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How terrorists target and attack health care facilities and personnel

“Terrorism & the Medical Environment” is designed to help save lives, money, property and medical professionals who are the victims and saviors of terrorist attacks


Louis R. Mizell and E. Reed Smith, MD introduce their book, “Terrorism & The Medical Environment,” in this excerpt. Medical facilities and health care workers have been and will continue to be terrorism targets. Read the book to learn the latest tactics, targets and trends as you prepare your EMS organization to respond to active shooter, hybrid targeted violent attacks and other terrorism incidents.

By Louis R. Mizell and E. Reed Smith, MD

The largest and second largest hostage-taking events in modern history did not take place at embassies, airports, government buildings or religious facilities; they both occurred inside public hospitals.

Launching “Operation Jihad” in 1995, 142 Chechen and Arab militants held 1,648 hostages — doctors, nurses, patients, visitors and security personnel — at a hospital in Budennovsk, Russia.

On the second day of the historic siege, Shamil Basayev, the leader of “Allah’s Warriors” (aka the “Wolves of Islam”) demanded a press conference that Russian authorities staunchly refused. But when a terrified hostage was ceremoniously marched out of the hospital and brutally executed at point-blank range ... and a second, third, fourth, fifth and sixth hostage met the same fate, authorities suddenly changed their minds and agreed to the televised media extravaganza. If Russia had not consented to the demands, hostages would likely have been sacrificed, one-by-one, until 1,648 corpses lay stacked on hospital grounds.

On Sunday, June 18, the fifth day of the crisis, the Russians conceded on live television to cease combat operations in Chechnya and to provide safe passage home for Allah’s Warriors. The bloody six-day hospital takeover resulted in 247 people killed, 414 men, women and children wounded, and the theft of medical supplies, radioactive isotopes and possibly even deadly biological agents. Succeeding in his mission, Basayev became the “Hero of Budennovsk” to his fellow Chechans and proved that sometimes, despite our denials, terrorism works. The war was stopped, if only temporarily, and Russia was forced to the negotiating table.

Setting an ominous precedence for the worldwide hospital and healthcare community — a targeting that continues even two decades later — at least four more Chechen attacks in 1996 alone involved medical personal and facilities. The incidents included the brutal murders of six Red Cross nurses and other employees at a hospital in Chechnya, the worst premeditated attack in the 133-year history of the International Committee of the Red Cross.

When most people think of “terrorism,” they generally conjure up images of airplane hijackings, kidnappings or assassinations of public figures, and the bombing of embassies, government facilities, religious groups and military bases. Most people do not normally view hospitals and the medical environment as major terrorist arenas. But there is something dangerously wrong with our world view; perception is at odds with reality.

The sad reality is that many of the deadliest terrorist bombings in recent years have occurred in the healthcare industry. Terrorists are increasingly using varied forms of the “double bomb” and “unwitting accomplice” tactic in the medical environment. When a doctor unknowingly transports a bomb to a hospital in the trunk of his car or an ambulance driver unknowingly transports a concealed bomb to a rescue site, they both become unwitting accomplices for the terrorists.

Hoping to dramatically increase casualties and demoralize their enemy, numerous groups have detonated one device in the community and then exploded a second bomb near the emergency room when first responders delivered the casualties to the hospital.

Limited only by their sense of the macabre, at least two dozen groups worldwide have used body bags and coffins to gain access or to escape secure installations, to smuggle people, weapons and explosives, to cross borders or to bomb hospital morgues and funeral services.

Sneaking past security at the Jibla Baptist Hospital in Yemen, a man supposedly seeking medical attention for his child, cradled an assault rifle beneath his coat as if he was holding a baby in his arms. Upon entering an office where a meeting was taking place, the man unwrapped his “baby” and assassinated three American medical workers.

Over and over again, terrorist bombers and assassins have donned white lab coats, draped stethoscopes around their necks, and — “abracadabra” — became doctors and nurses roaming the halls of hospitals, magically appearing and disappearing as they pleased.

From 1970 through 2014, at least 54 terrorist and guerrilla groups worldwide are known to have utilized some form of medical impersonation ruse for operations inside and outside the hospital environment. It is a tactic that is here to stay.

A highly effective and versatile tactic, terrorists past and present have posed as doctors, nurses and EMTs to conduct kidnappings, bombings, hijackings, assassinations, smuggling operations, robberies and hostage takeovers of embassies, prisons and hospitals.

Going far beyond the wearing of medical whites and scrubs, terrorists targeting hospitals have also pretended to be sick and injured patients, worried relatives, delivery personnel, hospital janitors, members of the press, workmen, police and security guards.

One of the most wanted terrorists in the Philippines attempted to fly out of the country swathed head-to-toe in bandages and plaster casts in an effort to escape a police dragnet. Claiming to have been in a horrible traffic accident, the terrorist leader was wheeled through the airport by a supposed nurse and was immobilized with fake plaster casts on both legs, one arm and chest and had red-stained bandages covering his head and face. In similar cases, physician sympathizers have provided would-be escapees with official documentation attesting to the passenger’s medical problems and needs.

Adopting a new genre specifically designed for the Age of Information, “Terrorism & the Medical Environment” is one part narrative (a non-fiction reference that reads like a thriller) and one part database (chronicles of incidents on scores of relevant subjects).

By assembling and assessing relevant intelligence from 124 countries, “Terrorism & the Medical Environment” is designed to help save lives, money, property and professional reputations — and is dedicated to the doctors, nurses, EMT’s, and other medical professionals who are both the victims and saviors of terrorism.


Reprinted from “Terrorism & The Medical Environment”
Learn more at
By Louis R. Mizell and E. Reed Smith, MD
Publisher by Louis Mizell, 2016
Available on Amazon

About the authors
A former U.S. Marine and Special Agent / Intelligence Officer with the U.S. Department of State, Louis R. Mizell has had a wide range of assignments in 105 countries. The author of nine books on terrorism, crime, security and safety including “Target USA” and “Street Sense for Parents”, Mizell has a Master’s Degree in law enforcement, taught a graduate course in international terrorism and has lectured on hospital security in the U.S. and four other countries. Quoted in more than 400 newspaper and magazine articles, Mizell has appeared in dozens of television news programs and documentaries.

Dr. E. Reed Smith is the Operational Medical Director for the Arlington County (VA) Fire Department, and an Associate Professor of Emergency Medicine at the George Washington University School of Medicine. He attended medical school at the Georgetown University, completed his residency training in Emergency Medicine at the George Washington University, and has spent the last 12 years developing training and programs to address regional emergency preparedness and operational gaps in the National Capital Region, including unique operational EMS sub-specialty teams and Rescue Task Force, an innovative pre-hospital response to active violence and explosive scenarios. Dr. Smith frequently presents at national and international medical conferences and delivers training to many groups ranging from tactical to operational to hospital-based.

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