Hostname: page-component-5cf477f64f-mgq6s Total loading time: 0 Render date: 2025-04-04T06:54:15.727Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  03 March 2022

Derrick Tin Open the ORCID record for Derrick Tin [Opens in a new window] ,
Saleh Fares ,
Mobarak Al Mulhim  and
Gregory R. Ciottone
Derrick Tin*
Affiliation:
Senior Fellow, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Cambridge, MassachusettsUSA
Saleh Fares
Affiliation:
Founder and President, Emirates Society of Emergency Medicine, Dubai, United Arab Emirates
Mobarak Al Mulhim
Affiliation:
Associate Director and Faculty, Executive Health and Dignitary Medicine - Disaster Medicine Fellowship, Beth Israel Deaconess Medical Center; Chief Officer, Clinical Shared Services, Easter Health Cluster, Saudi Arabia
Gregory R. Ciottone
Affiliation:
Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Associate Professor, Harvard Medical School, Cambridge, MassachusettsUSA
*
Correspondence: Derrick Tin, MBBS Senior Fellow, BIDMC Disaster Medicine Fellowship Department of Emergency Medicine Beth Israel Deaconess Medical Center Harvard Medical School Cambridge, MassachusettsUSA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The Middle East and North Africa (MENA) region has been, like many parts of the world, a hotbed for terrorist activities. 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. This study aims to provide an epidemiological description of all terrorism-related attacks in the Middle East sustained from 1970-2019.

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 which occurred in Iraq, Yemen, Turkey, Egypt, Syria, West Bank and Gaza Strip, Israel, Lebanon, Iran, Saudi Arabia, Bahrain, Jordan, Kuwait, United Arab Emirates, North Yemen, Qatar, and South Yemen from January 1, 1970 - December 31, 2019. Primary weapon type, primary target type, country where the incident occurred, and number of deaths and injuries were collated and the results analyzed.

Results:

A total of 41,837 attacks occurred in the Middle East from 1970-2019 accounting for 24.9% of all terrorist attacks around the world. A total of 100,446 deaths were recorded with 187,447 non-fatal injuries. Fifty-six percent of all attacks in the region occurred in Iraq (23,426), 9.4% in Yemen (3,929), and 8.2% in Turkey (3,428). “Private Citizens and Properties” were targeted in 37.6% (15,735) of attacks, 15.4% (6,423) targeted “Police,” 9.6% targeted “Businesses” (4,012), and 9.6% targeted “Governments” (4,001). Explosives were used in 68.4% of attacks (28,607), followed by firearms in 20.4% of attacks (8,525).

Conclusion:

Despite a decline in terrorist attacks from a peak in 2014, terrorist events remain an important cause of death and injuries around the world, particularly in the Middle East where 24.9% of historic attacks took place. While MENA countries are often clustered together by economic and academic organizations based on geographical, political, and cultural similarities, there are significant differences in terrorist events between countries within the region. This is likely a reflection of the complexities of the intricate interplay between politics, culture, security, and intelligence services unique to each country.

Keywords

counter-terrorism medicinedisaster medicineEMSprehospital medicineterrorism
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 2 , April 2022 , pp. 212 - 216
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Tin, D, Margus, C, Ciottone, GR. Half a century of terrorist attacks: weapons selection, casualty outcomes, and implications for counter terrorism medicine. Prehosp Disaster Med. 2021;36(5):526–530.10.1017/S1049023X21000868CrossRefGoogle ScholarPubMed
Terrorist attacks by region 2002-2018. Statistica. 2020. https://www.statista.com/statistics/489581/terrorist-attacks-by-region/. Accessed October 24, 2021.Google Scholar
Health Workers at Risk: Violence Against Health Care Global Report. 2019. https://reliefweb.int/report/world/health-workers-risk-violence-against-health-care. Accessed October 24, 2021.Google Scholar
Global Terrorism Database (GTD). START.umd.edu. https://www.start.umd.edu/data-tools/global-terrorism-database-gtd. Accessed July 18, 2021.Google Scholar
National Consortium for the Study of Terrorism and Responses to Terrorism (START). Codebook: Inclusion Criteria and Variables. College Park, Maryland USA: START; 2019.Google Scholar
United Nations Security Council. Anticipating Rise in Extremist Activity amid COVID-19, Counter-Terrorism Committees Striving to Continue Work Despite Severe Restrictions, Chairs tell Security Council. United Nations Security Council. 2020. https://www.un.org/press/en/2020/sc14363.doc.htm. Accessed October 24, 2021.Google Scholar
Tin, D, Hart, A, Ciottone, GR. A decade of terrorism in the United States and the emergence of counter-terrorism medicine. Prehosp Disaster Med. 2021;36(4):380–384.10.1017/S1049023X21000558CrossRefGoogle ScholarPubMed
Chemali, Z, Ezzeddine, FL, Gelaye, B, et al. Burnout among healthcare providers in the complex environment of the Middle East: a systematic review. BMC Public Health. 2019;19(1):1337.10.1186/s12889-019-7713-1CrossRefGoogle ScholarPubMed
Alsabri, M, Alhadheri, A, Alsakkaf, LM, Cole, J. Conflict and COVID-19 in Yemen: beyond the humanitarian crisis. Global Health. 2021;22(17):83.10.1186/s12992-021-00732-1CrossRefGoogle Scholar
Bou-Karroum, L, Daou, KN, Nomier, M, et al. Health care workers in the setting of the “Arab Spring”: a scoping review for the Lancet-AUB Commission on Syria. J Glob Health. 2019;9(1):010402.10.7189/jogh.09.010402CrossRefGoogle ScholarPubMed
Bou-Karroum, L, El-Harakeh, A, Kassamany, I, et al. Health care workers in conflict and post-conflict settings: systematic mapping of the evidence. PLoS One. 2020;15(5):e0233757.10.1371/journal.pone.0233757CrossRefGoogle Scholar
Horton, R. Offline: terrorism and Syria -"a crisis of the world.” Lancet. 2017;390(10098):924.10.1016/S0140-6736(17)32347-4CrossRefGoogle Scholar
Library of Congress. Library of Congress – Federal Research Division Country Profile: Iraq, May 2006. Fed Res Div. 2006;(May):1-23.Google Scholar
Lafta, RK, Al-Nuaimi, MA. War or health: a four-decade armed conflict in Iraq. Med Confl Surviv. 2019;35(3):209–226.10.1080/13623699.2019.1670431CrossRefGoogle ScholarPubMed
Aboulenein, A. Iraq’s healthcare system is in crisis. Patients are suffering. 2020. https://www.reuters.com/investigates/special-report/iraq-health/. Accessed October 24, 2021.Google Scholar
Woods, KM. Iraqi Perspectives Project. Primary source materials for Saddam and terrorism: emerging insights from captured Iraqi documents. Volume 4 (Redacted). 2007;i(July):456.10.21236/ADA479446CrossRefGoogle Scholar
Iraq Life Expectancy 1950-2021. MacroTrends. 2021. https://www.macrotrends.net/countries/IRQ/iraq/life-expectancy. Accessed October 24, 2021.Google Scholar
Iskandar, N, Rahbany, T, Shokor, A. Healthcare and terrorism: the Lebanese experience. Disaster Med Public Health Prep. 2021. Epub ahead of print.10.1017/dmp.2021.26CrossRefGoogle Scholar
Van der Zee, R. The doctor who ran a secret clinic under Isis. The Guardian. 2017. https://www.theguardian.com/global-development-professionals-network/2017/mar/31/i-try-to-put-hope-in-their-hearts-running-a-secret-clinic-under-islamic-state. Accessed October 24, 2021.Google Scholar
Guide to women’s healthcare in Saudi Arabia. Expatica. https://www.expatica.com/sa/healthcare/womens-health/womens-healthcare-in-saudi-arabia-71054/#Healthcare. Accessed October 24, 2021.Google Scholar
Women’s visits to hospitals without male guardians banned. Arab News. https://www.arabnews.com/news/525696. Accessed October 24, 2021.Google Scholar
Davis, L. Iraqi Women Confronting ISIL: Protecting Women’s Rights in the Context of Conflict. City University of New York (CUNY); CUNY Academic Works; 2016:27–78.Google Scholar
Sezigen, S, Kenar, L. Recent sulfur mustard attacks in Middle East and experience of health professionals. Toxicol Lett. 2020;320:52–57.10.1016/j.toxlet.2019.12.001CrossRefGoogle ScholarPubMed
Rosman, Y, Eisenkraft, A, Milk, N, et al. Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media. Ann Intern Med. 2014;160(9):644–648.10.7326/M13-2799CrossRefGoogle ScholarPubMed
Marcus, J. Saudi oil attacks: Who’s using drones in the Middle East? British Broadcasting Corporation. 2019. https://www.bbc.com/news/world-middle-east-49718828. Accessed October 24, 2021.Google Scholar
Tin, D, Kallenborn, Z, Hart, A, Hertelendy, AJ, Ciottone, G. Rise of the unmanned aerial vehicles: an imminent public health threat mandating counter terrorism medicine preparedness for potential mass casualty attacks. Prehosp Disaster Med. 2021;36(5):636–638.10.1017/S1049023X21000765CrossRefGoogle ScholarPubMed
Clarke, CP. Trends in Terrorism: What’s on the Horizon in 2020. Foreign Policy Research Institute. 2020. https://www.fpri.org/article/2021/01/trends-in-terrorism-whats-on-the-horizon-in-2021/. Accessed October 24, 2021.Google Scholar
Pledger, TG. The role of drones in future terrorist attacks. Association of the United States Army. 2021. https://www.ausa.org/publications/role-drones-future-terrorist-attacks. Accessed August 13, 2021.Google Scholar
Tin, D, Hart, A, Hertelendy, AJ, Kallenborn, Z, Ciottone, GR. Opioid attack and the implications for counter-terrorism medicine. Prehosp Disaster Med. 2021;36(6):661–663.10.1017/S1049023X21001059CrossRefGoogle ScholarPubMed