Mumbai is India's largest city and the financial capital of the country. Destruction of symbolic structures in large cities has been a worldwide strategy of terrorists for spreading hopelessness, fear, and panic. The recent Mumbai terror attacks were similar and included taking foreign nationals as hostages.

Victims profiles were studied for mode of injury (firearm, fire, blast, fall, or combination), the type of injury, and treatment. The level of hospital preparedness was described, especially for surge capacity. Terrorist events and conflict over the last five decades in Mumbai and India were analyzed. The Indian data was compared to global terrorism in order to suggest appropriate recommendations for countering terrorism in a developing country.

At least 173 people were killed and 308 were injured in the recent attacks. There were eight attack sites in downtown Mumbai, of which, three sites were patronized largely by western tourists and foreign delegates. Three were crowded public places, including a hospital. The most prevalent injuries were bullet wounds from automatic weapons, followed by blast, shrapnel, falls, and burns. All previous terrorist events in Mumbai are listed in the Table.

The attack of foreign nationals represents a proxy war, and the terrorists are looking for softer targets. Therefore, counter-terrorism initiatives must go beyond country-specific ' models. In developing countries where' public health infrastructure is an issue, adopting the “all-hazards” approach to disasters may be the direction required in order to build capacity for dealing with future events. While there is a push for top-end hospitals for “medical tourism”, India has realized that it is eventually the modest public hospital that responds to all disasters, including those caused by natural hazards or conflict. The financial capital of Mumbai has moved from low to moderate risk for terrorist activities over the past 15 years. The geopolitical reasons for this shift must be researched by social scientists.