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A Review of Ambulance Terrorism on the African Continent

Published online by Cambridge University Press:  27 February 2023

János Besenyő ,
Dennis G. Barten Open the ORCID record for Dennis G. Barten [Opens in a new window] ,
Harald G. De Cauwer Open the ORCID record for Harald G. De Cauwer [Opens in a new window] ,
Derrick Tin Open the ORCID record for Derrick Tin [Opens in a new window]  and
Attila Gulyás
János Besenyő
Affiliation:
African Research Institute, Donát Bánki Faculty of Mechanical and Safety Engineering, Óbuda University, Budapest, Hungary
Dennis G. Barten*
Affiliation:
Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
Harald G. De Cauwer
Affiliation:
Department of Disaster Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts USA; Harvard Medical School, Boston, Massachusetts USA
Derrick Tin
Affiliation:
Department of Neurology, Sint-Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
Attila Gulyás
Affiliation:
Doctoral School for Safety and Security Sciences, Óbuda University, Budapest, Hungary
*
Correspondence: D.G. Barten, MD Department of Emergency Medicine VieCuri Medical Center P.O. Box 1926, 5900 BX Venlo The Netherlands E-mail: dbarten@viecuri.nl
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Abstract

Background:

In recent decades, an increasing number of terrorist attacks have been carried out against medical institutions, hospitals, and health care workers. These attacks, that often result in high numbers of casualties and impaired access to health services, have a more significant impact on people’s sense of security than attacks against military and police targets. Attacks on ambulances – especially on the African continent – have been sparsely studied. This study examines attacks on ambulances on the African continent during the period from 1992-2022 (until December 31, 2021).

Methods:

Reports of ambulance terrorism were extracted from the Global Terrorism Database (GTD), RAND Database of Worldwide Terrorism Incidents (RDWTI), United Nation’s Safeguarding Health in Conflict Coalition (SHCC) database, Armed Conflict Location and Event Data Project (ACLED), Surveillance System for Attacks on Health Care (SSA) database, and Aid Worker Security Database (AWSD). Furthermore, a grey literature search was performed. The date and location of the attacks, perpetrators, weapon and attack types, and the number of victims (dead and wounded) and hostages were collected. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.

Results:

During the 30-year study period, 166 attacks were observed in 18 African countries. The number of attacks significantly increased since 2016, with 81.3% of the attacks taking place from 2016 to 2022. In total, 193 people died and another 208 were injured. Attacks with firearms were most frequently noted (92 cases; 55.4%), followed by attacks with explosive devices (26 cases; 15.7%). A significant number of ambulances were hijacked (26 cases; 15.7%) and subsequently used for other terrorist attacks. In seven attacks, ambulances were used as vehicle-born improvised explosive devices (VBIEDs).

Conclusion:

In this database study on ambulance terrorism in Africa, it was found that the reported occurrence of attacks increased from 2013 onwards, including the rise of ambulances used as VBIEDs. These findings suggest that ambulance terrorism represents a real, significant risk that both governments and health care institutions must address.

Keywords

AfricaambulanceCounter-Terrorism MedicineEmergency Medical Servicesterrorismviolence
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 2 , April 2023 , pp. 237 - 242
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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