffic crashes (RTCs) reported to Rescue 1122 during
Ramadan 2011
No.

Total no. of reported RTCs

12 969Total no. of victims rescued

14 788
No. (%) (n = 14 788)

Sex
Male

11 633 (79)

Female3 155 (21)

Age groups (years)
0–10

703 (5)

11–17

2 565 (17)18–27

4 325 (29)28–37

3 038 (21)38–47

2 198 (15)48–57

1 215 (8)> 58

744 (5)

Road user groups/type of vehicle
Motorcycle

9 101 (57)Car

2 118 (13)

Rickshaw

1 407 (9)Coach/van514 (3)Bus

352 (2)

Truck

366 (2)

Bicycle340 (2)

Tractor/trolley

223 (1)Non-motorized vehicle

221 (1)

Pedestrians

382 (2)Others958 (6)

Types of injuries sustained

Discussion
RTCs are the major emergency dealt
with by the Rescue 1122 ambulanceservice. The service has attended nearly
6 million RTCs in Punjab in the past 7
years. The results of this study revealeda growing rate of RTCs in 2011. Rescue 1122 faced an increased burdenof RTC emergencies in August 2011
(the Islamic month of Ramadan). In
this month, the number of RTCs was
1469 higher than the average of 11 573
RTCs per month. Speeding was theleading cause of these collisions and the
majority of the crashes were reported
between 14:00 and 18:00.
These findings could be attributed
to the fact that government offices andprivate businesses usually finish earlier
during Ramadan than during the rest

Variable

Minor a8 408 (59)Fractures

3 102 (22)Head

1 328 (9)Neck64 (0.4)

Spine

119 (1)

Causes of RTC
Speeding

4 893 (38)

Carelessness

3 769 (29)Wrong turn1 180 (9)Bad road conditions

231 (2)

Burst tyre

160 (1)

One wheeling

117 (1)

Collision with structure

165 (1)

Faulty vehicle

166 (1)

Bad weather conditions
Other causes

116 (1)
2 226 (17)Time of incident
06:00–10:00

1 767 (14)10:00–14:00

2 200 (17)14:00–18:00

5 516 (43)

18:00–22:00

2 192 (17)22:00–02:00
02:00–06:00

830 (6)464 (4)“Minor injury” stands for all those injuries where sustained injuries were not very serious (e.g. small cuts,
abrasions and scratches) and these victims were usually discharged from the scene of the crash after first aid.
a

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Supplement 3 2013of the year, as people wish to be at theirhomes before iftar (the evening meal
when Muslims break their fast). Thus, toreturn home early, drivers may become
impatient and violate traffic rules (e.g.
signal violations, speeding, overtaking),
often resulting in different forms of
RTCs.
Another study [15] conducted in
Karachi, which analysed frequency of
injuries in Ramadan in 2009 and 2010,
confirms this trend. It found that traffic
behaviour changed in the approach to iftar and speeding was observed, increasing the chances and severity of crashes[15]. This trend was also witnessed inother countries celebrating Ramadan[16–18].
Another reason for increased traffic and busy roads in Ramadan is theincrease in seasonal vendors. These
vendors often occupy spaces on themain roads and pedestrian pavements,
thus not only obstruct the flow of traffic
but also hinder pedestrian mobility.
Before iftar, the markets are also packed
with people buying traditional foods
for Eid.
In the present study, young motorcyclists were predominately involvedin the reported RTCs. Fractures ofextremities and head injuries werethe major injuries sustained by theseyoung people. This is in line with thefindings of WHO that young people,
especially motorcyclists in low-income
and middle-income countries, carry alarge proportion of the global burdenof road traffic death and serious injury[1–2]. Similar findings have also beenreported in research studies from Pakistan [4–8,21–23], India [24–27] andother countries [28–34].
In this study, motorcycling one
wheeling also contributed to the RTC
toll. This phenomenon has commonly
been observed in Pakistan’s big cities,
especially on weekends, public holidays,
Chand Rat (night before Eid) and New
Year’s night [35–37]. One wheeling on
14 August 2011 (Pakistan Independence Day) claimed 11 lives and injured
over 100 stunt bikers in 105 reported
RTCs in the provincial capital, Lahore[36].
One wheelers are often underageand display dangerous stunts on busy
roads, without taking basic precautionary measures such as wearing a helmet,
which usually results in severe head andspinal injuries [35–37]. One wheeling is unusual in the developed worldand seldom practiced as on busy roads
and streets in Pakistan [36]. In Pakistan
there are laws banning one wheelingand mandatory helmet wearing for
motorcyclists but these have not beenstrictly enforced [35–37].

The socioeconomic consequencesof road traffic injuries include costs ofprolonged medical care, loss of the family breadwinner and loss of income due
to disability; together these factors often
push families into poverty [38].

Conclusion
The study has described trends of RTCs
managed by Rescue 1122 at urban settings in Punjab, Pakistan. The Rescue
1122 ambulance service experienced ahigher burden of RTC emergencies in
the month of Ramadan 2011 comparedwith the preceding months of the year.
This increase was mostly concentrated
among younger ages, especially thosedriving motorcycles. Furthermore,
the majority of RTCs were caused byspeeding during the peak rush hours
before iftar.
RTCs are a significant publichealth issue in Pakistan. These crashes
and the resultant injuries have considerable physical and socioeconomic
impacts; therefore, this issue needs tobe addressed. Peer pressure, institutions, stringent law enforcement andpersonal commitment can play a vitalrole in improving road safety conditions.
Competing interests: None declared.

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