Road traffic collisions are a major global health problem. This is especially the case in developing countries, including Egypt. According to WHO&rsquo;s latest global status report on road safety, an average of 25 Egyptians are killed every day due to road crashes.<a href="#_edn1" name="_ednref1">[i]</a> Thousands more are injured and disabled.
The costs of road traffic injuries and fatalities are devastating. In addition to the dreadful and unbearable psychological and health costs, the economic losses to individuals, families and to society are extensive. Road traffic fatalities and serious injuries cost Egypt a 3.2% loss of its GDP, amounting to approximately $10.74 billion/year.<a href="#_edn2" name="_ednref2">[ii]</a> The financial costs on victims of a crash range from costs of treatment, rehabilitation, loss of productivity for those killed or injured and disabled, extending even beyond to family members who have to care for those injured. Those in the lower socioeconomic strata not only face existing financial and economic constraints, but they could easily slip into poverty if they fall victim to a crash. Survivors of crashes, their families, friends and other caregivers often suffer adverse social, physical and psychological effects.
<h3>Vulnerable road users</h3>
Anyone using roads is unquestionably at risk of injury and death in the event of a road crash, however some road users are more at risk than others. The risks and severity of road crashes are not equitably distributed. Vulnerable road users or VRUs refers to non-motorized road users, such as pedestrians and cyclists, as well as motorcyclists and persons with disabilities or reduced mobility and orientation.<a href="#_edn3" name="_ednref3">[iii]</a> Because VRUs do not have the same protection bestowed by the vehicle&rsquo;s shell and safety features, they incur much more severe and devastating injuries when involved in a road crash. The risk and the severity are even more compounded by the proximity to roads with high speeds and the absence or inadequacy of sidewalks, crossroads and bike lanes.
VRUs are generally at a greater risk of more serious injuries, which are usually caused by direct impact with the vehicle. The severity of injuries to the head, brain, thorax, pelvis and extremities is determined by the speed of the car on the road, the size and shape of the vehicle, as well as the age and ability of the VRUs.<a href="#_edn4" name="_ednref4">[iv]</a>
The socioeconomic status of VRUs also has an influence on the severity of injury when exposed to a car collision. Risk of severe injuries is not equitably distributed within the VRU group. Even though road users inside motorized vehicles constitute the majority of deaths on roads, as seen in Figure 1, VRUs are more likely to be from poorer communities than road users in motorized vehicles. In general, VRUs from lower socioeconomic strata are at higher risk of injury, as they make up the majority of VRUs, and incur more severe and more frequent injuries than those in higher income strata.<a href="#_edn5" name="_ednref5">[v]</a> &nbsp;
&nbsp;Figure 1: Deaths by road user category
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1605800988imageFiguew 1 En.png" alt="" width="500" height="327">
As shown in Figure 2, as per-capita income increases, so does vehicle ownership; the lower one&rsquo;s income, the greater the proportion of their mobility classified as vulnerable road use&nbsp;<a href="#_edn6" name="_ednref6">[vi]</a>.
Figure 2: Vehicle ownership
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1605801008imageFigure 2 En.png" alt="" width="500" height="425">
<h3>Road infrastructure and improvement of safety&nbsp;</h3>
According to the Central Agency for Public Mobilization and Statistics (CAPMAS), 9.4 million vehicles are in Egypt, 34.5% of which were in only three governorates, leading to traffic congestion within an over-stretched infrastructure. Confronted with an exponential growth of vehicles and a justifiable need for economic and social development, Egypt like many other developing countries has been investing heavily in road infrastructure.<a href="#_edn7" name="_ednref7">[vii]</a>
During the past few decades, road infrastructure investments, especially in urban, residential and high density settings, were mostly designed around automobiles. These roads have wide traffic lanes, limited sidewalks, inadequate safe crossing areas and nearly absent bike lanes, poorly separating VRUs from the threat of collision. According to the International Road Safety Assessment Program (iRAP), which performs an objective assessment of road infrastructure in terms of the level of safety for all types of road users (where 5 Star roads are the safest and 1 star roads are the least safe), 83% of Egyptian roads are least safe for pedestrians scoring 1 star, while 74% of those roads are least safe for cyclists (see Figure 3). Of the surveyed roads, 78% are without formal footpaths, 97% are without pedestrian crossings and 38% are undivided with vehicle speeds above 60 km/h.
Figure 3: Roads safe for cyclists
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1605801027imageFigure 3 En.png" alt="" width="500" height="245">
&nbsp;
VRUs, especially ones from lower socioeconomic strata, thus incur a significant burden of the frequency and severity of road traffic injuries<a href="#_edn8" name="_ednref8">[viii]</a>. Unless investments in road infrastructure take VRUs into consideration, especially inside cities and residential areas, these investments pose a danger of not only increasing VRUs&rsquo; risks to injuries and death but also increasing their risk of slipping even further into poverty or a lower socioeconomic stratum.&nbsp;
<h3>People-centric roads; moving forward</h3>
Reduction or elimination of the risks faced by VRUs is an important and achievable policy goal. Successful interventions to protect VRUs require granular collection and dissemination of data related to road traffic crashes, injuries, fatalities, demographics of those involved, as well as an account of the proximal and distal factors increasing crash risk.<a href="#_edn9" name="_ednref9">[ix]</a> They also require a change in the philosophical approach of road and urban planners and relevant decision makers. Such a philosophy ought to prioritize people over vehicles and value all the different uses of space, not just vehicular mobility.
While improved mobility is fundamental, efforts should also be made to ensure that streets are a place for social gathering, play, health &amp; climate improvement, economic development, all of which require streets to be safe environments for all road users, especially vulnerable ones.
When it comes to improving safety, two specific interventions are crucial:
<ul>
<li style="text-align: justify;">Reduction of speed and</li>
<li style="text-align: justify;">Physically separating VRUs from vehicles.</li>
</ul>
Speed is directly correlated with the severity and frequency of crashes. Speed mitigation designs and policies will go a long way towards ensuring the safety of VRUs. A road user struck by a vehicle traveling at 45km/hr has less than a 50% chance of surviving; however, when struck by a vehicle traveling 30km/hr, the probabilities of survival increase to more than 90%.<a href="#_edn10" name="_ednref10">[x]</a> More important than police enforcement of speed are traffic calming engineering interventions (e.g. reduction of the number and width of lanes; zigzag roads; speed bumps, roundabouts).<a href="#_edn11" name="_ednref11">[xi]</a> Significant reduction of speed is especially essential in dense areas, such as residential neighborhoods and inside cities.
Separating VRUs from motorized traffic is also crucial. This can be done through engineering interventions which modify public space, including:
<ul>
<li style="text-align: justify;">Protected sidewalks that meet defined safety standards,</li>
<li style="text-align: justify;">Safe and frequent pedestrian crossings</li>
<li style="text-align: justify;">Pedestrian refuges to shorten crossing distance and allow more time for slower crossers</li>
<li style="text-align: justify;">Sidewalk extensions for better visibility and physical distancing of road crossers</li>
<li style="text-align: justify;">Bicycle facilities (on road and off-road paths)</li>
<li style="text-align: justify;">Marked &amp; constructed buffers, such as street trees and a landscaped planted area.</li>
<li style="text-align: justify;">Segmented concrete pedestrian islands.</li>
</ul>
VRU injuries and fatalities represent a serious threat to the development of the individual, in specific, and the economy, in general. In addition, it endangers the quest for equity in health, development and good quality of life. Neglecting them is a big injustice and a serious hindrance to equitable societal development. Thus, addressing the needs of the weakest road users is essential if we are to ensure that road safety is equitably distributed. 
<hr>
<a style="color: #e5b53b;" href="#_ednref1" name="_edn1"></a><a href="#_ednref1" name="_edn1">[i]</a> Global Status report on Road Safety. WHO 2018 <a href="#_ednref2" name="_edn2">[ii]</a> Road Safety Opportunities &amp; Challenges, World Bank 2020 <a href="#_ednref3" name="_edn3">[iii]</a> EU Intelligent Transport Systems (ITS) Directive <a href="#_ednref4" name="_edn4">[iv]</a> Yang J. Review of injury biomechanics in car-pedestrian collisions. Report to European Passive Safety Network, 2002. <a href="#_ednref5" name="_edn5">[v]</a> Dandona R, et al. Incidence and burden of road traffic injuries in urban India. Injury Prevention, 2008, 14: 354&ndash;359; Rivara F, Barber M. Demographic analysis of childhood pedestrian injuries. Pediatrics, 1985, 76: 375&ndash;381. <a href="#_ednref6" name="_edn6">[vi]</a> Dargay et al (2006) Vehicle Ownership and Income Growth Worldwide: 1960-2030 <a href="#_ednref7" name="_edn7">[vii]</a> <a href="http://english.ahram.org.eg/NewsContent/1/64/270451/Egypt/Politics-/-million-licensed-vehicles-in-Egypt-CAPMAS.aspx">http://english.ahram.org.eg/NewsContent/1/64/270451/Egypt/Politics-/-million-licensed-vehicles-in-Egypt-CAPMAS.aspx</a> <a href="#_ednref8" name="_edn8">[viii]</a> Road Safety Opportunities &amp; Challenges, World Bank 2020 <a href="#_ednref9" name="_edn9">[ix]</a> Proximal factors of crashes refer to more direct events such as poor driving, while distal factors are indirect, such as the lack of enforcement of speeding laws. <a href="#_ednref10" name="_edn10">[x]</a> ETSC (2005) Motor vehicle speed in the EU. Brussels: European Transport Safety Council, <a href="http://www.etsc.eu/documents/FS_speed.pdf">http://www.etsc.eu/documents/FS_speed.pdf</a>. <a href="#_ednref11" name="_edn11">[xi]</a> Retting RA, Ferguson SA, McCartt AT (2003) A review of evidence-based traffic engineering measures designed to reduce pedestrian-motor vehicle crashes. Am J Public Health 93: 1456&ndash;1463.

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