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

Goniewicz

et al. 2022

Prehosp. Disaster med.

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Introduction: Over the past five decades, Eastern Europe has seen relatively little in terms of terrorist attacks. The recent escalation of the Russo-Ukrainian conflict has, however, placed a new spotlight on the region, and new questions and concerns around war, conflict, insurgency, and terrorism are being posed. The Russian invasion and extensive combat operations, the largest in Europe since World War II, are occurring across Ukraine where there are 15 active nuclear reactors, not including the Chernobyl site, that are vulnerable to attack or sabotage. In addition, Eastern Europe has been heavily affected by COVID-19, exposing broad vulnerabilities in an otherwise fragile health care system. This raises concerns over the ability of Eastern European health care institutions to absorb surge and manage terrorist attacks or acts of violent extremism. This study provides an epidemiological description of all terrorism-related fatalities and injuries in Eastern Europe sustained from 1970 – 2019. Method: Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database functions for all terrorism events which occurred in Eastern Europe from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of this study. Primary weapon type, country where the incident occurred, and number of deaths and injured were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. Results: There were 3,901 terrorism-related events in Eastern Europe between the years 1970 and 2019, inclusive. In total, the attacks resulted in 5,391 deaths and 9,538 persons injured. Explosives were the most commonly used weapon type in 59.2% of all attacks in the region, followed by firearms in 27.6%. Conclusion: From 1970 through 2019, a total of 3,901 terrorist attacks occurred in Eastern Europe, inflicting 5,391 deaths and 9,538 injuries. Of those, 72.3% occurred in Russia and Ukraine. Terrorist attacks sharply declined since the peak in 2014, but there is an overall uptrend in attacks since the 1970s.

Section: Discussionmentioning

confidence: 99%

An Epidemiological Analysis of Terrorism-Related Attacks in Eastern Europe from 1970 to 2019

Tin

Goniewicz

et al. 2022

Prehosp. Disaster med.

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“…This is relatively low compared to hospitals and other health care facilities in the same period. 2,12 The majority of attacks occurred in the last decade, which coincided with the global peak in terrorism.…”

Section: Discussionmentioning

confidence: 99%

“…Trends over time should therefore be interpreted with caution. 2,10 Conversely, the GTD is a key source for global data on terrorism incidents and is the best available database of its kind. It is evaluated as the most complete record of terrorist attacks in recent decades.…”

Section: Limitationsmentioning

confidence: 99%

“…From 1970 through 2019, there were 454 terrorist attacks against hospitals and 148 terrorist attacks against Emergency Medical Services causing 2,381 fatalities and 4,016 injured. 1,2 In the same period, vaccinators have been targeted 133 times, most of which have occurred since 2010. 3 Despite their pivotal role in health care, little is known about the risk for primary care providers (PCPs) and their offices as targets of terrorism.…”

Section: Introductionmentioning

confidence: 99%

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Primary Care as Primary Target: A Review of Terrorist Attacks Against Primary Care Providers and Their Offices

Wirken

Cauwer

et al. 2022

Prehosp. Disaster med.

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Background: Violence against primary care providers (PCPs) has increased during the current pandemic. While some of these violent acts are not defined as terrorist events, they are intentional events with an aim to disrupt, kill, or injure. Despite their pivotal role in health care, little is known about the risk for PCPs as targets of terrorism. 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 terrorist attacks against PCPs and their offices from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. Primary attack and weapon type, location (country, world region), and number of deaths and injuries were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. Results: There were 29 terrorist attacks against PCPs and their offices from 1970-2019. The majority of attacks occurred during or after 2010. There were 58 fatalities, 52 injured, and 13 hostages. Most documented attacks took place in Pakistan, the United States, and Sri Lanka. Bombings concerned 55% of cases and 21% were hostage-takings. Conclusion: Although less common than attacks on other health care related targets, terrorist attacks against PCPs have occurred. The majority of attacks occurred during the last decade. Future studies are warranted to further assess the risk of terrorist attacks against PCPs: before, during, and beyond the current pandemic.

“…Whilst in some countries more than 50% of healthcare facilities are situated in high-risk areas for natural disasters, other regions may be more susceptible to manmade disasters such as (cyber)terrorism. [5][6][7] The Sendai Framework for Disaster Risk Reduction 2015-2030 encourages to substantially improve resilience to damage to critical infrastructure and disruption of basic services by 2030. 8 This particularly concerns healthcare and educational facilities.…”

Section: Introductionmentioning

confidence: 99%

Three decades of hospital evacuations in the Netherlands: a scoping review

Fijten

Gaakeer

et al. 2022

Preprint

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Background: Hospitals are expected to provide their essential services under all circumstances, including disasters and crisis situations. However, crises and disasters may disrupt essential hospital functions, and necessitate evacuation of the facility. Data on the prevalence and causes of hospital evacuations is limited, whilst realistic evacuation planning will make hospitals more resilient during future crises and disasters. The aim of this study was to develop a systematic understanding of hospital evacuation frequency, causes and characteristics in the Netherlands. Methods: A systematic scoping review of news articles retrieved from the LexisNexis database, Google, Google News, PubMed and EMBASE between 1990 and 2020. All articles mentioning a hospital evacuation in the Netherlands were analyzed. Results: A total of 67 hospital evacuations were identified in a 30-year time period. The most common primary incidents were internal fire (33%), technological failure (21%) and hazardous materials (12%). Cascading events transpired in 37% of all events. As a result, internal fire (34%), internal power failure (19%) and hazardous materials (16%) were the most important reasons to evacuate a medical facility. The number of evacuees ranged from 1 to 339 patients (median 10.5, interquartile range 36), and there were 13 (19%) complete hospital evacuations. The frequency of hospital evacuations increased over time, with a more diverse etiology during later years. Conclusions: Hospital evacuations do occur, and hospitals are vulnerable to both internal and external hazards. Internal fire, internal power failure, hazardous materials and flooding incidents were the most important reasons to (partly) evacuate a hospital. Our findings suggest that facility-specific evacuation guidelines are necessary, and that evacuation preparedness will benefit if the most relevant evacuation scenarios are planned and practiced.