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Terrorist Attacks against Hospitals: World-Wide Trends and Attack Types

Published online by Cambridge University Press:  18 January 2022

Nitzan Ulmer ,
Dennis G. Barten Open the ORCID record for Dennis G. Barten [Opens in a new window] ,
Harald De Cauwer Open the ORCID record for Harald De Cauwer [Opens in a new window] ,
Menno I. Gaakeer ,
Vincent W. Klokman Open the ORCID record for Vincent W. Klokman [Opens in a new window] ,
Monique van der Lugt ,
Luc J. Mortelmans ,
Frits H.M. van Osch ,
Edward C.T.H. Tan  and
Arjen Boin
Nitzan Ulmer
Affiliation:
Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
Dennis G. Barten*
Affiliation:
Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
Harald De Cauwer
Affiliation:
Department of Neurology, Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
Menno I. Gaakeer
Affiliation:
Department of Emergency Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands
Vincent W. Klokman
Affiliation:
Department of Emergency Medicine, The Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
Monique van der Lugt
Affiliation:
Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
Luc J. Mortelmans
Affiliation:
Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium REGEDIM, Free University Brussels, Brussels, Belgium Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
Frits H.M. van Osch
Affiliation:
Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands NUTRIM, School of Nutrition and Metabolism, Maastricht University, Maastricht, The Netherlands
Edward C.T.H. Tan
Affiliation:
Department of Trauma Surgery and Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
Arjen Boin
Affiliation:
Department of Political Science, Leiden University, Leiden, The Netherlands
*
Correspondence: D.G. Barten, MD Department of Emergency Medicine VieCuri Medical Center P.O. Box 1926, 5900 BX Venlo The Netherlands E-mail: dbarten@viecuri.nl
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Abstract

Background:

Analysts have warned on multiple occasions that hospitals are potential soft targets for terrorist attacks. Such attacks will have far-reaching consequences, including decreased accessibility, possible casualties, and fear among people. The extent, incidence, and characteristics of terrorist attacks against hospitals are unknown. Therefore, the objective of this study was to identify and to characterize terrorist attacks against hospitals reported to the Global Terrorism Database (GTD) over a 50-year period.

Methods:

The GTD was used to search for all terrorist attacks against hospitals from 1970-2019. Analyses were performed on temporal factors, location, attack and weapon type, and number of casualties or hostages. Chi-square tests were performed to evaluate trends over time and differences in attack types per world region.

Results:

In total, 454 terrorist attacks against hospitals were identified in 61 different countries. Of these, 78 attacks targeted a specific person within the hospital, about one-half (52.6%) involved medical personnel. There was an increasing trend in yearly number of attacks from 2008 onwards, with a peak in 2014 (n = 41) and 2015 (n = 41). With 179 incidents, the “Middle East & North Africa” was the most heavily hit region of the world, followed by “South Asia” with 125 attacks. Bombings and explosions were the most common attack type (n = 270), followed by 77 armed assaults. Overall, there were 2,746 people injured and 1,631 fatalities. In three incidents, hospitals were identified as secondary targets (deliberate follow-up attack on a hospital after a primary incident elsewhere).

Conclusion:

This analysis of the GTD identified 454 terrorist attacks against hospitals over a 50-year period. It demonstrates that the threat is real, especially in recent years and in world regions where terrorism is prevalent. The findings of this study may help to create or further improve contingency plans for a scenario wherein the hospital becomes a target of terrorism.

Keywords

counter-terrorism medicinehospital preparednesssafetyterrorismviolence
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 1 , February 2022 , pp. 25 - 32
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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Footnotes

N Ulmer and DG Barten contributed equally to the manuscript.

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