High rates of serious road traffic accidents (RTAs) have been reported for several Arabian Gulf countries, including the United Arab Emirates (UAE), in recent years. This study aims to describe quantitatively the morbidity and mortality from RTAs in the UAE, to identify their trends during the period 1977-1998, to compare the results with those of developed countries, and to evaluate the information available on possible causes with a view to identifying the most useful direction for future research. Data were obtained from UAE's police and health sources and, for international comparison, from WHO Statistics reports and the published literature. Overall and cause-specific fatality and injury rates of RTAs were calculated. Estimates of trends were achieved by using linear regression. The characteristics of road users injured or killed were also analysed. The results revealed that during the period 1977-1998, the rates of RTAs per 100 000 population and per 100 000 motor vehicles declined in the UAE by a trend component of -56.3 (P < 0.001; R-2 = 0.69) and - 521.8 (P < 0.001; R-2 = 0.92), respectively. RTA fatality and injury rates based on the same denominators also declined by - 1.1 (P < 0.001; R-2 = 0.56) and - 13.3 (P < 0.001; R-2 = 0.47); and by - 3.8 (P < 0.02; R-2 = 0.23) and - 90.0 (P < 0.001; R-2 = 0.59), respectively. Paradoxically, however, except for a short period (1977-1985), a steady increase in the risk of injury and death in each RTA accompanied these declines. Between 1985 and 1998 the severity rate (the ratio of fatalities and injuries per 1000 RTAs) more than tripled in the UAE. The UAE's rates were high when compared with a number of selected countries. The cause for the increasing severity of RTAs is not clear but the most likely cause could lie in speeding, careless driving, the changing vehicle mix on the roads and the standard of immediate care available for victims. Further investigation is essential and will require close collaboration between police and health authorities. (C) 2002 Elsevier Science Ltd. All rights reserved.