Hostname: page-component-848d4c4894-2xdlg Total loading time: 0 Render date: 2024-06-24T11:16:51.313Z Has data issue: false hasContentIssue false
  • English
  • Français

Terrorist Attacks in Sub-Saharan Africa from 1970 through 2020: Analysis and Impact from a Counter-Terrorism Medicine Perspective

Published online by Cambridge University Press:  30 January 2023

Ryan Hata Open the ORCID record for Ryan Hata [Opens in a new window] ,
Alexander Hart ,
Attila Hertelendy Open the ORCID record for Attila Hertelendy [Opens in a new window] ,
Derrick Tin ,
Cara Taubman ,
Lenard Cheng  and
Gregory R. Ciottone
Ryan Hata*
Affiliation:
BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, Massachusetts USA Harvard Medical School, Boston, Massachusetts USA
Alexander Hart
Affiliation:
BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, Massachusetts USA Department of Emergency Medicine, Hartford Hospital, Hartford, Connecticut USA University of Connecticut School of Medicine, Farmington, Connecticut USA
Attila Hertelendy
Affiliation:
BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, Massachusetts USA Florida International University, Miami, Florida USA
Derrick Tin
Affiliation:
BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, Massachusetts USA Harvard Medical School, Boston, Massachusetts USA
Cara Taubman
Affiliation:
BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, Massachusetts USA
Lenard Cheng
Affiliation:
BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, Massachusetts USA Harvard Medical School, Boston, Massachusetts USA
Gregory R. Ciottone
Affiliation:
BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, Massachusetts USA Harvard Medical School, Boston, Massachusetts USA
*
Correspondence: Ryan Hata, MD Fellow, BIDMC Disaster Medicine Fellowship Department of Emergency Medicine Beth Israel Deaconess Medical Center and Harvard Medical School One Deaconess Road, WCC2 Boston, Massachusetts 02215 USA E-mail: rhata1@bidmc.harvard.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Sub-Saharan Africa (SSA) has become a hotspot for global terrorism, with nearly 50% of global terror-related deaths occurring in SSA in 2021. With a large population and complex geopolitical and social climate, terrorist activity further burdens an already strained medical system. This study provides a retrospective descriptive analysis of terrorist-related activity in SSA from 1970-2020.

Methods:

A retrospective analysis of the Global Terrorism Database (GTD) was performed for the region of SSA from 1970-2020. Data were filtered using the internal database search function for all events in the following countries: Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, the Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, People’s Republic of the Congo, Republic of the Congo, Rhodesia, Rwanda, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Swaziland, Tanzania, Togo, Uganda, Zaire, Zambia, and Zimbabwe. Number of attacks, deaths, and injuries, as well as primary weapons types, country where attacks occurred, and primary target types, were collated and analyzed.

Results:

A total 19,320 attacks were recorded, resulting in 77,565 deaths and 52,986 injuries. Firearms were the most frequent weapons used (8,745), followed by explosives (6,031), unknown (2,615), and incendiary (1,246), with all others making up the remainder (683.) Private citizens and property were the most frequently targeted entities (8,031), followed by general government facilities (2,582), police (1,854), business (1,446), military (805), diplomatic government facilities (741), and religious figures/institution (678), with all other targets making up the remainder (3,183).

Conclusion:

The majority of deaths from terrorism in SSA are the result of firearm attacks and explosions. Nigeria, Somalia, South Africa, The Democratic Republic of the Congo, and Sudan have had the largest number of attacks since 1970, and Nigeria has the largest number of people killed and injured. The health implications of terrorist attacks are often compounded by violence and pose unique challenges to governments, populations, and aid organizations. By understanding the impact and scope of terrorist activity in SSA, Counter-Terrorism Medicine (CTM) initiatives can be employed to improve health care outcomes.

Keywords

Counter-Terrorism Medicinedisaster medicineSub-Saharan Africaterrorismviolence
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 2 , April 2023 , pp. 216 - 222
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Omeni, A. The Chibok kidnappings in north-east Nigeria: a military analysis of before and after. Small Wars Journal. Published 2017. https://smallwarsjournal.com/jrnl/art/the-chibok-kidnappings-in-north-east-nigeria-a-military-analysis-of-before-and-after. Accessed August 14, 2022.Google Scholar
Adeboye, AO. Addressing the Boko Haram-induced mental health burden in Nigeria. Health Hum Rights. 2021;23(1):71–73.Google ScholarPubMed
Tin, D, Fares, S, Al Mulhim, M, Ciottone, GR. Terrorist attacks in the Middle East: a Counter-Terrorism Medicine analysis. Prehosp Disaster Med. 2022;37(2):212–216.Google Scholar
Lynne, O’Donnell. Terrorism is making a comeback, and Africa is the hot spot. Foreign Policy. Published 2022. https://foreignpolicy.com/2022/05/06/terrorism-africa-hotspot-isis-boko-haram/. Accessed July 26, 2022.Google Scholar
Amaefule, KE, Dahiru, IL, Sule, UM, Ejagwulu, FS, Maitama, MI, Ibrahim, A. Trauma intensive care in a terror-ravaged, resource-constrained setting: are we prepared for the emerging challenge? Afr J Emerg Med. 2019;9(Suppl):S32–S37.CrossRefGoogle Scholar
Omole, O, Welye, H, Abimbola, S. Boko Haram insurgency: implications for public health. The Lancet. 2015;385(9972):941.Google ScholarPubMed
Vision of Humanity. Global Terrorism Index - Countries most impacted by terrorism. Published 2022. https://www.visionofhumanity.org/maps/global-terrorism-index/#/. Accessed August 14, 2022.Google Scholar
The World Bank. Sub-Saharan Africa | Data. Published 2022. https://data.worldbank.org/country/ZG. Accessed July 26, 2022.Google Scholar
Department of African and African American studies. Introduction to African Languages | The African Language Program at Harvard. Published 2022. https://alp.fas.harvard.edu/introduction-african-languages. Accessed July 26, 2022.Google Scholar
Atran, S. The devoted actor: unconditional commitment and intractable conflict across cultures. Curr Anthropol. 2016;57(S13):S192–S203.Google Scholar
Tahir, M, Ibne Afzal, MN, Afridi, MA, Naseem, I, Bin Saeed, B. Terrorism and its determinants in the Sub-Saharan Africa region: some new insights. African Development Review. 2019;31(3):393–406.CrossRefGoogle Scholar
Marc, A. 20 years after 9/11, jihadi terrorism rises in Africa. Published 2021. https://www.brookings.edu/blog/order-from-chaos/2021/08/30/20-years-after-9-11-jihadi-terrorism-rises-in-africa/. Accessed July 26, 2022.Google Scholar
United Nations. Terrorist groups ‘exploiting power vacuums,’ UN chief warns. Published 2022. https://news.un.org/en/story/2022/06/1119992. Accessed August 31, 2022.Google Scholar
Geldsetzer, P, Reinmuth, M, Ouma, PO, et al. Mapping physical access to healthcare for older adults in sub-Saharan Africa: a cross-sectional analysis with implications for the COVID-19 response. medRxiv. 2020. Preprint.Google Scholar
Ojeleke, O, Groot, W, Bonuedi, I, Pavlova, M. The impact of armed conflicts on health-care utilization in Northern Nigeria: a difference-in-differences analysis. World Med Health Policy. 2022;14(4):624–664.Google Scholar
Ekzayez, A, Alhaj Ahmad, Y, Alhaleb, H, Checchi, F. The impact of armed conflict on utilization of health services in north-west Syria: an observational study. Confl Health. 2021;15(1):91.Google ScholarPubMed
Court, M, Edwards, B, Issa, F, Voskanyan, A, Ciottone, G. Counter-Terrorism Medicine: creating a medical initiative mandated by escalating asymmetric attacks. Prehosp Disaster Med. 2020;35(6):595–598.CrossRefGoogle ScholarPubMed
START (National Consortium for the Study of Terrorism and Responses to Terrorism). Global Terrorism Database 1970-2020. Published 2022. https://www.start.umd.edu/gtd. Accessed September 14, 2022.Google Scholar
Ogbonnaya, UM. Terrorism, Agenda 2063, and the challenges of development in Africa. South African Journal of International Affairs. 2016;23(2):185–199.Google Scholar
Agbiboa, DE. Borders that continue to bother us: the politics of cross-border security cooperation in Africa’s Lake Chad Basin. Commonw Comp Polit. 2017;55(4):403–425.Google Scholar
United Nations Counter-Terrorism Committee Executive Directorate (CTED). Civil Society Perspectives: ISIL in Africa – Key trends and developments. Published 2022. https://www.un.org/securitycouncil/ctc/sites/www.un.org.securitycouncil.ctc/files/files/documents/2022/Apr/cted_civil_society_perspectives_isil_in_africa_april_2022.pdf. Accessed September 16, 2022.Google Scholar
Tin, D, Margus, C, Ciottone, GR. Half-a-century of terrorist attacks: weapons selection, casualty outcomes, and implications for counter-terrorism medicine. Prehosp Disaster Med. 2021;36(5):526–530.CrossRefGoogle ScholarPubMed
Tin, D, Hart, A, Ciottone, GR. Rethinking disaster vulnerabilities. Am J Emerg Med. 2021;45:660–661.CrossRefGoogle ScholarPubMed
Tin, D, Granholm, F, Hart, A, Ciottone, GR. Terrorism-related chemical, biological, radiation, and nuclear attacks: a historical global comparison influencing the emergence of Counter-Terrorism Medicine. Prehosp Disaster Med. 2021;36(4):399–402.Google ScholarPubMed
Bieler, D, Franke, A, Kollig, E, et al. Terrorist attacks: common injuries and initial surgical management. Eur J Trauma Emerg Surg. 2020;46(4):683–694.CrossRefGoogle ScholarPubMed
Hussain, N, Okeke, IBJ, Oyebanji, AE, Akunne, JI, Omoruyi, OJ. Combat injuries sustained by troops on counter terrorism and counter-insurgency operations in North east Nigeria: implications for intervention. Afr J Emerg Med. 2021;11(1):196–201.CrossRefGoogle ScholarPubMed
Malchow, RJ, Black, IH. The evolution of pain management in the critically ill trauma patient: emerging concepts from the global war on terrorism. Crit Care Med. 2008;36(7 Suppl).Google ScholarPubMed
Celso, B, Tepas, J, Langland-Orban, B, et al. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma. 2006;60(2):371–378; discussion 378.Google ScholarPubMed
Van, DB, Song, KJ, Do, Shin S, et al. Association between scene time interval and survival in EMS-treated major trauma admitted to the intensive care unit: a multinational, multicenter observational study. Prehosp Emerg Care. 2022;26(4):600–607.Google Scholar
Alayande, B, Chu, KM, Jumbam, DT, et al. Disparities in access to trauma care in Sub-Saharan Africa: a narrative review. Curr Trauma Rep. 2022;8(3):66–94.CrossRefGoogle ScholarPubMed
Alfa-Wali, M, Sritharan, K, Mehes, M, Abdullah, F, Rasheed, S. Terrorism-related trauma in Africa, an increasing problem. J Epidemiol Glob Health. 2015;5(2):201–203.CrossRefGoogle ScholarPubMed
Butler, FK, Bennett, B, Wedmore, CI. Tactical combat casualty care and wilderness medicine: advancing trauma care in austere environments. Emerg Med Clin North Am. 2017;35(2):391–407.CrossRefGoogle ScholarPubMed
Seedat, M, Van Niekerk, A, Jewkes, R, Suffla, S, Ratele, K. Violence and injuries in South Africa: prioritizing an agenda for prevention. Lancet. 2009;374(9694):1011–1022.CrossRefGoogle ScholarPubMed
Vincent-Lambert, C, Westwood, R. Students’ views on the need for hostile environment awareness training for South African emergency medical care students. Afr J Health Prof Educ. 2019;11(1):12.CrossRefGoogle Scholar
United Nations Children’s Fund. Maternal mortality rates and statistics - UNICEF DATA. Published 2021. https://data.unicef.org/topic/maternal-health/maternal-mortality/. Accessed August 28, 2022.Google Scholar
World Health Organization. Newborn mortality. https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-mortality-report-2021. Accessed August 28, 2022.Google Scholar
Østby, G, Urdal, H, Tollefsen, AF, Kotsadam, A, Belbo, R, Ormhaug, C. Organized violence and institutional child delivery: micro-level evidence from Sub-Saharan Africa, 1989-2014. Demography. 2018;55(4):1295–1316.Google ScholarPubMed
Kotsadam, A, Østby, G. Armed conflict and maternal mortality: a micro-level analysis of sub-Saharan Africa, 1989-2013. Soc Sci Med. 2019;239:112526.CrossRefGoogle ScholarPubMed
Keasley, J, Blickwedel, J, Quenby, S. Adverse effects of exposure to armed conflict on pregnancy: a systematic review. BMJ Glob Health. 2017;2(4):e000377.CrossRefGoogle ScholarPubMed
Druetz, T, Browne, L, Bicaba, F, Mitchell, MI, Bicaba, A. Effects of terrorist attacks on access to maternal healthcare services: a national longitudinal study in Burkina Faso. BMJ Glob Health. 2020;5(9):e002879.CrossRefGoogle ScholarPubMed
Lagrou, D, Zachariah, R, Bissell, K, et al. Provision of emergency obstetric care at secondary level in a conflict setting in a rural area of Afghanistan - is the hospital fulfilling its role? Confl Health. 2018;12(1):2.CrossRefGoogle Scholar
Dunn, G. The impact of the Boko Haram insurgency in Northeast Nigeria on childhood wasting: a double-difference study. Confl Health. 2018;12(1):6.Google ScholarPubMed
United Nations Children’s Fund. Education under attack | UNICEF. Published 2022. https://www.unicef.org/education-under-attack. Accessed September 16, 2022.Google Scholar
Eseosa Ekhator-Mobayode, U, Hanmer, LC, Rubiano-Matulevich, E, Jimena Arango, D. The effect of armed conflict on intimate partner violence: evidence from the Boko Haram insurgency in Nigeria. World Dev. 2022;153:105780.CrossRefGoogle Scholar
Office of the Director of National Intelligence. Global trends. Published 2021. https://www.dni.gov/index.php/gt2040-home/gt2040-5-year-regional-outlooks/sub-saharan-africa. Accessed August 28, 2022.Google Scholar
Levin, AT, Owusu-Boaitey, N, Pugh, S, et al. Assessing the burden of COVID-19 in developing countries: systematic review, meta-analysis, and public policy implications. BMJ Glob Health. 2022;7(5):e008477.CrossRefGoogle ScholarPubMed
Selassie, AA, Habtamu, F. Seven charts that show Sub-Saharan Africa at a crucial point. IMF African Department. Published 2021. https://www.imf.org/en/News/Articles/2021/10/20/na102021-seven-charts-that-show-sub-saharan-africa-at-a-crucial-point. Accessed September 14, 2022.Google Scholar
Deaton, AS, Tortora, R. People in Sub-Saharan Africa rate their health and health care among the lowest in the world. Health Aff (Millwood). 2015;34(3):519–527.CrossRefGoogle ScholarPubMed
Basit, A. The COVID-19 pandemic. Counter Terrorist Trends and Analyses. 2020;12(3):7–12.Google Scholar