OCCUPATIONAL INJURIES IN A CONSTRUCTION

COMPANY IN SAUDI ARABIA- A CASE STUDY

Syed Faizul H. Sayeedi

Master's Thesis

Public Health

School of Medicine

Faculty of Health Sciences

University of Eastern Finland

December 2018

2

ABSTRACT

UNIVERSITY OF EASTERN FINLAND, Faculty of Health Sciences

Public Health

SYED FAIZUL H. SAYEEDI: Occupational Injuries in a Construction Company in Saudi Arabia

– a case study

Master's thesis 38 pages + 3 appendices

Supervisors: Kimmo Räsänen, MD, PhD, Professor in Occupational Health; Jarmo Heikkinen,

MD, Clinical Lecturer in Occupational Health

December 2018

Key words: occupational safety, occupational injuries, Saudi Arabia, construction, migrant

workers

OCCUPATIONAL INJURIES IN A CONSTRUCTION COMPANY IN SAUDI ARABIA-

A CASE STUDY

Construction is defined as erecting infrastructures such as buildings, tunnels, roads, bridges and

airports. It is a major industry in the world contributing significantly in gross domestic product

(GDP) of a majority of countries. It plays a vital role in the economy of a country providing

infrastructure and facilitating the production of goods and services.

Saudi Arabia possesses a huge reservoir of oil and gas and utilizes this natural wealth to develop

its economy. This has resulted in a rapid increase in construction industry to build the necessary

infrastructure. Since there was a lack of manpower and human resources in the local population,

migrant workers were recruited from developing countries mostly from Asian and African region.

The construction boom has inevitably brought occupational hazards with it. Construction is by far

the most accident-prone industry in developed countries and more so in the developing nations.

Arabian Gulf Region has some unique variables in construction industry predisposing the foreign

workers to occupational accidents. Due to the restricted flow of information from Saudi Arabia, it

is extremely difficult to gather and analyse data from construction companies. This is a case study

of a construction company in Saudi Arabia which attempted to analyse distribution and types of

injuries during a five month period in 2010 by age and nationality of the injured workers, and to

determine the part of body injured according to ILO classification 2000.

Incident rate of injuries was highest in May, 1.58/100 workers. Altogether 14 nationalities were

presented among the injured workers; Pakistanis, Indians and Moroccans being the most common

nationalities. Of the 431 injuries 47% were dislocations, sprains and strain. One-third were

affected in upper extremities, while more than a quarter were affected in lower extremities. There

were no statistically significant differences in type of the injuries by age group, while superficial

injuries were most common among Filipinos.

Injuries were common in this study. As this is a case study of only one of the construction

companies in Saudi Arabia, more studies and research need to be done to comprehend, manage

and prevent occupational injuries.

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ACKNOWLEDGEMENT

My profound and heartfelt gratitude to Dr. Kimmo Räsänen for his continuous support and

encouragement to complete this work. He has been a blessing to me and his unwavering faith in

me helped me realize this dream. Thank you Dr. Jarmo Heikkinen for your valuable input and

encouraging words. I deeply appreciate Annika Männikkö for her untiring assistance in

accomplishing my academics including this thesis.

My parents were the strength behind my endeavour. My wife and my children were my

inspirations to keep my hope alive.

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TABLE OF CONTENTS

1. INTRODUCTION...............................................................................................................7

2. LITERATURE REVIEW

2.1 Background....................................................................................................................8

2.2 Arabian Gulf construction industry..............................................................................10

2.2.1 Political instability.....................................................................................................11

2.2.2 Contract Forms..........................................................................................................11

2.2.3 Price inflation............................................................................................................11

2.2.4 Availability and quality of resources........................................................................11

2.2.5 Cross-cultural, religious differences and language barriers......................................12

2.2.6 Sponsorship (Kafala) system.....................................................................................12

2.2.7 Development of Saudi Arabia's construction industry..............................................13

2.3 Occupational safety......................................................................................................14

2.3.1 Occupational safety in construction industry............................................................16

2.4 Injuries in Construction................................................................................................19

2.4.1 Domino Theory.........................................................................................................20

2.4.2 Human Error Theories...............................................................................................20

3. AIM OF THE STUDY ......................................................................................................21

4. MATERIAL AND METHODS

4.1 Study design.................................................................................................................22

4.2 Study sample and setting .............................................................................................22

4.3 Data collection .............................................................................................................22

4.4 Data analysis ................................................................................................................22

5. RESULTS ..........................................................................................................................24

6. DISCUSSION

6.1 Review of the major findings.......................................................................................31

6.2 Ethical considerations...................................................................................................33

6.3 Strengths and weaknesses of the study.........................................................................33

6.4 Suggestions for future research....................................................................................34

7. CONCLUSION..................................................................................................................34

8. REFERENCES...................................................................................................................35

9. APPENDICES....................................................................................................................39

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Figure 1: Work-related annual deaths –World in 2008......................................................17

Figure 2: Number of injuries recorded during Jan-May period in 2010 in the case-study

construction company...........................................................................................24

Table 1. Work-related injuries and diseases in the world 2013.........................................18

Table 2. International Statistical Classification of Disease and Related Health Problems

according to ILO, based on ICD-10 (Types of Injury).........................................23

Table 3. International Statistical Classification of Disease and Related Health Problems

according to ILO, based on ICD-10 (Part of the body injured)............................23

Table 4. Monthly incidence rate of occupational accidents in the case-study construction

company in a five month period in 2010................................................................25

Table 5. Age and nationality distribution of injured workers during the study.................26

Table 6. Types of injuries according to ILO classification (2000) among the injured

workers during the study......................................................................................27

Table 7. Part of the body injured according to ILO classification (2000) among the injured

workers during the study.......................................................................................28

Table 8. Types of injuries by age group among the injured workers during the study......29

Table 9. Type of injuries by nationality among the injured workers during the study......30

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ABBREVIATIONS

AED Arab Emirate Dirham

AGR Arabian Gulf Region

FIDIC Federation des Ingenieurs Conseils

GCC Gulf Cooperation Council

GDP Gross Domestic Product

ILO International Labor Organization

KSA Kingdom of Saudi Arabia

RCA Root Cause Analysis

UAE United Arab Emirates

UK United Kingdom

USA United States of America

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1. INTRODUCTION

Construction is defined as an industry whereby government or private-sector companies make

buildings for residential or commercial utilization. These include public works and infrastructures

such as bridges, airports, roads, dams or tunnels (Weeks 1998). It is a diverse sector consisting

mainly of craft, professional and industrial services related to building, demolition, renovation

and maintenance (Buckley et al. 2016).

Construction is one of the largest employers globally, employing 5-10% of the work force of

industrialized and industrializing countries (Bosch and Philips 2003, Martin 2009). Globally, it

accounts for 11-13% of the world GP which is expected to grow by 15% by 2020 (Schilling

2015).

Occupational health and safety is a crucial predicament which warrants constant scrutiny and

mediation. According to International Labor Organization (ILO) estimates, worldwide there are

2.3 million deadly work-related accidents and sicknesses every year, 160 million non-fatal

occupational diseases and 317 million non-fatal occupational injuries (ILO 2013).

In the Arabian Gulf Region (AGR) in 2003, there were 5.9 to 9.8 fatal occupational accidents per

100,000 while non-fatal accidents were between 5570-9250 per 100,000 workers. Fall from

height and hit-by falling objects were the most common accident types in the AGR (Hämäläinen

et al. 2008). In 2014, Saudi Arabia's General Organization for Social Insurance documented the

total number of occupational accidents to be 69,241 (GOSI 2015).

This particular case study is about a construction company in Saudi Arabia which was one of the

biggest construction companies in the Middle East employing more than 50,000 people coming

from more than 50 countries.

I was employed by this construction company as a physician to look after the well-being and

health of the other employees. There were two types of job location during the length of my stay

at the organization; either in the housing area or camp of the workers or the construction site.

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Both these locations had a clinic equipped with first aid materials, ambulances and licensed

nurses apart from other administrative staff. The clinics received occupational as well as non-

work related illnesses. Occupational injuries cases were predominantly encountered in clinics at

construction sites as compared to non-work related cases which were seen more at the camp

clinics. Occasionally, however camp clinics would receive work accident cases as electricians,

plumbers, carpenters, drivers and others were working round the clock for the maintenance of the

services.

Initially the clinic would receive the injured employee and after stabilizing the patient, we would

refer him to a hospital for further evaluation and necessary management. My direct involvement

with the workers as a practitioner of adult medicine and occupational physician enabled me to

study the injuries during their job. This included the amount and types of injuries and the body

parts affected by those injuries.

Adding more to the scarce information available on accidents in construction sector would be

helpful for the supervisors at construction sites and to the policy planners in more general level.

2. LITERATURE REVIEW

2.1 Background

Construction is defined as an industry whereby government or private-sector companies erect

buildings for accommodation or commercial purposes. These include public works and

infrastructures such as bridges, airports, roads, dams or tunnels (Weeks 1998).

It is an extremely diverse sector consisting mainly of craft, professional and industrial services

related to the building, demolition and renovation. Civil construction (e.g., roads, water treatment

plants, bridges etc.) industrial construction (e.g. oil and gas platforms, miming infrastructure) and

residential and commercial construction (e.g. residential and office buildings) comprise major

sectors in construction industry. Occupationally the job categories vary from professional,

managerial, technical to manual laborers (Buckley 2016).

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Construction contributes significantly to the economic activity all over the world. Globally,

construction accounts for 11-13% of global GDP (Schilling 2015). Approximately, seven percent

of global employment is in the construction industry. It is a significant component of the global

economy and one of the largest employers worldwide. It plays an enormous role in the gross

domestic product (GDP) of a country.

Construction sector’s role in economic development is enormous as it creates the facilities

including the infrastructure transforming these basic building blocks into a progressively

compound system. Most substantially, this industry produces all the amenities required for the

manufacturing of materials and provision of services, which are required by the producers and the

consumers as well (Crosthwaite 1999).

In most of the countries, construction has a basic contribution in developing their economies. It

produces the foundation on which other parts of the economy grow which reflects their level of

prosperity (Al Hadir and Panuwatwanich, 2011). However the poor countries witness less growth

of the GDP spending which attains a peak in developing countries and then declines in advanced

countries (Crosthwaite 1999).

China and nations in the oil-exporting AGR attracted migrant workers due to their low interest

rates, fast growing economy and crucial investments in infrastructure. The Gulf Cooperation

Council (GCC) member-states (Saudi Arabia, Bahrain, United Arab Emirates {UAE}, Kuwait,

Oman and Qatar) inhabit approximately 15 million foreign nationals among 40 million locals.

Majority of these foreigners are contractual workers having two-to-three year contracts.

Subsequently every year around five to seven million migrants arrive to replace those workers.

These migrant workers are mostly employed in construction entities, domestic help and other

services (Bosch and Philips 2003, Martin 2009).

The AGR governments in mid-1970s utilized their enormous revenues from crude oil to erect

infrastructure, to build housing, and to broaden the economy; this marked the advent of the

migrant workers era. Between 1975 and 1980 in the first phase, construction projects were

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initiated which were usually controlled by multinational firms which recruited migrants workers

from Asian and other Arab countries (Martin 2009).

In developed nations 5-10% of the manpower are involved in construction sectors and in most of

these countries, companies employ relatively more part-time workers as compared to full-time

employees. Predominantly male, unskilled laborers form a major segment of construction

workers; others are grouped in multiple vocational trades like carpenters, electricians, painters

etc. In some countries especially in the rich Arabian Gulf states, the construction work is left to

migrant workers (Weeks 1998).

Construction projects are progressive and complex. Many types of contractors execute their work

at the same time and change with the different phases of the project. And as the work develops,

there is a simultaneous change in atmospheric temperature and ventilation (Weeks 1998).

2.2. Arabian Gulf construction industry

Arabian Gulf countries have a common language, Arabic, and share homogenous social, political

and economical features. Government in this region vary between absolute monarchy (Saudi

Arabia, Bahrain, UAE), state (Qatar), sultanate (Oman) to monarchy + republic (Kuwait).

Additionally, their local law consists of a common civil law mostly adapted from British / French

laws, as well as Islamic jurisprudence as in the case of Saudi Arabia. The impact of the peculiar

challenges associated with this area's construction industry are described in the following

sections.

AGR has an inclement climate; long summer months where temperature usually hovers above 40

degrees Celsius. In spite of official rules and regulations for the workers during these periods, the

implementation is far and few in between (Al-Sabah et al. 2014). Apart from heat, humidity and

night work are ubiquitous risks. Safety-related errors are high for Muslims during their fasting in

Ramadan (Fass 2017).

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2.2.1. Political instability

During the last two decades i.e. from 1980 to 1988 Iran-Iraq war followed by the First Gulf war

in 1990-1991 caused turmoil and a sweeping change in this part of the world. This turmoil

existed even after 2003 when the Second Gulf war resulted in Kuwait's freedom. In 2011, a

struggle for the people's democratic rights, also known as Arab Spring, in Tunisia quickly spread

also to countries in the AGR. These events further affected the construction sector.

2.2.2 Contract Forms

Some countries require the use of a contract form derived from Federation des Ingenieurs

Conseils (FIDIC). However these Gulf countries can modify the contracts based on their own

local laws. Saudi Arabia and Kuwait, for example, implements this contract with foreign

companies by mandating them to form local corporations with local partners. In this context, it

might be challenging to have a smooth working relationship with a suitable partner (Al-Sabah et

al. 2014).

2.2.3 Price inflation

Due to a huge demand of construction materials, price increase is also one of the risks in

construction (Langdon 2010). In addition, in the AGR, architecture, engineering and construction

market is hugely dependent on construction materials imported from abroad, the cost of which

escalates accordingly with an increase in crude oil prices, along with the rising cost of sea and air

cargo charges.

2.2.4 Availability and quality of resources

The scarcity of skilled labor and extremely low productivity levels are a vital concern in the AGR

in spite of the generally low labor costs. Since there is a tight control of governments on the

companies, the workers are promptly sent back to their home countries which hinders the

availability of a permanent experienced labor market. Recently, thousands of workers who

overstayed their visas or were working illegally for other sponsors were evicted from Saudi

Arabia as the government announced an immigration amnesty program (Al-Sabah et al. 2014).

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Mostly the workers have limited skills in latest algorithm in construction techniques and usually

these employees at site have exposure to clerical work only (Fass 2017).

2.2.5 Cross-cultural, religious differences and language barriers

Since there are a variety of nationalities in the same company site, this creates a language /

cultural barrier to communication. Illiteracy is also a common factor in these migrant workers

(Fass 2017).

The countries in AGR share a common written and spoken Arabic language with varying dialects.

However, they have crucial differences in history, ethnicity, culture and tradition making it

difficult for multinational companies to transfer their know-how from one place in the region to

another. Additionally there are special cultural, religious occasions and celebrations for example

the holy month of fasting (Ramadan) and Haj (pilgrimage) season. These peculiarities may be

challenging and lead to disputes among local workers and the foreign workers of multinational

companies (Al-Sabah et al. 2014).

2.2.6 Sponsorship (Kafala) system

Workers in the Middle East region are working under their sponsor (also known as Kafeel) who

have absolute control over them through this Kafala system. The workers cannot work for other

companies or leave the country on their own free will. These sponsors can terminate their

contracts without any obligation (Buckley et al 2016). The worker has to surrender his passport to

his employer and cannot leave the country without his sponsor's permission. Their ordeal starts

from their home country as they are forced to pay huge sums of money to employment agents

either by selling land, livestock, jewels or taking large loans.

Once these migrant workers reach their destination, a different contract is enforced upon them

which leaves them with little choice as their travelling documents have already been confiscated

(Connell and Burgess 2012).Labor standards are difficult to enforce. Suicides are not uncommon

in camps along with reports of numerous mortalities due to occupational accidents at the

construction sites (Connell and Burgess 2012).

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2.2.7 Development of Saudi Arabia's construction industry - based on Dubai experiences

Saudi Arabia is regarded as one of the rapidly growing countries in the AGR. In spite of this

reality, the general level of construction safety has been comparatively very low in Saudi Arabia.

Most of the construction businesses in Saudi Arabia have exerted their efforts to manage the

increasing expenditures as well as decrease project holdups due to work mishaps (Alli 2008).

Construction activities in Saudi Arabia have expanded at a fast pace especially during the past

two decades, which has subsequently lured international enterprises and firms to join and engage

in a multitude of developmental projects. Almost 15% of the total manpower of Saudi Arabia was

employed in the construction industry (Alli 2008).

There is a dearth of publications on Saudi Arabia's construction industry due to a tight control on

information coming out. Dubai model will be discussed which more or less correlates with the

scenario in Saudi Arabia.

Following the discovery of oil, AGR underwent a rapid economic development beginning from a

conventional agriculture foundation and trading with a population possessing least vocational

skills. In order to fulfill the mandatory requirements for a fast-paced financial growth, the lack of

manpower and skills were compensated by hiring contractual workforce from foreign countries.

The government completely regulated the industrial relations system as employers were to decide

workers' salaries and work-stoppages were (still are) considered illegal. There is a complete ban

on labor unions and collective bargaining agreement is forbidden. These laborers are meted out

with a very peculiar manner under local labor laws as compared to local or foreign professional

employees (Connell and Burgess 2012).

It is quite relevant to comprehend the situation of the migrant workforce which helps in

understanding the accident causations and consequent prevention strategy. The huge buildings

have been built by foreign workers, many of whom are hired on low salary such as 550 AED. In

14

contrast a UAE citizen (UAE) having primary school certificate receives 3000 AED and for those

who possess post-secondary qualification the pay is 5000 AED (Connell and Burgess 2012).

These inadequately paid foreign laborers face economic as well as social issues performing

difficult, dirty, hazardous, humiliating and unstable jobs that Emiratis generally avoid. Dubai's

rapid economic development has also come at a cost, as within the construction industry only,

approximately 880 people died from work-related accidents in 2005 (Jacob 2008). A UK report

linked the susceptibility of foreign workers due to non-existent or insufficient personal protective

equipment, an absence of safety training and poor English language skills leading to increase in

incidents of sickness, injury or even mortality at work (Anderson and Rogaly 2005).

At one end of social and economic spectrum are the migrant workers from UK, Germany and

South-Africa with professional degrees and experience and at the other end are the huge numbers

of semi-skilled workforce involved in the hospitality, construction and domestic services

industry. These are mostly Asian, and come from the Philippines, Indonesia, Pakistan, India,

Pakistan, Bangladesh and Thailand (Fernandez 2010).

Most of these workers are hired through employment agents in their native country. Upon arrival,

these laborers are accommodated in labor camps at or around the construction site in a poor living

and working condition (Buckley 2013).

There has been no official regulation of safety in construction industry in Saudi Arabia. A recent

study on safety amid various construction schemes throughout Saudi Arabia illustrates this fact:

one-fourth of the contractors failed to provide any orientation about safety to the novice workers;

one-fourth did not supply personal protective equipment; one-fourth were unable to deliver

emergency medical treatment at construction sites and more than one-third lacked trained safety

personnel (Berger 2008).

2.3 Occupational safety

Occupational safety and health means the science of the anticipation, recognition, evaluation and

control of hazards arising in or from the workplace that could impair the health and well-being of

15

workers, considering the plausible effect on the surrounding communities and the general

environment (Alli 2008).

It is a multi disciplinary activity encompassing the development of safe work, protection and

promotion of worker's health, his physical and mental improvement and social well-being thus

allowing them to lead socially and productive lives (WHO 2001).

Due to the globalization of the world economies, occupational safety has slowly and constantly

transformed in response to economic, social, political and technological changes (Alli 2008).

A coherent policy formulation includes governments, employers and workers participation. It

stresses upon; national goals, workers’ rights, government cooperation, national safety culture,

resources, coordination among institutions, compliance from employers and regular action. This

policy should be reviewed regularly (Alli 2008).

Occupational safety differs between nations, economic sectors and social groups. In developing

countries, agriculture, fishing and mining cause increased injury and mortality. Globally, women,

children, foreign workers and the poverty-stricken are often the most vulnerable and the most

impacted (ILO) (Bosch and Philips 2003).

Guaranteeing health and safety is a vital challenge in every society especially when the

fundamental information available is insufficient to plan potent mediation e.g. incident rates,

particular divisions of occupation, types of accidents, causative agents and available mitigation

strategies (Fass 2017).

A study based on questionnaire highlighted the important factors affecting the safety performance

in Saudi Arabia which include management involvement: planning and preparing for emergency

or catastrophe, mechanical and electrical equipment, crane and lifting machines, scaffolding and

ladders, prevention from fire and ionizing radiation, excavation, shoring and trenching (Jannadi

2002).

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2.3.1 Occupational safety in construction industry

Construction companies often follow the adage; Jack be nimble! Jack be quick! This guideline is

always adapted by construction enterprises engaged in a fierce global competition. The

construction process is an inherently turbulent process, as the products cannot be stored or

transported to a place of demand. The geographical, irregular, and recurrent instability of this

industry combines prominently to the hazards associated with gathering human and physical

resources within the construction industry (Bosch and Philips 2003).

As per ILO, one worker encounters death from an occupational accident or sickness and 160

workers suffer an occupational accident every 15 seconds. Moreover, 313 million accidents occur

on the job annually; a significant human cost. In a majority of work-related accidents there is a

long absence from job. The economic cost of substandard occupational safety and health

practices is approximately 4% of global GDP annually (Bosch and Philips 2003).

It has been recorded that the construction has the highest rate of debilitating injuries and deaths

compared with other industries. For example, even in countries like Japan, around 40% of work-

related accidents are in the construction industry. Similarly, in Ireland it is 50% and in the Great

Britain it is 25% (AlHadir and Panuwatwanich 2011).

Every year 2.3 million people die due to occupation related accidents all over the world; 2 million

due to occupational sickness and 0.3 million affected by work-related injuries. However, these

two elements i.e. occupational sickness and injuries are variable due to the degree of development

of that particular country (Takala et al. 2012).

Work-related injuries and occupational communicable diseases in industrialized nations causes

fewer mortality compared to the inordinate mortality figures due to non-communicable diseases.

Occupational illnesses which are linked to ageing and have a lengthy dormant phase are

obviously increasing. Meanwhile, the developed countries have been able to considerably

decrease the number of work-related injuries courtesy of structural modification and better

anticipation (Takala et al. 2012).

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Around 160 million workers encounter work-related injuries and these are the fourth major cause

of occupational mortality (Alli 2008).

Occupational well-being and health implementation vary prominently between nations, economic

divisions as well as company sizes. For instance, in Pakistan, a worker in a factory is eight times

more prone to work-related mortality as compared to his counterpart in France. Similarly, as in

construction, mining, agriculture and forestry also have highest death rate. Furthermore, small

workplaces have twice the rate of work-related injuries and deaths compared to large workplaces

(Alli 2008).

Figure 1. Work-related annual deaths –World in 2008 (Hamalainen & Takala 2008)

Although the occupational injuries are at a declining rate due to much better guidance, improved

administration and cultures, globally the fatalities in occupational industries has been on the rise

in Asian countries as construction, agriculture, manufacturing and mining have been shifted there

(Takala et al. 2012).

0.4% 8%1%

17%

32%

23%

1%

18%

Communicable diseases Respiratory Diseases Mental Disorders

Genitourinary system Cancer Circulatory diseases

Digestive system diseases Accidents and violence

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In developed countries, occupational injuries are a small problem now and chronic complications

like lung cancer, musculoskeletal diseases, circulatory disorders, and psychosocial aspects are on

the rise (Takala et al. 2012).

Health and safety and competitiveness are bound with each other i.e. the lesser the number of

accidents there is increased productivity and competiveness in any organization. Even registering

the accidents can affect the economy, as low reporting will give the decision makers a sense of

false alarm of safety which in turn can not only affect the competitiveness and productivity but

human rights issues as well (Takala et al. 2012). The table below illustrates this phenomenon.

Table 1. Work-related Injuries and Diseases in the World in 2013 (WSH 2013)

Region

Economically

Active

Population

Fatal

(Reported)

Four or

more

days

absence

Fatal

Injuries

ILO

estimates

Four or more

days absence:

ILO mid-point

estimate

Fatal work-

related

diseases

Total work-

related

mortality

High-Income

Areas 494,365,003 11,850 4,959,039 14,090 14,665,130 306,988 321,077

African Region 251,588,449 759 46,616 44,699 46,561,176 336,144 380,843

American Region 315,509,490 1,944 657,580 25,534 8,866,101 113,023 138,557

Eastern

Mediterranean 152,610,995 0 0 17,912 18,657,924 117,164 135,076

European Region 213,740,690 6,777 325,004 16,191 18,093,167 198,366 214,557

Southeast Asia 642,390,831 81 1,676 83,096 86,558,781 523,355 606,451

Western Pacific 921,078,060 193 43,756 119,058 124,019,195 427,530 546,588

Total 2,991,283,518 21,604 6,033,671 320,580 317,421473 2,022570 2,343,149

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In this context, reporting is also vital, as in rich nations, the reporting is fair unlike other

developing nations. Under-reporting might lead the decision makers to believe that everything is

normal which consequently undermines not only productivity and competitiveness but also

human rights (Takala et al. 2012).

A new philosophy Vision Zero has emerged which aims to modify the mindset and values of all

stake holders from business as usual to guaranteeing no harmful exposures, no sicknesses, no

accidents, no harassment, no violence and simply no trauma as the ultimate goal during entire

working life (Takala et al. 2012).

Former Secretary General of the United Nations, Kofi Annan has aptly reminded: "Health and

safety at work is not just sound economic policy it is a basic human right" (Takala et al. 2012).

2.4 Injuries in Construction

Construction is a hazardous work. Statistically, the highest rates of work-related deaths in the

world occurs in construction apart from agriculture, forestry and mining. According to the

National Safety Council, a thousand construction workers died during their job and another

350,000 suffered from debilitating injuries in the year 1996 alone. Although only 5% of the work

force of United States was involved in construction, occupational fatalities were 20% and

disabling injuries was 9% (Accidents 1997).

There is an increased risk of injury in construction workers who are younger than 24 years of age

(Loudoun 2010). Also, different types of construction workers have different types of injuries.

Consequently, masons tend to develop injuries due to overexertion as compared to carpenters

who are more prone to injuries involving hands and fingers (Helander 1991). Falls are the most

common cause of death in construction industry (Culver et al 1990).

All the construction work which include civil, industrial and commercial in Saudi Arabia is

undertaken by private contractors. Palaces and government buildings are also outsourced

including their maintenance as well. Therefore, in reality there is no public construction

enterprise.

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Generally migrants face abusive and exploitative work environment: forced labor, low wages, no

associations for their rights, discrimination, xenophobia and social exclusion. Specifically,

language barriers, family separation, psychosocial anxiety, violence and limited ability to obtain

medical care, makes these migrant workers especially exposed to workplace safety and health

risks (Alli 2008).

2.4.1 Domino Theory

Heinrich (1959) theorized a domino theory model for causation of accidents: communal

environment and ethnic descent, personal mistakes, hazardous act, mechanical and physical

danger, accidents, and injury. According to him: "An accident is an unplanned and uncontrolled

event in which the action or reaction of an object, substance, person, or radiation results in

personal injury or the probability thereof." Heinrich's work can be summed up in two points:

accidents are basically caused by the human beings; and an able and competent management is

accountable for the avoidance of accidents.

2.4.2 Human Error Theories

Behavior models and human component models symbolize the hypothesis of human error. In

behavior model, humans are to be blamed mostly for the errors whereas the human factor

approach not only blames human but also on the architecture of the workplace and jobs which

fail to examine human being's constraints ultimately having hazardous effects (Abdelhamid and

Everett 2000).

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3. AIM OF THE STUDY

The aim of this study was to analyze the occupational injuries in one construction company in

Saudi Arabia in a five months period in 2010. More specifically the aim was to

1) Determine distribution of occupational injuries by age group and nationalities

2) Determine types of occupational injuries and their distribution by age group and nationalities

3) Determine part of the body injured according to ILO classification 2000.

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4. MATERIALS AND METHODS

4.1 Study design

A retrospective cross-sectional analysis of the registers kept by the occupational health service of

the clinic of the construction company in Saudi Arabia. The monthly total number of employees

varied in the study period between approximately 5000 and 10,000. The time period was five

months.

4.2 Study sample and setting

The construction company which provided the workers with health facility through clinics at the

construction site and if the need aroused with further referral to hospital. The injured worker was

identified through his Iqama (residence permit issued by Saudi authorities) then attended by a

certified nurse and a doctor. All the pertinent data was written in a log book. Consequently he

was referred to the hospital if the condition of the patient warranted accompanied by the referral

paper.

4.3 Data collection

Non-computerized registers were used to analyze the appropriate information. The total number

of new cases of occupational injury was studied on a monthly basis. Data was extracted to a data

collection sheet which was developed during the study (Appendix).

4.4 Data analysis

The following data was analyzed according to ILO codes and classification adopted by the Sixteenth

International Conference of Labor Statisticians in October 1998. In this particular case study data was

collected on age, nationality, type of injuries, and, part of body injured The data was cross tabulated and

relevant differences in proportions were tested for statistical significance with chi2-test;

www.socscistatistics.com/tests/chisquare2/

23

Table 2. International Statistical Classification of Diseases and Related Health Problems

according to ILO, based on ICD-10

Code1 Superficial injuries and open wounds

Code 2 Fractures

Code 3 Dislocations, sprains and strains

Code 4 Traumatic amputations

Code 5 Concussions and internal injuries

Code 6 Burns, corrosions, scalds and frostbite

Code 7 Acute poisonings and infections

Code 8 Other specified types of injury

Code 10 Type of injury, unspecified

Table 3. International Statistical Classification of Diseases and Related Health Problems

according to ILO, based on ICD-10

Code1 Head

Code 2 Neck including spine and vertebra in the neck

Code 3 Back, including spine and vertebra in the back

Code 4 Trunk and internal organs

Code 5 Upper extremities

Code 6 Lower extremities

Code 7 Whole body and multiple sites

Code 8 Other parts of body injured

Code 10 Part of body injured, unspecified

24

5. RESULTS

The total number of workers in each month were as follows: January 9949, February 6843, March

7626, April 5195 and May 4947. As can be seen in Figure 1, January had the highest number of

accidents which correspond to the highest number of workers as well as compared to other

months. However, the incident rate was highest in May. The incident rate was lowest for the

month of March (Table 4).

Figure 2. Number of injuries by month recorded during Jan-May period 2010. The number at the

bottom denotes total number of workers in that particular month.

128

8880

59

76

0

20

40

60

80

100

120

140

January(n=9949)

February(n=6843)

March(n=7626)

April(n=5195)

May(n=4947)

Num

ber

of

inju

ries

per

mo

nth

Number of workers per month

25

Table 4. The monthly incidence rate (number of accidents/number of workers) of occupational

accidents in the study construction company in a five month period in 2010.

Month in 2010 Number of accidents Number of workers Incidence/100 workers

January 129 9949 1.30

February 85 6843 1.24

March 80 7626 1.05

April 59 5195 1.14

May 78 4947 1.58

Two-thirds of the workers were under 35 years of age, and only two percent were over 55 years

of age. Altogether 14 nationalities were represented. Almost one-third of the workers were

Pakistani, followed by Filipinos, Indians and Moroccans (Table 5).

26

Table 5. Age and nationality distribution of injured workers

Age, years n %

<25 56 (13)

25-34 219 (51)

35-44 111 (26)

45-54 34 (8)

>55 11 (2)

Nationality

Pakistani 128 (30)

Filipino 85 (20)

Indian 84 (19)

Moroccan 57 (13)

Turkish 27 (6)

Senegalese 12 (3)

Bangladeshi 10 (2)

Sri Lankan 10 (2)

Portugal 5 (1)

Nepalese 4 (1)

Lebanese 3 (1)

Chinese 3 (1)

Egyptian 2 (0.5)

Jordanian 1 (0.5)

All 431 (100.0)

All together 431 injuries were recorded during the study period. Almost half of the injuries were

dislocations, sprains and strain followed by lacerations, punctured wounds, blunt trauma to chest,

27

trunk etc, which made up more than one-third of injuries. More severe injuries like fractures and

traumatic amputations were rare, but however present (Table 6).

Table 6. Type of injuries according to ILO classification (2000)

Type of Injury n (%)

Dislocation, sprain & strain 204 (47)

Other specified types of injury 159 (37)

-Lacerations, punctured wounds,

blunt trauma to chest, trunk etc.

Superficial 54 (12)

Concussions & internal injuries 3 (1)

Fracture 2 (0.5)

Traumatic amputations 1 (0.5)

Burns, corrosions, scalds & frostbite 1 (0.5)

Acute poisonings and infections 1 (0.5)

Type of injury, unspecified 6 (1)

All 431 (100)

28

Of the 431 injuries, one-third affected upper extremities, while more than a quarter affected lower

extremities. Eye injuries were the third most common ones, followed by back and spine injuries.

Injuries to whole body / multiple sites as well as trunk / internal organs were (Table 7).

Table 7. Part of the body injured according to the ILO classification (2000)

Part of body injured n (%)

Upper extremities 136 (32)

Lower extremities 120 (28)

Head* 75 (17)

Back, including spine and vertebra 55 (13)

Whole body & multiple sites 15 (3)

Trunk & internal organs 10 (2)

Neck, including spine & vertebra 1 (0.5)

Part of body injured, unspecified 3 (0.5)

Other parts of body injured 16 (4)

All 431 (100)

*of these eye injuries, n=61

29

There were no statistically significant differences in type of the injuries by age groups (Table 8).

Table 8. Type of injuries by age group among the injured workers during the study.

Age group, years

Type of injury

<25

n=56 (%)

25-34

n=219 (%)

35-44

n=111 (%)

>45

n=45 (%)

All

n=431

p-value*

Dislocation,

sprain & strain

29 (52) 102 (47) 49 (44)

24 (53)

204

0.65

Fractures,

amputations

0 (0)

1

(1)

1 (1)

1 (2)

3

..

Superficial 4 (7) 27 (12) 17 (15) 6 (13) 54 0.46

Other specified

types of injury:

laceration, blunt

trauma to other

parts of body,

punctured

wound

20 (36) 84 (38) 41 (37) 14 (31) 159 0.83

Concussions &

internal injury,

burns, acute

poisoning

1 (2) 2 (1) 2 (2) 0 (0) 5 ..

Typeof injury,

unspecified

2 (3) 3 (1) 1 (1) 0 (0) 6 ..

All 56 (100) 219 (100) 111 (100) 45 (100) 431

*chi2–test; www.socscistatistics.com/tests/chisquare2/

.. p-value not calculated due to small number of observations or zero values in cells

30

There were no statistically significant differences in the type of injury, except superficial injuries,

which were most common among Filipinos and most rare among Moroccans (Table 9).

Table 9.Type of injuries by nationality among the injured workers during the study

Nationality

Pakistani Filipino Indian Moroccan Others All p-value

Type of injury n=128 (%) n=85 (%) n=84 (%) n=56 (%) n=78 (%) n=431

Dislocation, sprain &

strain

39 (30) 16 (19) 23 (27) 20 (36) 27 (35) 125

0.12

Fractures, amputations 0 (0) 0(0) 1 (1) 0 (0) 1 (1) 2 ..

Superficial 10 (8) 21 (24) 10 (12) 2 (4) 7 (9) 50 0.001

Other specified types

of injury: laceration,

blunt trauma to other

parts of body,

punctured wound

72 (56) 43 (50) 47 (56) 32 (57) 42 (54) 236 0.90

Concussions &

internal injury, burns,

acute poisoning

0(0) 0(0) 0(0) 0 (0) 1 (1) 1 ..

Type of injury,

unspecified

7 (5) 5 (6) 3 (4) 2 (4) 0 (0) 17 ..

All 128 (100) 85 (100) 84 (100) 56 (100) 78 (100) 431

*chi2_test; www.socscistatistics.com/tests/chisquare2/

.. p-value not calculated due to small number of observations or zero values in cells

31

6. DISCUSSION

6.1 Review of the major findings

In this particular case study, January had the highest number of accidents which corresponds to

highest number of workers however, month of May had the highest incident rate. One plausible

explanation could be the extreme heat which commences from March until October (temperatures

in this region exceeds 45 Celsius) combined with high humidity. Similarly when newly-arrived

workers (sans prior experience) are put to work in the construction site, the chances of accidents

are exponentially high. Occasionally, the project manager or supervisor would order to expedite

the work to receive the financial budget, usually disbursed in tranches, from the government.

Nevertheless, it was difficult to correlate the number of accidents in any particular period to

possible causative factors.

More than 50% of the injured workers were in their late 20s to early 30s. Since the construction

work requires hard manual labor such as lifting of heavy objects and manual shoveling,

performed under inclement weather conditions, more of the younger workforce is recruited.

Hence higher incidence in this younger age group. The other tenable reasons might include

limited experience and poor judgment. Only 25% of the injured workers were above the 55 age

group as their cohort was smallest in comparison with other age group.They were in this

company for at least ten years and were more into supervisory roles hence lesser involvement in

accidents and injuries.

There are nearly 50 million expatriates in the Gulf region; 33% in Saudi Arabia and 72 % in other

Gulf countries (Raghu and Sartawi 2012). Nearly two-thirds of the low-skilled laborers are from

Pakistan, the Philippines and India due to the prevalent economic situation including high

unemployment and currency difference in their countries. This situation makes it lucrative for the

Arab Gulf countries to acquire cheap labor. As the migrants constitute the bulk of construction

workers in Gulf countries consequently, south Asians constitute a majority of the injured workers

also in this case-study (75%); rest were Africans and Arabs.

Laceration, blunt trauma to other parts of the body and punctured wound were the most common

types of injuries amounting to one-half of the total injuries in all nationalities. Dislocation, sprain

32

and strain were the second-most common type of injuries ranging from 19% in Filipinos to 36%

in Moroccans. Consequently, superficial injuries were the third-most common type of injuries

ranging from 4% in Moroccan workers to 24% in Filipinos. Unspecified types of injuries ranged

between 4% (Indians) to 6% (Filipinos). Fractures, amputations, concussions and internal injury,

burns and acute poisonings were 1% of the total injuries. 17% of the injuries did not fit into any

of the above criteria.

Unsafe conditions at the worksite are the main cause of accidents resulting in injuries and even

death. Defective equipments, improperly constructed scaffolds, protruding metals, ungrounded

electrical tools, un-shored trenches etc are some of the examples which contribute either directly

or indirectly to the occuppational accidents. Additionally, management's failure to impart

conventional orientation, training as well as insufficient or substandard personal protective

equipment makes these workers vulnerable to accidents. Dislocation, strain and sprain,

lacerations, punctured wounds, blunt trauma and superficial injuries constitute almost 95% of the

total injuries. Dislocation, sprain and strain are mostly caused by jackhammer; lifting jobs are

also a causative factor. Superficial injuries include foreign bodies in eyes mostly due to welding

during which minute particles of iron get embedded in cornea or conjunctiva. Incidentally,

fracture and traumatic amputations were insignificant in this case study although being

conventionally higher in construction industry in other parts of the world. Due to the nature of

construction industry, acute poisonings and infections, burns, corrosions, scalds and frostbite

incidents are negligible.

ILO estimates 30% of the fatalities are due to falls (Weeks 2011), although this case-study paints

a completely different picture because of varied reasons. In European Union, Spain had the

highest number of injuries i.e. 70% which predominantly constituted fall, slip and struck-by

falling objects and fragments. Gulf countries also have a similar pattern as accidents due to falls

were 33.1% and struck-by 25.2% (Al-Humaidi and Tan 2010). The literature suggests that fall

from height, slips and struck-by are the major types of construction injuries.

Similarly, extremities are involved in more than half of the injuries as compared to other body

parts apparently due to their more frequent usage. As described before, eye injuries form a bulk

33

of injuries resulting from welding. Sandstorms are a regular feature in this part of the world

which can also cause minute sand particles to embed in the eye. Lifting weights beyond their

recommended limits and utilising incorrect posture leads to backache ranging from benign

muscular spasms, which resolve spontaneously, to herniated discs requiring hospitalizations.

6.2 Ethical considerations

There was no need for ethical approval of the study. Name of the construction company and the

patient identity were not disclosed. All the data was extracted anonymously to the data collection

sheet by the physician in charge (the student).

6.3 Strengths and weaknesses of the study

One strength of the study was that the student, as a physician in-charge of the clinic at the

construction site, was able to receive firsthand the workers who sustained injury during work

(occupational) or who suffered from non-work related sicknesses.

In case of any work-related injuries and depending upon the nature of the injury, the patient was

provided emergency treatment at the in-house clinic and referred to the designated hospital for

further evaluation and management depending on the severity of the injury. The injured worker

was consequently followed-up with the attending physician in the referred hospital until

discharged.

Consequently, a physical fitness to work was conducted and the employee would then be

evaluated by the physician prior to resume work. Each and every patients' data was recorded in a

log book maintained by the nurse and under the supervision of the physician. A monthly

compilation was then forwarded to the higher management.

One weakness of the study was that due to strict rules and regulations, unfortunately not much

data is available. However, this case study is quite reflective of the prevaling scenario at the

different construction sites all over the country. During the length of my employment in this

organization, I had been assigned at several construction sites and I observed similar situation.

34

6.4 Suggestions for future research.

As this is a case study of only one of the many construction companies in Saudi Arabia, more

studies and research need to be done to comprehend, manage and prevent occupational injuries.

The government has to legislate and implement the labor safety laws fairly and squarely with the

help of the stake holders. Transparency and unrestricted flow of information are key elements in

proper formulation of laws.

7. CONCLUSION

Construction is a hazardous occupation and the injuries in this sector far outweigh the number of

accidents in any other sector. Risk management which includes identification, assessment and

classification, is crucially vital to deliver construction projects in a successful manner.

Furthermore, risk management application should be evaluated by the construction companies in

order to isolate barriers and imperfections. Root Cause Analysis (RCA) is an indispensable tool

to identify and prevent future accidents. There should be more resources and time spent to

improve the safety performance in the construction industry.

Similarly, developing countries have a larger share of occupational injuries than the developed

countries. Migrant workers are more exposed to these occupational risks unlike the local workers

and there is dire need to improve conditions in their workplace vis-à-vis minimum wages,

accomodations and leaves. Management should be more proactive in ensuring safe procedures as

it has the most significant role by setting targets, providing safety training and inculcating

teamwork in a heterogeneous group along with suitable supervision. Personal attitude (of the

workers) is an integral part, too.

Due to restrictions in this region, the data coming from Arab Gulf states are few and far between

and hence greater transparency, awareness and auditing are mandatory to protect these workers

from injuries. All safety program implementations need to be followed by an effective

enforcement; both by the private contractor and the related governmental agency.

35

More research and case studies are needed to identify the elements or causative factors of

occupational accidents in the construction industry in this region to minimize the injuries,

decrease the costs and implement completion of the project in a timely manner.

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39

9. APPENDICES

Appendix 1. Example of the data extraction sheet, January 2010

January

Age (years) Nationality Initial diagnosis Specialist

27 Filipino foreign body, L eye ophthalmologist

37 Filipino foot sprain L Orthopedic

35 morocco small laceration scalp Emergency

27 morocco punctured wound sole L Emergency

26 indian foreign body, R eye ophthalmologist

37 Filipino foreign body, L eye ophthalmologist

35 Filipino trauma, R eye ophthalmologist

26 morocco cut wound middle finger L Emergency

28 morocco trauma, L eye Emergency

24 pakistani deep laceration forehead Emergency

45 Filipino sprain L hand Emergency

26 pakistani cut wound supraorbital R Emergency

24 indian pain swelling knee R Orthopedic

42 indian trauma knee L Orthopedic

23 pakistani foreign body R eye ophthalmologist

39 srilanka laceration tricep L Emergency

39 srilanka trauma forearm L Emergency

28 pakistani foreign body L eye ophthalmologist

40 Filipino foreign body R eye ophthalmologist

26 Filipino foreign body R eye ophthalmologist

27 pakistani ankle injury R Orthopedic

36 pakistani sprain R hand Orthopedic

36 Filipino laceration foot R Emergency

40

27 pakistani foreign body R eye ophthalmologist

36 indian deep cut wound forehead Emergency

23 Turkish foreign body R eye ophthalmologist

33 Filipino severe leg pain R Orthopedic

36 Filipino eye trauma R ophthalmologist

47 Filipino foreign body L eye ophthalmologist

32 indian sprain foot L Orthopedic

30 morocco trauma foot L Orthopedic

43 pakistani punctured wound foot L Emergency

37 Filipino foreign body L eye ophthalmologist

28 Filipino foreign body R eye ophthalmologist

32 Senegalese cut wound eyebrow R Emergency

30 pakistani foreign body L eye ophthalmologist

30 Filipino punctured wound Emergency

28 morocco laceration 4th digit R hand Emergency

24 indian puntured wound R sole Emergency

25 Filipino foreign body R eye ophthalmologist

40 Turkish trauma lower cheek R emergency

25 Pakistani knee joint pain R emergency

28 Pakistani crushing injury hand R emergency

25 moroccan trauma thumb R emergency

28 Filipino trauma chest R, tibia L emergency

29 Turkish low back pain emergency

36 moroccan trauma hand R emergency

24 Bangladeshi low back pain emergency

26 Pakistani trauma hand, 3rd digit R emergency

30 Turkish sprain foot R emergency

25 Pakistani ankle pain R emergency

28 Pakistani laceration hand L emergency

41

27 Pakistani sprain foot L emergency

38 Pakistani sprain hand L emergency

25 Bangladeshi wrist joint swelling L emergency

27 moroccan foreign body L eye emergency

29 Filipino trauma lower back emergency

41 Filipino low back pain emergency

24 indian trauma leg L emergency

27 Pakistani foot pain R emergency

23 Nepali trauma hand L emergency

33 moroccan trauma shoulder, hand L emergency

27 Pakistani trauma foot L emergency

39 senegalese low back pain emergency

36 Pakistani trauma chest emergency

32 indian trauma chest, knee R emergency

36 Pakistani trauma 3rd digit R emergency

40 Lebanese trauma hand R emergency

22 indian trauma hand L emergency

26 Pakistani foot swelling L emergency

29 Filipino trauma 4th digit, hand L emergency

30 Nepali cut wound hand L emergency

26 indian trauma 2nd digit L emergency

27 Pakistani trauma, face emergency

25 Pakistani trauma 2nd & 3rd digit emergency

34 Pakistani trauma thigh & scrotum emergency

22 moroccan trauma foot L emergency

36 Turkish trauma 2nd digit R emergency

50 Filipino trauma foot R emergency

24 moroccan low back pain emergency

40 moroccan trauma 2nd digit L emergency

42

36 indian knee joint pain L emergency

45 Pakistani low back pain emergency

27 Filipino low back pain emergency

33 Filipino strain leg R emergency

42 Filipino trauma head emergency

42 Bangladeshi trauma thumb L emergency

38 Filipino pain arm, elbow L emergency

36 Filipino pain shoulder L emergency

24 indian trauma chest emergency

28 indian knee joint pain R emergency

28 Turkish low back pain emergency

44 srilanka fracture, wrist L emergency

28 indian twisting injury knee L emergency

33 Filipino trauma leg L emergency

38 Filipino trauma foot R emergency

48 moroccan trauma foot L emergency

35 Bangladeshi trauma forehead & nose emergency

33 Bangladeshi sprain foot L emergency

34 indian foreign body R eye emergency

30 indian trauma shoulder L emergency

41 indian multiple trauma emergency

38 Pakistani severe backache & leg pain emergency

30 indian arm fracture R emergency

27 moroccan trauma arm R,thigh L, head emergency

22 Pakistani trauma 2nd & 4th digit L emergency

36 Filipino trauma leg R emergency

34 indian trauma knee R emergency

30 Filipino trauma eye R, forehead emergency

25 Pakistani trauma elbow R emergency

43

23 Pakistani swelling hand R emergency

29 Pakistani foreign body eye L emergency

47 Filipino twisted hand while drilling emergency

49 Pakistani trauma knee R due to fall emergency

30 Jordanian severe arm pain R emergency

27 Pakistani severe low back pain emergency

25 Pakistani unspecified injury due to fall emergency

26 indian foreign body eye R emergency

65 Portugal pain foot L emergency

35 srilanka trauma 3rd digit R emergency

28 Turkish pain shoulder R emergency

32 Filipino trauma leg L, back emergency

36 Filipino sprain foot L emergency

32 senegalese trauma shoulder R emergency

27 indian trauma chest wall emergency

42 Pakistani contusion knee R emergency

35 indian trauma head emergency

25 Pakistani trauma knee R emergency

Total cases = 128

Total number of workers = 9949

Incidence Rate/1000 workers = 128/9949 x 1000 =12.87

44

Appendix 2. Coding of the data

Age group Nationality group Type of injury (accdg. to ILO classification) Speciality Referred to

<25=1 Bangladeshi =1 Superficial = Code 1 Emergency = 1

25˗34=2 Filipino = 2 Fracture = Code 2 Ophthalmologist = 2

35˗44=3 Indian = 3 Dislocation sprain & strain = Code 3 Orthopedics = 3

45˗54=4 Jordanian = 4 Traumatic amputations = Code 4 Surgeon = 4

>55=5 Lebanese = 5 Concussions & internal injuries = Code 5

Moroccan = 6 Burns, corrosions, scalds & frostbite = Code 6

Nepali = 7 Acute poisonings & infections = Code 7

Pakistani = 8 Other specified types of injury = Code 8

Senegalese = 9 Type of injury, unspecified = Code 10

Srilanka = 10

Turkish = 11 Part of the body injured

Portugal = 12 Head = Code 1

Chinese = 13 Neck including spine & vertebra in the neck = Code 2

Egypt = 14 Back, including spine &vertebra in the back = Code 3

Trunk & internal organs = Code 4

Upper extremities = Code 5

Lower extremities = Code 6

Whole body & multiple sites = Code 7

Other parts of body injured = Code 8

Part of body injured, unspecified = Code 10

45

Appendix 3. Example sheet of the coded data

Age group Nationality group Type of Injury Part of body Injured Speciality

2 2 1 2 2

3 2 3 7 3

3 6 8 1 1

2 6 8 7 1

2 3 1 2 2

3 2 1 2 2

3 2 8 2 2

2 6 8 6 1

2 6 8 2 1

1 8 8 1 1

4 2 3 6 1

2 8 8 1 1

1 3 3 7 3

3 3 3 7 3

1 8 1 2 2

3 10 8 6 1

3 10 3 6 1

2 8 1 2 2

3 2 1 2 2

2 2 1 2 2

2 8 3 7 3

3 8 3 6 3

3 2 8 7 1

2 8 1 2 2

3 3 8 1 1

1 11 1 2 2

2 2 3 7 3

46