Mitigating the Terrorist Threat Against Hospitals- 4 Strategies

A car bomb explodes in front of a hospital followed by men rushing the building to kill survivors of the blast. Doctors, nurses, patients and others are targets and the shooters do not discriminate. They even lob explosives at a crowd of people huddling for safety in a hallway. No mercy is shown to anyone inside what was once a safe haven.

What sounds like a horribly detailed training scenario or a scene from a movie is actually the description of the attack on a hospital at the Yemen Defense Ministry on December 5, 2013. In all, 52 people died in the attack, much of which was captured on the hospital’s CCTV system. Al Qaeda in the Arabian Peninsula later apologized for the attack, saying it was not an intended target. The attack was nevertheless a frightening reminder to hospitals around the world about their vulnerability to terrorism.

A working paper published by the International Institute for Counter-Terrorism in 2013 entitled Terrorist Attacks Against Hospitals: Case Studies found about 100 terrorist attacks at hospitals worldwide that took place in 43 countries on every continent from 1983-2013. A total of 775 people died in these attacks and 1,217 others were wounded, according to the report. The most common types of attack against these hospitals were bombings, followed by armed assault, according to authors Ganor and Wernli.

As secondary, “soft” targets, hospitals are appealing to terrorists. The hospital as a secondary target takes away or severely cripples the ability of the hospital to treat the wounded from a terrorist attack, enhancing the death toll and causing chaos. While this is a rare threat, it is not one to be ignored. So, what can hospitals do to help prevent becoming a target for an attack? The layered approach to security already in use in many institutions is the key. Here are four examples of the layers to consider for your program:

Intelligence Collection and Analysis (outermost layer)

It’s important for hospital security departments to be aware of what is happening not only in their city or state, but what is happening around the world. Staying on top of terrorism trends and targets of attacks is just one way of being aware of the latest threats.

Other sources of intelligence can come from your regional fusion center, local/state/federal law enforcement, and the Department of Homeland Security. While your access to information may be limited depending on your role, establishing a relationship with these entities is key to staying on top of the latest intelligence.

As you collect intelligence, think about how it might pertain to your hospital or operations and use it accordingly to alert your staff, to enhance security measures, or to employ other mitigating strategies. By the way, intelligence sharing goes both ways, so be sure to keep your law enforcement and intelligence partners informed of suspicious incidents within your institution.

Solid Physical Security (outer & inner layers)

It goes without saying that good access control, and other well-planned, risk-based physical measures at your perimeter and inside your buildings can help to prevent access to people and assets within your hospital. CCTV coverage, while a deterrent, can also prove useful in investigating suspicious activity after it has been reported. The ability to lock down your building(s) quickly and effectively can also be an excellent tool when it comes to emergent threats.

Trained and Alert Employees (inner layer)

Security staff is not your only line of defense when it comes to identifying suspicious people. While Security Officers can be highly trained to recognize suspicious behavior, they are always limited in number. Educating staff across the hospital about how to recognize and report suspicious activity is a force multiplier, giving you hundreds, if not thousands of additional eyes and ears to protect your hospital. This training can typically be developed in-house and delivered during orientation or during staff meetings and in-service seminars. Alternatively, programs like SAVE can give employees more formalized and extensive training on the topic.

Specially Trained Security Staff (inner layer)

Security staff should be trained not only to recognize suspicious behavior, but should be aware of the possible vectors for terrorist attacks. They should be educated on the types of terrorist groups that are active, possible motives for attacks, and how to conduct conversational questioning. Programs such PATRIOT and SIRA teach officers these key skills and more, giving them the tools to conduct effective counter-surveillance on a daily basis.

Putting it All Together

While these layers are basic in nature, they can always be enhanced and built upon to create an effective deterrent to terrorism and, at the very least, a tripwire to alert you to suspicious activity related to terrorism or other criminal activity. The threat of a terrorist attack is a low probability, high impact concern that we all need to mitigate through effective intelligence collection, awareness, target hardening and training.

Photo Credit: Ben Rowe