From camels to cars, a world that hurts

By John Donnelly, Globe Staff  |  April 10, 2006

DURBAN, South Africa -- Dangers lurk everywhere. Camels buck boys in the Middle East. Twelve-year-old hockey players in Edmonton smash slightly smaller 11-year-olds into the boards. Cape Town toddlers trip over kerosene cookers, setting their pants on fire. Drivers in Lebanon stubbornly refuse to buckle up despite increasing carnage on the roads.

At the 8th Conference on Injury Prevention & Safety Promotion here last week, roughly 1,000 health experts and policymakers honed their plans for addressing road safety, suicide, domestic violence, and terrorism in US schools, among dozens of topics.

There were good reasons for such a spectrum: Injury prevention has long been ignored by most governments around the globe. But over the last few years, health experts have begun lumping together all types of injuries, from snowboarders' crashes to elder suicides, hoping policymakers will look anew at a problem that collectively kills more than 5 million people annually around the world. (AIDS, by contrast, is estimated to kill about 3 million per year.)

''What unites these different types of injuries is that they are all neglected," said Etienne Krug, the World Health Organization's director of WHO's department of injuries and violence prevention. ''They all need more attention. People who deal with all these traumas, from road traffic injuries to child abuse to firearms, burns, war injuries -- all need to bring these issues to the attention of governments."

Taken together, injury statistics are sobering. In the United States, for example, more than 43,000 people died last year from traffic accidents, and injuries are the leading cause of death for those ages 1 to 44. Each year in the United States, 30 million people experience some kind of injury that requires hospital assistance. The medical cost alone is estimated at $117 billion annually.

The strategy of drawing more attention to injuries in general has started to work. Several governments are studying injury trends. Vietnam, after collecting the data, recently completed a 10-year plan to reduce the number of all types of injuries. Mozambique is about to do the same after conducting one of the developing world's first nationwide surveys of causes of death. Using morgue data, a decade-long review of 11,717 non-natural deaths found that slightly more than 50 percent were caused by traffic accidents.

''We always knew it was a problem, but we didn't have the figures," said Dr. Carla Silva Matos, head of Mozambique's noncommunicable diseases in the Ministry of Health. ''Our collection of information was designed only for communicable diseases like malaria, AIDS, and tuberculosis. Now we need to act on the information. Our problem will be lack of human resources and lack of money."

WHO's Krug hopes that such studies will pinpoint not only the depth of the injury problem, especially in road accidents, but also specific issues unique to countries or regions.

One example, highlighted at the conference, was the dangers to children riding camels in the United Arab Emirates.

Machal Grivna, a professor at the United Arab Emirates University's faculty of medicine and health science, collected data on childhood injuries in the desert city of Al Ain from 2003 to 2005. The biggest problem was traffic accidents. But buried in the data he found that animals caused 3 percent of the injuries. By far, camels posed the greatest risk, especially to boys during camel races.

Grivna said 70 percent of the camel-related injuries were caused by falls. In 20 percent of the cases, camels kicked children, and in 10 percent they bit them. He made obvious suggestions: Children should wear helmets, especially during the desert races, and camels should wear mouth guards to prevent them from biting.

In Edmonton, concerned hockey officials asked for a study of injuries to 11-year-old players after a league reorganization that put the youngsters on the ice with 12-year-olds in competition. The researchers found that the number of injuries to 11-year-olds jumped to 79 in the first year from 22 the year before, when they were playing with younger children. The solution also was obvious, the researchers said: Go back to the old age divisions to protect the 11-year-olds.

Many issues defy such simple solutions. Burns to children in urban areas of sub-Saharan Africa are often linked to socioeconomic factors. Low-income families often use one room in which to sleep and eat, creating crowded spaces that toddlers find difficult to navigate.

And trying to get drivers in Lebanon to wear seat belts has been a frustrating experience for safety activists. In 1994, following the death of Tarek Assi, 19, in a car crash, several of his friends formed the Youth Association for Social Awareness, in part to promote seat belt usage. In 1993, 2 percent of Lebanese drivers wore seat belts; in 12 years of lobbying, they have increased that percentage to 20 percent.

But for a few tantalizing months in 2001, when the police enforced seat-belt laws, the compliance numbers zoomed to 80 percent in a matter of weeks -- close to the US figure of 82 percent. The campaign ended as quickly as it began following the Sept. 11 attacks in the United States. ''Attention to seat-belt use just drifted away," said Mona Khouri Akl, a Youth Association member.

In 2000, 567 people in Lebanon died in road accidents. In 2001, the number dipped to 365. Last year the number of deaths was 700.

Margie Peden, WHO's coordinator of its accidents prevention program, said the problem underscores the importance of governments making injury prevention a priority.

Akl and her colleagues ''worked so hard, but because the government doesn't get behind her, they'll never get more than 20 percent" seat-belt use, Peden said.

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