Fiscal Consequences of Terrorism

Abstract

Terrorism is the war of the future for the human race. It takes many forms, but in essence the common denominator is the calculated use of violence or the threat of violence to attain political, religious, or ideologic goals. This is done through intimidation, coercion, or instilling fear. It achieves chaos and mass hysteria and the occasional overwhelming of medical care systems and other municipal public services. This battlefield is no longer remote, and the arrival of large numbers of casualties presents a unique challenge to medical facilities used to dealing with only one or two simultaneous trauma patients. In addition, in the past decade, the anxiety over the use of unconventional weapons of mass destruction by terrorist groups has increased. In most instances, the initial response and management of the terrorist event are provided by the local civilian law enforcement and medical agencies, but, depending on the scale of the event, military units are usually involved, not to mention that military personnel, installations, and barracks are sometimes the target of terrorist acts.11,35 In theory, terrorism can be achieved by various means. The mere threat of using some vector of mass destruction can cause chaos and civilian unrest, even without actually performing the act (psychological terror). Longstanding threats can sometimes “bend” authorities and societies, thus reaching the goal of the party exercising the threat. The use of agents on property and human beings can be in the form of conventional munitions and explosives, chemical agents, toxic agents, biologic vectors, or nuclear threat. This latter problem has been the focus of several cover stories in the lay press in the past few years since the downsizing of the Soviet Union into many independent states, each capable of harboring these nuclear agents. With the exception of the chemical incidents in Matsumoto36 and the Tokyo subway27,28 in Japan, most terrorist attacks in the latter part of the twentieth century have used conventional weapons. Thousands of conventional traumatic injuries to the body and hundreds of fatalities have resulted. In the past, terrorists were assumed to seldom push their demands to the extent that they may lose their own lives. The experience in Beirut7,10,35 and the numerous suicide explosions in Israel22 involving fundamentalist groups have proved this notion to be obsolete. This article presents the various aspects of medical care in these events.