Coordinated simultaneous attacks in multiple geographic locations, both in the United States and abroad, with the intent to kill large numbers of people over minutes, hours, or days have become part of the regular strategy of terrorists. These attacks often employ a combination of conventional and unconventional weaponry and may involve weapons of mass destruction (WMD, including chemical, biological, radiological, nuclear, or explosive [CBRNE] agents and devices). Scenarios of this sort have been effectively carried out since the 1960s, resulting in the deaths of thousands and the psychological impacts that terrorists so eagerly desire. Near-simultaneous or simultaneous attacks utilizing conventional weapons (i.e., small arms and explosives), as witnessed most notably in the Boston Marathon bombings in April 2013, the Oslo attacks and massacre of 2011, the Mumbai attacks in 2008, the Madrid train bombings in March 2004, and the infamous 9/11 attacks, have been used with great success by terrorists.
This chapter discusses emerging tactics, including the coupling of conventional weapons and CBRNE agents in the minutes, hours, or days after the initial attack, in the execution of a “multimodality, layered attack.” Rather than targeting locations with a similar threat, those responsible select several types of attack modes. The Iran-Iraq War of the 1980s and the current civil war in Syria provide glaring examples of these tactics, combining conventional and chemical attacks that have significant implications for both the health care system, specifically prehospital and hospital communities, and society as a whole. Given terrorists’ motivations to repeatedly highlight their targets’ vulnerabilities, and the creative tactics that they use to do so, this chapter meets the urgent need for understanding multimodality, layered attacks and the means to manage their effects.
The notion of terrorism
An agreed-upon definition of terrorism itself must exist in order to understand the concept of multimodal, layered terrorist attacks. Although there is no universally accepted definition of terrorism, this chapter uses the U.S. Department of State’s definition found in Title 22, Chapter 38 , Sec. 2656f, of the United States Code, which states, “the term ‘terrorism’ means premeditated, politically motivated violence perpetrated against noncombatant targets by subnational groups or clandestine agents.” Special attention should be paid to the terms premeditated and noncombatant targets, highlighting that events of this kind are not accidental (see Chapter 36 ) and are aimed at civilians and off-duty military personnel.
Modes of Attack
Given the diversity of motives for and classifications of terrorism, a review of the two principal modes of terrorist attacks—conventional and unconventional—follows, with particular consideration given to simultaneous deployments within each mode.
Conventional Tactics
Conventional or traditional attack modes include those attacks that do not involve WMD. In conventional attacks, terrorists utilize small arms, explosives, and incendiary devices. Recent terrorist events indicate that these attacks can have a far more considerable impact than those that include WMD. As demonstrated by Faisal Shahzad’s attempted Times Square bombing in 2010 and the Boston Marathon bombings of April 2013, intelligence and experience continue to suggest that use of tried-and-true conventional weapons is likely to remain a favored choice of terrorists. This is especially true as the devices employed are inexpensive, are readily available, and require minimal skill to construct. Additional examples of such incidents include the bombings at the World Trade Center in New York City in 1993, the Oslo bombing in 2011, and the bombing of the Alfred P. Murrah Federal Building in Oklahoma City in 1995. One cannot forget the ongoing terrorism and myriad of IED attacks carried out throughout the Middle East.
Unconventional Tactics
Unconventional or WMD attack modes involve the use of CBRNE devices. The Aum Shinrikyo cult attacks utilizing sarin gas in Matsumoto, Japan, in 1994 and again in the Tokyo subway system in 1995, and the recent use of sarin on Syrian civilian populations, are examples of chemical terrorist attacks (see further discussion in Section 11). The sarin attack on the Tokyo subway caused hundreds of people to become ill, resulted in the deaths of 12 persons, and caused psychological harm to many more victims.
The 2001 anthrax attacks in Florida, New York City, New Jersey, Washington DC, and Connecticut represent the most recent large-scale example of a biological agent attack. In the incident, contaminated letters were processed and sent to media outlets and elected officials through the U.S. mail, resulting in several deaths and massive financial consequences. Although the use of biological weapons by terrorists has the potential to harm and kill thousands of people, the extent to which incidents involving weapons of this sort, such as the dissemination of anthrax or smallpox, will occur in the future in the United States or elsewhere is unknown. This is in part because terrorist attacks using biological weapons have been extremely rare, as most terrorist organizations lack both the sophisticated laboratories to develop and the complex delivery systems to disperse such agents. However, the line between chemical weapons and biological weapons is being blurred by rapid developments in biotechnology and the emergence of a new generation of toxins and bioregulators. As a result, the numerous problems in the detection of and response to chemical and biological incidents are now exacerbated by new challenges. Moreover, a follow-up attack that includes the release of an agent such as smallpox could pose threats to large populations because of the potential for person-to-person transmission, enabling spread to other cities and states and exacerbating what would already be a nationwide emergency. The employment of multiple chemical and biological agents is a probable scenario of the future, challenging the medical community to be increasingly proactive in its development of appropriate countermeasures.
Radiological weapons (see Section 10) or “dirty bombs” (see Chapter 77 ) disperse radioactive materials in a conventional device such as a bomb or other explosive container. To date, the use of nuclear and related weapons has been the sole purview of nation-states. In 1995 Chechen rebels were reported to have buried, but not to have detonated, a 30-lb box of cesium-137 and dynamite near the entrance of a busy Moscow park. More recently, six individuals were arrested after stealing a truck filled with hospital waste cobalt-60 in Mexico, widely considered a potential ingredient for a “dirty bomb.” This is only one example of myriad thefts of nuclear material in recent years. The potential use by terrorists of nuclear, radiological, and related weapons expands this threat to new actors with links to the global complex of nuclear weapons and nuclear power facilities.
The use of any or all of these attack modes is not the only issue of concern. The tactics through which they are employed, coordinated with or following a conventional attack, is the key issue at hand. A discussion of the use of multiple modes of attack deployed in a simultaneous or near-simultaneous manner follows.
Categorization of Simultaneous Attacks
Global and domestic affairs dictate that a broad variety of terrorism threats already exist, that others will emerge and develop, and that the United States will be among the targets of such threats for the foreseeable future. The most serious concern about terrorism is that terrorists are seeking to kill and injure more and more people. While this is so, it is also important to note that the desired effects of terrorism transcend physical harm to the victims and the accompanying psychological impacts on the target and the society to which it belongs. The psychosocial impacts of simultaneous attacks (e.g., crippling effects of attacks on energy or information technology infrastructure), even when thwarted, can result in behavioral changes that often affect the economy. These economic effects can have significant impacts, as seen after the 9/11 attacks when many elected officials, including the mayor of New York City, had to make repeated public appeals for people to visit theaters and restaurants and contribute to the local economy again. Unquestionably, mass fatalities that result from simultaneous attacks have an impact, as images and reports of thousands dead or injured are a heinous reality of terrorism, particularly with the proliferation of social media and the ability to instantly provide information and images from incident scenes.
The associated fear and anxiety about one’s own safety, concerns about the ability of government to protect its citizens, and the ominous danger brought about by the potential for future acts of terror that are of utmost importance to the terrorist. As a consequence, the terrorist’s victims must be carefully selected to ensure the maximum possible psychological impact on the target. While target selection is important (e.g., urban rail hub versus rural elementary school), the timing with which the attacks are carried out—particularly if in a coordinated, simultaneous manner—is also vital to ensuring desired impacts. On 9/11, 2752 people were killed, the most fatalities from any single documented terrorist event in the United States, and the method of attack selected by the terrorists was one that included coordinated, layered attacks across a variety of geographic areas. Although it was a day of utter devastation, one need only think about the effects had the terrorists added follow-up attacks that included a CBRNE event.
A discussion of the two core, but certainly not comprehensive, classifications of simultaneous, layered attacks follows. The first includes “multiple incidents in a single jurisdictional target.” Attacks of this sort may commence as a single incident (e.g., a single suicide bus bombing) but can quickly evolve into an attack against multiple targets, including first responders. For example, the March 2004 bombings in Madrid, the deadliest terror strikes in Europe since the bombing of Pan Am Flight 103 over Lockerbie, Scotland, in 1988 killed 270 people, and is the worst terrorist assault in Spanish history. The attacks took place at the height of a weekday rush hour when three separate trains were hit by 10 near-simultaneous explosions. The attacks occurred between 7:39 and 7:54 am , with multiple explosions at the Santa Eugenia, El Pozo, and Atocha stations. Although three other bombs were found and detonated by police, 192 people were killed and 1800 wounded. In attacks of this kind, multiple weapons or secondary devices are employed with the intention to kill large numbers, drain the resources of the affected jurisdiction by rendering an area insecure, and hamper both rescue efforts and injury control.
In such incidents, first responders become victims as well as they manage the initial event and may be struck by follow-up attacks. According to the National Counter Terrorism Center, “Terrorist groups … may target responders deliberately to enhance the magnitude of their terror attack, creating increased fear and media attention by demonstrating that even would-be rescuers are vulnerable to attack.” Given the sophistication of these types of attacks, improved coordination among the perpetrators is required, usually involving multiple people. Include the release of a chemical agent (e.g., tabun, a poison so powerful that even short-term exposure to small concentrations of its vapor results in immediate symptoms and possibly death) in the scenario and the effectiveness of a multimodality, layered attack becomes clear.
The second type of simultaneous attack classification involves “multiple incidents across multiple jurisdictional targets.” The incident may begin as one or more concurrent attacks that turns into an attack against multiple targets, again including first responders, in geographically separated areas with multiple weapons or secondary devices. These attacks are aimed at perplexing emergency response systems and draining resources of the local jurisdiction, if not state and federal levels. The coordinated terrorist attacks on Mumbai in 2008 are the most salient example of this tactic. These attacks targeted a train station, a Jewish Center, a theater, and a hospital and lasted over 4 days. The mobile terrorist teams killed over 100 people across multiple “soft targets” including the Cama Hospital and popular tourist destinations across Mumbai.
Although the events of 9/11 illustrate an attack using conventional means, the impact would have been exponentially worse had the perpetrators added the release of a CBRNE agent within the United States later in the day or in the days immediately following the initial attack. The addition of CBRNE agents, even if it added no more casualties, would worsen physical, psychological, and emotional trauma and further complicate and delay response by siphoning resources toward identification of the agent, conduct of an in-depth epidemiologic investigation, and extended incident and resource management.
The use of multiple CBRNE agents or the delivery of chemical and replicating agents or toxins, carefully chosen for their ability to generate specific symptoms and potentiate health effects, further complicates multimodality, layered attacks. Agent detection requires rapid diagnostic methods and procedures (e.g., syndromic surveillance) to identify illnesses that result from multiple agents.
Given the skills necessary to conduct such attacks— timing, organization, and coordination of the perpetrators—and possibly suicide attacks, several persons would be needed to carry out these attacks.
The near-simultaneous bombings of U.S. embassies in Nairobi, Kenya, and Dar es Salaam, Tanzania, which resulted in 224 deaths, are additional examples of multiple-incident, multiple-jurisdiction, layered attacks. The demonstration of an operational capability to coordinate two nearly simultaneous attacks on U.S. embassies in different countries to a large extent has influenced U.S. policy. Many terrorism experts point to the change in targeting and the style of attack as evidence of a possible broadening of the overall strategy from mainly guerilla insurgency against U.S. forces to a coordinated terrorist campaign that includes foreign elements. The evolution of these tactics is difficult to predict. In all cases, the aim of these attacks was to maximize injury and cause complex trauma, thereby elevating the killing ratio. Although the ability to conduct multiple coordinated attacks against several targets is not new for terrorist groups, the manner in which these attacks are being conducted indicates refined capabilities and sophisticated tactics, bringing into focus the reality that future terrorist attacks will likely include even greater use of multimodality, layered attack tactics.
Historical perspective
Prior to 9/11 approximately one thousand Americans had been killed by terrorist events either in this country or abroad since 1968—the year heralded as the advent of the modern era of international terrorism after the Popular Front for the Liberation of Palestine hijacking of an El Al flight. Simultaneous, large-scale attacks using conventional means such as car bombs are relatively uncommon. For reasons not well understood by scholars or practitioners, terrorists typically have not undertaken such coordinated operations. One thought is that smaller plots are easier to conduct and less likely to be thwarted, thereby improving their chance of completion. Conversely, the historical lack of large-scale, multiple simultaneous attacks may be a reflection of the logistical and other organizational obstacles that most terrorist groups are not able to overcome. In fact, the initial “planes operation” (as it was termed by Al Qaeda operatives) embraced the idea of using suicide operations to blow up planes as a refinement of the original “Manila” air plot. All of the planes hijacked were to be crashed or exploded at or about the same time to maximize the psychological impact of the attacks.
During the 1990s, perhaps only one other terrorist incident evidenced the characteristics of coordination and high lethality: the series of attacks that occurred in Bombay (now Mumbai) in March 1993, where a dozen or so simultaneous car bombings rocked the city, killing nearly 300 persons and wounding more than 700 others. Indeed, apart from the attacks on the same morning in October 1983 of the U.S. Marine barracks in Beirut and a nearby French paratroop headquarters, and the Irish Republican Army’s near-simultaneous assassination of Lord Mountbatten and remote-control mine attack on British troops in Warrenpoint, Northern Ireland, in 1979, it is hard to recall many other significant incidents reflecting such operational expertise, coordination, and synchronization.
That is not to say, however, that similar types of operations have not been planned and foiled. Ramzi Ahmed Yousef, the convicted mastermind of the 1993 New York World Trade Center bombing, and 15 other persons reportedly intended to follow that incident in June 1993 with the simultaneous bombings of the Holland and Lincoln tunnels and the George Washington Bridge—vital infrastructure used daily by tens of thousands of commuters between New Jersey and Manhattan. Yousef’s plans also included the simultaneous bombings of 11 U.S. passenger airliners while in flight over the Pacific Ocean in 1995. The importance of simultaneity in attacks is confirmed by these events and, more recently, by the interrogation of Khalid Sheikh Mohammed on August 18, 2003.
In 2010 an Al Qaeda in the Arabian Peninsula (AQAP) plot was disrupted in the latest stages of planning. AQAP placed explosive printer cartridges inside two cargo airplanes, with the intention of detonating these explosives nearly simultaneously while the planes were flying over the continental United States en route to Chicago. The plot was disrupted as a result of intelligence-sharing with Saudi intelligence services. Although few people would have been killed, the impact on world trade would have been tremendous.
Perhaps many people were lulled into believing that mass-casualty, simultaneous attacks in general, and those of such devastating potential as witnessed on 9/11, are beyond the capabilities of most terrorists. Yet, the tragic events of 9/11 demonstrate the profound error of such an assumption. The significance of past successes (e.g., foiling most of bin Laden’s terrorist operations between the August 1998 embassy bombings and the November 2000 attack on the U.S.S. Cole ) and the terrorists’ own incompetence and propensity for mistakes (e.g., Ahmad Ressam’s attempt to enter the United States from Canada in December 1999) was likely overestimated. The reality demands a robust, comprehensive emergency management strategy that addresses mitigation, preparedness, response, and recovery activities unique to these events to minimize pitfalls.
Preparedness
Much terrorism preparedness pre-9/11 focused on the comparatively low-end threat posed by car and truck bombs against buildings or the more exotic threats involving biological or chemical weapons or cyber attack. Other preparedness planning continues to (quite possibly erroneously) assume mass-casualty attacks involving biological or chemical agents released at key infrastructures (e.g., air and rail terminals). Mitigating and preparing for myriad attack tactics have been neglected in favor of other, less conventional threats (e.g,. chemical, biological, and radiological) with the possibility of using an aircraft as a suicide weapon almost completely discounted.
Although the so-called WMD were not used in the 9/11 attacks, the destruction was nonetheless “massive.” Consequently, the very real prospect of combining modern weapons technology (i.e., CBRNE weapons) with an age-old willingness to die in the act of committing an attack could be unprecedentedly dangerous. Furthermore, with increasing numbers of casualties from multiple suicide attacks occurring globally in places such as Afghanistan, Pakistan, Nigeria, Russia/Chechnya, and Iraq, a discourse on the threat of future suicide attacks is warranted. One need only to examine the Department of State’s Patterns of Global Terrorism (1983-2001) to see the efficiencies gained by attacks of this sort. Pape found that from 1980 to 2001, suicide attacks represented only 3% of all terrorist attacks but accounted for 48% of total deaths from terrorism. Ten years later, in 2011, suicide terrorism had declined to 2.7% of all attacks and 21% of terrorism fatalities.
In retrospect, it was not the 1995 Sarin Nerve Gas Attack on the Tokyo subway and nine attempts to use bioweapons by the Aum Shinrikyo cult that should have had the dominant influence on counterterrorist thinking pre-9/11. Instead, the 1986 hijacking of a Pan Am flight in Karachi and the 1994 hijacking in Algiers of an Air France passenger plane by terrorists belonging to the Armed Islamic Group, reportedly with the intention of crashing the planes into the centers of Tel Aviv and Paris, respectively, should have served as keen indicators of the type, scope, and overall capabilities of those responsible for events to come.
The pendulum has now swung in the other direction. After 9/11, defenses were hardened against conventional threats to the United States. Law enforcement and homeland security focused on “high-probability” incidents and on interdicting these threats. However, a strong argument can be made for continuing to prepare for low-probability, high-impact events. According to Nathan Myhrvold, founder of Intellectual Ventures , the attacks of 9/11 pulled our focus away from strategic nation-state threats, such as the Cold War, to tactical terror attacks like that of 9/11. He argues that the defense establishment is overlooking “strategic terrorism.” In the past, “strategic terrorism” could only be achieved by state-sponsored actors. However, advances in technology, coupled with the availability of nuclear and chemical material, has undermined the “lethality versus cost curve” and has “democratized” the ability to cause mass deaths. Small groups of people are equipped with an ability to create much greater lethality through their actions than any time in the past. For this reason, it is all the more important to analyze and prepare for multimodal layered terrorist attacks. Not only is it easier for a small group of individuals to wreak havoc; even a single person may have the ability to bring society to a halt with little expertise or money. Myhrvold predicts that this “strategic terrorism” use of chemical, biological, or nuclear weapons can make “9/11 look trivial by comparison.”
A commonly held notion is that terrorists are primarily interested in publicity and therefore have neither the need nor interest in annihilating large numbers of people. In 1975 Jenkins noted that “Terrorists want a lot of people watching and a lot of people listening and not a lot of people dead.” Just 10 years later, he reiterated, “Simply killing a lot of people has seldom been one terrorist objective. Terrorists operate on the principle of the minimum force necessary. They find it unnecessary to kill many, as long as killing a few suffices for their purposes.” The events of 9/11 and far-right, lone-wolf attacks like the Oslo massacre prove such notions now to be wishful thinking, if not dangerously anachronistic.
The primary goals for terrorists today are to instill fear, change patterns of living, and draw attention to their cause. This means maximizing morbidity and mortality. One need not look further than Al Qaeda’s first issue of Inspire magazine and its article “How to Make a Bomb in the Kitchen of Your Mom.” Terrorists today are looking for any attention they can garner—hence the pressure cooker bombs employed by the Boston bombers, built following the instructions in the article.” Anders Breivik’s acts in Oslo were extremely simple, but caused mass casualties and hysteria. A small explosion in one part of Oslo, followed by a mass shooting spree in a separate jurisdiction, paralyzed law enforcement. The desire to utilize simple tactics to achieve their goals reaches across ideological lines.
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