Health Care Implications of Terrorist Attacks in South Asia

Abstract

Background: The recent United States (US) troop withdrawal out of Afghanistan under a February 2020 US-Taliban agreement and the rapid concurrent collapse of the Afghan military, followed by the ascendance of the Taliban, has placed an international spotlight around the future of South Asian countries. Security threats, in particular, will likely escalate within the region and beyond, with significant concerns around the resurgence of terrorism and violence in the region. This study aims to provide an epidemiological description of all terrorism-related attacks in South Asia sustained from 1970 – 2019. These data will be useful in the development of education programs in Counter-Terrorism Medicine and provide an insight into potential attacks in the future. Methods: Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database search functions for all events which occurred in Afghanistan, Bangladesh, Bhutan, India, Maldives, Mauritius, Nepal, Pakistan, and Sri Lanka (collectively referred to as South Asia) from January 1, 1970 - December 31, 2019. Primary weapon type, primary target type, country where the incident occurred, and number of deaths and injuries were collated and exported for analysis. Results: In total, 23.69% of all terrorist attacks from 1970-2019 occurred in the South Asia region, causing 96,092 deaths and 141,333 non-fatal injuries. Of those, 50.1% of attacks in South Asia used explosives, 31.9% used firearms, 9.4% used unknown weapons, 5.9% used incendiary attacks, 2.3% were melee attacks, and <0.5% used chemical, biological, and other weapon types. Conclusion: Over 88% of the attacks occurred in Afghanistan, Pakistan, and India combined. While there has been a decline in attacks since a peak in 2014, there are concerns of a significant increase in terrorism activity in recent months which could impact an already fragmented health care system. The use of explosives and firearms as attack modalities accounted for 82.0 % of all weapon types used, but the impact of terrorism and conflict expands beyond simple death and casualty tolls.

Terrorism-Related Attacks in East Asia from 1970 through 2020

“…This follows the same trends seen in Western Europe, Eastern Europe, Middle East, and South Asia for similar study periods. 9,10,23,24 On the contrary, incendiary weapons were the most frequent weapon type, and firearms were the second, in the United States from 2008 through 2018. 13 This difference is due to the ease of accessibility of the population to assault weapons in the United States as opposed to other countries where firearms are more highly regulated.…”

“…25 Despite the up-trending pattern of terrorist attacks in East Asia observed since 1999, there have been decreasing trends observed in the Middle East, Eastern Europe, South Asia, and Western Europe since 2016. 9,10,23,24 This may in part be skewed by the different data collection methods inherent in the GTD, but still presents a point in need of further research.…”

“…Various studies have been published analyzing the open-source Global Terrorism Database (GTD) as the field of Counter-Terrorism Medicine (CTM) has developed. [9][10][11][12][13][14] These studies deal with themes of mitigation, preparedness, and response in the fields of emergency and disaster medicine as it applies to terrorism from a global perspective. [9][10][11][12][13] In addition, another systematic review study emphasized the importance of strategic communication, surveillance, planning, and training in preparation for mass-gathering terrorism, as demonstrated in the successful response to the Boston Marathon Bombing (Massachusetts USA) in 2013.…”

“…[9][10][11][12][13][14] These studies deal with themes of mitigation, preparedness, and response in the fields of emergency and disaster medicine as it applies to terrorism from a global perspective. [9][10][11][12][13] In addition, another systematic review study emphasized the importance of strategic communication, surveillance, planning, and training in preparation for mass-gathering terrorism, as demonstrated in the successful response to the Boston Marathon Bombing (Massachusetts USA) in 2013. 15 Most of these studies have emphasized the analysis of region-specific counter-terrorism strategies contributing to hazard vulnerability analyses (HVAs), and this study was undertaken to advance that purpose.…”

“…15 Most of these studies have emphasized the analysis of region-specific counter-terrorism strategies contributing to hazard vulnerability analyses (HVAs), and this study was undertaken to advance that purpose. [9][10][11][12][13] An analysis of past terrorism-related attacks in East Asia will help first responders, Emergency Medical Service (EMS) providers, hospital health providers, and administrative policymakers to establish HVAs and develop CTM management plans.…”