Accidents, injuries and violence
Travellers are more likely to be killed or injured in accidents or through violence than to be struck down by an exotic infectious disease. Traffic accidents are the most frequent cause of death among travellers. Traffic accidents and violence are significant risks in many countries, particularly developing countries, where skilled medical care may not be readily available. Accidents and injuries also occur in other settings, particularly in recreational waters in association with swimming, diving, sailing and other activities. Travellers can reduce the possibility of incurring these risks through awareness of the dangers and by taking the appropriate precautions.

Traffic accidents

Worldwide, an estimated 1.2 million people are killed each year in road crashes and as many as 50 million are injured. Projections indicate that these figures will increase by about 65% over the next 20 years unless there is new commitment to prevention.

In many developing countries traffic laws are limited or are inadequately enforced. Often the traffic mix is more complex than that in developed countries and involves two- and four-wheeled vehicles, animal-drawn vehicles and other conveyances, plus pedestrians, all sharing the same road space. The roads may be poorly constructed and maintained, road signs and lighting inadequate and driving habits poor. Travellers, both drivers and pedestrians, should be extremely attentive and careful on the roads.

There are a number of practical precautions that travellers can take to reduce the risk of being involved in, or becoming the victim of, a traffic accident.

Precautions

• ? Have full insurance cover for medical treatment of both illness and injuries sustained in accidents.
  
• ? Carry an international driving licence as well as your national driving licence.
  
• ? Obtain information on the regulations governing traffic and vehicle maintenance, and on the state of the roads, in the countries to be visited.
  
• ? Before renting a car check the state of the tyres, safety belts, spare wheels, lights, brakes, etc.
  
• ? Know the informal rules of the road; in some countries, for example, it is customary to sound the horn or flash the headlights before overtaking.
  
• ? Be particularly vigilant in a country where the traffic drives on the opposite side of the road to that used in your country of residence.
  
• ? Do not drive on unfamiliar and unlit roads.
  
• ? Do not use a moped, motorcycle or bicycle.
  
• ? Do not drive after drinking alcohol.
  
• ? Drive within the speed limit at all times.
  
• ? Always wear a safety belt where these are available.
  
• ? Beware of wandering animals.
  

Injuries and accidents in recreational waters

Recreational waters include coastal waters, freshwater lakes and rivers, swimming pools and spas. The hazards associated with recreational waters can be minimized by safe behaviour and simple precautions.

The most important health hazards in recreational waters are drowning and impact injuries, particularly head and spinal injuries. It is estimated that at least half a million deaths are caused by drowning every year. In addition, many more cases of “near-drowning” occur, often with life-long effects on health.

Drowning may occur when a person is caught in a tide or rip current, is trapped by rising tides, falls overboard from a boat, becomes caught in submerged obstacles, or falls asleep on an inflatable mattress and is carried out to sea. In swimming pools and spas, drowning or near-drowning and other injuries may occur close to outlets where suction is strong enough to catch body parts or hair so that the head is trapped under water. Drowning in swimming pools may be related to slip–trip–fall accidents leading to loss of consciousness on impact. If the water is not clear it may be difficult to see submerged swimmers or obstacles, increasing the chances of an accident in the water.

Children can drown in a very short time and in relatively small amounts of water.

The factor that contributes most frequently to children drowning is lack of adult supervision. Children in or near water should be constantly supervised by adults.

Drowning is also a hazard for those wading and fishing. Falling in cold water, particularly when wearing heavy clothing, may result in drowning as swimming ability is hampered.

Impact injuries are usually the result of diving accidents, particularly diving into shallow water and/or hitting underwater obstructions. Water may appear to be deeper than it is. Impact of the head on a hard surface may cause head and/or spinal injuries. Spinal injuries may result in various degrees of paraplegia or quadriplegia. Head injuries may cause concussion and loss of memory and/or motor skills.

Drowning and impact injuries in adults are frequently associated with alcohol consumption, which impairs judgement and the ability to react effectively. A detached retina, which can result in blindness or near-blindness, may be caused by jumping into water or jumping onto other people in the water.

Precautions

• ? Adopt safe behaviour in all recreational waters: use life jackets where appropriate, pay attention to tides and currents, and avoid outlets in spas and swimming pools.
  
• ? Ensure constant adult supervision of children in or near recreational waters, including small volumes of water.
  
• ? Avoid consumption of alcohol before any activity in or near water.
  
• ? Check the depth of the water carefully before diving, and avoid diving or jumping into murky water as submerged swimmers or objects may not be visible.
  
• ? Do not jump into water or jump onto others in the water.
  

Violence

Violence is a significant risk in many developing countries. Criminals often target
tourists and business travellers, particularly in countries where crime levels are
high. However, some sensible precautions may reduce this risk.

Precautions

• ? Be alert to muggings during the day as well as at night.
  
• ? Keep jewellery, cameras and other items of value out of sight and do not carry large sums of money on your person.
  
• ? Avoid isolated beaches and other remote areas.
  
• ? Avoid overcrowded trains, buses and minibus taxis.
  
• ? Use taxis from authorized ranks only.
  
• ? Avoid driving at night and never travel alone.
  
• ? Keep car doors locked and windows shut.
  
• ? Be particularly alert when waiting at traffic lights.
  
• ? Park in well-lit areas and do not pick up strangers.
  
• ? Employ the services of a local guide/interpreter or local driver when travelling to remote areas.
  
• ? Vehicle hijacking is a recognized risk in a number of countries. If stopped by armed robbers, make no attempt to resist and keep hands where the attackers can see them at all times