Chapter 8 Travel by Air, Land & Sea

Road & Traffic Safety

Erin K. Sauber-Schatz, Erin M. Parker, David A. Sleet, Michael F. Ballesteros

Globally, an estimated 3,400 people, including more than 500 children, are killed each day in motor vehicle crashes involving cars, buses, motorcycles, bicycles, trucks, and pedestrians. Annually, about 1.3 million people are killed and an additional 20–50 million are injured in motor vehicle crashes. Although only 54% of the world’s vehicles are in developing countries, 90% of the world’s crash deaths occur in these countries. Nearly half of people who die on the world’s roads each year are pedestrians, cyclists, and motorcyclists, also called “vulnerable road users.”

According to US Department of State data, motor vehicle crashes are the leading cause of nonnatural death among US citizens who die in a foreign country (see Chapter 3, Injury & Trauma). From 2015 through 2016, 484 US citizens living or traveling internationally died as a result of a motor vehicle crash. Most crash deaths (63%) occurred in drivers and passengers of passenger vehicles (cars, trucks, or sport utility vehicles), followed by 18% in motorcycle drivers and passengers; 10% of traffic-related fatalities involved pedestrians.

Table 8-01 shows the top 29 countries visited by US citizens, based on the Survey of International Air Travelers from the Department of Commerce. For each country, the estimated “motor vehicle crash death rate per 100,000 population” is listed as an indicator for the risk of motor vehicle crash death, along with the number of US citizens who died in each country from a crash death from 2015 through 2016.

Motor vehicle crashes are common among foreign travelers for a number of reasons. In many developing countries, unsafe vehicles (vehicles sold in 80% of all countries worldwide fail to meet basic safety standards promoted by the United Nations World Forum for Harmonization of Vehicle Regulations) and an inadequate transportation environment contribute to the crash injury problem. Motor vehicles share the road with vulnerable road users. The mix of traffic including cars, buses, taxis, rickshaws, large trucks, and even animals increases the risk for crashes and injuries. Speed is another risk factor for vehicular crashes, injuries, and deaths. Just 47 countries, comprising 13% of the world’s population, have laws that meet best practices on urban speed (≤50 km [31 mi] per hour). When driving, a lack of familiarity with the roads, driving on the opposite side of the road, the influence of alcohol, poorly made or inadequately maintained vehicles, travel fatigue, poor road surfaces without shoulders, unprotected curves and cliffs, and poor visibility due to lack of adequate lighting can also contribute to a crash.

When a crash occurs, the use of protective equipment significantly decreases the risk of injury and death. Seat belts, car seats, booster seats for children, and helmets (bike and motorcycle), are all proven ways to reduce crash-related injury and death, but this equipment may be scarce. In addition, timely and effective emergency and hospital care may be unavailable in some locations or not acceptable by US standards. Trauma centers capable of providing optimal care for serious injuries are uncommon outside urban areas in many international destinations.

Strategies to reduce the risk of motor vehicle crash injury are shown in Table 8-02. The Department of State has useful safety information for international travelers, including road safety and security alerts, international driving permits, travel insurance ( and, and the Smart Traveler Enrollment Program ( The Association for International Road Travel ( also has useful safety information for international travelers, including road safety checklists and country-specific driving risks.

Table 8-01. Twenty-nine most visited destinations for US citizens traveling abroad, 2015–2016: WHO estimated crash death rate (per 100,000 population) and number of US citizen crash deaths per country

Mexico 1 12.3 159
Canada 2 6.0 10
United Kingdom 3 2.9 3
Dominican Republic 4 29.3 15
Italy 5 6.1 3
France 6 5.1 1
Germany 7 4.3 10
Jamaica 8 11.5 14
Spain 9 3.7 2
China 10 18.8 12
India 11 16.6 9
Costa Rica 12 13.9 12
Bahamas 13 13.8 0
Japan 14 4.7 2
Ireland 15 4.1 0
Netherlands 15 3.4 1
Philippines 17 10.5 10
Colombia 18 16.8 1
Aruba 18 NA 0
Switzerland 20 3.3 0
Israel 20 3.6 0
Peru 20 13.9 3
Hong Kong 20 NA 1
Thailand 24 36.2 21
Austria 24 5.4 0
Greece 24 9.1 5
South Korea 27 12.0 6
Taiwan 27 NA 8
Australia 29 5.4 5

Abbreviation: NA, data not available.
1 US Department of Commerce, National Travel & Tourism Office. Top destinations of US residents traveling abroad, 2015– 2016. December 2017. [cited 2018 Apr 2]. Available from: programs/ifs/index.html.
2 World Health Organization. WHO global status report on road safety 2015. Geneva: World Health Organization; 2015 [cited 2018 Apr 2]. Available from:
3 US Department of State. Deaths of US citizens abroad by nonnatural causes. Washington, DC: US Department of State; 2018 [cited 2018 Mar 1]. Available from:
4 A total of 171 crash deaths occurred in countries not included in the list of top visited countries, including New Zealand (13 deaths); Honduras (11 deaths); Cuba and Cambodia (8 deaths each); Vietnam, Haiti, and Saudi Arabia (7 deaths each); and South Africa (6 deaths). All other countries not listed reported ≤5 deaths in 2015–2016.

Table 8-02. Recommended strategies to reduce road traffic crashes and injuries while abroad

Seat belts and child safety seats Always use seat belts and child safety seats. Whenever possible, rent vehicles with seat belts and ride in taxis with seat belts, opting for the rear seat. Bring car seats or booster seats from home for children. Remember you can refuse a taxi if seat belts are not available or the vehicle is in disrepair.
Driving hazards When possible, avoid driving at night in developing countries (adequate lighting is limited in many countries). Always pay close attention to the correct side of the road when driving in countries that drive on the left. Speed is a major risk factor for crashes, injury, and death. Note speed limits, but you will also need to take into account the driving conditions (road quality, infrastructure, weather).
Country-specific driving hazards Check the US Department of State Driving and Road Safety Abroad to learn more about driving in another country, and check the Association for Safe International Road Travel website for driving hazards or risks by country.
Helmet use Always wear helmets when riding a motorcycle, motorbike, or bicycle. Consider bringing one from home to ensure it meets safety standards. A good- quality helmet can reduce the risk of death by 40% and severe injury by 70%. When possible, avoid driving or riding on motorcycles or motorbikes, including motorcycle and motorbike taxis. Traveling overseas is not the time to learn to drive a motorcycle/ motorbike.
Alcohol-impaired driving Alcohol increases the risk for all causes of injury. Do not drive after consuming alcohol or other drugs, and avoid riding with someone who has been drinking. Penalties for impaired driving (alcohol or drugs) can be severe overseas, and laws vary widely by country.
Cellular telephones Do not use a cellular telephone or text while driving. Distracted driving increases your risk of a crash. Many countries have enacted laws banning cellular telephone use while driving, and some countries have made using any kind of telephone, including hands- free, illegal while driving.
Taxis or hired drivers Ride only in marked taxis. Try to ride in taxis with seat belts. If no seat belt is available, wait for another taxi. Hire drivers familiar with the area and that have official status or credentials as taxis. Ask the US embassy or consulate for taxi company recommendations.
Bus travel Avoid riding in overcrowded, overweight, or top- heavy buses or minivans, and avoid riding in mountainous terrain, at night, and with an impaired (alcohol or drugs) or distracted driver.
Pedestrian hazards Be alert when crossing streets, especially in countries where motorists drive on the left side of the road. Walk with a companion or someone from the host country. When available use crosswalks and follow pedestrian signals. Pay full attention to your surroundings when crossing streets (don’t walk distracted).


  1. 10 Facts on Global Road Safety. World Health Organization. [cited 2018 Apr 3]. Available from:
  2. 2017 UN Global Road Safety Week. FIA Foundation. [cited 2018 Apr 2]. Available from:
  3. National Center for Injury Prevention and Control: Motor Vehicle Safety. CDC. [cited 2018 Apr 3]. Available from:
  4. Violence and Injury Prevention: Road Traffic Injuries. World Health Organization. [cited 2018 Apr 2]. Available from:
  5. Violence and Injury Prevention: Developing Global Targets for Road Safety Risk Factors and Service Delivery Mechanisms. World Health Organization. [cited 2018 Apr 3]. Available from:
  6. WHO Global Status Report on Road Safety 2015. Geneva: World Health Organization; 2015.