Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T19:25:46.107Z Has data issue: false hasContentIssue false
  • English
  • Français

Five Decades of Global Chemical Terror Attacks: Data Analysis to Inform Training and Preparedness

Published online by Cambridge University Press:  24 July 2020

Michael A. DeLuca ,
Peter R. Chai ,
Eric Goralnick  and
Timothy B. Erickson
Michael A. DeLuca*
Affiliation:
Harvard Affiliated Emergency Medicine Residency Program, Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, USA
Peter R. Chai
Affiliation:
Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA The Fenway Institute, Boston, Massachusetts, USA The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, Massachusetts, USA
Eric Goralnick
Affiliation:
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Center for Surgery and Public Health, Brigham and Women’s Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA Gillian Reny Stepping Strong Center for Trauma Innovation, Boston, Massachusetts, USA
Timothy B. Erickson
Affiliation:
Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
*
Correspondence and reprint requests to Michael A. DeLuca, MD, Massachusetts General Hospital, Department of Emergency Medicine, 5 Emerson Place, Suite 101, Boston, MA02114, USA (e-mail: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Chemical weapons attacks during the recent conflict in Syria and Iraq highlight the need to better understand the changing epidemiology of chemical weapons use, especially among non-state actors. Public health professionals and policy-makers require this data to prioritize funding, training, chemical weapons preparedness, disaster response, and recovery. The purpose of this investigation is to provide descriptive data that can be used by policy-makers and public safety officials to better prepare for these potential attacks.

Methods:

A five-decade descriptive retrospective review of The Global Terrorism Database, maintained by the National Consortium for the Study of Terrorism and Responses to Terrorism, was conducted to understand trends in chemical agents, targets, and routes of exposure. We reviewed and analyzed data specific to these documented chemical attacks between 1970 and 2017.

Results:

383 terror attacks involved chemical weapons over the study period. A specific agent was named in 154 incidents, while 124 incidents could be classified into traditional chemical weapons categories (eg, vesicant, choking agents). A route of exposure was identified in 242 attacks, with the most common routes of exposure being dermal-mucosal and inhalational. Caustic agents were used in the highest portion of attacks (25%) where the route of exposure was known. Explosive devices were used in 21% of attacks to deliver these chemical agents. Of particular note, private citizens and educational facilities were targeted in 25% and 12% of attacks, respectively. The average number of attacks increased from 6 per year between 1970 and 2011 to 24.9 per year between 2011 and 2017 (coinciding with the start of the Syria conflict). The most commonly utilized chemicals were chlorine (26.0%), tear gas (20.8%), and cyanide (15.6%). Blood agent incidents declined from 32.6% before the September 11, 2001 attacks to 13.6% after 2001, while nerve agent attacks fell from 9.3% to 1.2%. In contrast, choking (namely chlorine) and vesicant (mustard) agent use increased from 7% to 48.1% and from 2.3% to 6.2% of attacks, respectively.

Conclusions:

Chemical weapon use in global terrorism remains an increasingly common occurrence that requires better characterization. The average number of chemical terrorist attacks per year is increasing, with a large proportion resulting from the conflicts in Iraq and Syria. Choking (chlorine) and vesicant (mustard) agents have become the predominant chemical terror agent since 2001, with a decreased incidence of blood (cyanogenic) and nerve (sarin) agents. Future preparedness initiatives should focus on vulnerable targets such as private citizens and educational institutions. Improving blast injury response is essential, along with prioritizing disaster training focused on choking agents, vesicants, and caustics.

Keywords

chemical weaponsterrorismemergency preparednessdisaster response
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 15 , Issue 6 , December 2021 , pp. 750 - 761
Copyright
Copyright © 2020 Society for Disaster Medicine and Public Health, Inc.

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

REFERENCES

Szinicz, L. History of chemical and biological warfare agents. Toxicology. 2005;214(3):167-181.CrossRefGoogle ScholarPubMed
Brooks, J, Erickson, TB, Kayden, S, Ruiz, R, Wilkinson, S, Burkle, FM. Responding to chemical weapons violations in Syria: legal, health, and humanitarian recommendations. Confl Health. 2018;12:12.CrossRefGoogle ScholarPubMed
United Nations Human Rights Council. Chemical weapons attacks documented by the Independent International Commission of Inquiry on the Syrian Arab Republic. United Nations. January 2018. https://www.ohchr.org/SiteCollectionImages/Bodies/HRCouncil/IICISyria/COISyria_ChemicalWeapons.jpg. Accessed September 24, 2019.Google Scholar
Human Rights Watch. Syria: a year on, chemical weapons attacks persist. Human Rights Watch. 2018. https://www.hrw.org/news/2018/04/04/syria-year-chemical-weapons-attacks-persist. Accessed September 24, 2019.Google Scholar
Schmitt, E. ISIS Used chemical arms at least 52 times in Syria and Iraq, report says. The New York Times. November 21, 2016. https://www.nytimes.com/2016/11/21/world/middleeast/isis-chemical-weapons-syria-iraq-mosul.html. Accessed October 26, 2019.Google Scholar
Rodriguez-Llanes, JM, Guha-Sapir, D, Schlüter, B-S, Hicks, MH-R. Epidemiological findings of major chemical attacks in the Syrian war are consistent with civilian targeting: a short report. Confl Health. 2018;12:16.CrossRefGoogle ScholarPubMed
Wessely, S, Hyams, KC, Bartholomew, R. Psychological implications of chemical and biological weapons. BMJ. 2001;323(7318):878-879.CrossRefGoogle ScholarPubMed
Boscarino, JA, Adams, RE, Figley, CR, Galea, S, Foa, EB. Fear of terrorism and preparedness in New York City 2 years after the attacks: implications for disaster planning and research. J Public Health Manag Pract. 2006;12(6):505-513.CrossRefGoogle ScholarPubMed
Roshan, R, Rahnama, P, Ghazanfari, Z, et al. Long-term effects of sulfur mustard on civilians’ mental health 20 years after exposure (The Sardasht-Iran Cohort Study). Health Qual Life Outcomes. 2013;11:69.CrossRefGoogle Scholar
Footer, KHA, Clouse, E, Rayes, D, Sahloul, Z, Rubenstein, LS. Qualitative accounts from Syrian health professionals regarding violations of the right to health, including the use of chemical weapons, in opposition-held Syria. BMJ Open. 2018;8(8):e021096.CrossRefGoogle ScholarPubMed
Chai, PR, Hayes, BD, Erickson, TB, Boyer, EW. Novichok agents: a historical, current, and toxicological perspective. Toxicol Commun. 2018;2(1):45-48.CrossRefGoogle ScholarPubMed
Chai, PR, Boyer, EW, Al-Nahhas, H, Erickson, TB. Toxic chemical weapons of assassination and warfare: nerve agents VX and sarin. Toxicol Commun. 2017;1(1):21-23.CrossRefGoogle ScholarPubMed
Watson, C, Watson, M, Gastfriend, D, Sell, TK. Federal funding for health security in FY2019. Health Secur. 2018;16(5):281-303.CrossRefGoogle ScholarPubMed
National Consortium for the Study of Terrorism and Responses to Terrorism: Using GTD [Internet]. 2019. https://www.start.umd.edu/gtd/using-gtd/ Google Scholar
National Consortium for the Study of Terrorism and Responses to Terrorism. About START [Internet]. https://www.start.umd.edu/about/about-start. Accessed May 25, 2019.Google Scholar
National Consortium for the Study of Terrorism and Responses to Terrorism (START). Global Terrorism Database [Data file]. 2018 https://www.start.umd.edu/gtd. Accessed May 25, 2019.Google Scholar
National Consortium for the Study of Terrorism and Responses to Terrorism (START). Codebook: Inclusion Criteria and Variables [Internet]. 2018. https://www.start.umd.edu/gtd/downloads/Codebook.pdf. Accessed May 25, 2019.Google Scholar
Organisation for the Prohibition of Chemical Weapons. POCW: What is a chemical weapon? 2019. https://www.opcw.org/our-work/what-chemical-weapon. Accessed May 25, 2019.Google Scholar
Ganesan, K, Raza, SK, Vijayaraghavan, R. Chemical warfare agents. J Pharm Bioallied Sci. 2010;2(3):166-178.CrossRefGoogle ScholarPubMed
Santos, C, El Zahran, T, Weiland, J, Anwar, M, Schier, J. Characterizing chemical terrorism incidents collected by the Global Terrorism Database, 1970–2015. Prehosp Disaster Med. 2019;34(4):385-392.CrossRefGoogle ScholarPubMed
Mathews, ZR, Koyfman, A. Blast injuries. J Emerg Med. 2015;49(4):573-587.CrossRefGoogle ScholarPubMed
Marcus, C, Pontasch, J, Duff, J, et al. Developing “herd immunity” in a civilian community through incorporation of “just-in-time” tourniquet application training. Prehosp Disaster Med. 2019;34(5):481-485.CrossRefGoogle Scholar
Ross, EM, Redman, TT, Mapp, JG, et al. Stop the bleed: the effect of hemorrhage control education on laypersons’ willingness to respond during a traumatic medical emergency. Prehosp Disaster Med. 2018;33(2):127-132.CrossRefGoogle ScholarPubMed
Fitzgerald, GJ. Chemical warfare and medical response during World War I. Am J Public Health. 2008;98(4):611-625.CrossRefGoogle ScholarPubMed
Jones, R, Wills, B, Kang, C. Chlorine gas: an evolving hazardous material threat and unconventional weapon. West J Emerg Med. 2010;11(2):151-156.Google ScholarPubMed
United Nations Human Rights Council. Report of the Independent International Commission of Inquiry on the Syrian Arab Republic. United Nations. September 2017:14. (Thirty-Six Session). https://www.ohchr.org/EN/HRBodies/HRC/IICISyria/Pages/Documentation.aspx. Accessed September 24, 2019.Google Scholar
Syrian American Medical Society. A new normal: ongoing chemical weapons attacks in Syria. February 2016. https://www.sams-usa.net/wp-content/uploads/2016/09/A-New-Normal_Ongoing-Chemical-Weapons-Attacks-in-Syria.compressed.pdf. Accessed September 24, 2019.Google Scholar
Schneider, T, Lutkefend, T. Nowhere to hide: the logic of chemical weapons use in Syria. Global Public Policy Institute. February 2019. https://www.gppi.net/media/GPPi_Schneider_Luetkefend_2019_Nowhere_to_Hide_Web.pdf. Accessed September 24, 2019.Google Scholar
Centers for Disease Control and Prevention. ATSDR - Medical Management Guidelines (MMGs): Chlorine. 2019. https://www.atsdr.cdc.gov/MMG/MMG.asp?id=198&tid=36. Accessed October 7, 2019.Google Scholar
Cancio, LC, Sheridan, RL, Dent, R, et al. Guidelines for burn care under austere conditions: special etiologies: blast, radiation, and chemical injuries. J Burn Care Res. 2017;38(1):e482-496.CrossRefGoogle ScholarPubMed
Govier, P, Coulson, JM. Civilian exposure to chlorine gas: a systematic review. Toxicol Lett. 2018;293:249-252.CrossRefGoogle ScholarPubMed
Toxic Industrial Chemicals and Chemical Weapons—ClinicalKey. https://www-clinicalkey-com.ezp-prod1.hul.harvard.edu/#!/content/playContent/1-s2.0-S0733862714000741?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0733862714000741%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2F. Accessed October 27, 2019.Google Scholar
Gnaneswaran, N, Perera, E, Perera, M, Sawhney, R. Cutaneous chemical burns: assessment and early management. Aust Fam Physician. 2015;44(3):135-139.Google ScholarPubMed
Das, KK, Olga, L, Peck, M, Morselli, PG, Salek, AJM. Management of acid burns: Experience from Bangladesh. Burns. 2015;41(3):484-492.CrossRefGoogle ScholarPubMed
Supplementary material: File

DeLuca et al. supplementary material

DeLuca et al. supplementary material

Download DeLuca et al. supplementary material(File)
File 14.2 KB