Terrorism is the intentional use of indiscriminate violence to create fear and terror as a means to achieve an ideological, financial, religious, or political aim. It is often used against non-combatant targets. Terror tactics may include biologic, chemical, nuclear, or explosive events.

Biologic

Bioterrorism is the intentional release of biological agents to cause illness or death in humans, animals, or plants. These agents may be bacteria, fungi, toxins, or viruses. They may be naturally occurring or human-modified.

The agents are typically found in nature, but they may be altered in a laboratory to increase their resistance to antibiotics, and ability to spread in the environment. Biological and chemical agents may be spread through the air, food, or water. Terrorists use biological agents because they are often difficult to detect and illness onset may be delayed for hours to days increasing dispersal. The challenge with bioweapons is that they may affect both enemy and friendly forces, and do not discriminate between combatants and civilians.

In the last 100 years, the United States and the international community have experienced multiple acts of bioterrorism which have targeted civilians.

1. World War I: Germany launched a biological sabotage campaign in France, Romania, Russia, and the United States by infecting horses and mules with glanders

2. World War II: Japanese biological weapons attacks in China, testing botulism, anthrax, and plague

3. 1972: Two college students, Allen Schwander and Stephen Pera, were arrested for planning to poison the Chicago water supply with typhoid bacteria

4. 1979: Anthrax leak from chemical weapons research facility, Sverdlosk, Soviet Union

5. 1984: The Bhagwan Shree Rajneesh followers in Oregon attempted to affect a local election by infecting doorknobs and salad bars in restaurants with Salmonella typhimurium bacteria

6. 1993: Aum Shinrikyo religious group released anthrax in Tokyo

7. 2001: Anthrax-laced of infectious anthrax were delivered to news media offices and the US Congress

Chemical

During World War I there was widespread use of chemical weapons resulting in many deaths, both military and civilian. The atrocities experienced on all sides of this conflict led to the 1925 Geneva Protocol, prohibiting the use of chemical and biological weapons in war. While most modern states are either signatories to, or voluntarily abide by, this treaty and subsequent United Nations resolutions, there have been a few instances of chemical weapos use more recently. Iraqi forces utilized organophosphate neurotoxins against several targets in 1987-1988 in the war with the Islamic Republic of Iran on both military and civilan targets. In 2017, the Syrian government was accused of using nerve agents and chlorine munitions against the town of Khan Sheikhoun in the ongoing civil war.

Nuclear

To date, other than the dropping of nuclear bombs by the United States to end World War II, there have been no acts of nuclear attack or nuclear terrorism. Nuclear terrorism is an act of terrorism in which a terrorist organization detonates a nuclear device. The possibility of terrorist organizations using nuclear is considered plausible as terrorists could acquire a nuclear weapon. However, despite thefts of small amounts of fissile material, there is no credible evidence any terrorist group has succeeded in obtaining the necessary multi-kilogram critical mass amounts of weapons-grade plutonium required to make a nuclear weapon.

Explosive

Traditional small-arms munitioins and improvised explosive devices are among the most common agents used in terrorist actions. Explosive devices and arms can be stolen or purchased, as was seen in the 2015 attacks on the Charlie Hebdo magazine in Paris. More commonly they are manufactured as improvised explosive devices and hidden, such as the 1988 Pan Am flight from Lockerbie, Scotland, the 2004 bombings of the Madrid subway, or the 2013 bombings of the Boston marathon race in the United States.

Terrorism Definitions

What is terrorism? What is a mass casualty incident?

1. The United Nations definition of terrorism describes it as “an anxiety-inspiring method of repeated violent action, employed by (semi-) clandestine individual, group, or state actors, for idiosyncratic, criminal, or political reasons, whereby—in contrast to assassination—the direct targets of violence are not the main targets.”

2. The Department of Defense defines terrorism as “the unlawful use of violence or threat of violence, often motivated by religious, political, or other ideological beliefs, to instill fear and coerce governments or societies in pursuit of goals that are usually political.”

3. The Federal Emergency Management Agency defines terrorism as “the use of force or violence against persons or property in violation of the criminal laws of the United States for purposes of intimidation, coercion, or ransom. Terrorists often use threats to create fear among the public, to try to convince citizens that their government is powerless to prevent terrorism, and to get immediate publicity for their cause”.

4. The US Code of Federal Regulations defines terrorism as “the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.”

5. A mass casualty incident is defined terrorist act that generates more patients than available resources can manage using routine procedures.

Terrorism is generally considered to be the use of force or violence outside the law to create fear among citizens with the intent to coerce some sort of action. Health professionals should be aware bioterrorism is a perfect vehicle for terrorists to strike fear into the hearts and minds of citizens in the hopes they will bend the will of the people to support their agendas. All health professionals need to be prepared for this potentially catastrophic event.