Half-a-Century of Terrorist Attacks: Weapons Selection, Casualty Outcomes, and Implications for Counter-Terrorism Medicine

Abstract

Background: High profile terrorist attacks in major capital cities have seemingly become a regular occurrence and the resultant mass-casualty events continue to challenge health care systems. Counter-Terrorism Medicine (CTM) addresses unique terrorism-related issues relating to the mitigation, preparedness, and response measures to asymmetric, multi-modality terrorist attacks. This study is an epidemiological examination of all terrorism-related events sustained from 1970-2019, analyzing historical weapon types used and the resulting fatal injuries (FI) and non-fatal injuries (NFI) sustained. Methods: The Global Terrorism Database (GTD) was searched for all attacks from 1970-2019. Attacks met inclusion criteria if they fulfilled the three terrorism-related criteria, as set by the GTD codebook. Ambiguous events were excluded. State-sponsored terrorist events do not meet the codebook’s definition, and as such, are excluded from the study. Available counts of FI and NFI in each incident were then sorted and aggregated by weapon type to enable mean and standard deviation calculations. Results: In total, 168,003 events were recorded from the years 1970-2019. Explosives, bombs, and/or dynamite (E/B/D) were the most commonly used weapon type and accounted for 48.78% of all terrorism events, followed by the use of firearms in 26.77% of events. A total of 339,435 FI and 496,225 NFI resulted from all terrorism events that occurred during the study period. Combined, E/B/D and firearms accounted for 75.55% of all events, 67.1% of all FI, and 79.3% of all NFI. Each individual terrorism event inflicted a mean FI rate of 2.14 FI per event (SD = 10.2) and a mean NFI rate of 3.22 NFI per event (SD = 45.19). Conclusions: Although terrorism is complex and does not solely rely on death tolls as a measure of success, this analysis shows a historic mean FI rate of 2.14 and NFI rate of 3.22 per event over the past 50 years. Proven weapons such as E/B/D and firearms combine to account for over 75% of weapon types used in all events. Use of weapons of mass destruction (WMDs) such as chemical, biological, radiation, and nuclear (CBRN) weapons has been rare (0.2%), yet has extreme high potential to inflict mass casualties with mean NFI rates of 49.62 and 28.75 for chemical and biological weapons, respectively.

Terrorist Attacks in the Middle East: A Counter-Terrorism Medicine Analysis

“…[19][20][21][22] The use of explosives and firearms as primary attack modalities in the Middle East follows the global trend in terrorist methodologies. 1 Chemical, biological, radiological, nuclear (CBRN) attacks, though rare, remain a significant threat in the region. Syria saw the use of Sarin gas in 2013 which killed 1,400 civilians and severely affected thousands more and Sulfur Mustard filled rockets were launched in Iraq in 2016.…”

“…Since the 1970s, 27.4% of all terrorist attacks took place in MENA, accounting for over 46,000 attacks, the highest of any region of the world. 1,2 The "war on terror" campaign following the September 11, 2001 attacks in the United States primarily targeted extremist groups located in numerous countries, particularly in countries in South Asia and the Middle East. Terrorist attacks can affect both demand for and provision of health care services and often places a unique burden on first responders, hospitals, and health systems.…”

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

“…15,16 The use of chemical agents as a terrorist attack methodology, though rare, has a high potential to inflict mass casualties. 17,18 Chemicals can be produced, stolen, or acquired and industrial chemical plants or vehicles used to transport chemicals could be sabotaged and cause local damage. Chemicals in liquid and vapor forms have higher potential for mass exposure and toxic plumes can likely spread over large areas.…”

A Counter-Terrorism Medicine Analysis of Drone Attacks

“…15 It is maintained by the National Consortium for the Study of Terrorism and Responses to Terrorism (START) at the University of Maryland, USA and is part of the US Department of Homeland Security's (Washington, DC USA) Centre of Excellence. 16 The GTD defines a terrorist attack as "the threatened or actual use of illegal force and violence by a non-state actor to attain a political, economic, religious, or social goal through fear, coercion, or intimidation. "…”

“…The GTD codebook defines a "successful" attack by the tangible effects of the attack and whether or not it took place. 16 It is not defined by the (larger) goals of the perpetrators, and the definition has variations depending on the attack type. For the purpose of this article, related attacks were approached as individual events, as listed by the GTD.…”