The Overlooked Killer.(World Affairs)(traffic accident)

Byline: Andrew Ehrenkranz and Adam B. Kushner; With Jason McLure in Addis Ababa

In Africa, traffic accidents are a leading cause of death, inspiring new calls for an end to the carnage.

Miscano Messelleh is a 52-year-old truckdriver, not a menace to society. But for many Ethiopians, the 4.5-metric-ton white Isuzu truck he propels down Ethiopian roads each night, and the thousands of others just like it, incite enough fear that locals have given them a nickname to symbolize their destructive power: they call the trucks "Al Qaedas." Messelleh himself killed someone while at the wheel recently, pointing to a spot just above the engine where paint is missing. About a month ago, driving to Addis Ababa down a notoriously chaotic stretch of the highway--full of trucks, pedestrians, donkey carts and livestock--he struck a man in his early 20s, who sailed through his windshield. The young man's parents have taken him to court.

These are everyday stories in Ethiopia, which has the highest per capita rate of car fatalities in the world, with 190 deaths per 10,000 vehicles. Across sub-Saharan Africa, AIDS is the only killer more devastating than traffic for people ages 15 to 44. For children, traffic is the No. 1 killer. An African is 100 times more likely than an American to die in a car. According to the World Health Organization, Africa has 4 percent of the world's cars--but accounts for more than 11 percent of the world's traffic casualties, and that is probably conservative. The WHO figures that road casualties in Africa are underreported by as much as twelvefold, and it predicts the death toll will rise an additional 80 percent by 2020, as the population grows and becomes more motorized.

Death by driving is an epidemic. Like any disease, its advance could be slowed with enough initiative, money and education. Yet while international funding for AIDS, malaria and TB totaled $4.7 billion over the past seven years, only $100 million was spent on promoting road safety. Belatedly, the world is taking notice. Last week the United Nations called road safety a "public health crisis, on the scale of AIDS, malaria and TB," and announced a global summit to be held in Russia next year.

One reason highway deaths are overlooked is that it's hard to pinpoint a cause. According to Messelleh, a big reason Ethiopian truckdrivers can be so lethal is their use of khat, an amphetamine-like plant they chew to stay alert behind the wheel for days on end, oblivious to the drowsiness that sets in when the drug wears off. "One of my friends went five days straight without sleeping," Messelleh says of a fellow truckdriver revved up on khat. "He drove into a ditch and died."

Another problem is the aging fleet of ...