WASHINGTON -- The indirect consequences of a terrorist attack may be more severe than the direct, long-term harm caused by a weapon of mass destruction, according to researchers from the Department of Veterans Affairs (VA) and a British medical school.
"We feel more vulnerable to these weapons because they can harm large numbers of ordinary citizens in places generally considered safe, such as where we work and live," said one of the study's co-authors, Dr. Kenneth C. Hyams, VA's chief consultant for occupational and environmental health.
The report, published this month in the Journal of Health Politics, Policy and Law, examines the multiple challenges of a terrorist attack using chemical, biological, nuclear or radiological (CBN) materials.
Beside casualties caused directly from an attack, "the normal reaction to an unfamiliar and life-threatening event -- fear, confusion and flight -- could cause greater damage than the attack itself," the report says.
The report lists many effects that would follow an attack involving not only the health of those in the immediate vicinity, but also a larger population. The effects include social and economic damage.
The report was co-authored by Dr. Frances M. Murphy, VA's Deputy Under Secretary for Health and Dr. Simon Wessely of Guy's, King's and St. Thomas's School of Medicine and Institute of Psychiatry in London.
"We have always to keep in mind that terrorism is not simply about killing people; it is about destroying our sense of well-being and trust in government. This cannot be allowed to happen either before or after a terrorist attack," said co-author Murphy.
The researchers concluded that unexposed citizens could overwhelm hospitals because symptoms that often occur in an emergency situation -- like headaches, shortness of breath and difficulty concentrating -- are similar to the early effects of chemical and biological warfare agents. Stress, fear, worry and grief will aggravate existing medical and psychological problems.
The report highlights the potential for an outbreak of "mass sociogenic illness," where acute physical symptoms, like loss of consciousness, can be triggered by unusual odors or even rumors of contamination following a widely reported CBN incident. Immediate effects on reproductive behavior also may occur, as reported following the radiation disaster in Chernobyl and the sarin gas attack in Tokyo.
The report also reviews longer-term consequences after the initial attack, such as prolonged medical and psychological effects. Permanent economic damage may be done to agricultural and manufacturing communities whose products may be avoided out of fear of contamination. People may lose confidence in their government and other community authorities if their information or responses are not credible.
The report also provides a prescription for reducing some negative effects of terrorist attacks. Key factors include the importance of long-term health care, effective communication by the government, timely health risk assessment, research and economic support.
Decisions about who provides health care and for how long need to be made, the report said. The public needs to understand both the health risks and the government's response. The report calls on public officials and scientific experts to be as "open, clear, and forthcoming as possible."
Implementing the recommendations will require communication, coordination, cooperation and basic education among local, state and federal government, health care professionals, law enforcement, the military, the press, business interests and the general public.
"Although high-tech solutions are important for countering the current terrorist threat, we need to place much more emphasis on basic education and planning for a coordinated response to terrorist attacks," Murphy said.
