Civil unrest or terrorism at mass gathering events can erupt with significant violence and multiple casualties. These are high-risk situations, not only because of physical casualties, but also because of ethical, political and psychological sequelae. Beyond specialized planning, multi-agency drills and proficient tactical medicine training, medical teams should co-create secured access and egress, alternative medical responses and rapidly-adapting coordination and secure communications with other agencies. Civil protests can escalate, especially when extremist groups infiltrate them. Multi-site violence and assaults can evolve, particularly in terroristic attacks. Key lessons include unrelenting vigilance until all participants have left the mass gathering scene in its entirety. Violence (bombs, shootings, vehicle attacks) will often erupt when mass gatherings are dispersing and considered over. Terrorists can also purposely target medical personnel or incite one event (fire, bomb, shooting) to create crushing stampedes or to herd crowds into more vulnerable areas where they can be further attacked more directly with other modern weapons. Terrorists often attack from elevated perches or generate “protracted suicide” incidents while holding hostages, including many severely-wounded. The resulting frustration, anger and guilt commonly can consume medical rescuers when beholding slaughtered innocents or simply because they were (appropriately) staged during containment of on-going violence.

Dar es Salaam’s politics became radicalised further still in the early 1970s. A series of developments – Britain’s proposal to sell arms to South Africa, a Portuguese invasion of Guinea-Conakry, and a coup in Uganda, plus internal unrest – propelled TANU into a gear-change in its socialist revolution. This resulted in the drafting of the ‘Guidelines’ or Mwongozo. This chapter shows how Mwongozo militarised Tanzanian society and concentrated power in the hands of party activists. These steps were taken with misgivings from Julius Nyerere and proved fractious among several of his trusted colleagues. While the government continued to talk the language of continental revolution, this was accompanied by a toughening of the national institutions of the party-state. The motor for development was increasingly believed to be popular mobilisation through the organs of the party rather than the economic planning that had previously tempered revolutionary interventionism. Meanwhile, the troublesome regime in semi-autonomous Zanzibar was brought to heel. National unity was achieved and enforced from above, but came at political cost.

Dar es Salaam’s politics became radicalised further still in the early 1970s. A series of developments – Britain’s proposal to sell arms to South Africa, a Portuguese invasion of Guinea-Conakry, and a coup in Uganda, plus internal unrest – propelled TANU into a gear-change in its socialist revolution. This resulted in the drafting of the ‘Guidelines’ or Mwongozo. This chapter shows how Mwongozo militarised Tanzanian society and concentrated power in the hands of party activists. These steps were taken with misgivings from Julius Nyerere and proved fractious among several of his trusted colleagues. While the government continued to talk the language of continental revolution, this was accompanied by a toughening of the national institutions of the party-state. The motor for development was increasingly believed to be popular mobilisation through the organs of the party rather than the economic planning that had previously tempered revolutionary interventionism. Meanwhile, the troublesome regime in semi-autonomous Zanzibar was brought to heel. National unity was achieved and enforced from above, but came at political cost.