The international burden of terrorism: an introduction.

Web Publication: 06 February 2004 There should be no doubt by now that the challenge of terrorism has left an indelible mark on the world as we know it. From the 11 September 2001 assaults on the New York City World Trade Center and the US Pentagon to the daily carnage in Iraq, as the traditional Turkish expression goes, we are truly "living the history". No group is as intimately connected to the need to respond to the unique demands of terrorism in the world today as is the readership of this journal. One of the first steps in addressing a challenge of this magnitude and complexity is to delineate the extent to which terrorism impacts human communities. To this end, Prehospital and Disaster Medicine began over a year ago, to lay out the foundation for two special theme issues on the topic of "Terrorism". The first of these two theme issues on terrorism is published here. In bringing together reports on the burden of terrorism in 17 countries on six continents, this theme issue offers the remarkable opportunity to consider the challenge of terrorism from an international perspective. With several reports coming from countries rarely represented in the English-language medical literature, this theme issue facilitates an unusual understanding of the international burden of terrorism. This collection of international reports also offers the opportunity to discover many of the lessons learned from a wealth of experience in planning, preparing, and responding to terrorist acts across the world. One particularly important lesson learned is that when it comes to dealing with terrorism, no country is an island. The challenge of terrorism spans all inhabited continents, crosses all cultures, and penetrates all jurisdictions. A related corollary is that terrorism is not just an affliction of the developed world. As several articles attest, terrorism has placed an enormous burden on a number of developing countries, such as Colombia, Indonesia, Peru, and Turkey. For example, some Americans still reeling from the events of 2001, may be surprised to learn that in Turkey since 1985 more than 30,000 persons have died from terrorismrelated causes. The impact of terrorism in the developing world is of paramount importance to trans-national or national organizations responsible for distributing resources aimed at managing this problem. This issue also provides striking evidence that the burden of so-called conventional terrorism on communities (i.e., bombings, shootings, hostage-takings, and hijackings) far outweighs any burden of unconventional terrorism (i.e., chemical, biological, radiological, and nuclear releases). In the country reports included here, only Japan lists any examples of terrorism-related chemical releases, and no article reveals any instances of biological, radiological, or nuclear release (other than benign "white powder" events stemming from the 2001 US anthrax letter attacks). This pattern has huge implications for the priorities of emergency management in communities at risk. It suggests that the first step in emergency preparedness for terrorism must be to ensure that communities have the requisite capacities, capabilities, and competencies to adequately respond to everyday bombings and shootings that generate large numbers of casualties before proceeding to contingencies related to the use of weapons of mass destruction.