Meeting the challenge of railway injury in a South African city

Background Efficient and safe transport infrastructure is vital for economic growth in developing countries. The city of Cape Town, South Africa, has an extensive rail network with high levels of injury and violence. We investigated the reporting and frequency of railway injuries and examined their reduction through a range of interventions. Methods We analysed railway injury and death reporting by Cape Town's rail utility, state mortuaries, and a regional trauma survey. The data were obtained over 2.5 years, and the use of more than one data source was necessary to increase the size of the data pool and to determine underreporting. Findings There were 379 railway-related deaths and 505 serious injuries during the study period. Most deaths (190) were train-pedestrian collisions, and the fatality rate on the metropolitan lines was about 60 per 100 million passenger journeys. There was substantial under-reporting by the rail utility of both fatal (20% under-reported) and non-fatal injuries (at least 24%). Many injuries occurred during peak commuting times and alcohol played an important part, especially in pedestrian fatalities. Interpretation Our results demonstrate the importance of a comprehensive, sustainable railway injury surveillance system to promote safety engineering and law enforcement in a metropolitan rail system.