Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-24T01:52:00.068Z Has data issue: false hasContentIssue false
  • English
  • Français

The Rising Threat of Terrorist Attacks Against Hospitals

Published online by Cambridge University Press:  24 March 2022

Bryan McNeilly Open the ORCID record for Bryan McNeilly [Opens in a new window] ,
Gregory Jasani Open the ORCID record for Gregory Jasani [Opens in a new window] ,
Garrett Cavaliere ,
Reem Alfalasi  and
Benjamin Lawner
Bryan McNeilly*
Affiliation:
University of Maryland Medical Center - Department of Emergency Medicine, Baltimore, MarylandUSA
Gregory Jasani
Affiliation:
University of Maryland School of Medicine - Department of Emergency Medicine, Baltimore, MarylandUSA
Garrett Cavaliere
Affiliation:
University of Maryland Medical Center - Department of Emergency Medicine, Baltimore, MarylandUSA
Reem Alfalasi
Affiliation:
New York Presbyterian-Columbia Irving Medical Center - Department of Critical Care Medicine, New York, New YorkUSA
Benjamin Lawner
Affiliation:
University of Maryland School of Medicine - Department of Emergency Medicine, Baltimore, MarylandUSA
*
Correspondence: Bryan McNeilly, MD 110 S Paca St 6th floor, Ste 200 Baltimore, Maryland21201USA E-mail: bryan.mcneilly@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible to the general public. Hospitals are also occupied with both staff and patients 24 hours a day, 365 days a year, meaning that any attack is almost guaranteed to inflict a multitude of casualties. In addition to the immediate effects of attacking a hospital, there are also uniquely devastating second- and third-order effects when hospitals are attacked.

Methods:

A focused search of the Global Terrorism Database (GTD) was performed to identify terrorist attacks against hospitals throughout the world. Data between the years 1970-2018 were selected, which included 191,465 entries in total. These entries were then searched for incidents containing the term “hospital” and the results were manually searched to identify trends in the number of incidents occurring per year, as well as the armament that was employed, and the regions of the world where the attacks occurred.

Results:

A total of 430 terrorist attacks on hospitals were identified in the GTD, resulting in 1,291 deaths and an additional 1,921 wounded. The frequency of terrorist attacks against hospitals has been steadily increasing over the last two decades and is disproportionate to the overall increase in terrorist attacks against all target types. Attacks have been carried out against hospitals in 61 different countries. The most common method used in these attacks was “bombing/explosion,” which accounted for 299 attacks. Of the known terrorist groups identified in the GTD, “Houthi extremists (Anshar Allah)” and “Islamic State of Iraq and the Levant (ISIL)” carried out the greatest number of attacks on hospitals.

Conclusion:

There has been a disproportionate rise in the frequency of terrorist attacks on hospitals when compared to other target types, highlighting the vulnerability of these key structures. Unsurprisingly, these attacks have inflicted large casualty counts in addition to disrupting community health care and disaster response. Attacks against hospitals have been reported on every inhabited continent except Australia, making their protection a matter of international security. The rate of terrorist attacks on hospitals has increased dramatically over the last two decades, creating an urgent need to develop improved defense strategies that will better ensure their protection.

Keywords

disaster medicinecounter-terrorism medicinehospital attackshospital securityterrorismterrorist attacks
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 2 , April 2022 , pp. 223 - 229
Check for updates
Copyright
© The Author(s), 2022. 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

De Cauwer, H, Somville, F, Sabbe, M, Mortelmans, L. Hospitals: soft target for terrorism? Prehosp Disaster Med. 2017;32(1):94–100.10.1017/S1049023X16001217Google ScholarPubMed
Martin, R. Soft targets are easy terror targets: increased frequency of attacks, practical preparation, and prevention. Forensic Research Criminology International Journal. 2016;3(2):273–278.10.15406/frcij.2016.03.00087Google Scholar
Cavaliere, G, Alfalasi, R, Jasani, G, Ciottone, G, Lawner, B. Terrorist attacks against healthcare facilities: a review. Health Secur. 2021;19(5):546–550.10.1089/hs.2021.0004Google ScholarPubMed
Jasani, G, Alfalasi, R, Cavaliere, G, Ciottone, G, Lawner, B. Terrorists use of ambulances for terror attacks: a review. Prehosp Disaster Med. 2021;36(1):14–17.10.1017/S1049023X20001260Google ScholarPubMed
Tin, D, Hart, A, Ciottone, G. Hardening hospital defenses as a counter-terrorism medicine measure. Am J Emerg Med. 2021;45:667–668.10.1016/j.ajem.2020.10.051Google Scholar
Ganor, B, Wernli, M. Terrorist attacks against hospitals case studies. International Institute for Counter-Terrorism. 2013. http://www.jstor.org/stable/resrep09457. Accessed August 2021.Google Scholar
Hancock, C, Johnson, C. Thinking the unthinkable: exposing the vulnerabilities in the NHS response to coordinated terrorist actions. International Systems Safety Conference. 2007. ∼http://www.dcs.gla.ac.uk/∼johnson/papers/NHS_terrorism.pdf. Accessed August 2021.Google Scholar
O’Reilly, D, Brohi, K. “Effects of terrorism on the healthcare community.” In: Shapira, S, Hammond, S, Cole, L. Essentials of Terror Medicine. New York USA: Springer; 2009.Google Scholar
Ellenberg, E, Taragin, M, Ostfeld, I. The medical costs of terror: a review of the literature. Am J Disaster Med. 2019;14(1):65–70.10.5055/ajdm.2019.0316Google ScholarPubMed
Mass Violence and Behavioral Health. Disaster technical assistance center supplemental research bulletin. https://www.samhsa.gov/sites/default/files/dtac/srb-mass-violence-behavioral-health.pdf. Accessed August 2021Google Scholar
Green, D, Buehler, J, Silk, B, et al. Trends in healthcare use in the New York City region following the terrorist attacks of 2001. Biosecur Bioterror. 2006;4(3):263–275.10.1089/bsp.2006.4.263Google ScholarPubMed
Ekström, A, Eng-Larsson, F, Isaksson, O, et al. The effect of a terrorist attack on emergency department inflow: an observation study using difference-in-differences methodology. Scand J Trauma Resusc Emerg Med. 2019;27(1):57.10.1186/s13049-019-0634-2Google ScholarPubMed
Global Terrorism Database. Code book: inclusion criteria and variables. 2019. https://www.start.umd.edu/gtd/downloads/Codebook.pdf. Accessed August 2021.Google Scholar
Council of Foreign Relations. Terrorism by the numbers. https://world101.cfr.org/global-era-issues/terrorism/terrorism-numbers#media-asset-1323. Accessed August 2021.Google Scholar
Schmid, A. Handbook of terrorism prevention and preparedness. 2020. https://icct.nl/handbook-of-terrorism-prevention-and-preparedness/. Accessed August 2021.Google Scholar
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):595–598.10.1017/S1049023X2000103XGoogle ScholarPubMed
Wax, J, Cartin, A, Craig, W, Pinette, M. US acute care hospital shootings, 2012-2016: a content analysis study. Work. 2019;64(1):77–83.10.3233/WOR-192970Google Scholar
Physicians for Human Rights. Attacks on health care in Syria. 2021. https://syriamap.phr.org/#/en/findings. Accessed August 2021.Google Scholar