10/01/2025
No seatbelts causing brain trauma crisis for South African children
January 8, 2025
The needless deaths of children – or traumatic injuries – caused by not wearing seatbelts is becoming a national crisis in South Africa, with thousands, each year, suffering brain damage because their parents don’t bother to buckle them up.
When a car travelling at just 60km/h crashes to a stop, a 10kg child in your arms becomes a 600kg projectile. There’s no way you will be able to stop them going through the windscreen. Anyway, your instinctive response in a crash is to throw out your arms and stop yourself.
Compared with adults, children’s heads are proportionally larger than their bodies and their necks are weaker. Unrestrained in a car crash, their heads become cannonballs, with disastrous effect. At only 50km/h, a collision without a seatbelt is the equivalent of falling from a three-storey building.
Daily Maverick reports that South Africa has the highest child brain trauma from accidents in the world because we’re not taking seatbelts seriously. Every year a single hospital in Cape Town – Red Cross – admits about 1 000 children with severe head injuries, 80% from car crashes. Nearly all of those were not wearing seatbelts.
Arrive Alive quotes a paramedic who said they very seldom have to unbuckle a dead person after a road crash. Safety belts save your life.
Shattered lives
At the Red Cross Children’s Hospital’s Institute of Child Health, the concern of two of the world’s top child neuroscientists – Professors Anthony Figaji and Ursula Rohlwink – about how casually we transport kids is tinged with incredulity.
Why do parents put their children at risk by leaving them unbelted in a car?
“These injuries are not just numbers on a chart,” said Figaji, “they represent lives shattered in an instant, and parents left grappling with guilt and anguish as doctors fight to save their child’s life.”
Rohlwink added: “Paramedics tell us they find the children lying many metres from the car, flung out because they weren’t wearing seatbelts.”
Trauma doesn’t end with the crash. Secondary injuries triggered by the initial impact continue to endanger the brain in the hours and days after the accident. Survivors often face severe disabilities – physical, cognitive and behavioural.
A crash’s effects on the brain itself can present in many ways, said Rohlwink. “The shearing of blood vessels can lead to clots that increase intracranial pressure. Fractures to the skull may expose the brain to infections like meningitis and the tearing of neuronal axons disrupts vital neural networks.
“These injuries can result in issues such as memory loss, difficulty with language, impaired motor function, and diminished executive abilities.”
Then there’re the long-term implications. Brain injury can prevent them from returning to school or later holding jobs, creating a lifetime of dependence on family and the State. The economic toll is staggering, with lost productivity and increased demand for disability grants further straining already stretched systems.
“The transformation is devastating for parents,” said Rohlwink. “They must reconcile their memories of a vibrant, healthy child with the reality of a life forever altered by injury.”
Trauma is an unrecognised pandemic, claiming more lives globally each year than HIV, tuberculosis (TB) and malaria combined. It kills far more than Covid-19 did.
This stark reality, documented by the World Health Organisation (WHO), should provoke outrage, said Figaji, yet it rarely hits the headlines.
Under strain
The Paediatric Neurosurgery Division at the Red Cross War Memorial Children’s Hospital is the leading tertiary paediatric neurosurgery service in sub-Saharan Africa.
In addition to brain trauma, they deal with a wide range of other child conditions, including spinal cord tumours, infections, hydrocephalus, congenital anomalies, epilepsy, movement disorders, vascular pathologies and other specialist conditions.
Accident nation
In South Africa, on average there’s a car crash every 10 minutes. There are many reasons – bad roads, a lack of discipline and a lack of concern for other people’s safety. People drive while drunk, without seatbelts or while talking on the phone. We are not a careful nation.
A chilling fact is that a South African child is 10 times more likely to die on our roads than a child in Switzerland. Deaths by road incidents in South Africa are nearly twice the international average.
You’re far more likely to die on peacetime roads than in battle.
The Automobile Association (AA) estimates that less than 60% of South Africans buckle up, and research by Volvo Car SA has found that 52% of people aged 18 to 24 say they “sometimes or never” wear a seatbelt.
The study also shed some light on why such a large portion of young people are refusing to wear seatbelts – 19% of young men considered it uncool and 8% of women cited peer pressure.
The study also found that passengers travelling in townships were even less likely to wear seatbelts, with 59% noting they sometimes or never buckled up.
International problem
The hidden costs of trauma are not confined to South Africa; it’s a worldwide problem. In an extensive report, Injuries and Violence, the WHO says injuries have been neglected on the global health agenda, despite being predictable and largely preventable. About 4.5m
people die from them each year – nearly twice the number who die from HIV/Aids, TB and malaria combined.
One in 61 of these deaths are from war and conflict but one in three are from road accidents. You’re far more likely to die on peacetime roads than in battle.
Nine out of every 10 road deaths occur in low- or middle-income countries. Even within countries, people from poorer economic backgrounds have higher rates of fatal and non-fatal injuries than people from wealthier backgrounds.
This holds true even in high-income countries. Risk factors common to all types of injuries include alcohol or substance use and inadequate adult supervision of children.
Disconnect
Nowhere is the impact of trauma more apparent than in children. South Africa is a country plagued by violence. Children are often caught in the crossfire or suffer abuse. Then there are the random tragedies – falling objects, playground accidents – all reflections of a society that has failed to prioritise its youngest members.
Unlike infectious diseases, trauma is often dismissed as a personal failing – poor driving, recklessness, or simply bad luck. But Figaji argues that trauma, like any other disease, is preventable. “We’ve mobilised society against infectious diseases with incredible success. Why can’t we do the same for trauma?”
Trauma disproportionately affects low- and middle-income countries, yet it’s not treated as a global health priority.
One answer, he says, is the lack of data. “While statistics on diseases like TB and HIV are meticulously recorded, data on trauma is fragmented. The closest available figures are death statistics, but these only represent the tip of the iceberg.”
What about the millions living with trauma-related disabilities? We have no way of quantifying their impact on society or resources. This lack of data makes it harder to argue for funding and policy changes. “Everything about our society should prioritise the safety of children,” said Figaji. “But in reality, we see a profound disconnect.”
Securing funding for trauma research is an uphill battle. Rohlwink recounted pitching the issue to an international funder that invests heavily in TB, HIV and malaria. Despite WHO data showing that trauma kills more people, the funder declined, saying they only support “diseases of poverty”.
“It’s a frustrating paradox: trauma disproportionately affects low- and middle-income countries, yet it’s not treated as a global health priority.”
Even within South Africa, evidence of child brain trauma faces scepticism. “When we present the statistics,” said Rohlwink, “local funders often say, ‘I can’t believe that’. It’s WHO data, but the lack of awareness about the crisis is staggering.”
Recognising the preventable nature of many of these injuries, Rohlwink and her colleagues have joined forces with the NGO Wheel Well to run a car seat donation campaign. The concept is simple: families with unused car seats can donate them to be redistributed to those in need. Supa Quick, a nationwide car maintenance company, has partnered with Wheel Well to serve as collection points.
Wheel Well founder Peggy Mars and her team meticulously inspect each donated car seat to ensure it meets safety standards. Usable seats are then distributed to families, along with education on their proper use. “A car seat isn’t effective if it’s not installed and used correctly,” says Rohlwink.
The campaign has already made a significant impact. Supa Quick recently donated 100 brand-new car seats, enabling the team to streamline training and handouts. But there’s still a long way to go. Many families struggle to find the time to drop off their car seats, and a substantial portion of donated seats fail safety inspections.
Rohlwink dreams of expanding the programme further, possibly through corporate sponsorships or a pick-up service for donated seats.
“There’s so much potential to make a difference,” said Figaji. “Our centre sees an extraordinary number of cases, giving us unmatched insights into brain trauma. This is an incredible opportunity to lead the way. It’s not just about saving lives; it’s about protecting futures.”
For parents, the message is straightforward: strap in your children, every single time. It’s a small act that could make the difference between life and death, between a full recovery after an accident and a life forever altered.
The needless deaths of children – or traumatic injuries – caused by not wearing seatbelts is becoming a national crisis in South Africa, with thousands, each year, suffering brain damage because their parents don’t bother to buckle them up. When a car travelling at just 60km/h crashes to a sto...
