The main objectives of this study are to present data on fatal motor vehicle accidents in Kuwait with a view to find out the principal epidemiological features, establish a baseline for future evaluation, use international death rates to compare Kuwait with other countries and offer specific recommendations as to how the risks involved can be reduced. The epidemiology of all fatal accidents which had occurred in Kuwait between I January 1977 and 31 December 1978 are analysed. This two-year series, which includes 726 accidents and represents 1.7% of all types of accidents, resulted in 803 deaths (7.3% of the national deaths toll) and 1175 injuries. The death rates per hundred million vehicle kilometerΒ’ of travel, per 100,000 registered motor vehicles and per 100,000 resident population in 1978 were about 8.5, 84.8 and 31.7 respectively. These figures reveal significantly higher rates than in some industrialized countries, thus ranking motor vehicle accidents among the four leading causes of death and probably as the commonest single cause of death in Kuwait. The study shows that children under the age of 15 yr contributed 26.2% of all motor vehicle fatalities, 40.9% of pedestrian deaths (55.2% of the series), 25% of pedal-cyclist deaths, 6.3% of motorcyclist deaths and 1.2% of driver deaths. It also confirms the importance of the motor vehicle-pedestrian type of accident (58.3%) and the over-representation of buses, trucks and motorcycles with respect to involvement in fatal accidents as compared to their relative ratios of registered vehicles. The principal recommendations call for the formation of a National Council for Road Safety, the establishment of intensive roadside care, traffic education of road users and at risk groups, improvement of the environment and the firm enforcement of the law to curb the toll of this killer disease in a traditional country undergoing rapid modernization like Kuwait.