A Review of Ambulance Terrorism on the African Continent.

BACKGROUND: In recent decades, an increasing number of terrorist attacks have been carried out against medical institutions, hospitals, and health care workers. These attacks, that often result in high numbers of casualties and impaired access to health services, have a more significant impact on people's sense of security than attacks against military and police targets. Attacks on ambulances - especially on the African continent - have been sparsely studied. This study examines attacks on ambulances on the African continent during the period from 1992-2022 (until December 31, 2021). METHODS: Reports of ambulance terrorism were extracted from the Global Terrorism Database (GTD), RAND Database of Worldwide Terrorism Incidents (RDWTI), United Nation's Safeguarding Health in Conflict Coalition (SHCC) database, Armed Conflict Location and Event Data Project (ACLED), Surveillance System for Attacks on Health Care (SSA) database, and Aid Worker Security Database (AWSD). Furthermore, a grey literature search was performed. The date and location of the attacks, perpetrators, weapon and attack types, and the number of victims (dead and wounded) and hostages were collected. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. RESULTS: During the 30-year study period, 166 attacks were observed in 18 African countries. The number of attacks significantly increased since 2016, with 81.3% of the attacks taking place from 2016 to 2022. In total, 193 people died and another 208 were injured. Attacks with firearms were most frequently noted (92 cases; 55.4%), followed by attacks with explosive devices (26 cases; 15.7%). A significant number of ambulances were hijacked (26 cases; 15.7%) and subsequently used for other terrorist attacks. In seven attacks, ambulances were used as vehicle-born improvised explosive devices (VBIEDs). CONCLUSION: In this database study on ambulance terrorism in Africa, it was found that the reported occurrence of attacks increased from 2013 onwards, including the rise of ambulances used as VBIEDs. These findings suggest that ambulance terrorism represents a real, significant risk that both governments and health care institutions must address.

Violence against healthcare workers br Hungarian experiences / Egészségügyi dolgozók ellen elkövetett eroszakos cselekedetek

Introduction: Violence against healthcare workers damages not only the health and dignity of employees but also the safety and productivity of institutions. Violence in healthcare also poses a threat to patient safety and the quality of patient care. Objective: The aim of the research is to get an idea of whether healthcare workers in Hungarian healthcare institu-tions, if they get involved in violent conflict, have someone to turn to at their workplace. It aims to explore whether communication, simulation and self-defense trainings are held in institutions, and to examine the relationship be-tween these prevention and treatment trainings with confidence. Method: Cross-sectional quantitative research has been conducted with an online questionnaire involving 720 health professionals. Results: It can be stated that when an atrocity hits a healthcare worker, he or she turns to his or her colleague during the violence and, after atrocity, asks the head nurse or a psychologist for help in processing the problem. 52% of verbal violence and 45% of physical violence were not reported by employees. A very high percentage (39%) of work-ers do not even know who to turn to if they are subjected to violent atrocity. The data show that communication training alone is not enough to make healthcare workers confident. However, participation in this training does not significantly reduce the average number of atrocities experienced in a year. Conclusion: The results obtained may also signal the need for communication training, but it is not enough in itself, it should be followed by simulation practice as well as self-defense education and practice. Participating in other communication or violence prevention training increases the confidence of healthcare workers, but communication training alone does not. There is no reporting obligation in the institutions so a lot of atrocities remain hidden.