Hospitals are vulnerable to terrorist attacks, as they must remain easily accessible to the general public. Hospitals are also occupied with both staff and patients 24 hours a day, 365 days a year, meaning that any attack is almost guaranteed to inflict a multitude of casualties. In addition to the immediate effects of attacking a hospital, there are also uniquely devastating second- and third-order effects when hospitals are attacked.

A focused search of the Global Terrorism Database (GTD) was performed to identify terrorist attacks against hospitals throughout the world. Data between the years 1970-2018 were selected, which included 191,465 entries in total. These entries were then searched for incidents containing the term “hospital” and the results were manually searched to identify trends in the number of incidents occurring per year, as well as the armament that was employed, and the regions of the world where the attacks occurred.

A total of 430 terrorist attacks on hospitals were identified in the GTD, resulting in 1,291 deaths and an additional 1,921 wounded. The frequency of terrorist attacks against hospitals has been steadily increasing over the last two decades and is disproportionate to the overall increase in terrorist attacks against all target types. Attacks have been carried out against hospitals in 61 different countries. The most common method used in these attacks was “bombing/explosion,” which accounted for 299 attacks. Of the known terrorist groups identified in the GTD, “Houthi extremists (Anshar Allah)” and “Islamic State of Iraq and the Levant (ISIL)” carried out the greatest number of attacks on hospitals.

There has been a disproportionate rise in the frequency of terrorist attacks on hospitals when compared to other target types, highlighting the vulnerability of these key structures. Unsurprisingly, these attacks have inflicted large casualty counts in addition to disrupting community health care and disaster response. Attacks against hospitals have been reported on every inhabited continent except Australia, making their protection a matter of international security. The rate of terrorist attacks on hospitals has increased dramatically over the last two decades, creating an urgent need to develop improved defense strategies that will better ensure their protection.

Little is known about the involvement of security personnel in Irish psychiatric care. Content analysis of inspection reports is a feasible way to investigate this under-researched topic. We aimed to (i) Describe the number of approved centres per year in which we observed comments about the presence of security personnel in published reports of inspections conducted from 2008 to 2012 (ii) Report the main themes of all text relating to security personnel published in these inspection reports.

We conducted a content analysis of all 349 inspection reports published between 2008 and 2012.

The number of approved centres in which security personnel were noted increased from 3% to 8% between the years 2008 and 2012. This increase was not statistically significant when the same unique centres were compared between years (p=0.684). Employment details such as contracted employment relationship, location relative to the approved centre and hours of work appeared inconsistent across centres. Role functions of security personnel differed across centres and ranged from monitoring the entrance of a unit to observing, restraining and secluding patients. Contrasting perceptions of suitability were evident in the inspection reports. The extent to which the training needs of security personnel were met was unclear from the reports.

Activity of security personnel in psychiatric hospitals may not be role appropriate, compliant with legislation or conducive to treatment. Best practice guidelines should be developed in consultation with multiple stakeholders.