Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-05-23T00:15:28.427Z Has data issue: false hasContentIssue false

A Proposed Universal Medical and Public Health Definition of Terrorism

Published online by Cambridge University Press:  28 June 2012

Jeffrey L. Arnold*
Office of Emergency Preparedness, Yale New Haven Center for Emergency and Terrorism Preparedness, Yale New Haven Health System, New Haven, Connecticut, USA
Per Örtenwall
Beredskapsenheten, Goteborg, Sweden
Marvin L. Birnbaum
Emergency Medical Services Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
Knut Ole Sundnes
Office for War Surgery and Emergency Medicine, Joint Medical Command, Norwegian Defense Forces, Sessvollmoen, Norway
Anil Aggrawal
Professor of Forensic Medicine, Maulana Azad Medical College, New Delhi, India
V. Arantharaman
Department of Emergency Medicine, Singapore General Hospital, Singapore
Abdul Wahab Al Musleh
Chairman of Accident and Emergency and EMS, Assistant Medical Director, Director of Hamad International Training Center, Hamad General Hospital, Doha, Qatar
Yasufumi Asai
Chairman, Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan
Frederick M. Burkle Jr.
The Center for International Emergency, Disaster and Refugee Studies, The Schools of Public Health and Medicine, Johns Hopkins University Medical Institutions, Baltimore, USA
Jae Myung Chung
Chairman and Professor, Department of Emergency Medicine, Kyungpook National University Hospital, Taegu, South Korea
Felipe Cruz Vega
Disaster Division Head, Mexican Social Security Institute, Mexico City, Mexico
Michel Debacker
Senior Lecturer in Disaster Medicine, Free University Brussels and Catholic, University of Leuven, Belgium
Francesco Della Corte
Department of Anesthesiology and Intensive Care, Università del Piemonte Orientale, Novara, Italy
Herman Delooz
Department of Emergency Medicine, Free University of Brussels, Belgium
Garth Dickinson
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
Timothy Hodgetts
Royal Centre for Defence Medicine, Selly Oak Hospital, Birmingham, United Kingdom
C. James Holliman
Department of Emergency Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania, USA
Campbell MacFarlane
Head of EMS Training, Gauteng Provincial Government, South Africa and Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
Ulkumen Rodoplu
Emergency Medicine Association of Turkey, Izmir, Turkey
Edita Stok
Ministry of Health, Ljubljana, Slovenia
Ming-Che Tsai
Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan Republic of China
Medical Director Yale New Haven Center for Emergency and Terrorism Preparedness, 1 Church Street, 5th floor, New Haven, CT 06510 USA, E-mail:


The lack of a universally applicable definition of terrorism has confounded the understanding of terrorism since the term was first coined in 18th Century France. Although a myriad of definitions of terrorism have been advanced over the years, virtually all of these definitions have been crisis-centered, frequently reflecting the political perspectives of those who seek to define it.

In this article, we deconstruct these previously used definitions of terrorism in order to reconstruct a definition of terrorism that is consequence-centered, medically relevant, and universally harmonized. A universal medical and public health definition of terrorism will facilitate clinical and scientific research, education, and communication about terrorism-related events or disasters.

We propose the following universal medical and public definition of terrorism: The intentional use of violence — real or threatened — against one or more non-combatants and/or those services essential for or protective of their health, resulting in adverse health effects in those immediately affected and their community, ranging from a loss of well-being or security to injury, illness, or death.

Theoretical Discussion
Copyright © World Association for Disaster and Emergency Medicine 2003

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.)


1. Council on Foreign Relations: Terrorism: An introduction. Council on Foreign Relations. Web site. Available at Accessed 01 June 2003.Google Scholar
2. Malik, O: Enough of the Definition of Terrorism. London: Royal Institute of International Affairs, 2000, pp 166.Google Scholar
3. Altran, S: Genesis of suicide terrorism. Science 2003; 299:15341539.CrossRefGoogle Scholar
4. Commission of the European Communities: Proposal for a Council Framework Decision on Combating Terrorism. The European Union On-Line Web site. Available at Accessed 20 June 2003.Google Scholar
5. Department of Justice, Canada: Royal Assent of Bill C-36, The Anti-Terrorism Act. Department of Justice Web site. Available at Accessed 20 June 2003.Google Scholar
6. Federal Bureau of Investigation: Terrorism in the United States 1999. Federal Bureau of Investigation Web site. Available at Accessed 01 June 2003.Google Scholar
7. Ganor, B: Defining terrorism: Is one man's terrorist another man's freedom fighter? The International Policy Institute for Counter-Terrorism Web site. Available at Accessed 01 June 2003.Google Scholar
8. National Center for Health Statistics: Classification of death and injury resulting from terrorism. Centers for Disease Control Web site. Available at Accessed 01 June 2003.Google Scholar
9. United Kingdom Parliament: Terrorism Act 2000. HMSOnline Web site. Available at Accessed 20 June 2003.Google Scholar
10. United Nations Office on Drug and Crime: Definitions of terrorism. United Nations Office on Drug and Crime. Web site. Available at Accessed 01 June 2003.Google Scholar
11. Beaton, R, Murphy, S: Psychosocial responses to biological and chemical terrorist threats and events. Implications for the workplace. AAOHN Journal 2002; 50: 182189.CrossRefGoogle ScholarPubMed
12. Centers for Disease Control and Prevention: New classification for deaths and injuries involving terrorism. MMWR 2002; 51(special issue):1819.Google Scholar
13. The Oxford English Dictionary (CD-ROM, version 3.0) 2nd ed. New York, NY: Oxford University Press; 2002.Google Scholar
14. Brown, L (ed): The New Shorter Oxford English Dictionary on Historical Principles. 4th ed. New York: Oxford University Press, 1999, pp 13801.Google Scholar
15. Krug, EG, Dahlberg, LL, Mercy, JA, Zwi, AB, Lozano, R (eds): World Report on Violence and Health. Geneva: World Health Organization, 2002, p 5.Google ScholarPubMed
16. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p 100) and entered into force on 07 April 1948.Google Scholar
17. Friel, JP (ed): Dorland's Illustrated Medical Dictionary. 26th ed. Philadelphia: WB. Saunders Company, 1981, p 583.Google Scholar
18. Price-Smith, AT. Wilson's bridge: A Consilient Methodology for Analysis of Complex Biological-Political Relationships. Program on Health and Global Affairs (PHEGA), University of Toronto: Center for International Studies working paper 1998–8. November 1998. pp 243.Google Scholar
19. Burkle, FM: Mass casualty management of a large-scale bioterrorist event: An epidemiological approach that shapes triage decisions. Emerg Med Clin N Am 2002; 20: 409436.CrossRefGoogle ScholarPubMed
20. Zwi, A, Uglade, A: Political violence in the third world: A public health issue. Health Policy and Planning 1991; 6: 203217.CrossRefGoogle Scholar
21. International Committee of the Red Cross: International Humanitarian Law. Answers to Your Questions. Geneva: International Committee of the Red Cross, 2002, p 35.Google Scholar