Pedestrians are the road users at greatest risk, in most developing countries accounting for up to 75% of all road fatalities. While this can be partially explained by the low motorization levels in developing countries with walking trips likely to dominate travel patterns, traditional transport planning and road design have tended to focus on providing for motor vehicles and have largely overlooked pedestrians and their safety. The WHO published a safety manual on pedestrain safety in 2013 that contains practical information on how to plan, implement and evaluate a pedestrian safety programme.

Low-income countries have also been found, in general, to have a higher percentage of child pedestrian deaths, largely explained by the population age distribution and increased exposure for that age group. According to WHO estimates for 2012, over 1000 people under the age of 25 were killed a day, most of which most occurred in low-income and middle-income countries. Older pedestrians are also associated with a very high rate of road injury and death, mainly due to the increased physical frailty of the elderly.

The United Nations estimates that between 6% and 10% of people in developing countries are disabled. Accurate data on disability is scarce, but it is obvious that transport systems in most developing countries are not friendly to pedestrians, let alone disabled people. Behaviour of pedestrians is often not straightforward travel from one place to another. Reasons for walking can be divided into three categories: journeys to work or school etc., exercise, or leisure. When people are walking, they usually choose the shortest route and do not want to spend any extra time on the trip. They obey the rules when they think it is sensible and necessary.

Taking the shortest route can mean that they do not use underpasses or pedestrian crossings. They may not obey traffic lights, if waiting for the green light seems to take too long. Pedestrians on familiar routes tend to pay less attention to traffic than when walking in unknown surroundings. Children may play and can also suddenly rush into the street.

On their own, pedestrians are not a danger to themselves or others, but the conflict between motorized traffic and vulnerable road users that is potentially dangerous. Typical dangerous factors for pedestrians are drivers travelling at too high speeds given the traffic circumstances, overtaking just before a pedestrian crossing, when pedestrians are not able to judge the speed when choosing a 'gap' in the traffic to cross the road, and a lack of attention from both pedestrians and drivers.

Most countries provide some pedestrian facilities, but in most cases the road environment is not designed with pedestrians in mind. Bearing in mind that there are differences between urban and rural traffic mix and speed, there are a number of proven low cost measures to help pedestrians, which can be affordable on a wide scale and are easily implemented.

A clear and wide pedestrian footway on urban roads and along rural highways is essential. Where pedestrian traffic is significant but insufficient to justify a footpath, hard shoulders should be sealed in order to provide a smooth compacted surface for pedestrians, as a comparable but preferable alternative to the paved roadway. As the majority of pedestrian injuries occur while crossing a road, the need for safe and efficient pedestrian crossing facilities could arguably be the most important pedestrian safety factor. Pedestrian refuges are a common pedestrian crossing feature in developed countries, yet they are rarely used in developing countries.

Pedestrians should not have to cross more than two lanes of traffic at a time without a central median provided for refuge, allowing the pedestrians to cross the road in two stages. Zebra crossings (where pedestrians are supposed to be granted immediate priority over approaching vehicles) are provided in some developing countries, but in the vast majority of cases, can be quickly dismissed as a token measure with few, if any, actual benefits.

Unlike zebra crossings, signalized pedestrian crossings offer the default priority to vehicle traffic with pedestrians allowed to cross only on signals. Unfortunately, like zebra crossings, they are not self-enforcing and rely on driver compliance with crossing regulations. In low flow, relatively low speed areas, raised pedestrian crossings have the potential benefits of reducing approach speeds, which reduce the likelihood of a road crash and the relative injury severity of it. Other safety measures are visibility of all the road users and the lighting of the streets.

The provision of vulnerable road user facilities does not guarantee effective usage and compliance by vulnerable road users and drivers. Education and publicity programmes are needed to improve understanding and awareness while enforcement can help motivate correct behaviour patterns by persuasion (verbal warnings) and punishment. Improving the provision of the usually poor emergency medical services can also result in a higher proportion of victims surviving on the road or on the way to a health clinic.