Introduction: Using an ambulance as an attack modality offers many advantages to a terrorist organization. Ambulances can carry more explosives than most vehicles and can often bypass security. Yet, studies examining how terrorist organizations have incorporated ambulances into their attacks are lacking. Study Objective: This article seeks to identify and analyze known instances in which an ambulance has been used in a terrorist attack. Methods: The Global Terrorism Database (GTD) was searched for terrorist events that involved the use of an ambulance from the years 1970-2018. Variables of event time, location, and loss of life were analyzed. Results: Twenty instances where an ambulance had been used in a terrorist attack were identified from the GTD. Fifteen of the attacks occurred in the Middle East, while the remaining five occurred in Southeast Asia. All attacks except one had occurred after 2001, and 13 had occurred within the past decade. Most attacks (12/20) resulted in up to three people killed, while six attacks had 10-20 casualties. The deadliest attack occurred in Kabul, Afghanistan in 2018 and caused over 100 casualties. One event did not have casualty information in the GTD. In all cases, ambulances were used as vehicle-borne improvised explosive devices (VBIED) by terrorist organizations. Conclusion: This study shows that terrorists are increasingly acquiring and utilizing ambulances in their attacks, often with deadly consequences. Security and public health experts must be aware of this hazard and work to deny terrorists access to these vehicles.
Introduction:Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible to the general public. Hospitals are also occupied with both staff and patients 24 hours a day, 365 days a year, meaning that any attack is almost guaranteed to inflict a multitude of casualties. In addition to the immediate effects of attacking a hospital, there are also uniquely devastating second- and third-order effects when hospitals are attacked.Methods:A focused search of the Global Terrorism Database (GTD) was performed to identify terrorist attacks against hospitals throughout the world. Data between the years 1970-2018 were selected, which included 191,465 entries in total. These entries were then searched for incidents containing the term “hospital” and the results were manually searched to identify trends in the number of incidents occurring per year, as well as the armament that was employed, and the regions of the world where the attacks occurred.Results:A total of 430 terrorist attacks on hospitals were identified in the GTD, resulting in 1,291 deaths and an additional 1,921 wounded. The frequency of terrorist attacks against hospitals has been steadily increasing over the last two decades and is disproportionate to the overall increase in terrorist attacks against all target types. Attacks have been carried out against hospitals in 61 different countries. The most common method used in these attacks was “bombing/explosion,” which accounted for 299 attacks. Of the known terrorist groups identified in the GTD, “Houthi extremists (Anshar Allah)” and “Islamic State of Iraq and the Levant (ISIL)” carried out the greatest number of attacks on hospitals.Conclusion:There has been a disproportionate rise in the frequency of terrorist attacks on hospitals when compared to other target types, highlighting the vulnerability of these key structures. Unsurprisingly, these attacks have inflicted large casualty counts in addition to disrupting community health care and disaster response. Attacks against hospitals have been reported on every inhabited continent except Australia, making their protection a matter of international security. The rate of terrorist attacks on hospitals has increased dramatically over the last two decades, creating an urgent need to develop improved defense strategies that will better ensure their protection.
Healthcare facilities play an essential role in response to terrorist attacks, but they also can be ''soft targets'' due to their accessibility and limited security. In this review, the authors used the Global Terrorism Database to conduct a search on terrorist attacks directed against hospitals and healthcare facilities between 1970 and 2018. Search terms included ''healthcare,'' ''doctor,'' ''nurses,'' ''vaccinators,'' ''clinic,'' and ''hospital,'' which resulted in 2,322 healthcare-related entries. The dataset was then manually searched for attacks on healthcare facilities, resulting in a total of 901 attacks in 74 different countries. The prevalence of healthcare facility attacks has increased, with 57% (515) occurring after 2001. The most common method of attack was bombing, followed by direct attacks on healthcare infrastructure and armed assaults.Healthcare facilities remain vulnerable to violence, and lessons learned in the aftermath of these incidents can be used to raise awareness about important safety-related concerns within the national response framework. Healthcare and security experts must be aware of the vulnerability of this crucial infrastructure and take active steps to prevent attacks.
Vaccinators fulfill an important role in a nation's public health by reducing the burden of disease on the population.Understanding patterns of attack employed against vaccinators is important to determine how to protect them. We conducted a search of the Global Terrorism Database for terrorist attacks against vaccinators that occurred between the years 1970 and 2018. Using the search terms ''hospital,'' ''healthcare,'' ''clinic,'' ''doctor,'' ''nurses,'' ''vaccinators,'' and ''vaccinations,'' 2,322 healthcare-related entries were identified. We then manually searched the dataset for incidents related to attacks on vaccinators, which resulted in the identification of 133 attacks against vaccinators. The majority (128 out of 133) of attacks occurred during or after 2010. Every attack except one has occurred in the Middle East, South Asia, or sub-Saharan Africa. Pakistan has seen the most attacks against vaccinators, with 112 incidents recorded. Vaccinators continue to be vulnerable to terrorist attacks. Protection of healthcare personnel during mass vaccination efforts is critical so that they can continue their life saving mission.
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