CAIRO, Egypt – In the bustling neighbourhood of Heliopolis in Africa’s most populated city, it’s nearly impossible to cross the streets without risking a 40-mile-per-hour collision. A man driving a motorcycle nestles his phone against his ear. A car whizzes by with a child sitting on the lap of the driver. The chaotic scene was the norm in the city I volunteered in for several months in 2025.

Sparse traffic lights, limited seatbelt use, and crosswalks that are not always observed, while a daily reality for the city’s residents, pose significant challenges for pedestrian safety in Cairo. Researchers point to the city’s rapidly-built roads and infrastructure programs, designed to improve traffic congestion, as further limiting pedestrian access. 

Over 75,000 traffic-related injuries occurred in the North African country, with more than 5,000 deaths each year, according to the latest statistics from Egypt’s national bureau. Pedestrians accounted for a third of these deaths, and researchers say the figures likely underestimate the true burden.

The greater Cairo region, like the rest of the country, is designed around vehicles. An estimated 97% of streets in Egypt lack traffic lights, and 78% of streets do not have footpaths for pedestrians, according to a 2019 World Bank estimate cited in an American University in Cairo (AUC) analysis.

“Already the [pedestrian] mortality rate has increased in Heliopolis,” said Mennah Fathy, an urban researcher with the Institute for Traffic and Development Policy (ITDP) Cairo office. 

Children under 15 years and pedestrians are the most likely to be fatally injured.

Cairo is just one of several African megacities. Nigeria’s Lagos, the Democratic Republic of Congo’s Kinshasa, and Angola’s Luanda are all expected to continue surging in population. 

Urban health experts link limited pedestrian infrastructure to higher pollution exposure, reduced physical activity, and traffic congestion. The city also ranks in the top 200 most air polluted cities, according to the recent IQAir report – and the country  as a whole is ranked ninth. Yet recent initiatives from the city and from other organizations have both raised awareness – and begun to tackle the dangers of Cairo’s streets. 

New throughways and cut trees deter walking 

In Cairo’s eastern neighborhoods of Misr Gedida, Heliopolis, and Medinat Misr, coffee shops, grocery stores, and markets line the streets. But despite their proximity, pedestrians often struggle to reach them across wide, fast-moving throughways. 

Other Cairenes noted that they rarely use the broken and blocked sidewalks.

“If you need to walk, we walk on the streets,” said Fatma Khalid, a cultural guide at a Cairo language school. She joked that locals can “immediately tell” if someone is not from Egypt if they try to walk on the sidewalks.

But broken sidewalks are only part of the problem, said ITDP’s Fathy. Expanded roadways have made walking both riskier and less appealing in Cairo’s heat as tree cover and greenery essential to keeping pedestrians cool make way for asphalt. 

“Cairo didn’t used to be this way,” said Shahyra, a 30-year-old real estate consultant, at a Cairo coffee shop. “We used to walk, be outside. Now we sit in the AC and Uber for ten minutes to the grocery store.”

The combined pressures of rapid urban growth, rising temperatures, and worsening air quality have also changed how many residents move around the city. Cairenes who can afford it increasingly opt for shorter car rides instead of walking.

With fewer opportunities to walk, residents lose an important source of daily physical activity which researchers say contributes to rising obesity and type 2 diabetes in Egypt and other LMICs.  

Heliopolis’s original urban design, which dates back to the early 20th-century when the Belgian industrialist Edourd Empain commissioned the city, had walking-friendly squares and intentional public transit systems. Now, “that’s been destroyed in favor of highways,” said Fathy. 

In the newer developments built on reclaimed desert, like the 6th of October City, the New Administrative Capital, and the 5th Settlement, the entire urban design is car-oriented, according to the ITDP, which has researched and proposed ways to improve active mobility in the new settlements. 

In both older and newer areas, “these changes deter walking and active mobility” and threaten road safety, said Fathy.

Traffic-related deaths are not “accidents”

Some 30 years ago, Hany Kamel’s training as a pilot was cut short in a car crash on the highway from Alexandria to Cairo. Injuries to his arms and head forced him to leave his specialized training school and recuperate.

He made a career as a professional driver instead, racking up accreditations from driver safety programs. 

The scars on his arms are a physical reminder of the cost of unsafe roads. “People here don’t follow many of the rules,” he said of the Cairo drivers swerving in and out of traffic.

“Driving in Egypt is extremely dangerous,” the US State Department warns its citizens in its travel guidance to the country. “Egypt has one of the highest rates of road deaths in the world due to unmarked surfaces, pedestrians and animals crossing streets, and speed bumps along major highways.”

Urban experts don’t place the blame solely on road users, but on the design of highways and roads. 

“Safe roads are a right, not a luxury,” Dr Etienne Krug, WHO director of the department of social determinants of health, argued in a recent commentary. “While drivers are bound to make errors, transportation planners work on the basis of reducing risks.”

The approach focuses on improving road design, vehicle safety, speed management, and post-crash care.

Proven measures to keep pedestrians safe include crosswalks, appropriate driving speeds, and improved visibility for pedestrians. The approach, focusing on improved road design, vehicle safety, speed management, and post-crash care, has proven challenging to implement in many countries. 

International calls for safer roads

More than one pedestrian or cyclist is killed every two minutes on the world’s roads. Nearly 1.2 million people are killed and as many as 50 million are injured each year, making road traffic injuries a leading cause of death and disability worldwide, according to the World Health Organization (WHO). 

For young people aged five to 29 years, cars, buses, trucks, and motorcycles are the number one cause of death. Pedestrians and cyclists face particularly high risks in low- and middle-income countries (LMICs). 

“The risk is remarkably high in low and middle-income countries, where millions face huge risks each day as they walk to work or school on streets with no sidewalks, and no safe places to cross busy roads. Just a tiny fraction of the world’s roads – far less than 1% – have safe cycle lanes,” said the WHO’s Krug.

The overwhelming majority of traffic fatalities – 92% – occur in LMICs, even though these countries have 60% of the world’s vehicles.

That’s not to say the problem is solely concentrated in lower-and-middle income countries. The pedestrian fatality rate in the US is two to five times higher compared to other developed peer nations. That rate has jumped 80% since 2009, per a 2025 AAA Foundation for Traffic Safety report. Those in urban, lower-income areas are at highest risk. The report underscored that pedestrians in US urban centers are often forced to walk along poorly lit roads without sidewalks to reach the nearest crosswalk. 

In light of this, the United Nations announced in May 2025 its 8th annual Global Road Safety week with the goal of spurring local and national action for safer roads. 

“These actions will help promote and facilitate a shift to walking and cycling, which are more healthy, green, sustainable and economically advantageous modes of transport,” said the UN in a statement.  

The safety awareness week comes as traffic fatalities have grown in the past decade across multiple regions.

Safer streets also mean cleaner air, more active population

Fathy said city authorities have often overlooked the health and safety benefits of walkable urban design. In discussions with city authorities about active transport, the ITDP found that walkability was not a main priority.

“They don’t always see the health co-benefits,” said Fathy, referring to reductions in air pollution and increases in active mobility. Even when the health benefits are recognized, walking is often not convenient for daily commutes to school, the metro, or work, Fathy added.

WHO’s Krug calls safe streets a “treasure trove” of add-on benefits: walking or cycling reduces the risk of chronic diseases, curbs air pollution, reduces traffic congestion, and limits climate pollutants. 

Egypt, like many others in the Middle East and North Africa, is facing a growing chronic disease crisis the benefits of safe streets could play a role in alleviating. Two-thirds of the population is either overweight or obese; nearly a quarter of all adults live with diabetes. 

New metro, bus systems offers promise of expanded, but patchwork public transportation

Cairo’s traffic intensity has improved dramatically in the past decade as a new metro line and bus rapid transit (BRT) system provide alternatives for its residents. 

The new metro line runs east to west through the city and is packed in rush hour, offering air-conditioning and two “ladies only” cars. Similarly, the Western BRT bus corridor is part of Egypt’s vision to improve the public transport sector. 

The result, however, has been what some experts describe as a “patchwork” network of improved public transport.

A metro stop in a neighbourhood may not be accessible or have a nearby bus stop. Other Cairenes complain of having to take Ubers just to reach a metro stop.

“I either take an Uber or I walk to the microbus stop and then transfer from the microbus to the autobus line,” said Manal, an HR trainer in Cairo’s Dokki quarter. 

Fathy’s commute is also a trek – driving her car to a metro stop and then Ubering to her workplace. “These new settlements, and moving the administrative capital to the eastern side of Cairo, means that people have to commute across Cairo. We don’t have a culture of moving to be close to work.” 

Gathering municipal and cultural support

If you asked a school-age child in the 6th October settlement in Cairo to envision roads in their neighbourhoods, they would draw wide, multi-lane highways with no trees. 

“The younger generations living in the new cities are increasingly removed from the idea of walking, cycling, or public transport,” said Fathy. “They’re not aware of the advantages.” 

These insights emerged from focus groups Fathy and colleagues conducted in three schools in the car-centric peripheries of Cairo. After these workshops, the researchers later proposed safer street designs around school zones to improve air quality and promote walking and cycling. 

And in the historic quarter of Heliopolis, initially designed to be transport and walking-friendly, the loss of tree cover and the bisecting throughways present a still larger challenge. 

Fathy notes that “transformation” of an area like Heliopolis requires a return to its past culture of walkability and green streets, through initiatives like car-free pedestrian zones.

Even though international groups like ITDP have struggled to gain permission and government cooperation for these initiatives, Fathy hopes that with a return to a walkability mindset, Cairo’s rapid growth can include space for smart, green urban design. 

Halfway through this “decade of road safety,” Cairo’s road safety progress mirrors that of other megacities, where population growth has so far outpaced infrastructure and public transport projects.

While the primary aim of these investments has been to reduce traffic time and congestion, these improvements fall in line with the United Nations General Assembly’s 2020 goal of preventing at least 50% of road traffic deaths and injuries by 2030. 

“We’ve seen a lot of improvement in the past five-to-ten years,” she said. The expanded metro system, and public bus lines are all “significant improvements,” especially efforts to make public transport safer for women, and reducing the number of private cars on the roads.

But whether Cairo’s future streets resemble the wide highways drawn by schoolchildren — or greener boulevards built for walking and cycling — may depend on how quickly the city reimagines its roads.

Image Credits: S. Samantaroy/HPW, WHO, IQAir, S. Samantaroy.