Rtavis Annual Report 2006 Eng

Cambodia Road Traffic Accident and Victim Information System

Annual Report 2006

© HIB - Sem Panhavuth

Developed by:

Ministry of Interior

Ministry of Health

Ministry of Public Works and Transport

Handicap International Belgium

Notice: This report may be freely reviewed, abstracted, reproduced or translated in part or in whole, but not for the purposes of sale.

Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Table of Content Table of Content ...................................................................................................................................................... 1 List of Figures .......................................................................................................................................................... 2 Foreword .................................................................................................................................................................. 4 Note from the Minister of Public Works and Transport ......................................................................................... 4 Note from the Minister of Health ........................................................................................................................... 5 Note from the Ministry of Interior........................................................................................................................... 6 Note from Handicap International Belgium ........................................................................................................... 7 I. Introduction........................................................................................................................................................... 8 II. Executive Summary ............................................................................................................................................ 9 Introduction............................................................................................................................................................ 9 Key figures .......................................................................................................................................................... 10 Differences between Phnom Penh and provinces .............................................................................................. 16 III. System coverage .............................................................................................................................................. 17 Data sources ....................................................................................................................................................... 17 Geographic coverage .......................................................................................................................................... 19 IV. Evolution of data .............................................................................................................................................. 20 V. 2006 data analysis............................................................................................................................................. 22 Introduction.......................................................................................................................................................... 22 Victim Information................................................................................................................................................ 22 Age.................................................................................................................................................................. 22 Gender ............................................................................................................................................................ 25 Type of road user............................................................................................................................................ 27 Occupation ...................................................................................................................................................... 30 Severity of injuries and hospital discharge ..................................................................................................... 31 Nature of injuries............................................................................................................................................. 33 Cost of treatment ............................................................................................................................................ 34 Driving license................................................................................................................................................. 34 Accident Information............................................................................................................................................ 34 Day and time of accident ................................................................................................................................ 34 Time of accident.............................................................................................................................................. 36 Causes of accident ......................................................................................................................................... 37 Human error................................................................................................................................................ 38 Weather conditions..................................................................................................................................... 39 Vehicle defect ............................................................................................................................................. 39 Road conditions .......................................................................................................................................... 39 Type of collision .............................................................................................................................................. 39 Cost of accident .............................................................................................................................................. 41 Location of accident ........................................................................................................................................ 42 Country level............................................................................................................................................... 42 Phnom Penh ............................................................................................................................................... 43 Kandal......................................................................................................................................................... 46 Kampong Cham.......................................................................................................................................... 46 Type of road .................................................................................................................................................... 47 Road characteristics ....................................................................................................................................... 48 Transfer to hospital ......................................................................................................................................... 48 Attendance of police ....................................................................................................................................... 49 Appendix ................................................................................................................................................................ 50 Evolution of data during the year ........................................................................................................................ 50 Number of casualties reported at health facilities ............................................................................................... 52 Number of casualties reported at traffic police districts ...................................................................................... 54 Data collection forms........................................................................................................................................... 57 Hospital data collection form........................................................................................................................... 57 Traffic police form ........................................................................................................................................... 58 Feedback form .................................................................................................................................................... 59 Contacts ................................................................................................................................................................. 60

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

List of Figures Figure 1: Main road safety indicators – differences between Phnom Penh and provinces .................................... 16 Figure 2: RTAVIS data collection flow ..................................................................................................................... 17 Figure 3: Percentage of casualties reported to RTAVIS – 2006 ............................................................................. 17 Figure 4: Evolution of the number of casualties and health facilities data sources – January to December 2006 . 18 Figure 5: RTAVIS geographical coverage, December 2006 ................................................................................... 19 Figure 6: Evolution of road traffic accidents and casualties in Cambodia, 1995 – 2006 (base 100 = 1995) .......... 20 Figure 7: Fatality rates in Cambodia 1995 – 2006 and its target for 2010 and 2020 .............................................. 20 Figure 8: The evolution of the numbers of fatalities in Phnom Penh – March 2004 to December, 2006................ 21 Figure 9: Fatality rates – comparisons between selected countries – 2006 ........................................................... 22 Figure 10: Percentage of casualties and fatalities by age category – 2006............................................................ 23 Figure 11: Percentage of casualties and population by age category – 2006 ........................................................ 23 Figure 12: Percentage of fatalities by age category in different regions of the world – 2002 for the world and SEA figures, 2006 for Cambodia............................................................................................................................. 24 Figure 13: Under 25 year-old fatality rates (per 100,000 inhabitants) in Cambodia and other regions – 2006 ...... 24 Figure 14: Age pyramid of casualties – Phnom Penh versus the rest of the country – 2006 ................................. 25 Figure 15: Percentage of casualties by gender for different age categories – 2006............................................... 26 Figure 16: Number of fatalities per 100,000 inhabitants by gender for different age categories – 2006 ................ 26 Figure 17: Percentage of fatalities and casualties by type of transports – 2006..................................................... 27 Figure 18: Comparison of fatality rates between two-wheelers and four-wheelers, calculated per 10,000 registered two-wheelers and four-wheelers – 2006......................................................................................................... 27 Figure 19: Percentage of casualties by type of transport – Phnom Penh versus the rest of the country – 2006 ... 28 Figure 20: Percentage of casualties by type of transport for different age categories – 2006................................ 28 Figure 21: Percentage of motorbikes’ rider by helmet using – 2006....................................................................... 29 Figure 22: Chance to be injured if wearing or not a seatbelt – 2006....................................................................... 29 Figure 23: Percentage of fatalities and casualties by occupation – 2006 ............................................................... 30 Figure 24: Percentage of casualties by type of transport for farmers – 2006 ......................................................... 31 Figure 25: Percentage of casualties by severity of injury – 2006............................................................................ 31 Figure 26: Hospital discharge – 2006...................................................................................................................... 32 Figure 27: Percentage of casualties and fatalities per type of transport – 2006 ..................................................... 32 Figure 28: Percentage of casualties by category of trauma – comparison between Phnom Penh and provinces – 2006 ................................................................................................................................................................ 33 Figure 30: Percentage of car/truck/bus driver's casualties having a driving license – 2006................................... 34 Figure 31: Number of casualties per day – 2006 .................................................................................................... 35 Figure 32: Percentage of casualties – differences between weekday and weekend – 2006.................................. 35 Figure 33: Percentage of casualties per day of the week – 2006 ........................................................................... 36 Figure 34: Percentage of casualties – differences between day and night – 2006................................................. 36 Figure 35: Percentage of casualties per hour of the day – 2006 ............................................................................ 37 Figure 36: Percentage of casualties by cause of accidents – 2006 ........................................................................ 37 Figure 37: Percentage of fatalities by cause of accident –- 2006 ........................................................................... 38 Figure 38: Percentage of casualties by cause of accident – differences between age categories – 2006............. 39 Figure 39: Percentage of casualties by type of vehicle involved – 2006................................................................. 40 Figure 40: Percentage of accidents by type of collision – 2006 .............................................................................. 40 Figure 41: Percentage of vehicles involved in road traffic accident by type of vehicle manoeuvre – 2006 ............ 41 Figure 42: Percentages of 4 wheel right hand drive vehicles among total 4 wheel vehicles registered and involved in accidents – 2006 ......................................................................................................................................... 41 Figure 43: Number of road traffic accidents per province – 2006 ........................................................................... 42 Figure 44: Number of road traffic fatalities per province – 2006 ............................................................................. 42 Figure 45: Number of road traffic fatalities and casualties by province per 100,000 inhabitants – 2006................ 43 Figure 46: Top ten Phnom Penh communes affected by road traffic casualties – measured as number of casualties per inhabitant – 2006 ..................................................................................................................... 44 Figure 47: Black spot of road accidents in Phnom Penh – 2006 ............................................................................ 45 Figure 48: Top ten Kandal communes affected by road traffic casualties – measured as number of casualties per inhabitant – 2006 ............................................................................................................................................ 46 Figure 49: Top ten Kampong Cham communes affected by road traffic casualties – measured as number of casualties per inhabitant – 2006 ..................................................................................................................... 46 Figure 50: Percentage of casualties by type of road – 2006................................................................................... 47 Page 2

Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 51: Number of fatalities per 100 million vehicles kilometers by national road – 2006.................................. 47 Figure 52: Percentage of casualties by type of road design – 2006 ....................................................................... 48 Figure 53: Percentage of casualties by type of transport to the hospital – 2006 .................................................... 48 Figure 54: Duration to arrive at the hospital – 2006 ................................................................................................ 49

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Foreword Note from the Minister of Public Works and Transport

The traffic accident in Cambodia in the last recent years has becoming a great catastrophe which is threatening to both the people’s welfares and lives and has been destroying numerous public and private properties countrywide. Report in 2006 on traffic accident confirmed that, the traffic accident has increased compared to the last years. Everyday, 4 people died and many more were injured by the traffic accidents, so much tragedy has becoming the legend for the society, in particular the victim’s families. Since 2005, the Royal Government of Cambodia has been establishing the National Road Safety Committee (NRSC) in order to implement the action plan of road safety which comprises of 15 points aiming to reduce the traffic accident. The road traffic law was declared in 2006 and came into effect on 01 March 2007 onward. The National Road Safety Committee (NRSC) as well as on behalf of Ministry of Public Works and Transport (MPWT) will conduct the education, awareness on the road traffic laws and regulations to the people and will strengthen the laws to be more effective in order to prevent and reduce the road traffic fatality rates to the minimum level in accordance with the Asian nation’s plan and the Royal Government, and will reduce the fatality rate to 5 within the year 2010 and under 2 in 2020 in 10,000 vehicles. Apart from these, the NRSC has been doing many more activities such as the celebrating of the National Road Safety Week and the Road Traffic Victim’s Day of the year, conducted training on road traffic laws and the vehicle driving skills to people and conducted public awareness campaigns, particularly in the major national public holidays. Finally, I would like to extend my thanking to Handicap International Belgium (HIB) that has been supporting to compile and edit the report on Road Traffic Accident and Victim Information System (RTAVIS) reflecting the traffic situation in Cambodia and I would like to appeal to all Cambodians, particularly the road users to strictly paying their respects to the road traffic laws and regulations and always be stuck with good morals and patience during driving to avoid the traffic accident from happening eventually. Protect your life for the ones you love.

In lieu of –

Minister of Ministry of Public Works and Transport (MPWT) and Chairman of National Road Safety Committee (NRSC)

Vice Chairman of National Road Safety Committee Chum Iek

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Note from the Minister of Health Traffic accident has severely and negatively affected the social welfare and national economy. The traffic accident has also hampered the national development, losing lives and disabling the people who are the workforce of the national economy. The long lasting treatment and the long lasting rehabilitation together with the loss of revenues due to disability or the loss of key persons in the families can make those families even poorer. All these reasons are the necessary things that attention should be paid on the traffic safety issues. Ministry of Health is very proud to actively participate in implementing the action plan of the national traffic safety in particular the collaboration with the working partners such as Ministry of Public works and Transports, Ministry of Interior and the related institutions such as Handicap International Belgium in order to compile the Road Traffic Accident and Victim Information System (RTAVIS), the unique database collection system for accidents and injuries along the public road. According to the regular records in the reports on the traffic accidents in 2006 has confirmed that, the traffic accident has not yet decreasing. And through this report, it enable us to develop the action plans to prevent the traffic accidents in the present and in the future, in accordance with the new traffic laws being adopted for public uses in order to strengthen the traffic conditions in the country. Ministry of Health will continue its collaboration with Handicap International Belgium and other partners to extend the database system along the state owned hospitals and other private clinics to cover the types of injuries and develop the database system to monitor and follow up on the general injuries. Injuries are the remarkable physical health that is increasing in Cambodia, while we still don’t have proper monitoring and follow-up system. The Ministry of Health has actively participated in the Awareness and Education Campaign on top of the Road Traffic Accident and Victim Information System (RTAVIS) in order to maximize the helmet wearing rates and the behavioural changes of people on how to safely trafficking on the public roads. These campaigns were successfully organized. In the coming years, the efforts of Ministry of Health will mainly focusing on the improvement of the emergency assistance and the injuries treatment before and after arriving in the hospital. To offer the punctual treatment of injuries have the important roles in managing, monitoring and following up the injuries more effectively. Finally, I would like to express my thanks to Handicap International Belgium and the World Health Organization (WHO) who have organized and compiled this report in close collaboration with Ministry of Health in order to reduce the injuries in Cambodia to the minimum levels.

HE Dr. Nuth Sokhom Minister of Health

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Note from the Ministry of Interior Based on the drastic increment of people and travelling means including the improperly managed traffic orders, this has led Cambodia to become the country that has higher rate of traffic accidents than other countries in the region if comparing the numbers of vehicles. Currently, in the average, more than 3 persons are killed and many others are injured everyday. The accident is not only for the victims and their families, but it also becomes the obstacle affecting the economic policy and the poverty reduction strategy of the Royal Government of Cambodia. Ministry of Interior expresses its sadness for the traffic accidents and the catastrophe stemmed from the traffic accidents as mentioned above. The Ministry of Interior has pointed out to the Skilled Department of General Commissariat of National Police in charge this affair, to try to find out good measures by all means to reduce the numbers of traffic accidents within the year 2007 and in the coming years. The information on traffic accident data has shown other detailed and important factors which are the benefits for providing comprehensive knowledge to the society and are the masterpieces of efforts, good collaboration between Ministry of Interior, Ministry of Public Works and Transport, Ministry of Health, Ministry of Education and Sports and Handicap International Belgium, even though there are some lacks of materials or finances but is the important compass for us to find out the experience in order to take actions in reducing this accident. In order to make things better improved, we need to increase our collaboration between Ministry of Interior, Ministry of Public Works and Transports, Ministry of Health, Ministry of Education Youth and Sports and Handicap International Belgium in order to analyze and raise the exact, on time plan in order to prevent and deal with all encountered problems in an effective way. Ministry of Interior would like to appeal to all levels of people to pay strictly respect and follow the Traffic Laws and to participate in safeguarding the traffic orders for the benefits of the general traffic stability and for the life and personal properties preventions as well.

Commissariat General of National Police Deputy Commissioner General

Sim Sophal

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Note from Handicap International Belgium Fort those who would still doubt about the dramatic consequences of road traffic accidents in Cambodia, the reading of this third RTAVIS report will offer a useful, even if frightening, experience. With more than 26,000 yearly traffic casualties, almost 14,000 vehicles involved, 1,300 fatalities and 6000 severe injuries, Cambodia ranks amongst the most affected countries in the region in terms of fatalities. The figures collected in the first months of 2007 reflect an even worse situation, with two permanent features: the leading cause of traffic accidents is human behaviour and young people account for most casualties. In this respect, the recent decision of the Cambodian authorities to approve a new Land Traffic law is a clear sign of the Government’s commitment to improve the security on the Cambodian roads. This law paves the way for the implementation of various actions aimed at drastically improve the road safety situation. Such an improvement will however request strict enforcement measures, effective education and awareness campaigns and a strong coordination of all stakeholders under the leadership of the National Road Safety Committee. Handicap International Belgium is proud to have contributed to the achievement of this report, that not only contains a detailed and accurate assessment of the road safety situation, but also proposes numerous recommendations to make the combat against road accidents a reality. This report could not have been possible without the cooperation of numerous people and institutions that have shown a keen interest in the improvement of road safety in Cambodia. Our particular thanks go to the Ministry of Public Works and Transport, the Ministry of Health and the Ministry of Interior which continued to share their experience and data, as well as to the Belgian Technical Cooperation and the World Health Organization, whose representatives in Cambodia and in headquarters have been very supportive. Sincere thanks are also due to the doctors and staffs of numerous hospitals, health centres, and private clinics as well as to all traffic police officers who devote time and enthusiasm to fill in the data collection forms every day. They are the key contributors in the success of the system. Special thanks as well are due to the Handicap International Belgium road safety team, and in particular to its manager, Ms. Sann Socheata, and her colleagues, Mr. Meas Chandy, Mr. Sem Panhavuth, Ms. Ou Amra, Mr. Uy Math, Mr. Yorn Virak and Mr. Pea Kimvong, whose commitment and hard work made the publication of this report possible. Last, we are pleased to mention our generous donors, the Belgian and the French Cooperation as well as the World Health Organization, for their continuous support in this crucial issue and the European Union for the publication of this report.

Handicap International Belgium Country Director Bruno Leclercq

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

I. Introduction The objective of the Road Traffic Accident and Victim Information System (RTAVIS) is to provide government and development stakeholders in Cambodia with accurate, continuous and comprehensive information on road traffic accidents and victims. It should allow them to better understand the current road safety situation, plan appropriate responses and evaluate impact of current and future initiatives. RTAVIS collects, centralizes, analyses and disseminates information provided by three different sources: - Public health facilities; - Private clinics; - Traffic police. The system has been progressively developed since March 2004 by the Ministry of Public Works and Transport, the Ministry of Interior and the Ministry of Health, with the technical support of Handicap International Belgium. In Siem Reap, Otdar Mean Chey and Kampong Cham provinces, the system is also supported by the Belgian Technical Cooperation. The system is developed in the framework of Action 2 (Road Accident Data Systems) of the National Road Safety Action Plan of the Royal Government of Cambodia. The present report analyses the information collected by RTAVIS for the year 2006. It is a synthesis of all the monthly reports that were published throughout 2006. The previous annual reports (annual report 2004 and 2005), as well as all monthly reports, can be found on the following website: www.roadsafetycambodia.info and www.cnctp.info In 2007, RTAVIS will continue to be developed and will progressively be integrated in a broader injury surveillance system, collecting data not only on road traffic injuries but also on other kinds of injuries such as falls, domestic accidents, violence and drowning.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

II. Executive Summary Introduction The year 2006 saw the adoption by the national assembly of the new traffic law. This new traffic law is an important milestone and its approval must be considered as a major step taken by the Government of Cambodia in its struggle against road safety issues. In 2006 the NRSC and HIB have made official their collaboration by signing a cooperation agreement defining the implementation of specific aspects of the National Road Safety Action Plan. The combination of these two major events gives a legal framework of intervention which will support the implementation of actions aiming at reducing the impact of road traffic accidents: human behaviour is indeed by far the leading cause of road traffic accidents in Cambodia and awareness and education campaigns alone are not sufficient to prevent them. RTAVIS, in 2006, developed a national network of data collection, both with the traffic police and health structures. GPS use by traffic police was piloted in Phnom Penh, traffic accidents are located accurately and black spots can be mapped. The use of GPS will be extended in 2007. The year 2007 will be also crucial since the recently approved law will have to be enforced. That will be done only through the implementation of a broad scope of actions which will address the problems at various levels. The collaboration of the whole of the actors will be required to achieve this objective.

Recommendation 1: Enforce the new land traffic law The new land traffic law has been signed by the King February 8, 2007. The new law introduces key new elements that are expected to have a strong impact on the road safety situation: 1 ƒ Every motorcyclist using a motorbike from 49 cc need to have a driving license ; 2 ƒ Helmet wearing is compulsory for all 2-3 motorized wheelers drivers ; ƒ Fastening seatbelts is compulsory for all car front seat occupants; ƒ Blood alcohol concentration limit is provided; ƒ Fines and penalties are better detailed and adapted to the gravity of the infraction. The new law will then need to be accompanied by several sub-decrees to describe the enforcement mechanisms and their timing. A transition period, accompanied by effective awareness and education campaigns, will be necessary. 3

Recommendation 2: Improve law enforcement by training and motivating traffic police . Law enforcement is still very weak. Experience in other countries shows that even if traffic laws are very stringent, they are useless without adequate enforcement. Traffic police officers should be trained on the new traffic law and receive incentives to enforce it correctly. As part of an output from the training, a national enforcement action plan should be developed. At the same time, traffic police officers should be provided appropriate tools to ensure the effectiveness of its enforcement (alcohol test, speed gun…). Traffic police officers currently lack respect by the population. A campaign to improve their legitimacy and their image should be developed, simultaneously with clear changes in the way they operate. Recommendation 3: Continue to provide the National Road Safety Committee with adequate funding4 and human resource development The National Road Safety Committee will not function effectively if it does not have appropriate funding and the improvement of capacity building among its staffs to perform its activities. 1

Driving licenses are currently not compulsory for motorbikes below 100 cc and most motorbikes in use in the country are below 100 cc. Therefore, most motorcyclists in the country do not have to pass a theoretical and practical examination before driving a motorcycle and most likely do not know the traffic rules. 2 Ideally, motorbikes' passengers should also have to wear helmets. 3 Cf. Action 8 of the National Road Safety Action Plan: Law Enforcement. 4 Cf. Actions 1 and 3 of the National Road Safety Action Plan: Establishing a National Road Safety Committee and Road Safety Funding.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Recommendation 4: Continue to establish a "culture of road safety" in Cambodia Besides the actions taken at the ministry level, the civil society has a very important role to play in improving road safety. Several actions can be taken simultaneously by victims' associations, NGOs, international organizations, private companies and individuals in a coordinated way. A particular emphasis should be put on the organization of national road safety campaigns and events, such as the National Road Safety Week in April5, and the National Remembrance Day of Road Traffic Victims6 in November. Recommendation 5: Further develop the national road traffic accident data collection system at the national level, combining data coming from various sources7. Over the last 3 years, RTAVIS has been able to combine data coming from 3 different sources to produce detailed analysis on road traffic accidents and casualties. The network now covers the overall country with its 3 sources and the data collection capacity of the system has increased. Such a system must be further continued to develop in order to: 1. Have a better understanding of the road safety situation; 2. Evaluate road safety actions and the implementation of the national road safety action plan; 3. Advocate for more action on road safety. Notice: RTAVIS now cover the whole country geographically, traffic police data have been integrated 24 provinces, new hospital, clinics and health centres have been progressively added to the system. The Cambodian Demographic and Health Survey 2005 indeed estimated the number of road traffic casualties at around 122,800, while RTAVIS reports 26,146 casualties in 2006.

Key figures General figures -

In 2006, 26,146 road traffic casualties were reported to RTAVIS, resulting from 9,338 accidents. Among them, 1,292 were fatalities (an average of 3.5 fatalities per day) and 6,033 were severely injured. Almost 14,000 vehicles were involved in those accidents.

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The number of road traffic fatalities has more than doubled over the last 5 years.

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Road traffic accidents increased proportionally more than road traffic and population.

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There are 18 fatalities per 10,000 registered vehicles. It has increased 15%, compared to 2005. It is a very big challenge for the country to achieve the target for 2010 (7 fatalities per 10,000 vehicles), which is set in the National Road Safety Action Plan. Cambodia has one of the highest fatality rates in the region, compared to the number of vehicles in use in the country. Compared to the number of inhabitants, the rate is however still below many other countries.

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In Phnom Penh, the number of fatalities has decreased by 13% from 2005 to 2006. The significant decreases have been noticed during Pchum Ben celebration and water festival.

Notice on 2007: The figures for the first 2 months of 2007 show a sharp increase of the number of fatalities: on average, more than 4 people died per day due to road traffic accidents in Cambodia during the first 2 months of 2007.

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It has been approved by the government of Cambodia to be the national road safety week from 07th to 14th of April The same day of the International Remembrance Day of Road Traffic Victims. Cf. Action 2 of the Road Safety Action Plan: Road Accident Data Systems.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Age of casualties -

The average age of casualties is 28. 70% of casualties are among the active part of the population (age 20 to 54). People aged between 20 and 29 years old represent the highest percentage of casualties and fatalities. More than 50% of casualties are between 15 - 29 years old, although they represent only 31% of the population. Conversely, children (0-14) account for 10% of casualties although they represent 37% of the population.

Recommendation 6: Develop a specific strategy to address road safety issues among young drivers. The age pyramid of Cambodian population shows that almost 40% of the population is aged below 15 years old. It means that in the coming years, a growing number of young people will start to drive on Cambodian roads. Knowing that young people between 15 and 29 are currently associated with more than 50% road traffic casualties, there is a risk that this percentage will further increase in the future. It is therefore essential to target future road users by notably developing effective road safety education in primary and lower secondary schools. Gender of casualties -

Males account for 72% of casualties, although they account for only less than 50% of the population. the number of male fatalities in 100,000 inhabitants is 4 times higher than female fatality rate (14.5 compared to 3.6) This over-representation of males in the casualties is especially important in the working–age proportion.

Recommendation 7: Consider males as a cluster of population specifically at risk when developing a specific strategy to address road safety issues among drivers. The figures show that males represent a higher ratio of casualties per inhabitants: they account for 72% of casualties8, although they account for only 49% of the population. This over-representation of males in the casualties is especially important in the working–age proportion of the population (20-39 years old), where males represent around 80% of casualties. This element has to be taken in consideration when developing awareness campaigns. Type of transport -

Motorbikes’ users account for the large majority of casualties and fatalities (72% and 59% respectively), followed by pedestrians, bicyclists and car users. Pedestrians share 16% of fatalities, while they represent only 8% of casualties. The percentage of pedestrian and bicycle casualties is much higher among children and old people. Almost 50% of casualties below 5 years old are pedestrians.

Recommendation 8: The heterogeneity of the Cambodian traffic shall be taken in consideration in roads engineering Cambodian roads are characterized by a wide variety of types of traffic (motorbikes, cars, tricycles, tuk-tuks, minivans, trucks, oxcarts, etc). Separation between four-wheelers and two-wheelers on national roads and on main town streets would reduce the number of accidents, and at the same time it would improve traffic flows. Although accounting for only 8%, pedestrian is the second most at-risk population after motorbike users. The access to pavement should be given back to pedestrian in Phnom Penh. Most child casualties are pedestrians. Teaching them the basic rules and risks of the road can allow them to travel safer from home to school and elsewhere. The road infrastructure should be improved for pedestrian friendly environment. Helmet wearing -

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26% of casualties suffer from head injuries, which is in line with the world average of 28%. More than 45% of casualties injured in Phnom Penh suffer from cranial trauma. This is partly due to the fact that a larger proportion of motorbike's casualties is noticed in Phnom Penh (83% compared to 69% in province). 73% in Phnom Penh and 72% in provinces.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

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72% of casualties suffering from a cranial trauma are indeed motorbike users and only 4% are wearing a helmet at the time of the accident. 38% of motorbikes’ riders were suffering from head injury. 19% of motorbikes’ rider involved in an accident in 2006 and who were not wearing helmet did suffer from head injury. This figure is decreasing to 12% when wearing a helmet.

Recommendation 9: Develop specific awareness and enforcement campaigns to increase helmet wearing9. A large number of head injuries could be avoided if people were wearing helmets correctly. Awareness campaigns organized so far by Handicap International Belgium in collaboration with the Ministry of Health and several other stakeholders have already allowed increasing two and half of the helmet wearing rate in Phnom Penh (from 8 to 21%). Seatbelt In 95% of the cases, a 4-wheels vehicles driver/passenger who was moderately, mildly or severely injured in a traffic accident did not wear a seatbelt. Recommendation 10: Develop specific awareness and enforcement campaigns to increase seatbelt fastening. A large number of injuries could be avoided if people were fastening their seatbelt correctly. Awareness campaigns should take this element in consideration when focusing on 4-wheel vehicles, and mainly private cars and taxis. Occupation of casualties -

The active part of the population is the most affected by road traffic accidents. The percentages of fatalities by occupation are following the similar pattern as casualties: farmers share the highest percentage, followed by workers and students. Farmers constitute the larger group of fatalities than casualties (26% of fatalities, 24% of casualties). Farmers are victims of motorbike accidents in 72% of the cases.

Recommendation 11: Take in consideration the evolution of motorbike ownership among the rural population. The yearly increase observed in the percentage of farmers being victims of accident (9% in 2004, 19% in 2005 and 24% in 2006) seems to indicate that an increasingly number of farmers use motorbike when traveling. Awareness campaigns should take this element in consideration when organised in rural areas, with a specific attention on traffic rules, adopting a defensive way of driving and wearing of helmet. A community-based approach should be encouraged in this respect. Severity of injuries and hospital discharge -

5% of casualties are fatalities. 23% of casualties are severely injured (requiring surgery or admission to intensive care). In total, 26% of casualties suffer from head injuries. 38% of motorbikes’ riders were suffering from head injury, 22% were severely injured and 4% died. Car users and pedestrians suffer more fatalities than other types of road users. Although more than 80% of the casualties were fully treated and sent home, 7% were referred to another hospitals and 2% requested to be treated by a private clinic or a traditional healer.

Nature of injuries -

82% of fatalities suffered from head injuries. 26% of casualties suffer from head injuries, which is slightly lower than the world average of 28%.

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Cf. Action 12 of the Road Safety Action Plan: Road Safety Public Campaigns. This recommendation is strongly supported by the World Health Organization and Handicap International, which launched several campaigns to promote the use of helmets.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

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A higher percentage of head injuries is noticed in Phnom Penh compared to the rest of the country (more than 45%). The average cost of medical treatment is US$ 79 per casualty.

Driving license -

Only 55% of car/truck/bus drivers have a valid driving license at the time of the accident. 22% of children between 5 and 14 years old who were victim of a motorbike accident were driving the motorbike by themselves at the time of accident.

Recommendation 12: Take measures to enforce the law regarding the driving license validity. This action must be linked to a monitoring of the quality of the training given prior to the delivery of the license. A monitoring of the quality of the examination as well as the training offered by the driving schools should be considered10. A specific attention should be paid to the validity of driving license for motorbikes. Day of accident -

On average, more than 70 road traffic casualties are reported every day by RTAVIS11. Several peaks (up to 300 casualties a day) are noticed, corresponding mainly to Khmer national holidays. Weekend (Friday 6 pm until Sunday midnight) accidents are responsible for 36% of casualties. A higher percentage of casualties are noticed on Saturdays, especially during the night. A lower percentage of casualties occur on Friday evenings.

Time of accident -

Nighttime accidents are responsible for 30% of casualties. One peak of casualties is observed between 6 pm and 7 pm.

Causes of accident -

"Hit and run" accidents12 represent 23% of accidents and are responsible for 21% of casualties. Only 37% of the casualties are responsible for the accident in which they have been injured. Human error is responsible for more than 90% of casualties. Road and weather conditions are responsible for more than 10% of casualties while vehicle defect is responsible for only 4% of casualties. Almost 50% of fatalities are due to non appropriated speed, while other 20% are caused by alcohol abuse.

Recommendation 13: Develop enforcement campaigns on driving rules. Current road users' behavior in Cambodia is generally erratic, undisciplined and inconsistent. With the rapid increase of speed and traffic, the situation will worsen and awareness campaigns alone will have to be coupled with a strict enforcement of the law, a better driving examination system and a better control of the driving schools. Recommendation 14:Develop awareness and enforcement campaigns targeting drunken driving Type of collision (vehicles involved) -

Motorbike-motorbike collisions are responsible for 34% of the casualties, followed by motorbike-car collisions (16%) and motorbikes that fell alone (11%). Pedestrians are mainly injured by motorbikes rather than by cars. Motorbike-pedestrian collisions indeed represent 5% of casualties while car-pedestrian collisions represent only 1% of casualties. 32% of four-wheelers involved in road traffic accidents are right-hand drives, although they present only 5% among 4 wheel vehicle official registered. On average, 2.8 people are injured per accident.

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Cf. Action 10 of the Road Safety Action Plan: Drivers Training. All hospitals and private clinics do not yet participate to RTAVIS and the actual average daily number of casualties is therefore higher than 70. The Cambodian Demographic and Health Survey 2005 indeed estimated the number of road traffic casualties at around 122,800. We estimate that this figure is more close to the reality, which would make an average daily number of road traffic casualties of 340. 12 Accidents where the driver of the vehicle causing the accident escapes after the accident. 11

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Type of collision -

24% of accidents are head-on collisions and right-angle, followed by rear end (11%). 71% of vehicles were going straight ahead at the time of the accidents.

Cost of accident The average damage cost per vehicle involved in accident is US$ 160. Knowing that 13,977 vehicles were involved in accidents in 2006, the total estimation of damage cost is US$ 2,236,320. Location of accident -

More than 40% of casualties are injured in urban areas. Almost 12% of accidents occurred in Phnom Penh, followed by Kampong Cham (9%), Kandal (8%) and Battambang (8%). In Phnom Penh, the top three communes affected by road traffic casualties (measured as number of casualties per 1,000 inhabitants) are Preak Lieb, Chrouy Changva, and Chakto Mukh. The two first are located along major national roads. In terms of population density, the highest fatality rates are observed in Krong Kep and Sihanouk Ville, which are the most popular leisure places for Cambodian people during holidays and weekends.

Type of road -

63% of casualties are injured in accidents occurring on national/provincial roads. In comparison with the volume of traffic, national road 4 is the most deadly, followed by national roads 2 and 7.

Road characteristics -

More than 70% of casualties are injured in accidents occurring on straight roads. 74% of casualties are injured in accidents occurring on paved roads.

Recommendation 15: Develop specific actions targeting the national roads13. There is a direct link between the length of the paved road network and the number of accidents. National roads have recently been rehabilitated and traffic volume, as well as speed on those roads, is increasing rapidly. The number of accidents on those roads is therefore expected to increase even more rapidly. Road safety action plans are urgently needed to accompany road rehabilitation and construction to ensure that: - Hazardous locations and black spots are clearly identified and marked; - Schools and markets are clearly identified and protected, notably with speed breakers; - Villagers are properly informed on the additional risks that the road brings; - Speed limits are clearly indicated and respected. Transfer to hospital ƒ ƒ ƒ

Only 25% of casualties are transferred to the hospital or clinic by ambulance. This is mainly an issue in provinces where only 19% of casualties are transferred to the hospital by ambulance. 33% of casualties arrive at the hospital less then 30 minutes after the accident while more than 30% of casualties take more than 2 hours to reach hospital. In the provinces, 37% of seriously injured casualties take more than 2 hours to reach the hospital.

13

This recommendation is supported by a program of Handicap International which is supporting local NGOs and village committees to initiate road safety actions in village located along national roads.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Recommendation 16: Improve emergency assistance to traffic victims14. This is one of the most urgent recommendations. The current Cambodian healthcare system is currently not capable of absorbing the current and expected number of road traffic casualties. The problem is especially serious in remote areas along national roads where casualties sometimes have to wait several hours before being taken to hospital. The equipment and competence of the district hospitals are generally not sufficient and casualties often travel from one district hospital to a referral hospital before being sent to Phnom Penh. Ambulance services should also be improved and people should be better informed of what to do in case they are victims or witnesses of accidents (who to call, what first aid they can provide, etc). Traffic police should as well be properly trained on first aid. Police attendance Police are present on the accident site in almost 63% of the cases.

14

Cf. Action 11 of the Road Safety Action Plan: Emergency Assistance to Traffic Victims.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Differences between Phnom Penh and provinces The key indicators mentioned here above are national averages. However, important differences are noticed between Phnom Penh and the provinces. The figure here below summarizes the main differences. Figure 1: Main road safety indicators – differences between Phnom Penh and provinces Number of casualties reported to RTAVIS Age Percentage of casualties aged between 15 and 24 years old Type of road user Percentage of motorbike riders Percentage of pedestrians Percentage of car riders (private and taxis) Percentage of bicycle riders Occupation Percentage of students Percentage of farmers Percentage of workers Nature of injuries: (1) Percentage of casualties suffering from cranial trauma Day of accident: Percentage of casualties injured during the weekend (from Friday 6 pm to Sunday midnight) Time of accident: Percentage of casualties injured during nighttime (from 6 pm to 5.59 am) Peak(s) of casualties Cause of accident: (2) Percentage of casualties injured in accidents due to human error High speed Alcohol or drug abuse Dangerous overtaking Other Percentage of casualties injured in accidents due to road conditions Percentage of casualties injured in accidents due to weather conditions Percentage of casualties injured in accidents due to vehicle defect Type of collision: Percentage of casualties injured in motorbike-motorbike collisions Percentage of casualties injured in motorbike-car collisions Percentage of casualties injured in motorbike-pedestrian collisions Hit and Run: (3) Percentage of casualties injured in accidents where the driver of the vehicle causing the accidents escaped after the accident Time to be transferred to hospitals: Percentage of casualties arriving at hospitals between 10 and 30 minutes after the accident Percentage of casualties arriving at hospital more than 2 hours after the accident Way to be transferred to hospitals: (4) Percentage of casualties transported by ambulance Attendance of police: Percentage of cases were police was present on the accident site

Phnom Penh only 2006

All Provinces without Phnom Penh 2006

5,547

20,599

43%

2,357

34%

7,044

83% 8% 2% 3%

4,627 467 137 169

69% 8% 6% 6%

13,724 1,594 1,155 1,194

28% 3% 31%

1,466 152 1,631

20% 30% 18%

3,890 5,855 3,372

47%

1,986

37%

4,808

37%

2,042

36%

7,370

42%

2,304

27%

5,660

7pm - 9pm

5pm - 7pm

98%

5,235

92%

17,898

35% 18% 19% 26%

1,889 991 1,009 1,346

44% 17% 11% 20%

8,442 3,403 2,111 3,942

4%

197

13%

2,702

1%

66

3%

514

1%

61

4%

892

44%

2,399

31%

6,138

28%

1,418

16%

3,247

9%

491

7%

1,522

21%

211

22%

1,404

40%

1,665

26%

3,205

17%

716

37%

4,527

41%

1,681

19%

2,145

59%

3,248

64%

12,368

Note: - (1) and (4): Based on hospital data only. - (2): Some accidents were due to more than one cause. - (3): Based on traffic police data only Page 16

Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

III. System coverage Data sources Research shows that in most countries official accident statistics based on traffic police reports only underestimate the real number of road traffic casualties15. To avoid this underreporting, RTAVIS therefore collects data at three different data sources, as illustrated by the figure here below: Figure 2: RTAVIS data collection flow

In 2006, traffic police reported 40% of casualties. The other 60% were reported by health facilities only (without police records), as shown on the figure below. Figure 3: Percentage of casualties reported to RTAVIS – 2006 Casualties reported by traffic police only 33%

Casualties reported by health facilities only 60%

Casualties reported by both traffic police and heath facilities 7%

Notice: To avoid double entries between health facilities and traffic police data, when a casualty is reported by a health facility as well as by the traffic police, it is taken into account only once and shared around 7% of the casualties.

15

Recent research shows that statistics based on traffic police only report 60% of seriously injured road traffic casualties in developed countries.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Private clinics play a growing role in the treatment of road traffic casualties. In Phnom Penh, they have treated more than 35% of the casualties in 2006. Health facility data sources have been progressively added into the RTAVIS coverage, as shown on the chart below. In December 2006, 129 health facilities (provincial hospitals, referral hospitals and health centers) were participating in RTAVIS. This number has steadily increased during the year. Full country coverage with hospital and traffic police data has been achieved by the end of 2006.

3,500

140

3,000

120

2,500

100

2,000

80

1,500

60

1,000

40

500

20

0

Number of health fecilities data sources

Number of casualties

Figure 4: Evolution of the number of casualties and health facilities data sources – January to December 2006

0 Jan-06

Feb-06

Mar-06

Apr-06

May-06

Jun-06

Number of casualties reported to RTAVIS

Jul-06

Aug-06 Sep-06

Oct-06

Nov-06

Dec-06

Number of health fecilities data sources

Notice on Injury Surveillance In 2007, several workshops will be organized by the Ministry of Health, HIB and other interested stakeholders to extend the data collection system set up for RTAVIS to other types of injuries, such as falls, drowning, domestic violence,... Injuries in general are indeed estimated to be a growing cause of death and disability in Cambodia but there is currently no ongoing data collection system to monitor these issues16.

16

The Demographic and Health Survey performed in 2005 in Cambodia estimated that road traffic injuries represent 45.9% of injuries, followed by falls from tree/building (14.2%).

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Geographic coverage By the end of 2006, RTAVIS covered 24 Cambodian provinces with traffic police and health facilities data17, as shown on the figure here below. All traffic police officers have been trained on the RTAVIS data collection forms since 2005. Training of hospital and private clinic staffs has been finalised in mid-2006, in collaboration with the Ministry of Health. Figure 5: RTAVIS geographical coverage, December 2006

17

Although they have received training, none health facilities from Pailin and Mondol kiri did report in 2006.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

IV. Evolution of data Road traffic accidents, casualties and fatalities continue to increase more proportionally than road traffic and population. Over the last 5 years, the number of accidents increased by 50% and the number of fatalities has more than doubled. In the meantime, population has increased by 12% and the number of registered motorized vehicles has been increased by 70%. 18

Figure 6: Evolution of road traffic accidents and casualties in Cambodia , 1995 – 2006 (base 100 = 1995) 1600 1400 1200 1000 800 600 400 200 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Population

Traffic

Number of accidents

Fatalities

Generally, the fatality rate (in 100,000 inhabitants) has been increased since 1995, with the highest rate in 2006 (9.2 fatalities per 100,000 inhabitants). In 2006, there are 18 fatalities per 10,000 registered vehicles. It has increased 15%, compared to 2005. It is a very big challenge for the country to achieve the target for 2010, which is set in the National Road Safety Action Plan. Figure 7: Fatality rates in Cambodia 1995 – 2006 and its target for 2010 and 202019 25.00 21.5 18.4

20.00

18.1 15.7

12.7

Fatality rates

15.00

12.0

12.4 9.2

10.00 6.4

5.00

4.5 0.9

4.1 0.9

3.2 0.8

6.4 3.7

3.7 0.9

1.7

7.7

7.0

6.5

4.2

3.3

2.0

Number of fatalities per 100,000 inhabitants

Target for 2020

Target for 2010

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

0.00

Number of fatalities per 10,000 registered vehicles

18

Sources: Population: First Revision of Population Projections for Cambodia 1998 -2020, National Institute of Statistics, Ministry of Planning, June 2004; ƒ Traffic and accident figures: Ministry of Public Works and Transport. 19 Sources: National Road Safety Action Plan ƒ

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Notice: RTAVIS has been recently created. Long period evolution charts or year to year comparisons at the national level are therefore not yet possible for 1995 up to 2005. The graphs (figure 6 and 7) are based on figures provided by the traffic police only. In Phnom Penh, the number of fatalities has decreased by 13% from 2005 to 2006. The significant decreases have been noticed during Pchum Ben celebration and water festival. This can show the positive impacts of road safety actions, organized by road safety related stakeholders, especially the government during the celebrations. Figure 8: The evolution of the numbers of fatalities in Phnom Penh – March 2004 to December, 2006 Pchum Ben celebrations

Number of fatalities in Phnom Penh

35

Water festival

30 25 20 15 10 5 0 Jan

Feb Mar

Apr May Jun 2004

Jul 2005

Aug Sep

Oct

Nov Dec

2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

V. 2006 data analysis Introduction Notice: RTAVIS now cover the whole country geographically, traffic police data are collected in the 24 provinces, new hospital, clinics and health centres have been progressively added to the system to reach a total of 129 health facilities in December 2006. The number of casualties and accident provided in this report remain nevertheless inferior to the actual number. The Cambodian Demographic and Health Survey 2005 indeed estimated for every 1,000 people in the population, 19 suffered an injury and accidental death. 45.9% of them are due to road traffic accidents. So, the number of road traffic casualties could be estimated at around 122,800, while RTAVIS has reported 26,146 casualties in 2006. In 2006, 26,146 road traffic casualties have been reported by RTAVIS, resulting from 9,338 accidents. Among them, 1,292 were fatalities. The fatality rate, calculated in comparison with the number of inhabitants, is still low compared to neighbor countries such as Vietnam. However, calculated in comparison with the number of vehicles in use in the country, the fatality rate is already high, as shown on the figures here below. Figure 9: Fatality rates – comparisons between selected countries – 2006 25

23.5 19.7

20

Fatality rates

23.1

18.1 16

15

15

13.6 9.2

10 6

6.8

8.7 8.6 6.5 3.9

5

0 China

Laos

Vietnam

Cambodia

Number of fatalities per 10,000 registered vehicles

Ecuador

Malaysia

Botswana

Number of fatalities per 100,000 inhabitants

Victim Information Age -

The average age of casualties is 28. The active part of the population is the most affected by road traffic accidents: 70% of casualties are among the active part of the population (age 20 to 54). People aged between 20 and 29 years old represent the highest percentage of casualties and fatalities. Although, people aged older than 34 years old represent low percentages of casualties, but they have higher percentages of fatalities, which mean they have higher risk of death in an accident than other groups, especially for those who are older than 55 years old.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 10: Percentage of casualties and fatalities by age category – 2006 25% 22%

Percentage

20%

19% 16% 14%

14%

15%

10%

9%

10%

8% 8%

5%

4% 4%

4% 4%

5-9

10-14

9%

10% 7% 6%

8% 6%

2% 2%

6% 4% 3%

0% >5

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

>=55

Age Category Percentage of casualties

-

Percentage of fatalities

People aged between 20 and 24 years old account for 22% of casualties although they represent only 11% of the population. Conversely, children (0-14) account for 10% of casualties although they represent 37% of the population. Figure 11: Percentage of casualties and population by age category – 2006 25%

22%

20% 15%

16%

14% 14% 12%

12%

11%

11%

10% 5%

9% 8%

4%

8% 5%

4%

6%

6% 5%

8% 6%

6% 4% 3% 3%

2%

0% >5

5-9

10-14

15-19

20-24

Percentage of casualties

25-29

30-34

35-39

40-44

45-49

50-54

>=55

Percentage of population

On average, the proportion of young adult casualties and fatalities is higher in Cambodia than the South East Asian or the world average. People aged between 15 and 29 years old account for indeed almost 45% of the fatalities in Cambodia while they represent around 25% of the fatalities in the rest of the world.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 12: Percentage of fatalities by age category in different regions of the world – 2002 for the world and SEA figures, 2006 for Cambodia 50%

Cambodia

Percentage of fatalities

45%

SEA

40%

World

35% 30% 25% 20% 15% 10% 5% 0% <5

5 -14

15 - 29

30 - 44

45 - 59

60 +

Age category

On the other hand, the fatality rate (in 100,000 inhabitants) among people aged under 25 years old in Cambodia is low then the averages in WHO regions.

Fatality rates (in 100,000 inhabitants)

Figure 13: Under 25 year-old fatality rates (per 100,000 inhabitants) in Cambodia and other regions20 – 2006 30 25

24.2 17.9

20 15 10.8 10

9.7

7.8 5.5

5 0 AFRO

20

10.7

AMRO

EMRO

EURO

SEARO

WPRO Cambodia

Sources: WHO and RTAVIS - 2006

Page 24

Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

The age pyramids of road traffic casualties vary a lot between Phnom Penh and the rest of the country. The proportion of young adults (age 20 to 24) is much more important in Phnom Penh (28% compared to 20%) The proportion of people above 55 years old is also higher in provinces than in Phnom Penh. Figure 14: Age pyramid of casualties – Phnom Penh versus the rest of the country – 2006

Gender Males represent a higher ratio of casualties per inhabitants: they account for 73% of casualties21, although 22 they account for only 49% of the population . This over-representation has slightly increased in 2006 compared to 2005 (71%). It is also in line with what is observed in other countries in the region and in the world: - In 2006, males accounted for 69% of casualties in Laos and for 68% of casualties in Vietnam23. - In 2002, males accounted for 73% of all road traffic deaths in the world24. This over-representation of males in the casualties is especially important in the working–age proportion of the population (20-39 years old), where males represent around 80% of casualties.

21

73% in Phnom Penh and 72% in provinces. Sources: RTAVIS and First Revision of Population Projections for Cambodia 1998 - 2020, National Institute of Statistics, Ministry of Planning, June 2004.

22

23 24

Source: Data collection systems developed by Handicap International and authorities in Laos and Vietnam. Source: World Report on Road Traffic Injury Prevention, WHO, Geneva, 2004.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 15: Percentage of casualties by gender for different age categories – 2006

On average, the number of male fatalities in 100,000 inhabitants is 4 times higher than female fatality rate (14.5 compared to 3.6). The highest male fatality rate is among 25-29 years old group (more than 31), while the highest rate among female is the group older than 55 years old (8.3).

Number of fatalities per 100,000 inhabitants

Figure 16: Number of fatalities per 100,000 inhabitants by gender for different age categories25 – 2006 35.0

31.7

30.0 24.9

25.0

23.6 19.9

20.0

16.2

15.0

14.5

11.2 8.3

10.0 5.0

6.3

3.6 1.9 1.5

2.3

2.7 2.1

2.4

10-14

15-19

4.1

3.4

3.6

4.4

4.6

20-24

25-29

30-34

35-39

40-44

5.3

3.6

0.0 0-4

5-9

Male

25

28.6

27.3

25.5

45-49

50-54

>=55

Average

Female

Sources: First Revision of Population Projections for Cambodia 1998 -2020, National Institute of Statistics, Ministry of Planning, June 2004.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Type of road user Motorbikes’ users account for the large majority of casualties and fatalities (72% and 59% respectively), followed by pedestrians, bicyclists and car users. It is very interesting to note that pedestrians share 16% of fatalities, while they represent only 8% of casualties. Figure 17: Percentage of fatalities and casualties by type of transports – 2006 Motor tricycle Tricycle Bus

Type of transports

Minibus Pick-up Remorque Car (taxi) Other Heavy truck Light truck Car (private) Bicycle

0% 0% 0% 0% 0% 0% 1% 1% 1% 1% 2% 2% 2% 2% 3% 2% 3% 1% 3% 3% 5% 3% 5% 5%

Pedestrian

8%

16% 59%

Motorbike 0%

10%

20%

30%

Fatalities

40%

50%

60%

72% 70%

80%

Casualties

In comparison, fatalities rate of four-wheelers (per 10,000 registered four-wheelers) is similar to fatalities rate of twowheelers (per 10,000 registered two-wheelers). Conversely, four-wheelers represent only 25% of total registered vehicles. Figure 18: Comparison of fatality rates between two-wheelers and four-wheelers, calculated per 10,000 registered twowheelers and four-wheelers – 2006 16 14

13.8

12

10.3

10 8 6 4 2 0 Motorized two-wheelers

Motorized four-wheelers

Page 27

Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

The percentage of motorcycle and pedestrian casualties is much higher in Phnom Penh than in the rest of the country, while the percentage of bicycle casualties is much higher in provinces than in Phnom Penh. Figure 19: Percentage of casualties by type of transport – Phnom Penh versus the rest of the country – 2006

The percentage of pedestrians and bicycle casualties is much higher among children and old people: - Almost 50% of casualties below 9 years old are pedestrians. - 20% of casualties between 10 and 14 years old are pedestrians and almost 30% are bicycles riders26. - 16% of casualties above 55 years old are pedestrians Figure 20: Percentage of casualties by type of transport for different age categories – 2006

26

It is also interesting to note that 33% of casualties between 5 and 14 years old are motorbikes riders and that 22% of them were driving the motorbike by themselves at the time of accident.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Helmet wearing Only 4% of motorbike riders who had an accident in 2006 wore a helmet at the time of the accident. This percentage is low compared to the average wearing rate measured in Phnom Penh which was almost 21%27. It indicates that motorbike riders who wear a helmet are obviously adopting a better behaviour, are more careful than those who do not wear a helmet and therefore less likely to be involved in an accident. In case of heavy accident, helmet seems to be still efficient as it decrease, although slightly, the percentage of fatalities to 3% (compare to 4% when the motorbike rider do not wear a helmet). The role played by the helmet is obvious in lighter motorbike accidents (which remain the majority of the cases). In 2006, motorbike riders who wore a helmet suffered from head injuries in 12% of the cases compared to19% when not wearing a helmet. Figure 21: Percentage of motorbikes’ rider by helmet using – 2006 25% 19%

20% 15%

12%

10% 4%

3%

5% 0%

Percentage of fatalities

Percentage of head injury

Wearing helmet

Not wearing helmet

Seatbelt Only 5% of 4-wheels vehicles drivers/passengers who were injured in a traffic accident in 2006 wore a seatbelt at the time of the accident. The figure 22 illustrates clearly the role played by the seatbelt in case of collision. The chances to be injured, moderately, mildly or severely are much higher when not wearing a seatbelt. Figure 22: Chance to be injured if wearing or not a seatbelt – 2006 120% 96%

94%

100%

94%

80% 60% 40% 20%

6%

6%

4%

0% Sever

Moderate

Wearing safety belt

Mild

Not wearing safety belt

27

This average helmet wearing rate is measured regularly by the Ministry of Health, during 5 days, at different time and locations, to measure the effectiveness of helmet wearing awareness campaigns.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Occupation -

The active part of the population is the most affected by road traffic accidents. The percentages of fatalities by occupation are following the similar pattern as casualties: farmers share the highest percentage, followed by workers and students. Farmers constitute the larger group of fatalities than casualties (26% of fatalities, 24% of casualties). Motorbike taxi drivers constitute 5% of the total number of fatalities, while they represent only 3% in casualties. In 2006, 119 tourists/expatriates were reported among the casualties Figure 23: Percentage of fatalities and casualties by occupation – 2006 Office em ployee Fisherm an Retire Tourist/Expatriate Teacher Other Car taxi driver Police

Occupation

Other governm ent em ployee Soldier Child Unem ployed Motor taxi driver Vendor/Sm all business

0% 1% 0% 0% 1% 0% 1% 0% 2% 1% 2% 1% 2% 1% 2% 1% 3% 3% 3% 2% 3% 3% 4% 2% 5% 3% 5%

7% 6% 6%

House keeping/Servant

16%

Student Worker

22% 21% 20%

Farm er

24%

0%

5%

10%

15%

Casualties

Fatalities

20%

25%

26%

30%

It is interesting to note that farmers, representing the population with the most at-risk when classified by occupation, are victims of motorbike accidents in 72% of the cases.

Page 30

Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 24: Percentage of casualties by type of transport for farmers – 2006

Again, there are important differences between Phnom Penh and the rest of the country: - Farmers represent the biggest category of casualties in provinces (30%) while they represent only 3% in Phnom Penh. - Workers represent the biggest category of casualties in Phnom Penh (31%) while they represent 18% of casualties in provinces. - Students represent 28% of casualties in Phnom Penh and 20% in provinces. - The number of tourists/expatriates victims of accidents was reported higher in provinces than in Phnom Penh.

Severity of injuries and hospital discharge Almost 4% of casualties die immediately at the scene of the accident and 23% are severely injured. Figure 25: Percentage of casualties by severity of injury – 2006

Page 31

Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Although 80% of the casualties are fully treated at hospitals, 7% are referred to another hospital and 2% request to be treated by a private clinic or a traditional healer. Figure 26: Hospital discharge – 200628

A larger proportion of fatalities are noticed among pedestrian and four-wheeler casualties than among motorbike and bicycle casualties. Figure 27: Percentage of casualties and fatalities per type of transport – 2006

28

Notices: ƒ This graph only reports the casualties treated at health facilities. Many casualties reported by the traffic police are not taken into account in this graph. Those casualties either did not go to a hospital at all either were treated by a private clinic or a traditional healer that does not participate to RTAVIS. ƒ "Patient will die at home” refers to the cases where the victim is so injured that death is unavoidable (as diagnosed by the doctor), but the victim prefers to quit the hospital.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Nature of injuries In total, 26% of casualties suffer from head injuries, which is in line with the world average of 28%. However, a higher percentage of head injuries is noticed in Phnom Penh compared to the rest of the country. More than 45% of casualties injured in Phnom Penh suffer from cranial trauma. This is partly due to the fact that a larger proportion of motorbike's casualties is noticed in Phnom Penh (83% compared to 69% in province). 72% of casualties suffering from a cranial trauma are indeed motorbike users and only 4% are wearing a helmet at the time of the accident29. Figure 28: Percentage of casualties by category of trauma – comparison between Phnom Penh and provinces – 2006

Head injuries account for 82% of fatalities. It is interesting to note that only 2% of fatalities were wearing a helmet. In addition, 20% of casualties suffer from fractures and almost 50% suffer from serious cuts/wounds. Figure 29: Percentage of fatalities by category of trauma – 2006

29

This percentage is very low compared to the average helmet wearing rate in Phnom Penh which was almost 21% at the end of 2006. This average helmet wearing rate is measured regularly by the Ministry of Health, during 5 days, at different time and locations, to measure the effectiveness of helmet wearing awareness campaigns.

Page 33

Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Cost of treatment The average cost of medical treatment is US$ 79 per casualty. Driving license Only 55% of car/truck/bus drivers’ casualties have a valid driving license at the time of the accident. Figure 30: Percentage of car/truck/bus driver's casualties having a driving license – 2006

Accident Information Day and time of accident On average, more than 70 road traffic casualties are reported every day in Cambodia. Several peaks (up to 300 casualties a day) are noticed, corresponding mainly to Khmer national holidays, as shown in figure 31. Notice: All hospitals and private clinics do not yet participate to RTAVIS and the actual average daily number of casualties is therefore higher than 70. The Cambodian Demographic and Health Survey 2005 indeed estimated the number of road traffic casualties at around 122,800. We estimate that this figure is closed to the reality, which makes an average daily number of road traffic casualties up to 340.

Page 34

Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 31: Number of casualties per day – 2006 14-16th of April Khmer New Year

21-23rd of September Pchum Ben celebrations st

29-31 of January Chinese New Year

4-6th of November Water Festival

Weekend (Friday 6 pm until Sunday midnight) accidents are responsible for 36% of casualties. A higher proportion of weekend's accidents is noticed in Phnom Penh (37% of casualties, compared to 36% of casualties in the rest of the country). Figure 32: Percentage of casualties – differences between weekday and weekend – 2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

A higher percentage of casualties is noticed on Saturdays, especially during the night. A very low percentage of casualties occur on Friday evenings. Figure 33: Percentage of casualties per day of the week – 2006

Time of accident In total, nighttime accidents are responsible for 30% of casualties. Here again, a higher proportion of nighttime's accidents is noticed in Phnom Penh (42% of casualties, compared to 27% of casualties in the rest of the country). Figure 34: Percentage of casualties – differences between day and night – 2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

One peak of casualties is observed between 5 pm and 6 pm during the week day, and between 7 pm and 8 pm during the weekend. Figure 35: Percentage of casualties per hour of the day – 2006

Causes of accident About one fifth (21%) of casualties are injured in "hit and run" accidents30 and 37% of the casualties reported by the traffic police are responsible for the accident in which they have been injured. Human error is responsible for more than 90% of casualties. Road and weather conditions are responsible for less than 13% of casualties while vehicle defect is responsible for only 4% of casualties. Figure 36: Percentage of casualties by cause of accidents – 2006 100%

94%

90% 80% 70% 60% 50% 40% 30% 20%

11%

10%

2%

4%

Weather condition

Vehicle defect

0% Human error

30

Road condition

Accidents where the driver of the vehicle causing the accident escapes after the accident.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Human error Almost 50% of fatalities are due to non appropriated speed, while other 20% are caused by alcohol abuse. It is interesting to note that the percentages of fatalities for speed and alcohol abuse are higher than percentages of casualties, which show that a person has a higher risk of death in speed and alcohol abuse than other kinds of human errors. Figure 37: Percentage of fatalities by cause of accident –- 2006 Using mobile phone Not respect traffic signs Drug abuse Wrong use of high beam Human errors

Other Not respect traffic lights Driving against flow of traffic

0% 0% 0% 0% 0% 0% 1% 0% 1% 1% 1% 1% 1%

3% 2% 2%

Fatique or illness

4% 8% 4% 6% 5% 7%

Not respect right of way Change lane without due care N/A

12% 13%

Dangerous overtaking

20% 18%

Alcohol abuse

49%

Speed

41%

0%

5%

10%

15%

20%

Casualities

25%

30%

35%

40%

45%

50%

Fatalities

Dangerous overtaking is mainly an issue in Phnom Penh (19% of casualties compared to 11% in provinces). Speed is an issue mainly in provinces on national/provincial roads. Speed also concerns more students than other categories of casualties (speed is responsible for 47% of student casualties compared to 40% for farmers and workers). Alcohol abuse is of course more a problem during the night than during the day, although 12% of accidents occurring during the day are due to alcohol, 32% of accidents occurring during the night are due to alcohol. Alcohol abuse is more a problem among the 25 – 44 age category, as illustrated on the figure 38. It is a lower issue for students (alcohol is responsible for 15% of student casualties, compared to 20% for farmers and 22% for workers).

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 38: Percentage of casualties by cause of accident – differences between age categories – 2006

Weather conditions Rain and wet road are responsible for 2% of casualties. Vehicle defect Break failure, tire blow out and headlight failure are responsible for 3% of casualties, followed by steering wheel failure, load off failure and other are responsible for 1%. Road conditions Potholes, dirt/sand/gravel, animal on the road and dust are responsible for 11% of casualties. Type of collision -

Motorbike-motorbike collisions are responsible for 34% of the casualties, followed by motorbike-car collisions (16%) and motorbikes that fell alone (11%). It is interesting to note that pedestrians are mainly injured by motorbikes rather than by cars. Motorbike-pedestrian collisions represent 5% of casualties while car-pedestrian collisions represent only 1% of casualties.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 39: Percentage of casualties by type of vehicle involved – 2006

24% of accidents are head-on collision and right-angle, followed by rear end (15%). Notice: The data for the two figures (40 and 41) come from traffic police only. Data might therefore slightly differ from the previous figure (39) which is based on data coming from both health facilities and traffic police. Figure 40: Percentage of accidents by type of collision – 2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

71% of vehicles were going straight ahead at the time of the accidents. Figure 41: Percentage of vehicles involved in road traffic accident by type of vehicle manoeuvre – 2006

-

32% of four-wheelers involved in road traffic accidents are right-hand drives, although they present only 5% among 4 wheel vehicles officially registered.

Percentage of 4 wheel right-handdrive vehicles

Figure 42: Percentages of 4 wheel right hand drive vehicles among total 4 wheel vehicles registered and involved in accidents – 2006

-

32%

35% 30% 25% 20% 15% 10% 5%

5%

0% Among total regisited 4 wheel vehicles

Among total 4 wheel vehicles involved in accidents

On average, 2.8 people are injured per accident.

Cost of accident The average damage cost per vehicle involved in accident is US$ 160. Knowing that 13,977 vehicles were involved in accidents in 2006, the total estimation of damage cost is US$ 2,236,320.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Location of accident Country level -

More than 40% of casualties are injured in urban areas.

The provinces most affected by road traffic accidents, according to traffic police data only, are Phnom Penh (12% of accidents), Kampong Cham, Kandal and Battambang, as shown on the figure below. Figure 43: Number of road traffic accidents per province – 2006

The provinces most affected by road traffic fatalities, according to RTAVIS data, are Phnom Penh, Kampong Cham, Kandal, as shown on the figure below. Figure 44: Number of road traffic fatalities per province – 2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

In terms of population density, the highest fatality rates are observed in Krong Kep and Sihanouk Ville, which are the most popular leisure places for Cambodian people during holidays and weekends. Noticeably, there is a very high fatality rate in Sihanouk Ville, while the casualty rate is low, which is shown the highest risk of death in an accident, compared to other provinces.

Number of fatalities per 100,000 inhabitants M ea Ka Ba n C Ka m tt h m po a m e y po n ba n g n Ka g C g m C ha Ka po hhn m m ng an po S g ng p e T u Ka hom m p Ka Ka ot n oh d K al on Kr Kr g on a ti g e K O M dd o P a e p ar nd ili M ol n Ph ea Ki n r Si no ch i ha m e y P Pr nou e n ea k h h Vil Pr Vih le ey ea V r Ro P eng t a ur Si nak sat St e m K ue R iri ng e Sv T a p ay ren Ri g e Ta ng ke o

25 20 15 10

5

450 400 350 300 250 200 150 100 50 0

Ba n

te ay

0

500

Number of casualties per 100,000 inhabitants

Figure 45: Number of road traffic fatalities and casualties by province31 per 100,000 inhabitants – 2006

Number of fatalities per 100,000 inhabitants

Number of casualties per 100,000 inhabitants

Notice Figure 43 is based on traffic police data only. Figures 44 and 45 are based on RTAVIS data (combining traffic police and health facilities data). Phnom Penh The top three communes affected by road traffic casualties (measured as number of casualties per inhabitant) in Phnom Penh are Preak Lieb, Chrouy Changva, and Chakto Mukh. The two first are located along major national roads.

31

Sources: RTAVIS and First Revision of Population Projections for Cambodia 1998 - 2020, National Institute of Statistics, Ministry of Planning, June 2004.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 46: Top ten Phnom Penh communes affected by road traffic casualties – measured as number of casualties per inhabitant – 2006

Introduction of GPS From July 2006, Global Position System (GPS) devices have been introduced to the traffic police in Russei Keo District in Phnom Penh. The GPS coordinates allow us now to exactly locate accidents, using GIS data. GPS devices will be progressively introduced from June 2007 to other districts of Phnom Penh and provinces crossed by major national roads. On the medium term, this will enable RTAVIS to identify black spots of the Cambodian Road System. The following chart shows the locations of road traffic accidents in Russei Keo district from July to December 2006.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Figure 47: Black spot of road accidents in Phnom Penh – 2006

As figure above, national road number 5 is the most affected by road accident. At the specific location where black spots are concentrated, the road is particularly narrow, mix of traffic and busy. A local market is encroaching upon the road (see pictures).

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Kandal The top three communes affected by road traffic casualties (measured as number of casualties per inhabitant) are Bak Khaeng, Preak Anhchanh and Baek Chan. Figure 48: Top ten Kandal communes affected by road traffic casualties – measured as number of casualties per inhabitant – 2006

Kampong Cham The top three communes affected by road traffic casualties (measured as number of casualties per inhabitant) are Memong, Memot and Koang Kang. Those three communes are located along major national roads. Figure 49: Top ten Kampong Cham communes affected by road traffic casualties – measured as number of casualties per inhabitant – 2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Type of road More than 60% of casualties are injured in accidents occurring on national/provincial roads. Figure 50: Percentage of casualties by type of road – 2006

In comparison with the volume of traffic, national road 4 is the most deadly, followed by national road 2 and 7.

Number of fatalites per 100 million vehicles kilometers

Figure 51: Number of fatalities per 100 million vehicles kilometers by national road32 – 2006

40 35 30 25 20 15 10 5 0 NR 4

32

NR 2

NR 7

NR 6

NR1

NR 5

NR 3

NR 6A

Source for the number of vehicle kilometers: The Study on the Road Network Development in Cambodia, Interim Report, JICA, March 2006.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Road characteristics More than 70% of casualties are injured in accidents occurring on straight roads. Figure 52: Percentage of casualties by type of road design – 2006

74% of casualties are injured in accidents occurring on paved roads. Transfer to hospital Only 25% of casualties are transferred to the hospital or private clinic by ambulance. This is mainly and issue in provinces where only 19% of casualties are transferred to the hospital by ambulance. Figure 53: Percentage of casualties by type of transport to the hospital – 2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

-

33% of casualties arrive at the hospital less then 30 minutes after the accident while more than 30% of casualties take more than 2 hours to reach hospital. In the provinces, 37% of seriously injured casualties take more than 2 hours to reach the hospital. Figure 54: Duration to arrive at the hospital – 2006

Attendance of police Police is present on the accident site in more than 60% of the cases. This percentage is the same during the day and the night and between Phnom Penh and provinces.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Appendix Evolution of data during the year

Notice: the weighted average is not equal to the average of the monthly figures because the number of casualties differs from one month to another.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Notice: the weighted average is not equal to the average of the monthly figures because the number of casualties differs from one month to another.

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Number of casualties reported at health facilities

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Number of casualties reported at traffic police districts

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Data collection forms Two different data collection forms are being used: the hospital data collection form, using the casualty as point of entry, and the traffic police data collection form, using the accident as entry point. Doubles entries are checked using the name of the casualty, the date and time of accident as well as the location. Hospital data collection form

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Traffic police form

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Feedback form Please send back this form to the following address: ƒ By mail: Handicap International – Road Safety Program Manager – #18, Street 400 – Phnom Penh ƒ By fax: +855 (0)23/216 270 ¾

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Cambodia Road Traffic Accident and Victim Information System Annual Report 2006

Contacts Further analysis and additional information is available on request. Please do not hesitate to contact one of the following persons: ƒ

For additional analysis/customized reports: Mr. Jean-François Michel Coordinator of Operations Handicap International Belgium Mobile: 012 217 427 E mail: [email protected] Ms. SANN Socheata Road Safety Program Manager Handicap International Belgium Mobile: 012 563 172 E mail: [email protected]

ƒ

For information regarding the road safety situation in Cambodia: HE. UNG Chun Hour Director General of Transports & Director of Land Transport Department Permanent Member of National Road Safety Committee Chairman of the General Secretariat of the National Road Safety Committee Ministry of Public Works and Transport Mobile: 012 818 835 Email: [email protected] General PHOU Khon Director of Order Department General Commissariat of National Police Ministry of Interior Mobile: 012 611 456

ƒ

For information regarding emergency assistance in Cambodia: Dr. PRAK PISETH Raingsey Director Preventive Medicine Department Mobile: 012 862 022 Email: [email protected]

ƒ

For information regarding the technical aspects of the database: Mr. SEM Panhavuth RTAVIS Manager Handicap International Belgium Mobile: 012 545 334 E mail: [email protected] Ms. OU Amra RTAVIS Officer Handicap International Belgium Mobile: 016 338 178 E mail: [email protected]

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Editor RTAVIS Handicap International Belgium # 18, Street 400, Phnom Penh Kingdom of Cambodia Phone: +855 – 23 – 217 298 Email: [email protected] Website: www.handicapinternational.be

With the support of:

European Union

Belgian Cooperation

World Health Organization