Terrorism reports: The tip of the iceberg


  • Eytan Ellenberg, MD, MPH, PhD
  • Mark Taragin, MD, MPH
  • Zvia Bar-On, MD, MHA
  • Osnat Cohen, SW
  • Ishay Ostfeld, MD, MHA




terrorism, war, disaster, databases, acute stress reaction


Importance: Medical impact of terror is a public health issue as the threat is growing all over the world.

Objective: Our objective was to compare the number of injured and incidents in the three different databases and reports [Global Terrorism Database (GTD), Israeli Security Agency (ISA) and National Insurance Institute (NII)] in Israel.

Design: Retrospective study.

Setting: Analyses of three different databases (GTD, ISA and NII) and basic comparison.

Main Outcome(s) and Measure(s): The victims reimbursed for medical expenses are the largest population. The number of injured as described by GTD and ISA database are less important. The 2010-2013 years are marked by more incidents recognized in Israel vs GTD assessment (except in 2014).

Conclusions and Relevance: The number of victims being reimbursed for medical and mental health services is radically different from the GTD and the ISA reports. Public Health specialists should be advised of this phenomenon to deliver their right approach (including mental health) to growing threat and develop new definition of victim of terror.

Author Biographies

Eytan Ellenberg, MD, MPH, PhD

Researcher, Bureau of Medical Affairs, National Insurance Institute of Israel, Jerusalem, Israel

Mark Taragin, MD, MPH

Deputy Director, Bureau of Medical Affairs, National Insurance Institute of Israel, Jerusalem, Israel

Zvia Bar-On, MD, MHA

Medical Coordinator, Bureau of Medical Affairs and terror victims unit, National Insurance Institute of Israel, Jerusalem, Israel

Osnat Cohen, SW

Director, Terror Victims Unit, National Insurance Institute of Israel, Jerusalem, Israel

Ishay Ostfeld, MD, MHA

Chief Medical Officer, Bureau of Medical Affairs, National Insurance Institute of Israel, Jerusalem, Israel


Institute for economics and peace: Global terrorism Index 2015. Available at http://economicsandpeace.org/wp-content/uploads/2015/11/Global-Terrorism-Index-2015.pdf. Accessed 6 August 2016.

Ben-Ishay O, Mitaritonno M, Catena F: Mass casualty incidents--time to engage. World J Emerg Surg. 2016 Feb 3; 11:8.

Baker MS: Casualties of the Global War on Terror and their future impact on health care and society: A looming public health crisis. Mil Med. 2014 Apr; 179(4): 348-355.

National Consortium for the Study of Terrorism and Responses to Terrorism (START): Global Terrorism Database. University of Maryland [Data file] (2015). Available at http://www.start.umd.edu/gtd. Accessed 6 August 2016.

Edwards DS, McMenemy L, Stapley SA: 40 years of terrorist bombings - A meta-analysis of the casualty and injury profile. Injury. 2016 Mar; 47(3): 646-652.

Israel Security Agency: Available at https://www.shabak.gov.il. Accessed on August 2016.

Shamai M, Ron P: Helping direct and indirect victims of national terror: experiences of Israeli social workers. Qual Health Res. 2009 Jan; 19(1): 42-54.

National Insurance Institute of Israel: Report 2014. Available at https://www.btl.gov.il/Publications/Skira_shnatit/2014/Pages/default.aspx.

Bodas M, Ben-Gershon B, Rubinstein Z: The evolution of the emergency mental health system in Israel - from the 1980's until today. Isr J Health Policy Res. 2015 Jul 15; 4: 25.

Silver RC, Holman EA, McIntosh DN: Nationwide longitudinal study of psychological responses to September 11. JAMA. 2002 Sep 11; 288(10): 1235-1244.

Balasinorwala VP, Shah N: Acute stress disorder in victims after terror attacks in Mumbai, India. Br J Psychiatry. 2009 Nov; 195(5): 462. doi: 10.1192/bjp.195.5.462.

Caramanica K, Brackbill RM, Liao T: Comorbidity of 9/11-related PTSD and depression in the World Trade Center Health Registry 10-11 years post disaster. J Trauma Stress. 2014 Dec; 27(6): 680-688.

Gruebner O, Sykora M, Lowe SR: Mental health surveillance after the terrorist attacks in Paris. Lancet. 2016 May 28; 387(10034): 2195-2196.

Stratton SJ: Using pre-existing databases for prehospital and disaster research. Prehospital and Disaster Med. 2015; 30(1): 1-3.



How to Cite

Ellenberg, MD, MPH, PhD, E., M. Taragin, MD, MPH, Z. Bar-On, MD, MHA, O. Cohen, SW, and I. Ostfeld, MD, MHA. “Terrorism Reports: The Tip of the Iceberg”. American Journal of Disaster Medicine, vol. 12, no. 4, Oct. 2017, pp. 257-60, doi:10.5055/ajdm.2017.0278.




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