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LEARNING TO RESPOND
TO VIOLENT
EXTREMIST ATTACKS![]()
Section 5
Strategies to Build Resilience
It is important to strengthen
the resilience of the
community and the nation to
deal with crises that come
our way.
MR MASAGOS ZULKIFLI
MINISTER FOR THE ENVIRONMENT
AND WATER RESOURCES
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CHAPTER16
Preparing for the Day After Terror: Five Things to Do to Build National Resilience
JETHRO TAN, JANE QUEK, and
GABRIEL ONG
Home Team Behavioural Sciences Centre,
Ministry of Home Affairs, Singapore
Introduction
The recent spate of terror attacks across the world serves as a stark reminder that no country is truly safe from the reaches of terrorism. While it is necessary to invest in countering the advances of terrorists, societies and nations can no longer simply take on just a prevention strategy towards such threats. In fact, policymakers have also since adopted a resilience approach towards dealing with the threat of terrorism (Government of Singapore, 2018), which, in essence, assumes that a crisis (i.e., a terrorist attack) will eventually come to pass within oneās nation, and policymakers must thus plan for resources to cope with its aftermath (Gomes et al., 2015; Tan et al., 2016). This ensures that when a terrorist attack comes to fruition, the nation can recover and resume day-to-day functioning quickly (i.e., being resilient).
Governments need to be prepared to cope with the day after a terrorist attack. Through the lens of resilience, a nation must āadapt and respond to crisis, with the goal of survival and continuity in her core structures and people, allowing the nation to thrive post-crisisā (Tan et al., 2016, p. 309). To be resilient against attacks, nations need to first understand what can happen in the aftermath of such crises, and then plan for the whole of nation to cope with these consequences.
This chapter aims to provide strategies for nations to build resilience in the aftermath of a terrorist attack. This is done through a practical approach of (i) understanding what may potentially happen to a nation after an attack, and subsequently (ii) developing strategies that can be undertaken to address these consequences.
Five Consequences of a Terrorist Attack
There will be Deaths and Injuries
Terrorists often aim to promote their cause or ideology by causing deaths or damaging infrastructure within a society (Schmid, 2004). The 2001 September 11 attacks on the U.S. (i.e., 9/11 attacks) illustrated a highly devastating outcome of a terrorist attack, with an estimate of 3,000 deaths as a result of the event (9/11 attacks, 2010). More recent attacks suggested that the 9/11 attacks in actuality reflected an extreme scenario, in contrast to other terror attacks that resulted in substantially smaller number of causalities. Such examples include the 2014 Sydney Siege, 2016 Berlin truck attack, as well as the 2017 London Bridge attack.
Regardless of the extent of deaths and injuries in the aftermath of terror attacks, emergency response will be a key challenge. Emergency services will be required to conduct triaging and management of medical aid following an attack, and such mass causality incidents will naturally demand extensive use of emergency resources. Operations may extend beyond regular hours and team morale within the uniform services will be tested. Furthermore, emergency service providers must also be prepared for deaths within their own pool of emergency responders. For example, in the aftermath of the World Trade Centre plane crashes of the 9/11 attacks, 343 firefighters and paramedics died in their line of duty (Kean & Hamilton, 2004). Under these circumstances, emergency responses could be hindered by the sudden lack of manpower.
Prepare to deal with causalities during a major attack
The effectiveness of the emergency servicesā response towards an attack will be most integral in determining the success of dealing with deaths and casualties. In fact, emergency responses to the 2013 Boston Marathon bombing were found to be effective and arguably also the reason why the number of deaths could be minimised to three (Biddinger et al., 2013; Gates et al., 2014); post-attack analysis have also identified that the stateās emergency respondersā and agenciesā frequent participation in exercises prior to the bomb attack had increased Bostonās preparedness (Gates et al., 2014). These exercises had involved the joint participation of multiple agencies, which further enhanced coordination between the public agencies and hospitals (Massachusetts Emergency Management Agency, 2014).
In essence, emergency services need to plan for the eventuality of a terror attack occurring and train responders accordingly. Additionally, it is integral to ensure that these planning and training involve the various critical agencies. In the Singapore context, this may mean joint exercises involving the police, civil defence, army, and hospitals to work out coordinated plans and procedures. Crisis leaders should then also consider how such plans will be carried out in the event of lower emergency respondersā headcount because of death or injuries. Building spare capacities in terms of manpower and effective shift planning would be key in such instances.
From a cultural standpoint, the management of deaths should entail being cognisant of any cultural issues pertaining to funerals. A multiracial and religious society ā like Singapore ā will have to prepare for various funeral rituals of the various faith groups, and this is important because funerals provide meaning-making to the deceasedās next-of-kin (NOK) (Giblin & Hug, 2006). Crisis managers and responders need to work out how post-crisis operations can accommodate or even facilitate the meaning-making for NOKs. In addition, as seen in the aftermath of previous terror attacks, victims may have to be declared as dead in absentia. This may cause considerable stress to NOKs. Thus, considerations must be taken on how to communicate the bad news of death in a culturally sensitive manner, so as not to aggravate the psychological trauma that will be experienced by NOKs.
There will be Short- and Long-term Health Consequences
Intelligence sources and historical records have indicated that biological and chemical forms of terrorist attacks are significant threats due to their propensity to cause widespread harm in urban cities (Kawana et al., 2001; Okumura et al., 2005). In the aftermath of the 1995 Tokyo Subway sarin gas attack, the release of the sarin toxicant had caused widespread immediate health implications to commuters in the subway (Pletcher, 2018). The Centres for Disease Control and Prevention (CDC) (2015a) reports that some examples of somatic symptoms of sarin contamination are weakness, drowsiness, and chest tightness. Additionally, some primary responders suffered from secondary contamination during the rescue and recovery efforts (Pangi, 2002).
The 2001 anthrax attacks in the U.S. illustrated how biological agents can, and will likely, be used as a means of terrorism. In the attack, anthrax spores were found to have been deliberately distributed through mail sent to media companies and political stakeholders, causing a total of five deaths and 17 infections (āTimeline: How the anthrax terror unfoldedā, 2011). While not contagious via person-to-person contact, anthrax infections can be transmitted through inhalation, ingestion, or skin absorption (CDC, 2015b; Riedel, 2005), causing somatic symptoms leading up to death after an incubation period of up to 19 days (Riedel, 2005). This makes such threats harder to detect, and also more difficult to allay fears that the public may have. Following the anthrax attacks, the U.S. CDC had to send out advisories to remind the public āthat they need not fear opening letters and packages delivered to their homesā (āCDC: Donāt worry, open mail happyā, 2001, para. 6).
The effects of terror attacks can also be long-term. Studies conducted years after the 9/11 attacks have shown that asthma prevalence in the victims have risen to three times the national rate (āA message from the commissionerā, 2018). This can be attributed to the air pollution caused by the plane crash at ground zero (Biello, 2011). Emergency workers who were responding to the crisis also experienced significant long-term health concerns due to the air pollution (Lippmann et al., 2015).
Health concerns grow beyond the typical casualties and injuries familiar to us; both the sarin and anthrax attacks have highlighted how terrorists can utilise tools and weapons that can cause medical effects detrimental to individualsā health. These health consequences also have the propensity to be contagious, which makes the threat difficult to contain. The long-term health consequences of terrorist attacks are also often neglected in lieu of the immediate pressing concerns at the point of crisis.
Prepare for health consequences of terrorist attacks
Emergency plans for the aftermath of a biological or chemical attack will vary according to the destructive agent used. With that said, it is imperative for the government to prepare drawer plans to manage these novel threats. Given the nature of such āinvisibleā threats, it is then crucial to prepare the public to identify and know what to do in the event of such attacks. The SGSecure movement in Singapore, which aims to equip citizens with essential resources to cope with a terror attack, has already served as a platform to impart such knowledge to the citizens. Continued effort to train and update the public on the what-to-dos can mitigate the spread of biological and chemical attacks.
There must be plans to deal with the long-term health consequences of a terror attack. In fact, these health ramifications can add up to significant economic costs for both individuals and nations. Being prepared, in ways such as providing health coverage and ensuring ample resources to provide interventions, are crucial to the resiliency of the nation.
There will be Psychological Impact on Society
Terrorist attacks are designed to cause not only physical, but also psychological damage through inciting fear and uncertainty within the populace (Borum, 2004; Neo et al., 2015). When oneās sense of safety and security is breached, societal resilience is compromised. Psychological impact can disrupt the day-to-day functioning of societies even after the recovery phase of the crisis (Gomes et al., 2015), and can manifest both at the individual and societal levels.
A study by Fetter (2005) showed that after a mass casualty event such as a terror attack, individuals will experience psychosocial responses such as anxiety, survivor guilt, grief, paranoia, and withdrawal. There exists conclusive evidence that this psychological distress will manifest in direct victims, indirect victims, emergency responders, and the general population at large after a terror attack (Salguero et al., 2011; Tanielian & Stein, 2006). Psychosomatic symptoms such as being unable to sleep, loss of appetite, or even irritableness were reported in up to 44% of the population (Schuster et al., 2001).
In further follow-up studies after terror attacks, researchers also found significant increase in the prevalence rates of mental disorders such as Post-Traumatic Stress Disorder (PTSD) (Neria et al., 2011). While estimates suggested only about 10% of initial mental-health support seekers eventually developed PTSD, this long-term impact can do significant harm to the overall well-being of the nation.
Aside from the clinical manifestations, psychological impact can also linger in the populace. Research has espoused that societies that experienced a recent terror attack may experience fear, confusion, disbelief, shock, despair, and panic, and this may cause societies to no longer be able to maintain daily routines (Hobfoll et al., 2007). Resuming normalcy is a key tenet of resilience (Gomes et al., 2015; Tan et al., 2016), and a reluctance to return to day-to-day functioning constitutes a serious threat to the recovery efforts of a nation. Even more alarmingly, a nation like Singapore ā who has not yet experienced a major terror incident ā is likely to experience these psychological effects more intensely, due to the novelty of the event.
Deal with psychological trauma and plan for effective crisis communications
It is evident that planning a response for psychological interventions post-terror attack is integral. While therapy is required for severe diagnosis such as PTSD, many of the psychosomatic symptoms that prevail after terror attacks can be addressed by Psychological First Aid (PFA) (World Health Organization, War Trauma Foundation, & World Vision International, 2011). In essence, PFA is about providing timely social support to those who need it in the aftermath of a crisis (World Health Organization, War Trauma Foundation, & World Vision International, 2011); having a ready pool of PFA providers within the community will thus be useful to quickly address the psychological symptoms after a terror incident. Governments need to recognise that they have to go beyond simply addressing physical damages, and invest also in addressing the psychological trauma in the aftermath of terror. Thus, the SGSecure movementās deliberate focus on training PFA within the community (Government of Singapore, 2018) serves to highlight the importance of PFA as an emergency skill, supplementing other skills such as medical first aid, cardiopulmonary resuscitation (CPR), and use of the automated external defibrillator (AED).
From a societal perspective, there is a need for leaders to engage in effective crisis communications to address the psychological effects of terror attacks. By addressing the publicās information needs quickly and effectively, it fills in the gap for the need for information by the public. This reduces the spread of rumours and its undesirable consequences (Fearn-Banks, 2007), and the feelings of āambiguityā and confusion associated with the aftermath of an attack (Hobfoll et al., 2007; Tan et al., 2017). More importantly, it c...
