The white-tiled floor of Togo’s largest trauma unit is awash with the blood of motorcycle riders.
The patients’ limbs are fractured, their scalps gashed and feet grotesquely twisted. Every day is the same – a relentless production line of injury which the hospital must triage.
Due to a shortage of beds, paramedics place the latest victims of motorcycle carnage on plastic sheets on the ground. Power cuts are frequent – but there is no panic; the doctors stitching up a motorbike-taxi passenger continue resourcefully by torchlight, like battlefield medics.
In this chaotic emergency ward, they know all too well that every motorcycle journey on the death-trap streets of the capital Lomé is a roll of the dice.
“On the worst days we have 40 admissions from motorcycle accidents,” says Dr Ariste Dantio, a medic at Sylvanus Olympio Hospital. “But we never have fewer than 20. There is never any pause.
“The situation has never been as bad as it is right now. When I first came here four years ago, I was extremely shocked, but you get used to it. We have amputations regularly. There are deaths too, usually when the thorax has been punctured.”
With motorcycle ownership in sub-Saharan Africa increasing from less than five million in 2010 to an estimated 27 million in 2022, the rate of death and injury from road crashes has similarly surged.
The World Health Organization states that road traffic injuries are the leading cause of death among 15 to 29-year-olds in the region – far outweighing diseases, hunger, conflict and terrorism.
Although the continent has the lowest rate of motorisation, it has the most dangerous roads in the world.
In Togo, 72 per cent of all road deaths are due to motorcycles, accounting for 681 lost lives in 2021. Latest data suggests there were 189 motorcycle deaths in December alone, a horrifying statistical high in the small West African nation which tops the continent’s motorcycle accident tables.
In Lomé, which has a population of 2 million, 27 per cent of riders have endured a life-changing injury, according to a recent report published by the road safety charities FIA Foundation and Amend.
While the easy availability of low-cost motorcycles from China has provided cheap transport and greater freedom for millions seeking better lives, the risks involved have contributed to a road accident epidemic.
According to analysis from the Global Burden of Disease, more than 85,000 African children are killed or injured on the roads every year, while the average rate of road death across the continent is 26.6 per 100,000 people, compared to less than 2.4 per in the UK.
Africa’s rapid urban expansion is set to further exacerbate the issue, says FIA Foundation chief executive Saul Billingsley, with many cities predicted to double in size between 2010 and 2030.
“As the continent rapidly motorises, African governments and international development agencies must act urgently now to make tackling road deaths a priority,” he says.
“It is often the poorest people that bear the horrifying brunt of these daily tragedies, the casualties of which outnumber war or terrorism but slip past unnoticed and unchallenged by leaders at every level.”
In the congested corridors of Sylvanus Olympio Hospital, nurses occasionally tread on barely conscious riders in shredded clothing, left lying on the floor with bandaged legs protruding.
‘My left foot was left hanging’
Those in beds and trolleys are the lucky ones. Surrounded by their families, who sit nervously waiting for the doctor’s prognosis, these patients all tell a similar story.
“I crashed into a car bumper when another motorcycle cut me up,” says 46-year-old Raouf Salifou. “My motorcycle fell on its side. The tibia bone in my leg was completely broken. I was in so much horrible pain and bleeding a lot.
“I came to hospital in my brother’s car because there wasn’t an ambulance that could collect me. I have been here for three days. They have bandaged my leg. I am waiting to know if I can have an operation.”
Akoussan Houvezoun, a supervisor for one of Lomé’s motorbike-taxi agencies, explains how he was rammed from the back by speeding riders – a common occurrence on the capital’s streets.
“My left foot was just left hanging, twisted in the wrong direction,” says the 57-year-old, against a backdrop of high-pitched screams from an adjoining ward.
“Two other people were injured in the same accident as well. One of them was carrying a passenger on his bike who had just been injured in another accident. She was injured in two accidents in the same morning!”
It’s not just the young who have made it onto the hospital’s trauma ward. One bed is occupied by a 70-year-old grandmother, who fractured her left leg after another rider slammed into the back of her motorbike-taxi.
“This was my first motorcycle accident in my whole life,” says Ayana Ayivi. “The roads have become too busy, too dangerous, and most riders take no notice of those around them.”
A survey conducted by Amend last year suggests only 5 per cent of motorcycle-taxi riders in Togo, who represent more than half of all users, provide helmets for their passengers. Only 10 per cent of those riders had a licence, and 96 per cent were self-taught.
Motorcycles are propelling Togo’s economic growth, with UN data revealing that 300,000 were imported in 2020 alone.
With no buses, and the train line passing through Lomé used only for freight, a motorbike is the only available option for those who aspire to earn more by travelling for work – a potentially deadly gamble they accept.
Auxiliary nurse Frederika Kpegoh admits she can ill afford to allow the life-changing wounds she is confronted by on a daily basis to alter her own travel habits.
The 53-year-old still travels by motorcycle, despite being seriously injured in three separate crashes in the last 15 years.
“The first time another motorcycle hit me head-on,” Frederika recalls. “There was blood coming from my nose and my mouth, and it felt like my eyes were bursting out. I was in so much pain. I had been thinking of borrowing a helmet, but I never bothered. No one did at that time.
“I had a broken cranium, so I was extremely lucky to survive.
“Afterwards I did at least buy a helmet, but I am still amazed that so few people are wearing them.”
Her injuries from the third crash, in which she suffered a broken clavicle, were the worst. She described an out-of-body experience, looking down on her prostrate figure, and then rousing to see a kneeling stranger praying for her at the roadside.
Yet Frederika continues to entrust her life in blind faith rather. Little consideration is given for keeping safe on the roads.
“Sometimes I think that God is looking after me because I have had three serious accidents,” she says, a statement reflected throughout Lomé in Bible-quoting posters pasted to road barriers.
“There is never enough money to buy a car, so I am obliged to use a motorcycle again. The doctors told me I shouldn’t, but I have no other option.”
Despite all the death and destruction, the expansion of motorcycle use in African countries like Togo has also brought clear benefits for local people.
Tom Bishop, a former UK Highways Agency consultant who now works as programme director for Amend, says more people, especially young men with low levels of education, are now employed and earning money thanks to the motorcycle.
“Previously they would have been farming in rural areas,” he says. “They can come into town and with relatively few hurdles they can earn a daily income. That’s a big benefit across the continent.
“We have heard plenty of stories of riders who have been able to send their daughters to school, whereas before it might have only been their sons. Another side of this is pregnant women being able to go to hospital rather than giving birth in a rural area.”
‘Lives on the line every day’
Nonetheless, this freedom of opportunity can all change with a single crash, Bishop adds. “They are putting their lives on the line every day because they have no social security.”
Mechanic Komi Sogbossi speaks from experience. His own future has been rewritten following a horrific crash which fractured his tibia – the bone cracked cleanly in two and perforated his skin – and left him facing exorbitant surgery costs, the equivalent of two years’ salary.
The 43-year-old father had no choice but to turn down the surgery and has since returned home from the hospital, just four days after his crash at a busy crossroads in Lomé.
“When I felt the shock of the impact after hitting a car at 40 kilometres an hour, I looked down at my foot and saw that it was completely deformed,” he recounts. “I was screaming with pain and crying.
“It’s bad, I know, and they have told me I need an operation, but I cannot pay for it, so I have been forced to accept herbal remedies in the hope I can heal at home.”
But Komi knows he’ll never be able to work properly again. Speaking in the dirt yard to the rear of his cinder block house, he struggles to hobble around on the single crutch his relatives purchased at the hospital. Komi knows he’ll never be able to walk properly again.
Some have been forced to turn to money lenders to fund their surgery – like Koffi Agbadji, who borrowed two and a half million CFA Francs, equivalent to $4,200, after crashing on his motorbike.
“They left me on a stretcher, so I was looking left and right to get enough money to pay for the surgery,” Koffi says, brandishing his X-ray at the same time.
“I borrowed so much. But now I remain in discomfort because the metal plates in my knee, which was totally smashed, are still there, and I cannot afford to pay more for them to be taken out.”
The incessantly busy intersection at Marché de Be on the edge of Lomé is a nerve-shredding experience, a terrifying cacophony of spluttering engines, angry beeping, pollution and law-breaking traffic.
Riders whizz past carrying towers of plastic chairs, and even a wooden door, on their heads. One man clutches three goats with one hand and steers with the other.
Some bikes have two or three children on board, usually with one in front of the rider and two at the back. The children’s faces look gleeful, as though on an amusement park thrill ride. Sometimes there are whole families of five, including both parents, on the same bike, or babies wedged precariously between two adults.
Rarely do passengers have handles to grip, and almost all do not wear helmets; few of those that do have the chin straps attached.
The acceleration when the lights go green is unruly, prompting roadside vendors to scramble to the kerbside. Although traffic police are stationed at the junction, they do nothing to prevent infractions.
Dr Anani Abalo, who leads the trauma unit, says that another alarming contributor to surging crashes is abuse of the prescription opioid tramadol by young riders.
They pop 200mg pills smuggled in from nearby Nigeria throughout the day, putting them in a dazed stupor, and clumsily incapable of braking and steering.
Over five days in Lomé, The Telegraph witnessed several accidents.
In one particularly distressing collision on Togo’s coastal highway, a woman was left crying out in pain after being knocked off her motorcycle, her jeans and white T-shirt covered with blood stains.
Scenes that would be considered exceptional in Europe are routine here.
In Italy, once considered a road traffic injury hotspot, the number of fatalities has almost halved since 2006, down from 5,669 to 2,395 in 2020. The UK, meanwhile, had 1,608 road deaths in 2021 – the sixth lowest death rate per million people across the continent.
In total, more than 1.3 million people die on the world’s roads every year. But Sir David Spiegelhalter, a leading British statistician, says this scale of mortality is absorbed more easily than more startling mass casualty events.
“People do definitely treat, psychologically, deaths from road accidents differently to deaths from terrorism.” he says. “It’s a well-known fact that people feel that road accidents are part of normal life to some extent, that they are not completely preventable even though you want to make the risk as low as possible.
“While they sometimes can be completely imposed, very often you are a participant in a road accident. Even if an action is forced upon you, it’s not done for malicious reasons.”
Nothing in Lomé illustrates the horrors behind Togo’s motorcycle boom better than the traffic hurtling down the highway outside La Promotion school, in the north of the city, where eight-year-old Romeo Kudadjey was hit walking home in March 2021.
The speeding motorcycle’s impact snapped Romeo’s tibia bone in two, leaving him with a permanent scar. He was unable to walk for six months.
Although a mother and a child were killed at the same spot last year, nothing has been done, with calls for a pedestrian bridge left unanswered.
When the school opened 30 years ago, the highway did not exist, but children have taken second place in the rush to expand transport infrastructure.
“It was the speed more than anything,” says Romeo’s mother Poori, 42. “The rider completely disrespected the rules. Nothing happened except the confiscation of his motorcycle.”
For the bereaved, there is nowhere to direct their fury.
Valentin Soncy, whose 44-year-old brother Augustin died from a motorcycle collision this month, lists the changes required to avert future unnecessary deaths.
“The government needs to ensure that motorcycle drivers are more civilised,” says Valentin. “If they drive too fast, without indicating, without stopping at red lights, then they must be stopped by the police.”
His impassioned words dissolve in the diesel smog of lorries leaving the container port behind us, carrying spare parts for Togo’s ever-growing motorcycle fleet.
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