Skip to main content Accessibility help

Mass Casualty Response in the 2008 Mumbai Terrorist Attacks

  • Nobhojit Roy, Vikas Kapil, Italo Subbarao and Isaac Ashkenazi


Objectives: The November 26-29, 2008, terrorist attacks on Mumbai were unique in its international media attention, multiple strategies of attack, and the disproportionate national fear they triggered. Everyone was a target: random members of the general population, iconic targets, and foreigners alike were under attack by the terrorists.

Methods: A retrospective, descriptive study of the distribution of terror victims to various city hospitals, critical radius, surge capacity, and the nature of specialized medical interventions was gathered through police, legal reports, and interviews with key informants.

Results: Among the 172 killed and 304 injured people, about four-fifths were men (average age, 33 years) and 12% were foreign nationals. The case-fatality ratio for this event was 2.75:1, and the mortality rate among those who were critically injured was 12%. A total of 38.5% of patients arriving at the hospitals required major surgical intervention. Emergency surgical operations were mainly orthopedic (external fixation for compound fractures) and general surgical interventions (abdominal explorations for penetrating bullet/shrapnel injuries).

Conclusions: The use of heavy-duty automatic weapons, explosives, hostages, and arson in these terrorist attacks alerts us to new challenges to medical counterterrorism response. The need for building central medical control for a coordinated response and for strengthening public hospital capacity are lessons learned for future attacks. These particular terrorist attacks had global consequences, in terms of increased security checks and alerts for and fears of further similar “Mumbai-style” attacks. The resilience of the citizens of Mumbai is a critical measure of the long-term effects of terror attacks.

(Disaster Med Public Health Preparedness. 2011;5:273–279)


Corresponding author

Correspondence: Address correspondence and reprint requests to Dr N. Roy, Jamsetji Tata Centre for Disaster Management, Tata Institute of Social Sciences, Deonar Farm Road, Mumbai, India 400 088 (e-mail:


Hide All
1.World Gazetteer. World: largest cities and towns and statistics of their population. Published 2010. Accessed October 16, 2011.
2.Cocks, RA.Medical care in civil disorder. Trauma. 1999;1:255263.
3.Rabasa, A, Blackwill, R, Chalk, PThe Lessons of Mumbai.Arlington, VA: RAND Corporation; 2009.
4.Peleg, K, Aharonson-Daniel, L, Michael, M, Shapira, SCIsrael Trauma Group. Patterns of injury in hospitalized terrorist victims. Am J Emerg Med. 2003;21 (4):258262.
5.Copenhagen Consensus Center. Copenhagen Consensus 2008. Accessed October 16, 2011.
6.Abul Aziz, A.The burden of terrorism in Malaysia. Prehosp Disaster Med. 2003;18 (2):115119.
7.Duraphe, ATMumbai terror attack final form.Submitted in the court of Addl. Ch. M.M., 37th Court, Esplanade. Published 2009. Accessed October 16, 2011. Ceballos, JP, Turégano-Fuentes, F, Perez-Diaz, D, Sanz-Sanchez, M, Martin-Llorente, C, Guerrero-Sanz, JE.11 March 2004: The terrorist bomb explosions in Madrid, Spain—an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care. 2005;9 (1):104111.
9.Roy, N.Attack on the Taj Mahal Palace Hotel: a proxy war on America? Disaster Med Public Health Prep. 2009;3 (1):1.
10.Madhiwalla, N, Roy, N.Bombing medical facilities: a violation of international humanitarian law. Indian J Med Ethics. 2009;6 (2):6465.
11.Kirschenbaum, L, Keene, A, O’Neill, P, Westfal, R, Astiz, ME.The experience at St. Vincent's Hospital, Manhattan, on September 11, 2001: preparedness, response, and lessons learned. Crit Care Med. 2005;33 1(Suppl)S48S52.
12.Frykberg, ER.Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53 (2):201212.
13.Peleg, K, Aharonson-Daniel, L, Stein, MIsraeli Trauma Group (ITG). Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg. 2004;239 (3):311318.
14.Deshpande, AA, Mehta, S, Kshirsagar, NA.Hospital management of Mumbai train blast victims. Lancet. 2007;369 (9562):639640.
15.Rignault, DP, Deligny, MC.The 1986 terrorist bombing experience in Paris. Ann Surg. 1989;209 (3):368373.
16.Kluger, Y, Peleg, K, Daniel-Aharonson, L, Mayo, AIsraeli Trauma Group. The special injury pattern in terrorist bombings. J Am Coll Surg. 2004;199 (6):875879.
17.Centers for Disease Control and Prevention. Emergency preparedness and response.Predicting casualty severity and hospital capacity Predicting triage severity. Accessed October 16, 2011.
18.Shenoy, S, Pai, P, Dalvie, S, Bapat, R.Analytical data of January 1993 communal riot victims—the KEM Hospital experience. J Postgrad Med. 1993;39:1013.
19.Kashuk, JL, Halperin, P, Caspi, G, Colwell, C, Moore, EE.Bomb explosions in acts of terrorism: evil creativity challenges our trauma systems. J Am Coll Surg. 2009;209 (1):134140.
20.Roy, N, Murlidhar, V, Chowdhury, R.Where there are no emergency medical services-prehospital care for the injured in Mumbai, India. Prehosp Disaster Med. 2010;25 (2):145151.
21.Lerner, EB, O’Connor, RE, Schwartz, R.Blast-related injuries from terrorism: an international perspective. Prehosp Emerg Care. 2007;11 (2):137153.
22.Goenka, AH, Jethwani, KKEM Hospital's response to serial bomb blasts in the Mumbai suburban trains on 11th July 2006: students' perspective.;year=2006;volume=52;issue=4;spage=330;epage=330;aulast=Goenka. Published 2006. Accessed October 16, 2011.
23.Rodoplu, Ü, Arnold, JL, Tokyay, R, Ersoy, G, Cetiner, S, Yücel, T.Mass-casualty terrorist bombings in Istanbul, Turkey, November 2003: report of the events and the prehospital emergency response. Prehosp Disaster Med. 2004;19 (2):133145.
24.Kosashvili, Y, Daniel, LA, Peleg, K, Horowitz, A, Laor, D, Blumenfeld, A.Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted? Injury. 2009;40:727731.
25.Caldicott, DG, Edwards, NA, Tingey, D, Bonnin, R.Medical response to a terrorist attack and weapons of mass destruction. Emerg Med (Fremantle). 2002;14 (3):230239.


Mass Casualty Response in the 2008 Mumbai Terrorist Attacks

  • Nobhojit Roy, Vikas Kapil, Italo Subbarao and Isaac Ashkenazi


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed