Fatalities due to terrorist attacks against healthcare facilities stratified by country economy

Terrorist attacks on healthcare facilities disrupt healthcare delivery with increasing frequency. This study aims to assess the association between the number of casualties in terrorist attacks against healthcare facilities and economic classification of a country. Utilizing data from 1970 to 2018 compiled in the Global Terrorism Database, 901 attacks against healthcare settings were identified in 74 countries. Based on the World Bank economic classification, these 74 countries were categorized into low, lower-middle, upper-middle, and high-income groups. We further grouped these into "developed" (high-income countries) and "developing" economies (low, lower-middle, and upper-middle economies). A Poisson regression was developed to assess the association between country economic classifications and the number of casualties in attacks on healthcare facilities. A total of 901 incidents of terrorist attacks against healthcare facilities satisfied the database query, with 239 attacks listing at least one casualty. This demonstrated that, in this database set, 30 people in economically developing countries were killed per healthcare facility attack for every one person killed in an attack in a country with a developed economy. Terrorist attacks against healthcare facilities in countries with lower economic status resulted in greater casualties than similar attacks against healthcare facilities in high-income or economically developed countries. This knowledge can help shape ongoing research into terrorism prevention, mitigation, and resource allocation to protect vulnerable healthcare facilities.