Road traffic accidents result in substantial injury and death in Karachi. We reviewed the patient logs of the two largest government hospitals in Karachi between December 1993 and February 1994 to identify those persons most likely to be injured in a road traffic accident and to identify the vehicle types which were most likely to be involved. 86% of 727 road injury victims were male. Their mean age was 31 years. One hundred of thirty-one (18%) died. Pedestrians and motorcyclists were the most common victims accounting for 46% all injuries and 51% of deaths. Although buses and trucks were less than 4% of the registered vehicles in Karachi they were the striking vehicle among 49% of all injuries and 65% of the deaths. Road traffic accidents disproportionately affect wage earners. Specific interventions to improve the road safety of trucks and buses are needed.