Chemical Warfare Agents in Terrorist Attacks: An Interregional Comparison, Tactical Response Implications, and the Emergence of Counterterrorism Medicine

Cheng

Shin

et al. 2023

Prehosp. Disaster med.

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Introduction: The use of chemical, biological, radiation, and nuclear (CBRN) weapons is not new, and though rare, it is an issue of concern around the world due to their ability to cause large-scale mass-casualty events and their potential threat to global stability. The purpose of this study is to explore the use of CBRN weapons by non-state actors through analysis of the Violent Non-State Actor (VNSA) CBRN Event database, and aims to better inform health care systems of the potential risks and consequences of such events. Methods: Data collection was performed using a retrospective database search through the VNSA CBRN Event database. Results: A total of 565 events were recorded. Five hundred and five (505) events (89.4%) involved single agents while 60 events (10.6%) involved multiple agents. Fatalities numbered 965 for chemical agents, 19 for biological agents, and none for radiological and nuclear events. Injuries numbered 7,540 for chemical agents, 59 for biological agents, 50 for radiological events, and none for nuclear attacks. Fatality and injury per attack was 2.22 and 17.37, respectively, for chemical event agents and 0.15 and 0.48, respectively, for biological event agents. Conclusion: Violent Non-State Actors were responsible for 565 unique events around the world involving the use of CBRN weapons from 1990-2020. The United States (118), Russia (49), and Iraq (43) accounted for the top three countries where these events occurred. While CBRN events remain relatively rare, technological advances have the potential to facilitate the use of such weapons as part of a hybrid warfare strategy with significant repercussions for civilian health and health care systems.

Section: Discussionmentioning

confidence: 99%

“…19 This level of sophistication certainly raises concerns about the possibility of the deployment of these agents in a coordinated or complex multi-modal attack. 4 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Descriptive Analysis of the Use of Chemical, Biological, Radiological, and Nuclear Weapons by Violent Non-State Actors and the Modern-Day Environment of Threat

Cheng

Shin

et al. 2023

Prehosp. Disaster med.

Self Cite

“…Cluster munition has been used on multiple occasions to date, of which some impacted healthcare facilities [23]. The use of drones, chemical weapons, and the civilian healthcare response preparedness and toxidrome recognitions are core research and discussion topics within counter-terrorism medicine [25][26][27][28][29][30].…”

Section: Resurfaced Use Of Chemical Weaponsmentioning

confidence: 99%

Hybrid warfare and counter-terrorism medicine

Eur J Trauma Emerg Surg

Barten

Granholm

et al. 2023

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Introduction March 9, 2022. An airstrike by Russian forces destroying a maternity hospital in Mariupol, Ukraine. The image of a severely injured pregnant woman covered in blood being stretchered away against the backdrop of destroyed buildings. Mutterings of the use of chemical weapons. This paper is a primer for healthcare personnel and health systems on hybrid warfare and counter-terrorism medicine. Discussion While recent events and images arising from conflicts around the world represent a cruel hallmark in today’s history, attacks against healthcare facilities and innocent civilians are not new and continue to be perpetrated around the world. In war, the Geneva Convention protects civilians and healthcare institutions from harm but when war crimes are being committed and civilians knowingly targeted, parallels from a healthcare perspective can be drawn with terrorism events. Increasingly, civilian institutions and in particular the healthcare sector, are drawn into such conflicts and understanding the health system impact of hybrid warfare and other asymmetrical attack methods is of great importance. Conclusion The field of Counter-Terrorism Medicine (CTM) explores the healthcare impacts of intentional, man-made attacks and much recent research and discussions around this topic are extremely relevant and applicable not just to the ongoing hybrid war in Ukraine, but to today’s threat climate all around us.

Chemical Agent Use in Terrorist Events: A Gathering Storm Requiring Enhanced Civilian Preparedness

Ciottone

2022

Prehosp. Disaster med.

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Background: The use of chemical weapons in terrorist attacks, though rare, remains a significant challenge and concern due to their ability to inflict mass casualties. Chemical attacks remain a topic of interest for Disaster Medicine (DM) and Counter-Terrorism Medicine (CTM) specialists and are clearly an area in need of enhanced preparedness. This study aims to provide an epidemiological description of all terrorism-related attacks using chemical agents as a primary weapon, sustained from 1970 - 2019. These data will be useful in the development of education programs in CTM and provide an insight into how best to prepare for 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 using chemical weapons as a primary attack method from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. The GTD also details the specific chemical used, when known, in the summary of incidents. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. Results: A total of 292 terrorist attacks involving chemical agents as a primary attack method were recorded from 1970 - 2019, registering 284 deaths and 13,267 injuries. Acid (52) was the most commonly used chemical agent, followed by “unspecified poison” (43), “unknown chemical agents” (29), “unspecified gas” (27), tear gas (27), chlorine gas (24), cyanide (21), mercury (9), pepper spray or mace (9), mustard gas (8), insecticide or 1080 (8), diphenylamine chloroarsine (7), phosphate or phosphorous (3), sodium hydroxide or corrosive liquid (3), sarin (2), “unspecified drugs” (2), VX nerve gas and other nerve gas (2), pesticides (2), cleaning chemicals/paint thinner (2), ammonia (2), anesthesia agent (1), arsenic (1), chlorine and mustard gas mix (1), phenarsazine chloride (1), rat poison (1), unknown irritative gas (1), hydrochloric acid and sodium cyanide mix (1), unknown white powder (1), antiseptic dye (1), and chlorine gas and white phosphorous mix (1). Conclusion: The use of chemical weapons in warfare, though prohibited by the Chemical Weapons Convention (CWC), remains a rare but concerning terrorist attack methodology. In recent years, there have been more instances where potentially deadly chemicals have been used in civilian settings. Dual use industrial chemicals, in particular, pose a significant concern. Acid was the most commonly used chemical weapon in 52 attacks. Tear gas, chlorine, and cyanide were each used in over 20 attacks. Both DM and CTM specialists advocate for better preparedness and response training for intentional events in civilian settings.