Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-15T21:44:03.899Z Has data issue: false hasContentIssue false
  • English
  • Français

50 Years of Mass-Fatality Terrorist Attacks: A Retrospective Study of Target Demographics, Modalities, and Injury Patterns to Better Inform Future Counter-Terrorism Medicine Preparedness and Response

Part of: Prehospital and Disaster Medicine Counterterrorism Collection

Published online by Cambridge University Press:  09 August 2021

Derrick Tin Open the ORCID record for Derrick Tin [Opens in a new window] ,
Attila J. Hertelendy Open the ORCID record for Attila J. Hertelendy [Opens in a new window] ,
Alexander Hart  and
Gregory R. Ciottone
Derrick Tin*
Affiliation:
Senior Fellow, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Cambridge, MassachusettsUSA
Attila J. Hertelendy
Affiliation:
Faculty, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA
Alexander Hart
Affiliation:
Director of Research, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Instructor, Harvard Medical School, Boston, MassachusettsUSA
Gregory R. Ciottone
Affiliation:
Director, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA
*
Correspondence: Derrick Tin, MBBS BIDMC Disaster Medicine Fellowship Department of Emergency Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Cambridge, MassachusettsUSA E-mail: derrick@alphazodiac.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Terrorism-related deaths have fallen year after year since peaking in 2014, and whilst the coronavirus disease 2019 (COVID-19) pandemic has disrupted terrorist organizations capacity to conduct attacks and limited their potential targets, counter-terrorism experts believe this is a short-term phenomenon with serious concerns of an escalation of violence and events in the near future. This study aims to provide an epidemiological analysis of all terrorism-related mass-fatality events (>100 fatalities) sustained between 1970-2019, including historical attack strategies, modalities used, and target selection, to better inform health care responders on the injury types they are likely to encounter.

Methods:

The Global Terrorism Database (GTD) was searched for all attacks between the years 1970-2019. Attacks met inclusion criteria if they fulfilled the three terrorism-related criteria as set by the GTD codebook. Ambiguous events were excluded. State-sponsored terrorist events do not meet the codebook’s definition, and as such, are excluded from the study. Data analysis and subsequent discussions were focused on events causing 100+ fatal injuries (FI).

Results:

In total, 168,003 events were recorded between the years 1970-2019. Of these, 85,225 (50.73%) events recorded no FI; 67,356 (40.10%) events recorded 1-10 FI; 5,791 (3.45%) events recorded 11-50 FI; 405 (0.24%) events recorded 51-100 FI; 149 (0.09%) events recorded over 100 FI; and 9,077 (5.40%) events recorded unknown number of FI.

Also, 96,905 events recorded no non-fatal injuries (NFI); 47,425 events recorded 1-10 NFI; 8,313 events recorded 11-50 NFI; 867 events recorded 51-100 NFI; 360 events recorded over 100 NFI; and 14,130 events recorded unknown number of NFI. Private citizens and property were the primary targets in 67 of the 149 high-FI events (100+ FI). Of the 149 events recording 100+ FI, 46 (30.87%) were attributed to bombings/explosions as the primary attack modality, 43 (28.86%) were armed assaults, 23 (15.44%) hostage incidents, two (1.34%) were facility/infrastructure attacks (incendiary), one (0.67%) was an unarmed assault, seven (4.70%) had unknown modalities, and 27 (18.12%) were mixed modality attacks.

Conclusions:

The most common attack modality causing 100+ FI was the use of bombs and explosions (30.87%), followed by armed assaults (28.86%). Private citizens and properties (44.97%) were most commonly targeted, followed by government (6.04%), businesses (5.37%), police (4.70%), and airports and aircrafts (4.70%). These data will be useful for the development of training programs in Counter-Terrorism Medicine (CTM), a rapidly emerging Disaster Medicine sub-specialty.

Keywords

counter-terrorism medicinedisaster medicinemass casualtyterrorism
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 5 , October 2021 , pp. 531 - 535
Check for updates
Copyright
© The Author(s), 2021. 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

Dudley, D. Coronavirus Prompts Fall in Terrorist Activity, But Effect Could Be Short-lived. Forbes. https://www.forbes.com/sites/dominicdudley/2020/11/25/coronavirus-prompts-fall-in-terrorist-activity-but-downturn-could-be-shortlived/?sh=51c1913b7e95. Accessed March 19, 2021.Google Scholar
Arianti, V, Muh, Taufiqurrohman. The impact of Covid-19 on terrorist financing in Indonesia. The Diplomat. https://thediplomat.com/2020/11/the-impact-of-covid-19-on-terrorist-financing-in-indonesia/. Accessed March 19, 2021.Google Scholar
Kruglanski, AW, Gunaratna, R, Ellenberg, M, Speckhard, A. Terrorism in time of the pandemic: exploiting mayhem. Glob Secur Heal Sci Policy. 2020;5(1):121–132.CrossRefGoogle Scholar
INTERPOL – Terrorist groups using COVID-19 to reinforce power and influence. Interpol. Special Report. https://www.interpol.int/en/News-and-Events/News/2020/INTERPOL-Terrorist-groups-using-COVID-19-to-reinforce-power-and-influence. Accessed March 19, 2021.Google Scholar
Barton, G. In COVID’s shadow, global terrorism goes quiet. But we have seen this before, and should be wary. The Conversation. https://theconversation.com/in-covids-shadow-global-terrorism-goes-quiet-but-we-have-seen-this-before-and-should-be-wary-144286. Accessed March 19, 2021.Google Scholar
Anticipating Rise in Extremist Activity amid COVID-19. UN Security Council. Press Release. https://www.un.org/press/en/2020/sc14363.doc.htm. Accessed March 19, 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.CrossRefGoogle ScholarPubMed
Global Terrorism Database (GTD). START.umd.edu. https://www.start.umd.edu/data-tools/global-terrorism-database-gtd. Accessed March 14, 2021.Google Scholar
Codebook: Inclusion Criteria and Variables. College Park, Maryland USA: National Consortium for the Study of Terrorism and Responses to Terrorism; 2019.Google Scholar
Human Rights Watch. Iraq: ISIS Executed Hundreds of Prison Inmates. Human Rights Watch. https://www.hrw.org/news/2014/10/30/iraq-isis-executed-hundreds-prison-inmates. Accessed March 16, 2021.Google Scholar
Labott, E, Kopan, T. John Kerry: ISIS responsible for genocide. CNN. https://edition.cnn.com/2016/03/17/politics/us-iraq-syria-genocide/index.html. Accessed March 16, 2021.Google Scholar
Horror in Mogadishu - A bomb blast in Somalia’s capital exposes the government’s failures. Middle East & Africa. The Economist. https://www.economist.com/middle-east-and-africa/2017/10/17/a-bomb-blast-in-somalias-capital-exposes-the-governments-failures. Accessed March 16, 2021.Google Scholar
Comparison of the largest terrorist groups. https://www.worlddata.info/terrorism/groups.php. Accessed March 30, 2021.Google Scholar
Rozenfeld, M, Peleg, K. Categorization of terrorist explosion settings - Is it that simple? Injury. 2016;47(6):1358–1359.CrossRefGoogle ScholarPubMed
Edwards, DS, McMenemy, L, Stapley, SA, Patel, HDL, Clasper, JC. 40 years of terrorist bombings-a meta-analysis of the casualty and injury profile. Injury. 2016;47(3):646–652.CrossRefGoogle ScholarPubMed
Magnus, D, Khan, MA, Proud, WG. Epidemiology of civilian blast injuries inflicted by terrorist bombings from 1970-2016. Def Technol. 2018;14(5):469–476.CrossRefGoogle Scholar
Sorbie, C. Explosions and blast injuries. CDC Inj Prev Dep Heal Hum Serv. 2009;32(11).Google ScholarPubMed
Tessler, RA, Mooney, SJ, Witt, CE, et al. Use of firearms in terrorist attacks: differences between the United States, Canada, Europe, Australia, and New Zealand. JAMA Intern Med. 2017;177(12):1865–1868.CrossRefGoogle Scholar
Stefanopoulos, PK, Mikros, G, Pinialidis, DE, Oikonomakis, IN, Tsiatis, NE, Janzon, B. Wound ballistics of military rifle bullets: an update on controversial issues and associated misconceptions. J Trauma Acute Care Surg. 2019;87(3):690–698.CrossRefGoogle ScholarPubMed
Tin, D, Hertelendy, AJ, Issa, F, Ciottone, GR. Understanding adaptive bioterrorism methods: counter terrorism medicine implications of Bongkrekic acid poisoning. J High Threat Austere Med. 2021;3(1):2015–2017.CrossRefGoogle Scholar
Hugelius, K, Becker, J, Adolfsson, A. Five challenges when managing mass casualty or disaster situations: a review study. Int J Environ Res Public Health. 2020;17(9).CrossRefGoogle ScholarPubMed
Gabbe, BJ, Veitch, W, Curtis, K, et al. Survey of major trauma center preparedness for mass casualty incidents in Australia, Canada, England, and New Zealand. EClinicalMedicine. 2020;21:100322.CrossRefGoogle ScholarPubMed
De Cauwer, H, Somville, F, Sabbe, M, Mortelmans, LJ. Hospitals: soft target for terrorism? Prehosp Disaster Med. 2017;32(1):94–100.CrossRefGoogle ScholarPubMed
Tavares, W. Impact of terrorist attacks on hospitals. J Emerg Nurs. 2018;44(2):188–190.CrossRefGoogle ScholarPubMed
Tin, D, Hart, A, Ciottone, GR. Rethinking disaster vulnerabilities. Am J Emerg Med. 2021;45;660–661.CrossRefGoogle ScholarPubMed
Tin, D, Hart, A, Ciottone, GR. Hardening hospital defenses as a counter-terrorism medicine measure. Am J Emerg Med. 2021;45:667–668.CrossRefGoogle Scholar
Peleg, K, Bodas, M, Hertelendy, AJ, Kirsch, TD. The COVID-19 pandemic challenge to the all-hazards approach for disaster planning. Int J Disaster Risk Reduct. 2021;55:102103.CrossRefGoogle Scholar