Introduction
London (England), Madrid (Spain), Paris (France), Moscow (Russia), Tokyo (Japan), and many other capital cities around the world have been subjected to terrorist attacks on their transport systems with devastating consequences. Large crowds in small enclosed spaces, disruption to people movement, and the psychosocial and financial repercussions of attacks are some of the many soft target vulnerabilities of mass-transit systems.
This study is an epidemiological examination of all terrorism-related events targeting air, sea, and ground transport modalities sustained from 1970-2019, comparing the rates of fatal injuries (FI) and non-fatal injuries (NFI).
Methods
Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). This database is open-access with publicly available data collection methodology utilizing artificial intelligence that identifies events from news media around the world daily, as confirmed by human evaluation of the events by the National Consortium for the Study of Terrorism and Responses to Terrorism (College Park, Maryland USA). The GTD defines terrorist attacks as: “The threatened or actual use of illegal force and violence by a non-state actor to attain a political, economic, religious, or social goal through fear, coercion, or intimidation.” The GTD database does not include acts of state terrorism. The GTD contains no personal identifiers for victims and links specific events to open-source news articles.
The GTD database was downloaded and searched using the internal database search functions for all events that occurred from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. “Transportation,” “Airport and Aircraft,” and “Maritime” as primary target types were selected for the purpose of this study, and events were further sub-classified by region, weapon type used, and by suicide attack (SA). “Airport personnel” were excluded. All classifications and sub-classifications were pre-determined by the GTD. It is worth noting that events using transport modalities as an attack methodology/weapon (such as the United States September 11, 2001 and the Nice, France 2016 truck attack) are not included in this study, unless the primary target was transport related. The use of “vehicles” as a primary attack modality is excluded in this study. “Transportation” includes attacks on public transportation systems only and is sub-classified into “bus, (excluding tourists),” “train/train tracks/trolley,” “bridge/car tunnel,” “bus station/stop,” “highway/road/toll/traffic signals,” “subway,” “taxi/rickshaw,” and “unspecified.”
Military transports are excluded in “transportation,” “airports and aircrafts,” and “maritime” sub-categories and are thus excluded in this study.
Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. Attacks met inclusion criteria if they fulfilled the three terrorism-related criteria below, as set by the GTD. Ambiguous events were excluded when there was uncertainty as to whether the incident met any of the criteria for GTD inclusion as a terrorist incident. These criteria were determined within the database and not by the authors:
Criterion I: The act must be aimed at attaining a political, economic, religious, or social goal.
Criterion II: There must be evidence of an intention to coerce, intimidate, or convey some other message to a larger audience (or audiences) than the immediate victims.
Criterion III: The action must be outside the context of legitimate warfare activities (ie, the act must be outside the parameters permitted by international humanitarian law, particularly the admonition against deliberately targeting civilians or non-combatants).
Results
There were 8,729 transportation-related (air, sea, and ground) attacks documented during the study period with 19,020 fatalities and 45,218 NFI. This accounted for 5.2% of all terrorist attacks (168,003 total events), 5.6% of all FI (total 339,435), and 9.1% of all NFI (total 496,225). The mean FI was 2.2 per event and the mean NFI was 5.2 per attack with the latter accounting for one of the highest NFI rates across all target types (Table 1).
Table 1. Breakdown of Fatal Injuries and Non-Fatal Injuries by Target Type
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Abbreviation: NGO, nongovernmental organization.
South Asia (28.4%), Middle East and North Africa (18.2%), and South America (14.9%) accounted for 61.5% of all transport-related attacks (Table 2 and Figure 1).
Table 2. Regional Breakdown of Transport Attacks
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![](https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary:20220324015653500-0247:S1049023X22000371:S1049023X22000371_fig1.png?pub-status=live)
Figure 1. Regional Breakdown.
Explosives (61.5%), firearms (16.3%), and incendiary attacks (14.6%) were the leading weapon types used and buses (33.2%) and trains (25.7%) were most commonly targeted (Table 3 and Table 4).
Table 3. Weapon Type Used on Transport Attacks
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Table 4. Breakdown by Specific Transport Modes
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Attacks on subways inflicted a disproportionately high 51.5 NFI per attack (Table 4). Attacks that were sub-classified as SA showed significantly elevated FI and NFI ratios per attack across all transport modalities with subway attacks recording the highest ratios for both FI (13.71 per attack) and NFI (139.00 per attack; Table 5 and Figure 2).
Table 5. Suicide Attack Related Fatal and Non-Fatal Injuries by Transport Modality
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![](https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary:20220324015653500-0247:S1049023X22000371:S1049023X22000371_fig2.png?pub-status=live)
Figure 2. Injury Ratios: Overall versus Suicide Attacks.
Discussion
In 2019, Americans took 9.9 billion trips on public transportation, which provides people with mobility and access to employment, community resources, medical care, and recreational opportunities in communities. 1
Transport modalities, especially mass-transit systems, are vulnerable soft targets: easily accessible, relatively unprotected, and a place where a large number of civilians congregate. Reference Shvetsov, Sharov and Kozyrev2 Attacks on such modalities can be highly lethal but can also inflict extensive psychosocial injuries on local populations, disrupt day-to-day community functions, and can lead to significant financial damage to both government and private organizations. Reference Howitt and Makler3
It is estimated that over 90% of public assistance recipients are dependent on public transportation and attacks on such systems, and the resulting disruptions to the service, will likely disproportionally affect the poor. Reference Steinfeld, Maisel and Steinfeld4
Population behavioral responses in the aftermath include generalized travel anxiety as well as avoiding public transport and shifting to individual modes of transport (which can result in increased congestion and higher rates of traffic-related incidents, trauma, and death). Reference Elias, Albert and Shiftan5–Reference Ayton, Murray and Hampton7 Economic impacts include cleanup and repair costs but can also extend to travel and tourism activities.
While the airline industry has historically imposed more stringent security checks and regulations in regards to both domestic and international air travel, land-based mass-transport systems face the difficult dilemma of balancing the tradeoff between security considerations and service accessibility. Reference Howitt and Makler3 Airline-style security screening and other target hardening measures would likely hinder the efficient flow of people but minimize and mitigate the risks of an attack.
While the weaponizing of transport modalities to commit terrorism acts are beyond the scope of this paper, events such as September 11, 2001 and other vehicular ramming and explosions such as the 2016 Nice, France truck attack have emerged as widely recognized terrorist methods, raising further concerns around the security of transport systems around the world. Reference Bloom8
The lethality of explosive attacks depend on several factors: density and distance of population in the vicinity, the duration and magnitude of the blast wave, open air versus confined space, open versus closed doors, diameter of tunnel (tube tunnel versus sub-surface tunnel), proximity to other vehicles or buildings, and potential tertiary injuries from collapsing structures; explosions near or within hard solid surfaces can be amplified multi-fold due to shock wave reflections and, as an example, collapse of the upper deck of a bus onto the lower deck will likely result in larger number of casualties. Reference Turégano-Fuentes, Caba-Doussoux and Jover-Navalón9
Furthermore, suicide bombing attacks can inflict a significantly higher death and injury toll than conventional attacks on any given transport modality. This is likely due to the agility of suicide bombers and their ability to move, change directions, infiltrate busy and populated areas relatively undetected, or change time and location of targets in real time. Reference Tin, Galehan, Markovic and Ciottone10
Subway attacks have been shown to be particularly lethal out of all the various transport modalities. Confined spaces with closed doors and limited evacuation paths are extremely prone to amplified pressure effects of blast attacks. While simple blast waves in open space create a rapid rise in air pressure, they tend to also rapidly dissipate, whereas confined space explosions with restricted venting can create complex patterns of shock wave reflections and interactions. Explosion-related high temperatures and inability for gaseous products to dissipate would produce more pressure, leading to prolonged blast exposures, higher pressures, and thus greater transfer of energy to the human body, increasing the risk of primary blast injuries such as blast lungs, belly, and brain as well as other organ trauma. Blast injuries are typically classified into Primary (blast wave), Secondary (debris displaced by blast wind), Tertiary (person displaced by blast wind or from surrounding structural collapse), and Quaternary injuries (any injuries that are not primary, secondary, or tertiary; eg, fire, smoke, and toxins). Reference Adler and Rosenberger11
Enclosed spaces with limited ventilation systems are also especially vulnerable to smoke inhalation injuries and chemical attacks. The 1995 Tokyo Subway Sarin gas attack remains one of the most significant terrorist acts in history, killing 12 and injuring over 5,500 others. Reference Tin, Granholm, Hart and Ciottone12
Emergency medical care responses to subway attacks are often hampered by communication failure and difficult accessibility, potentially delaying rescue and time to medical treatment. While advances in technology, communications, computational capabilities, and data platform integration have significantly improved disaster risk reduction strategies and help manage responses to mass-casualty incidents over the years, Tim O’Toole, former Managing Director of the London Underground (London, England), captured the importance of individuals in enacting the emergency response when he spoke to the Committee reviewing the 2005 London attacks: “the big lesson for us is to invest in your staff, rely on them; invest in technology, but do not rely on it.” 13
Although sophisticated counter-terrorism intelligence and technologies have evolved during recent years and attack risks can be mitigated through a number of relatively simple measures (such as installing metal detectors at entrances to public stations, security check points, and roadblocks), novel attack methodologies such as the use of drones need to be carefully considered and examined. Reference Borrion, Tripathi, Chen and Moon14–Reference Tin, Hart and Ciottone16 Explosive-equipped drone swarms can be pre-programmed or manually flown into civilian air, land, and sea transport systems with little resistance and special considerations need to be taken when transporting dangerous or hazardous material goods. Reference James17
The “if you see something, say something” campaign was originally implemented in 2001 by the New York Metropolitan Transportation Authority (New York USA) to inspire, empower, and educate the public on suspicious activity reporting. By 2006, reports of suspicious packages in New York grew to over 37,000 and in 2010, the US Department of Homeland Security (Washington, DC USA) licensed the phrase for the purpose of creating a nation-wide campaign. The slogan has since been adopted by a multitude of national agencies across many cities around the world, including the Transportation Security Administration (Arlington, Virginia USA), Amtrak (Washington, DC USA), colleges, and sporting venues. 18
Limitations
The GTD is a comprehensive record of global events. It is maintained by the National Consortium for the Study of Terrorism and Responses to Terrorism and is the basis for other terrorism-related measures, such as the Global Terrorism Index (GTI). Reliance wholly on the GTD is partially mitigated by confirmation with other lay sources and searches for other online searches, but if there are incidents not reported in the GTD, this could limit the veracity of the findings. One of the main limitations of the GTD dataset is their Criterion III, which removes all suicide bombings that occurred within the context of war. Another classification in the GTD dataset “Doubt Terrorism Proper” will exclude cases based on five alternate designations. The two most relevant to suicide bombings are “insurgency/guerrilla actions” and “intra/inter group conflicts” which may have terrorist attacks attached to these but will not be counted for the purposed of the GTD dataset. Although publicly available datasets, such as Chicago Project on Security and Threats (CPOST), report on a greater number of suicide bombings, they do not collect datasets on other terrorist events. Therefore, for comparative purposes, using the GTD was the publicly available dataset. Furthermore, injuries and fatalities were cross-matched with news records rather than formal hospital or coroner reports, and so rely on the completeness and accuracy of these sources.
Conclusion
Transport modalities are vulnerable terrorist soft targets. The repercussions of attacks on public transport modalities represent a significant and unique psychosocial and economical risk to the affected communities. Suicide attacks on subways represent a unique and significantly higher casualty risk than other transport modalities. Risk mitigation strategies should be regularly revisited by Counter-Terrorism Medicine (CTM) specialists.
Conflicts of interest/funding
The authors declare no conflict of interest and no financial disclosures.