The impact of a terrorist attack: Survivors’ health, functioning and need for support following the 2019 Utrecht tram shooting 6 and 18 months post-attack

Abstract

BackgroundExtremely violent events such as terrorist attacks and mass shootings form a severe risk for the health and wellbeing of affected individuals. In this study based on a public health monitor, we focus on the health impact (including PTSD symptoms, physical problems and day-to-day functioning) of the Utrecht tram shooting, which took place in the morning of March 18th 2019. A lone gunman opened fire on passengers within a moving tram. Four people died, and six people were injured in this attack. The attack resulted in nationwide commotion and drew much media attention. Aim of this study was to increase insight into the health effects for the survivors (those directly impacted by a terrorist attack and the bereaved), and whether they received the needed care and support.MethodsSemi-structured interviews with accompanying questionnaires were conducted at six and 18 months post-attack. Overall, 21 survivors (victims/witnesses and loved ones of deceased victims) participated in the first series of interviews, 15 in the second series. Qualitative data were analyzed using reflexive thematic analysis, quantitative data was only described because of the low sample size.ResultsAt both six and 18 months after the attack many survivors had been able to resume daily life, and most rated their overall health as (very) good or excellent. At the same time, a substantial portion suffered from health problems such as posttraumatic stress symptoms and other complaints, and needed professional care. Furthermore, those in need did not always find their own way to appropriate care through the existing health system: half of the survivors still needed support in finding the right care 18 months later.ConclusionAlthough the design and implementation of this public health monitor were accompanied by multiple challenges, it was possible to track a portion of the survivors and gain insight in the considerable health burden of the attack. Also, it is clear in this study that the health impact of terrorism affects survivors in the long run and requires attention from health authorities and professionals, as survivors were not able to find the right care by themselves.

De beelden die ons bewegen, de voorspelbaarheid van de rampen die we samen creëren

“…59 p Vooralsnog registreren we gedupeerden van een ramp te selectief, terwijl de registratie het vertrekpunt vormt voor essentiële processen als behoeftepeilingen, gezondheidsonderzoek, gerichte dienstverlening en evaluatie. [60][61][62] q Dit samenspel tussen enerzijds blootstelling aan rampen en andere potentieel schokkende gebeurtenissen, anderzijds de culturele en sociaaleconomische context van de populatie in relatie tot mentale gezondheid is eerder beschreven als de kwetsbaarheidsparadox. 47,48 De paradox is dat een veilige en welvarende context op het niveau van samenlevingen niet beschermend werkt maar juist een risico vormt voor de mentale gezondheid.…”