Globally, about 1.24 million people die every year on roads, and another 20 to 50 million sustain nonfatal injuries as a result of road traffic crashes. These injuries and deaths have immeasurable impact on the families affected, whose lives are often changed irrevocably by these tragedies, and on the communities in which these people lived and worked. Many millions more are left with disabilities or emotional scars that they carry for the rest of their lives. Pakistan ranks among the most hazardous countries in the world in terms of road safety. Road crashes occur frequently as trucks come into contact with other vehicles such as four-wheelers, two-wheelers, three-wheelers, carts, as well as pedestrians. Road traffic accidents are the fourth largest contributing factor to poor environmental health in Sindh. In addition to their role in causing fatalities, injuries, pain and suffering, road accidents generate significant economic costs. Statistics of road accidents in the last 10 years in Pakistan presents a horrible view, according to which around 15 people are killed in road accidents every day, in all over the country. The highest death toll is recorded in the province of Sindh. A recent study in Karachi indicates that fatalities from road traffic accidents are at least twice as high as official statistics. A recent road traffic injury surveillance project in Karachi and hospital data collected by the national road safety secretariat of Pakistan indicate that the incidence of serious road traffic accident injuries in Sindh may be 60 to 100 times higher than official statistics reported in 2011. Many road traffic injuries result in permanent disability with lifetime consequences on ability to work and perform normal daily activities. In Pakistan, about nine percent of road traffic injuries involve head injury, meaning that about four percent of injured people from road accidents in Pakistan may sustain permanent neurological or brain damage. Additionally are permanent disability from spine injuries, lost limbs, and other types of injuries. The fatality, disability and injury rates indicate that there were 1,800-2,200 deaths, 5,400-6,600 cases of permanent disabilities, 59-105 thousand other serious injuries, and 423-474 thousand minor injuries in Sindh in 2009 alone. In Sindh, the 135-kilometre Jamshoro-Sehwan Sharif section of the Indus Highway has become epicenter of traffic accidents. The road is single and traffic load has increased manifold after the completion of the Aamri-Qazi Ahmed Bridge on the Indus River. The heavy-duty vehicles including trucks, trawlers and dumpers are recklessly driven without any check. There is no motorway police to regulate traffic, while government hospitals in Manjhand and Sann are not well-equipped to tackle victims of road accidents. As a result, a significant number of injured people has either lost their lives or become disabled due to non-availability of proper treatment in these hospitals. Moreover, these government hospitals often remain devoid of senior medical staff. There is a need to take short and long term measures to contain road accidents on this section of the Indus Highway including deployment of motorway police, installation of proper signage and educating drivers and commuters about the speed limit and use of seat belt etc. The road must be made dual carriage to save lives of thousands of people who commute every day. In this regard, both Sindh and federal government should come together to fulfil their responsibilities instead of putting blame on each other. A study conduced by the World Bank tells us that the cost of health effects of road traffic accidents in Sindh was estimated at Rs 25 to 60 billion per year in 2009, with a mid-point estimate of Rs 43 billion. This cost is equivalent to about 0.7 to 1.6 percent of Sindh’s GDP in 2009, with a mid-point estimate of 1.15 percent of GDP. Additionally are material damage costs such as vehicles, structures etc and other costs that are difficult to quantify due to data limitation. Road traffic injuries are the eighth leading cause of death globally, and the leading cause of death for young people aged 15 to 29. The cost of dealing with the consequences of road traffic crashes runs into billions of dollars. Current trends suggest that by 2030 road traffic accidents will become the fifth leading cause of death unless urgent action is taken. Economically disadvantaged communities are hardest hit by both direct medical costs and indirect costs such as lost wages that result from these injuries. At the national level, road traffic injuries result in considerable financial costs. Most importantly, road traffic injuries are preventable. In 2004, the World Health Organisation and World Bank jointly stressed the need for “systems approach” and multi-sectoral action for prevention of road traffic injuries. The systems approach to road safety involves identifying the interactions between the road users, the vehicle and the road environment. The writer is Executive Director, Centre for Environment & Development