Spike in road deaths stirs alarm in India

NEW DELHI -- With up to six lanes of high-speed asphalt, India's new superhighway is a source of national pride and a symbol of the country's economic boom, linking New Delhi, Calcutta, and Mumbai.

But the Quadrilateral Highway now puts speedy late-model BMWs on the same roadway used by barefoot women balancing jugs of water on their heads, causing a surge in road deaths and injuries across the nation.

India is among many developing nations looking at the mayhem on their highways, and hoping to find ways to save hundreds of thousands of lives each year. New and sobering statistics show that road accidents now are the number two killer of young people age 5 to 29 worldwide. And by 2020, road accidents could constitute the world's third-largest health problem of all ages in terms of disabilities, death, and lost wages.

In this country of 1.1 billion people, an estimated 270 people die each day from road accidents, and specialists predict that will increase by roughly 5 percent a year.

''When you have economic development, a human disaster often follows on the roads," Etienne Krug, the World Health Organization's director of injuries and violence prevention department, said in an interview in South Africa recently. ''There's a big drama going on of all these lives lost. People believed if they were going to be a more developed country, they needed more roads and cars, and the price to pay will be more fatalities. But we can show them this doesn't have to be the case."

Cutting-edge research on road dangers from around the world will be debated next week at an international conference on safety in Durban, South Africa. The event will bring together more than 1,000 scientists, surgeons, and public health specialists.

The new studies draw inspiration from the successes in the 1960s and early 1970s in well-off nations such as the United States, where public campaigns led by Ralph Nader and scientific data helped achieve large reductions in road casualties. But the problems faced now by poorer countries, which account for nearly 90 percent of the world's 1.2 million road deaths annually, are different from those tackled in the West.

For example, enforcing seat belt laws in India would have little effect in a country where less than 5 percent of road travelers are riding in cars -- most are on foot, motorbikes, or carts. Of far greater importance in India, specialists say, will be safer road designs and stiff enforcement of helmet and drunken driving laws.

The Quadrilateral Highway, a 15-year project begun in 1998, passes through Ahmedabad, a city of about 4 million people.

The consequences of the roadway peril were apparent in the city's Civil Hospital one recent day. One man fell off his motorbike on a rain-slicked street, hitting his head on the pavement and losing consciousness. A bicyclist fractured his skull after a man driving a scooter rammed him to the ground. And a 4-year-old girl was riding in a van that collided with a truck, killing her 8-year-old brother and jarring her head so violently that she could no longer see.

Ahmedabad's roads are full of herds of animals, motorcycles, scooters, rickshaws, bicycle-pulled carts, and pedestrians.

Three-lane roads expand into seven or even 10 lanes. Bicyclists fill any gap. At train crossings, when the safety gates are lowered, hundreds of motorbikes and scooters jockey for position along the front, gunning their engines for the moment the gates lift. At that moment, a few shoot across, most inch, and passersby cover their faces with scarves against exhaust clouds.

Late last year, Gujarat state, of which Ahmedabad is the capital, became the fourth of India's 31 states to enact a federal helmet law for motorcyclists and scooters. The law, which exempts women and children passengers after an outcry from groups about the cost of helmets, has been slowly catching on. A recent informal count by a reporter of 300 motorcycle and scooter operators and passengers -- excluding women and children -- found 172 wearing helmets, or 57 percent.

Dr. Manjul Joshipura, director of Academy of Traumatology in Ahmedabad, attempted to cut down on traffic fatalities with another approach -- creating an emergency response team to try to get those injured to hospitals earlier. The city's eight hospitals agreed to take in road accident victims, and Joshipura set up an emergency call center.

The new system has started slowly. It receives only about one call a day. ''We could be 10 times busier," Joshipura said. ''Public awareness is our biggest problem -- they don't know yet to call us."

Other developing countries, however, have recorded progress on prevention efforts. In Thailand, a national statistical evaluation of acute trauma care at hospitals found that traffic injuries were the biggest problem; the results led to new campaigns against drinking and driving. Ghana recently installed speed bumps on crash-prone sections on highways. And Colombia reduced traffic fatalities in Bogotá by half from 1995 to 2002 by increasing patrols for drunk drivers; promoting seat belt use and observation of pedestrian crossings; and constructing pedestrian bridges and a mass transportation system, the TransMilenio.

In New Delhi, Dinesh Mohan, a white-bearded, US-trained professor and specialist on road safety, said that villagers frustrated by the slow pace of government action often act on their own to improve safety.

''Each time a child is killed, people put up speed bumps," said Mohan, 60, coordinator of the Indian Institute of Technology's transportation research and injury prevention program. ''And that has probably saved thousands of lives."

He said India's road safety problems are mirrored in such countries as Iran, El Salvador, and Malaysia, which share some of the highest rates of road fatalities in the world. The problem, he said, is that many countries fail to plan adequately to ensure safety.

''We don't have the option of two parallel roads like the United States has," he said. ''In the US, you have the expressway and the slow road. Our present highways are violating all safety norms because cars, buses, and trucks are speeding on them with no concern for how local people are also using those roads."

Even when Indian officials improve public transportation, it often increases the risk on the roads.

Outside St. Stephen's Hospital in central New Delhi, Dr. Mathew Varghese, the hospital director, took a visitor to a busy road just outside the institution. He pointed to an elevated Metro system. In building the Metro, he said, the city took down a traffic light, which had allowed pedestrians to cross safely to the hospital.

Now, because of concrete barriers, pedestrians must walk an extra half-mile to get to the hospital, or gamble and cross the busy street.

''I lost one of my nurses here," Varghese said, barely controlling his anger. ''She was hit by a vehicle and killed. I've had mothers hit on two-wheelers here. I've had stillborns delivered at my hospital because the mother was hit. The city is building a Metro system, saying how wonderful it is, but they are not looking at what is happening right underneath it. And they think we are progressing."

John Donnelly can be reached at donnelly@globe.com