Road traffic injuries in Nepal during COVID-19 lockdown

Background

The world experienced a series of unprecedented events since December 2019 after the detection of the novel coronavirus disease 2019 (COVID-19) (Asian Development Bank, 2020). The World Health Organisation (WHO) declared it a worldwide pandemic on 11 March 2020 (World Health Organization, 2020). During this period, social-distancing and lockdown were implemented throughout the world. As of 14 June 2020, the spread of COVID-19 has reached all countries and territories around the globe with 282,733 deaths (Worldometer, 2020)

The concept of restrained movement and physical distancing is believed to support the breaking of the chain of infection (World Health Organization, 2014) and slowing the spread of the virus by limiting contact with infected people and contaminated surfaces. In many countries, everyone but essential workers have been instructed to stay at home and work from home. Consequently, transportation through all means has reduced in an unprecedented manner. There are also reports of improvement in air quality (Wang et al., 2020) and reduced bed occupancy for road crash trauma in emergency departments (Zhu et al., 2020), which might have enabled health service systems to prepare and cope with a sudden rise in the number of COVID-19 hospitalisation. However, keeping people at home was not an easy job; governments had to impose notices with strict provisions – including fines and potential imprison if their decisions were violated.

Nepal has also joined the global practice for the prevention of the spread of COVID-19 and declared a ban on long-distance public travels from 22 March 2020 through the Prime Minister's statement to the nation. "All international flights coming to Nepal have been suspended effective from March 22 until 31. Effective from March 22, long-distance passenger vehicles will be suspended throughout Nepal for some time. Crowded places like cinema halls have been shut down for the time being." Prime Minister KP Sharma Oli, 20 March 2020 (Embassy of Nepal, 2020).

Within the window of the partial lockdown, an estimated 1.5 million residents left the capital Kathmandu for different parts of the country. Similarly, about half a million migrant workers from India also returned to their homes in the wake of the government’s decision to lock down the country (Pokhrel & Awale, 2020). This resulted in a sudden rise in the use of motorised vehicles during the 21st, 22nd, and 23rd of March. Meanwhile, the second case of COVID-19 was detected on 23 March. Only then did the Government decided to impose countrywide complete lockdown, from 24 March 2020 (Budhathoki, 2020). Hence, the country's efforts and resources converged towards the prevention of coronavirus transmission.

However, the government authorised a special pass-permit to use private vehicles and motorcycles in case of an emergency. Only vehicles required for essential services, i.e. ambulances, police, fire service, milk-tankers, water-tankers, and food deliveries, were allowed on the road without the pass. Due to these activities, a sudden decline in vehicular movement was observed in Nepal. Subsequently, a large reduction in the number of crashes and casualty was expected during this lockdown. Unfortunately, there were frequent media reports of road crashes occurrences, injuries, and deaths despite of nationwide lockdown.

This paper aims to describe the situation of road traffic crashes and the subsequent casualties during the period of COVID-19 lockdown using secondary sources of data. Similarly, it also aims to relate relevant lessons learned from prevention measures for coronavirus to harness prevention from road crashes in the post-lockdown period.

Methods

This study utilised two secondary data sources, i.e. media reports, and published or unpublished police records. Data collection was done in two ways: 1) a daily online search of media reports for vehicle crash incidents on Google, it was done using search terms in Nepali language in order to capture most of the reports across the country. The search terms were on “deaths or injuries” due to “road crash” “car crash” “motorcycle crash” “vehicle crash” “pedestrian hit by” “bicyclist hit by” “ambulance crash” “tractor crash” “truck crashes” or “crashes or collisions occurred during lockdown;” and 2) through contacting the police to obtain road crash records. From both these data sources, only limited number of variables were available. The location of crash, vehicles involved in crashes and their counterparts (animal, people, or objects etc.), resultant number of deaths & injuries, and the age and gender of victims were extracted from media reports into an Excel spreadsheet. The total number crashes, deaths and injuries occurring in districts and provinces were taken from police records. This paper includes the road crashes information for 82 days of the lockdown (24 March to 14 June 2020) from media reports and police records. The exact location and types of vehicles involved in fatal crashes were not available from the Police data, therefore the exact detail of the vehicles and the location of crashes were extracted from the media reporting. With the available information of location, Palika level – (local government unit) for fatal crashes, the cases were nationally mapped. Similarly, comparisons have been made between the data for the same period for both the sources, where needed.

Results

Altogether, there were 1,801 incidents of road crashes recorded by the traffic police in 82 days (24 March to 14 June 2020) of lockdown from all seven provinces of Nepal, which included 2,602 vehicles (96% motorized) that claimed 256 lives and led to a further 1,824 injuries (among which 32% were severely injured). However, the media mostly reported fatal crashes, as 200 deaths and 322 injuries were extracted through media reports for the same period. The number of deaths and injuries reported by local media and taken from police records are given in the Underlying data (Sedain & Pant, 2020).

In this lockdown, no vehicles were allowed to operate without a government-issued pass for essential services. Police records show that in 82 days of full lockdown, an average of 3.1 people died and 22.2 people were injured daily as a result of road crashes. The media reporting of fatal road crashes was 21.8% less than the police record, and very few injuries and vehicle crashes were reported (Table 1).

Kathmandu Valley comprises of three districts, namely Kathmandu, Bhaktapur, and Lalitpur. Nepal Police has not recorded the road traffic deaths separately for these three districts and the records of the crashes were presented for Kathmandu Valley as a whole. Therefore, by including the three districts of Kathmandu Valley, Table 2 displays road traffic deaths from the 12 districts. In the lockdown period, 12 districts comprised more than half (53.4%) of the total deaths in Nepal. The largest number of people were killed in Kathmandu Valley’s roads, followed by Kailali. Furthermore, Province 5 has the highest proportion (20.3%) of road traffic deaths, followed by Bagmati province (13.6%).

The information on fatal crashes by location extracted from media reports has been visualized (Figure 1) to show the crash-prone areas of Nepal. The visualization has shown that fatal crashes were concentrated more in the middle and lower region of country. Regarding provinces, the fatal crashes were higher in various locations of Bagmati Province and Province 5. The visualization additionally demonstrates that a large number of fatal crashes have occurred in local units in the junction of national highways of different local government units (or Palikas).

Figure 1. Visualization of road crashes deaths during COVID-19 lockdown reported in the media by Palika and national highway.

Source: Locations of road crashes and fatalities from media reports. Map reproduced with the permission of the Survey Department of Nepal (2020) (Nepal Government Survey Department, 2020).

Table 3 shows the type of vehicles that instigated crashes and their counterparts involved in it. Motorcycles were the most common vehicles involved in fatal crashes, as usual. Among the total vehicles involved in the crashes, more than one-fifth (22.1%) were motorcycles followed by jeeps, tractors, and trucks. Along with other vehicles, 20 ambulances were found to have instigated road crashes which either hit other vehicles, people animals or roadside objects. The majority of the vehicles involved in the crashes were, reportedly went out of driver's control (52.2%) due to speeding. Similarly, 37 pedestrians were hit by the vehicles in these 82 days.

Discussion

Since testing for COVID-19 cases commenced in Nepal, 5,760 positive cases (as of 14 June 2020) and 19 deaths have been identified (Worldometer, 2020). On the contrary, 256 deaths and 1,824 injuries from road crashes were recorded between 24 March to 14 June 2020.

Road traffic injuries are the leading cause of death for the people aged 5–29 years worldwide (World Health Organization, 2018). It is also the leading cause of death and disabilities among people aged between 15 and 49 years in Nepal (Pant et al., 2020). Regardless of the figures, which may vary from source to source, we aim to highlight road safety measures and their importance for the essential-service vehicles during adversity.

The total burden of road traffic injuries in Nepal is calculated to be approximately 123 million USD, and 90% of this amount comprised of indirect costs (Banstola et al., 2020). Two-wheeled motorized vehicles (motorcycles and scooters) were most frequently involved in crashes and are found to be putting the largest burden on the economy directly and indirectly (Sapkota et al., 2016). Tractors and jeeps were the second-most frequently involved vehicles in road crashes, which is shown by both the police and media records. An incident of injury tends to become a matter of interest to the media even in an adverse situation. Therefore, not all incidents of road crashes are covered by media. From our data, it is also apparent that the fatal cases are consistently reported in police records and media reports but cases of injuries are much less reported by the media.

From police records, an average of 154 incidents of road crashes takes place weekly, killing 22 people and causing 156 injuries during the period of lockdown. In the normal situation 7.6 people die in the road crashes (Nepal Police, 2019) and in this lockdown with the minimal transport mobility about 40% (3.1) people die per day in Nepal. Similarly, the ratio of deaths and injuries - a number that has surged from 1 death per 22.8 injuries during the non-lockdown period (Karkee & Lee, 2016), to 1 death per 7.1 injuries in lockdown. Perhaps the injured individuals were involved in more severe crashes during lockdown due to people's tendency to maintain higher speeds on the road. Drivers want to drive their vehicles at high speeds for different reasons (Gabany et al., 1997), and when the roads are empty, speeding might become obvious if there are no measures in place for speed control.

Conclusion

Roadways are the major means of transport in Nepal. In this lockdown, large number of people had to make journeys to their homes by roads; many of those were exposed to the risks of unsafe roads transportation which led to their deaths and injuries. Therefore, this lockdown has reinforced how important the management of safer mobility issue is in Nepal. Interestingly, some of the preventative measures that have been proven effective to decelerate the spread of coronavirus apply in the context of road safety as these measures can teach us something for the road safety epidemic as well (Job, 2020). Therefore, for better road safety, unnecessary travels must be avoided and a safe distance should be maintained between the vehicles on the move. Likewise, the use of helmets, seat-belts, and child restraints are similar to the use of PPE, whereas the regular testing of vehicles, like COVID testing, is a must. In cities, traffic congestion was eased during the lockdown which consequently resulted higher speed, increasing the chances and impact of crashes. Therefore, awareness of safety and taking into account road and weather conditions when deciding to take a journey would help to keep people safe on the roads. The Government of Nepal has mobilised unprecedented amount of resources in terms of human resources, budget and materials to address COVID-19 which has kept the rates of infection and deaths at minimum. If similar efforts and investments are done to address the problem of road traffic injuries, it would be possible to reverse the trend of ever-increasing burden of road injuries.

Data availability