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I Greaves. Terrorism J R Army Med Corps 2001; 147: 142-146 J R Army Med Corps: first published as 10.1136/jramc-147-02-06 on 1 June 2001. Downloaded from SPECIAL ARTICLE Terrorism – New threats, new challenges? I Greaves Introduction indistinct and broader movements. Groups The conviction of David Copeland for the appear to be more loosely connected or bombings which culminated in the atrocity at indirectly linked through networks of the Admiral Duncan in Soho, London on professional (full time) terrorists and Friday 30th April 1999 has given us another amateur supporters, sympathisers and would eponymous terrorist, the Soho Bomber, to add be terrorists who may lack the expertise of to a long catalogue of those who chose such their more established counterparts. methods to further their political, sectarian The absence of any central command or or personal aspirations. Yet the Soho Bomb authority is significant in that it may be a was in a number of ways different to the long factor in removing any previous inhibitions run of more familiar terrorist atrocities. This on the terrorist’s desire to inflict widespread article reviews the changing demographics of casualties. In addition, the potential terrorism and their likely effects on law locations for terrorist atrocities are likely to enforcement and the health services be much more diverse than before: we are all response. potential victims, irrespective of location. The victimisation of traditional terrorist The New Terrorism? adversaries is likely to be much less obvious In the past, terrorism has been largely than previously. practiced by groups of individuals belonging It seems characteristic of the new terrorist to an identifiable organisation with defined that no responsibility is claimed for incidents. political, economic or social objectives. Such By maintaining their anonymity, they may organisations include the Japanese Red believe that they are able to capitalise further Army, Germany’s Red Army Faction and on the fear and alarm generated by their Italy’s Red Brigade as well as nationalist violence. terror groups such as the Abu Nidal The likelihood of casualties in a terrorist Organisation, the Provisional IRA and the incident, whatever the agent, is directly Basque separatist group ETA. linked to the notice given prior to the attack. http://militaryhealth.bmj.com/ These groups issued communiqués taking It is the actions of the police following the credit for and explaining their activities and receipt of such a warning that will largely however distasteful their actions might be, determine how many people are killed and their ideology and motivation was usually injured. The Omagh bomb on 15th August clear. 1998 showed only too clearly what can All these familiar terrorist groups engaged, happen if the security services are given for the most part, in highly selective and maliciously false information. Unfortunately, mostly discriminate (in their own eyes at it is characteristic of the many smaller least) acts of violence. They bombed various terrorist groups and isolated operators that, symbolic targets representing the source of just as they tend not to claim responsibility on October 1, 2021 by guest. Protected copyright. their discontent : embassies, associations of for incidents, neither do they give prior the “opposition”, the security forces and warnings. This is particularly likely to be the National Airlines. The aim of each atrocity case when the atrocity is not designed to was to attract attention to themselves and publicise a political agenda. Apparent their cause and to spread terror. “humanitarian” actions, in avoiding The new generation of terrorist seems to casualties, may bring some positive benefit be different to this familiar paradigm. to organised groups, by creating an Terrorists are increasingly part of far more impression of clemency, those who kill for This paper is based on presentations by Colonel Peter Roberts L/RAMC, Professor of Military Surgery Royal Defence Medical College and Royal College of Surgeons of England, Major Ian Greaves RAMC Consultant in Emergency Medicine British Army, Dr Duncan MacPherson Head of the Emergency Planning Unit, Department of Health, Deputy Maj Ian Greaves RAMC Assistant Commissioner Alan Fry, National Co-ordinator, Anti-Terrorist Branch, Regimental Headquarters, Metropolitan Police and Detective Chief Inspector David Johnson, Metropolitan Police given Keogh Barracks, at the Terrorism: New Threats, New Challenges Colloquium at the RUSI on 15th June 2000. Ash Vale, It originally appeared in the Journal of the Royal United Services Institute (October 2000 Vol Aldershot, 145 No 5) and is reproduced by kind permission of the RUSI to whom the editor is most Hants GU12 5RQ grateful. I Greaves 143 other reasons or none, or for the apparent includes representatives from the NHS, the J R Army Med Corps: first published as 10.1136/jramc-147-02-06 on 1 June 2001. Downloaded from pleasure of killing, are unlikely to be Armed Forces (offering expertise in ballistic motivated by such considerations. injury and chemical and biological warfare.), It might be argued that the Soho Bomber The Department of Health, The Home is the archetype of the new terrorist, a lone Office (Terrorist Protection Unit) and the operator representing no-one but himself, Security and Police Services. not subject to any apparent code, however This group has identified three areas of perverted, and armed with the expertise of concern: education, expertise and data the internet. collation (and analysis). If this is truly the face of terrorism to come, With regard to education, clinicians, police then the changing demographics of terrorism officers and other professionals who are will have dramatic effects on the two main involved in the response to terrorism need to agencies responsible for responding to be educated and informed at a level which is terrorism: the health services and the police. appropriate and relevant to their personal Having said that, it would be an extremely responsibilities. Similarly, appropriate sanguine individual who predicted the end of expertise needs to be readily available, by conventional politically motivated terrorism. means of a clear easily accessible process in What seems likely is a general shift of all parts of the country and at all times. emphasis. Finally, medical and forensic data from Furthermore, where apparently organised previous (and future) terrorist incidents groups continue to indulge in terrorist needs to be collected, collated and analysed. activities, examples such as the sarin release Initiatives are now in place regarding by the Aum Shinriko sect on the Tokyo education and expertise, our third aspiration underground in 1995 suggest that we are may be harder to achieve. The threats from likely to see the increasing use of chemical conventional weapons and chemical and and biological agents. Fortunately, to date, biological agents are different and are although terrorists are classically more discussed separately. imitative than innovative, there has not yet been a further significant chemical (or Conventional Threats - bombs biological) atrocity. and bullets Medicine and Terrorism The conventional weapons of the terrorist In medical terms, there is no doubt that it is are the bomb and the bullet. Despite the the civilian services, namely the National changes discussed above, it seems likely that, Health Services, which have to provide the for the most part, terrorist casualties will initial response to the injuries associated with continue to result from the use of terrorism. In the case of the Soho bomb, commercial and improvised ballistic http://militaryhealth.bmj.com/ these injuries were all the more devastating as weapons. a result of the six inch nails packed into the There are undoubtedly pockets of explosive device. Such injuries, of course, are knowledge about the clinical and forensic all the more difficult to manage because of aspects of blast and gunshot injuries, but the numbers of casualties typically many areas of the United Kingdom have no associated with terrorist incidents. Such large direct experience of the consequences of numbers of casualties are all too likely to terrorism. The response to the Soho bomb overwhelm hospital emergency departments. only confirmed once again the effects of such In the aftermath of the Soho bombing, a an atrocity on unprepared medical, nursing and other health services staff.The nails that number of the clinicians involved on October 1, 2021 by guest. Protected copyright. commented that the response might have lacerated the flesh of the victims were been more effective and less traumatic for designed not only to mutilate and to their staff if they had had previous experience terrorise the victims and survivors, but also or training in this area and if access to expert to terrorise those who would be called upon advice had been available to them. Just as to respond to the incident. Such reactions such expertise is not widely available to the can not improve the quality of patient care. NHS, there is no formal national means of Although there can be no substitute for access to it for the police and similar direct clinical experience, education, in agencies. providing vicarious experience can have a Furthermore, were we in the UK ever to positive effect in preparing not only clinicians experience a chemical or biological terrorist but all those who are likely to be confronted incident, even greater problems would be with the results of terrorism. Thus the likely to arise in terms of its initial “terror effect” of terrorism can be reduced. recognition and management. Although This might be considered to be a form of there is a co-ordinated response at “psychological prophylaxis”. government level, there is undoubtedly a Educational initiatives are also important deficit at clinical level. in improving the clinical management of As a consequence of comments such as individual patients. Clinicians and others these, the Forensic and Medical Aspects of need to be informed about the clinical Terrorism Group was established.
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