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In the last quarter of the century, there is a dramatic change in most of the terrorist activities, as they are well-planned, with a purpose to accomplish a precise identifiable and seemingly attainable political goal. In the past, most of the terrorist activities involved incidents like high-jacking an aircraft or the taking of a hostage following which certain demands were made. Their aim was usually to release their friends, or group leaders' from prisons.
Terrorism in the last few decades has taken a more violent and destructive turn, and quite often the demands are not made. Terrorism today is an act which is sudden, unprovoked, sheer brutal attack on innocent civilians killing several people in a crowded market or a gathering. Most of there terrorist attacks have had a political objective, which have now become rather diffused since the 9/11 attack. It now seems that the idea is to create fear and panic, and primarily to get publicity through the television news and print media
According to several orthodox cultures, the terrorists resorted to this particular type of extremism as the only way for accomplishing political change. Also it appears to be interconnected to globalization and the increased impact of the United States and other Western countries. This has added to the resentments of the people of that part of the world. Thus it is the larger developments, changes in the international political structure, and expansion of globalization throughout the world that explains this trend in terrorism.
The sixty years of suffering of the Palestinians and their unsuccessful efforts to get an independent state is one of the major reasons for the unrest in the Muslim World. The recent siege (412 Palestinian children perished between the 27th of December 2008 and the 18th of January 2009 as a result of the bombings and atrocities carried out by the Israeli Occupying Forces The end year of 2009 inevitably This markeds the First Year Memorial of Operation Cast Lead, when almost 1,400 Palestinians, mostly civilians were killed during the course of a brutal military operation carried out by Israeli authorities. Thousands more were wounded or displaced. 412 Palestinian children perished between the 27th of December 2008 and the 18th of January 2009. These children were killed as a result of the bombings and atrocities carried out by the Israeli Occupying Forces) affected the Palestinian social fabric completely. As the trauma grows with every violent incursion into Palestinian communities; hatred and tendency of revenge also increases among them. During the Gulf War, and more recently in Afghanistan, the terrorist groups often resort to psychological warfare because it's the only tactic they have available to them.
'They don't have M-16s, and we have M-16s. They don't have the mighty military power that we have, and they only have access to things like kidnapping,'
says Haroun, a clinical professor of psychiatry at the University of California, San Diego. (cited in Warner, 2005).1 In reality these terrorist attacks does not harm the enemy physically very much, as few people could be killed in an attack. But the repercussions are tremendous from the psychological point of view. Ordinary people viewing the terrorist attack in person or watching it on television, gets anxious, terrified, and often develop a sense of foreboding fear, which in turn may lead to demoralization in the entire society.
Whatever is their modus operandi, terrorists share very similar aims. Alexander and Klein (2006) concisely identified the aims of terrorism as follows:
- To create pervasive fear, anxiety and panic
- To generate a collective and individual sense of helplessness, vulnerability and hopelessness
- To demonstratereveal the incompetenceineffectiveness and/or inabilityincapability of the authorities to provide security and protectionsafety against such opponents
- And provoke the establishment into errors or over-reactions which will disaffect the general public or specific influential bodies.
The last point is essentially vital as observed by the widespread concerns as for example the shooting of an innocent man by the Metropolitan Police in London sometime ago (as a result of consequent to the wrong information that he was a 'suicide bomber'); the incarceration of 'terrorist suspects' in high security prisons of Guantanamo Bay and Belmarsh; and the introduction of repressive legislation. Moreno (2003) has persuasively proven how easy it is in a democratic society to subordinate hard-earned civil liberties to the need to introduce counter-terrorist legislation. The terrorist attacks provide harsh reminders that in today's world, one does not know what news may come next on television or other news media. Particularly disturbing television images of horrific incidents can trigger the innate 'startle response' no matter how close or far away from home the event happened. Historically, every military clash has led to psychological warfare in some form in one way or another as the enemy aims to break the morale of their opponent. Due to progress in technology; the popularity of the internet; and increase of news coverage, the rules of engagement in this type of psychological battle have changed.
Whether it is a substantial attack or a single dreadful act, the effects of psychological warfare are not restricted to the physical damage it produces. Instead, the intent of these attacks is to instillinstil a sense of fear that is much greater than the actual threat itself.
According to Professor Richard Bulliet of Columbia University:
There are various ways to have your impact. You can have your impact by the magnitude of what you do, by the symbolic character of target, or the horrific quality of what you do to a single person.
Interestingly the way media covers the event in fact determines the effect on the people. For instance, according to Bulliet, the Iranian hostage predicament, in 1979, which though lasted for 444 days, was infact actually one of the most harmless of - (word harmless???) criticalthings events that occurredhappened in the Middle East in the last 25 years. All the U.S. hostages were released ultimately unscathed., butHowever this hostage event remains a psychological scarblemish for manyseveral Americans who watched powerlessly, each evening's newscast, they counted days the hostages were being held in custody.
The terrorists often take advantage of images of a group of masked individuals coercing and intimidating exerting total power over their captives to sendconvey the message that the act is a collective demonstrationdisplay of the group's power rather than an individual criminal act.
You don't have the notion that a certain person has taken a hostage. It's an image of group power, and the force becomes generalized rather than personalized. The randomness and the ubiquity of the threat give the impression of vastly greater capacities. (cited in Warner, 2005).
Remote Repercussions of Terrorist Attacks
When a horrific event occurs, it is natural to feel disturbed, even if the act occurred thousands of miles away. The human reaction is to put oneself in the situation because as normal human beings, people have the capacity to empathize. And consequently these people may develop similar psychological symptoms. Witnessing an act of psychological terror can also disrupt our belief system, says Charles Figley, PhD, director of the Florida State University Traumatology Institute. (cited in Warner, 2005).
We walk around, psychologically, in a bubble, and that bubble represents our belief system and values. Most often we assume incorrectly that other people have the same values and social niceties as we do. When that is violated or challenged, the first response is usually an effort to protect our beliefs and, in other words, to deny that it actually happened.
When A s soon as confronted with proof of terror, such as pictures of atrocities, Figley says there are a few different waysdifferent ways in which people typically react:
They perceive perpetrators to be inhumane.
Become fearful as they perceive they are living in a callous and unsafe world because the graph bar of inhumanityhumanity has been lowered even further. Believe that it's only a fleeting incident which could be easily explained away or deconstructed by precise things that have taken place, such as
' if we hadn't done this, then that would not have happened. 'It's uncomfortable believing that the world is less safe, so we have to imagine or construct a scenario that will allow us to feel more safe again and resist change,' says Figley.
There is an interesting and strange symbiotic relationship between terrorism and the media. Bruce Hoffman, the director of the Centre for the Study of Terrorism and Political Violence, in his book Inside Terrorism has written a clear summary of some of the major historical trends in international terrorism. He makes careful distinctions between the motivations that drive political (or ethno-nationalist) terrorism and religious terrorism, and he explains also shows why the rise of religious terrorism, coupled with the increased availability of weapons of mass destruction, may foretellpredict an eraepoch of even greater violence. In the past, Hoffman argues, the main goal of the terrorist was not to kill and destroy, but to attract media attention to his cause in the hope of initiating reform.
For the religious terrorist, however, violence is first and foremost a sacred act or divine duty executed in direct response to some theological demand or imperative ... religious terrorists see themselves not as components of a system worth preserving but as 'outsiders', seeking fundamental changes in the existing order. (Hoffman, 2006).
In this context Hoffman does not 'choose sides', he refers to in this framework, pointing to the bombings of the World Trade Center ,and Oklahoma City and the Tokyo,to the Sarin nerve gas attacks, in Tokyo in order to demonstrate that radicalsfundamentalists of any religious denomination are capable of extreme acts of terrorism.
Terrorism is an aggressive-hostile action which is mainly intended to harm and terrify civilians, in order to promote a particular aim, or with an the idea, which may be social political or other. The terrorist attacks, are now gaining major importance than wars in the news headlines worldwide
Terrorism and its Effects on Mental Health
Whether it's a massive attack or a single dreadfulhorrific act, the effects of psychological warfare are not restrictedlimited to the physical damage inflicted. Infact the primary objectivestead, the goal of these attacks is to inculcate a sense of fear whichthat is much greater than the actual threat itself. Therefore, the impact of psychological terror depends largely on how the acts are revealedpublicized and interpreted.
Typical reactions to major trauma on the individuals and communities are well-documented but the literature on the individual reactions to terrorist incidents is scarce. Most of the reactions at the initial phase following trauma are normal reactions and only few individuals display florid psychopathology. (Alexander and Klein, 2006).
Normal individual reactions to a terrorist attack are:
- Emotional Reactions : shock, numbness, denial , fear, anxiety , helplessness, hopelessness.
- Cognitive dysfunctions as disorientation, confusion ,intrusive thoughts, images, memories ,hypervigilance (i.e. increased sense of risk),impaired concentration and memory.
- Changes in social interaction, like withdrawal ,irritability ,loss of trust and faith , avoidant behaviour (i.e. of any reminders of the event).
Physical reactions as autonomic hyperarousal , ,loss of energy. insomnia
- Autonomic hyper-arousal, insomnia, loss of energy.
- Emotional shock, numbness, denial, fear, anxiety helplessness, hopelessness.
- Cognitive disorientation, confusion, intrusive thoughts, images, memories.Hyper-vigilance, impaired concentration and memory.
- Social withdrawal, irritability, loss of trust and faith, avoidant behaviour (i.e. of any reminders of the event).
These 'normal' reactions comprise most of the core symptoms of PTSD, i.e. intrusive experiences, hyper-arousal and avoidant behaviour, as defined in the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10; WHO, 1992). For a formal diagnosis of PTSD, such symptoms must be experienced for at least a few weeks. (The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] also necessitatesrequires that such symptoms mustto be present for one month. (American Psychiatric Association, 1994).
In addition the impact on individuals, terrorism has mass psychogenic impacts. 'Mass psychogenic illness' has been defined as:
The rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss or alteration of function whereby physical complaints that are exhibited unconsciously have no corresponding organic aetiology. (Bartholomew & Wessely, 2002). 
As regards community reactions, they may present with distinct features. Tyhurst provides a three phase model of community response. (Tyhurst, 1951). In Phase I, most individuals are liable to be stunned, numbed or even in denial. Denial was the commonly reported reaction among the office staff of Capital Hill, Washington DC following the 'anthrax' scare in 2001. It took some time for the affectees to realize they might have been exposed to a toxic substance. North et al., 2005). Widespread panic is not a typical reaction (though widely depicted in 'disaster films', etc.). Approximately 10 per cent of victims are likely to panic, and this reaction is most likely when victims believe they are trapped and feel helpless. Durodie & Wessely, 2002).
In the 1987 King's Cross underground fire most passengers did not panic; on the contrary, they sought out the usual methods of entry and exit. (Donald & Canter, 1992). Similar personal reactions were observedgiven after the London terrorist incidents of July 2005. Hence the civil contingency planning clearly should not be based on ill-informed assumptions about human behaviour. 'Even in extreme situations human behaviour can be rational, altruistic, and even heroic.'
In Phase II which is the 'Recoil Phase', individuals seek to make sense of what has happened. They seek reunion with their common sources of support, e.g. families, friends and colleagues. Even makeshift groups may develop as individuals seek understanding and mutual support. During this period, the community develops a sense of order and control, and the concerned relief authorities can do a lot much to facilitate this step towards recovery..
Phase III, the 'Recovery Phase' is characterized by alternating episodes of adjustment and relapse and there may be some obvious examples of resilience and positive outcomes. Further comprehensive research studies must be A lot of research still needs to be done in order to understand how communities cope with chronic exposure to threat and adversity, but Jones and his colleagues have reassessed the social effects of air raids in Great Britain during the Second World War. They indicate a high level of civilian resilience developed during that period. (Jones et al., 2004). Similarly, law enforcement authorities have commented on the apparently low level of violence-related psychopathology reported in Northern Ireland during the 'Troubles'.
Clinical data is still not enough to identify It is unclear, as to what are the protective factors in these circumstances. Extensive denial, social cohesiveness, a united front against a common enemy or some other as yet undetermined influences could be termed as 'protective factors'.
Mental Health Studies
Mental health research studies are conducted worldwide to explore the effects of terrorism both on the individuals and the community. Whereas some emphasize the psycho-pathological effects of terror (Galea, Ahern, Resnick et al., 2002), others focus on the human suffering, which is not identical to psychiatric morbidity (Wessely 2003), and on community and cultural factors that enable people to endure the stressful event (Hobfoll, 2003). This conflict between two distinct approaches (Wessely, 2003) ishas yet to be bridged. Any horrific event can affect people directly or indirectly even if they are not the targets. Hence the target of the interventions is not the individual victim only, but all the people more indirectly affected by the incidence. An impartial approach may be suitable. The World Health Organization (WHO) has issued guidelines for action during emergencies which seem to support such a stand (WHO, 2003).
Experiencing or witnessing a violent attack does not necessarily mean that the individual 'will inevitably develop psychiatric morbidity' (Curran, and Miller, 2001). After the September 11, 2001 attacks in New York City, it was observed that:
In the aftermath of terrorist attacks, many Americans ... regarded their distress as a 'normal reaction rather than a disorder needing [psychiatric] care. (Drus and Marcus, 2004).
Presently available data suggest that it takes more than the agent (e.g., threat to life) to lead to psychopathology. Indeed, the role of the environment is of significance, as a part of the epidemiological triangle that has been discarded by a greater focus on host-related factors (e.g., gender or age of the victim). ) A study on adults have recognized a group of factors, including religious beliefs, ideological commitment and social capital, that have protected communities which were highly exposed to terrorist attacks (like the loss of dear ones, physical injuries and property damage etc). Ideology and religion may be used as a healing power, but also as a weapon. This is especially true in the [Middle East] region. (Solomon, and Laufer (2005); Shalev et al.; Shalev, Tuval-Mashiach & Hadar, 2004; Kaplan et al.; Kaplan, Matar, Kamin, et al., 2005; Billig, Kohn, and Levav, 2004).
All the research data today gives hope that, by advancing research on the mental health effects of war-related activities will be conducive to the development of new techniques to counter the psycho-social aftermath of wars and other such traumatic events., Ppsychiatrists worldwide are joining the call by WHO member states to devise means to restore the psycho-pathological damage sustained by victimized populations. The World Psychiatric Association (WPA) has been active in the recent Gaza Massacre,by giving an official statement. (See Mario Maj. statement in Chapter 1V -Wars in the Muslim World1).
Nonetheless On the other hand, psychiatrists could play other roles even at the risk of raising idealistic initiatives which cynics might like to dismiss. There are several possibilities open for psychiatrists who, by the nature of their profession can, besides promoting health, support peace rather than war. Psychiatrists and other mental health professionals from countries in conflict could engage in alliance in a number of activities (e.g., teaching, exchange of experiences in program development and services, communication), while they are actively, tenaciously and continuously supported by WPA.
Most importantly, psychiatrists must endeavour to make their societies even more ardently aware that in armed confrontations no one is a winner but that everyone is a victim. The model of collaboration in the Balkans, where mental health is a bridge to reconciliation within the framework of the 'Stability Pact', is a concrete example of what could be achieved when a unifying language is spoken, and when such an effort is reinforced by dedicated support from sources that are not part of the conflict.
Terrorism is a paradox—a topicalcontemporary, high-profile subject with clear relevance to the real-world today relevance, yetNevertheless with limited authentic and desperate shortage of research data available es in the area. Therefield there is an urgent need to encourage the younger researchers to take a keen n interest in continuing maintaining research activities .y in the area.
Psycho-Social Effects of Terrorism on the Muslim World
While nothing is easier than to denounce the evildoer, nothing is more difficult than to understand him. (Mikhailovich Dostovsky)
The Muslim World has endured a succession of terrorist attacks in the last decade and faced the 'war against terrorism' with endurance and resilience. The countries most affected were Iraq, Gaza, Afghanistan, Pakistan, and particularly the FATA region in Pakistan which has been labelled as the centre of terrorist training. Pakistan also became the first line of defense in this 'War on Terror'. The most distressing aspect of this war is the amount of destruction, damage and killing of innocent civilians of these regions. Ironically the damage done following the declaration of this war is to a large extent much greater than the loss which resulted due to the actual terrorist incident of 9/11 in New York.
The Muslims worldwide have confronted the worst degree of terrorism from the powers who claim to bring peace and justice in the world. It is logical and justifiable to control and battle against those who are involved in such degrading and inhumane acts of terrorism, however, some contemplation is necessary to remodel unreasonable and illogical methods or strategies chosen to fight this terrorism. The international media has been a major partner in this 'war against terrorism' and played a key role in portraying religious extremism in Islam as the major cause of present-day terrorism. But this is untrue since Islam is primarily a religion of peace, love and harmony. Unfortunately, clerics who have limited knowledge of the teachings and values of the Islam have misguided some people for their vested interests. The misinterpretation of the teachings of Islam by irresponsible clerics has led to fanaticism.
Islam is the most practical religion of the world. As narrated by Dr Muzammil H. Siddiqi:
The concept of human rights in Islam is based on two important principles: dignity of human beings and justice. Islam emphasizes that all human beings are honoured by Allah subhanahu wa ta'ala. Allah wants all human beings to live in peace and harmony and for this reason He wants us to establish justice in this world. Without justice there is no dignity and without dignity and justice there cannot be any peace.
There are several passages in the Holy Quran verifying the above narration:
If any do fail to judge by (the light of) what God (Allah) hath revealed, they are (no better than) unbelievers. (Holy Quran 5:44).
o ye who believe! Stand out firmly for God (Allah), as witnesses to fair dealing, and let not the hatred of others to you make you swerve to wrong and depart from justice. Be just: that is next to piety: and fear God (Allah). For God (Allah) is well-acquainted with all that ye do. (Holy Quran 5:8).
Human blood is sacred in any case and cannot be spilled without justification. Violating this rule is equivalent to killing all of humanity:
if anyone slew a person — unless it be for murder or for spreading mischief in the land — it would be as if he slew the whole people. (Quran 5:32).
Hence the Holy Quran advocates that death of a single human being is a death of humanity. At present it is vital to understand that words 'terrorism' and 'war against terrorism' apparently seems to be propaganda against Islam and Muslims. Such perceptions against Islam and the Muslims have taken a toll on the social, psychological and emotional well-being of Muslims in different parts of the world. (Zafar, 2007).
Psycho-Social Impacts of Gaza Conflict: On 31 January 2008, the Gaza Community Mental Health Programme (GCMHP) organized a Conference on 'Effects of Siege on Life and Mental Health of Palestinians in Gaza Strip'. Taysir Diab, Clinical Psychiatrist and Supervisor at GCMHP, talked about the mental impacts of the siege based on GCMHP's experience. He stated that there It is not one, but were a group of bio-psycho social factors that which caused mental illness. Diab of these factors under the siege on Gaza; and that the and its psychological, physical and social impacts of these factors were clinically identifiable. The siege, he said, had a direct effect on the appearance of new psychiatricmental cases and the relapse of old ones.
There are personal differences on the physical and psychological levels; there are protective factors such as religion, patriotism, norms and values, as well as social support. All these factors along with others contributed in the protection of individuals.
and the development of new mental illnesses in the Palestinian people.
According to Diab, a vast majority of the Palestinian populations were suffering from symptoms of psychiatricmental disorders. He pointed out that the clients of GCMHP's Community Centers suffered from various psychological problems, including panic, insecurity feelings of insecurity, easily provoked aggressiveness, anger, easily provoked, psychosomatic disorders, depression, frustration, low morale, fear, poor concentration, lack of belonging or affiliation, lack of confidence in self and others, emotional numbness,numbness, and PTSD symptoms., various physical complaint, Oobsessiveon-Ccompulsive Disorders were common, and there was a definite rise in illness relapses.rise in illness relapses.
Diab further mentioned that the siege affected the vulnerable groups, in particular children who suffer increasingly from fear, panic, and at times apathylack the feeling of risks, tendency of sadness and insecurity feelings of insecurity., as well as Bbed-wetting and stutteringstuttering, was also a common presentation. He also pointed that the siege affected the mental health professionals in term of increasing their mental stresspressures and state of frustration, avoidance, nervousness, and professional burn-out.
Furthermore, Ahmad Abu Tawahina, Senior Clinical Psychologist and Director General of GCMHP, statedmentioned that the major aimplan behind the siege imposed by Israel wasis to implantinstil panic and fear among the Palestinians citizens. He said:
We, as Palestinians, must never live a frustrating and despairing life and have to get rid of the negative impacts of siege since life goes on, and the professionals must exert all efforts in order to help people cope with the difficult situations.
Twahina also stated that it was vital that Palestinians should not drown in terror and fear since most of the above mentioned symptoms are natural reactions to a madcrazy reality. He also addressed the concept of 'victimof 'victim psychology' and commented on the importance of offering the mental services for people who suffer from frequent depressions, and increasing concerns. According to him the mental suffering affects everybody but at different levels, and that theere is depression, anxiety, tension, and despair is prevalent at the entirewhole community levels. In his work paper, .
Samir Zaqout, a psychologist at GCMHP, discussedtalked about the social changes resulting from the siege. He statedadded that:
the siege started in 1948 when Israeli Occupation practiced siege policy in an attempt to deny the Palestinians their identity:
The siege is doubled as it is imposed by Israel and the international community since they didn't allow the Palestinians to practice their rights in a democratic way.
Further, Zaqout pointed that the siege affected the Palestinian social fabric and domestic relations as hatred and tendency of revenge increased among the Palestinians. It also affected the moral values and accepting the other as well as increasing inter and intra familial disputes and conflicts.
Summing up the proceedings of the Conference Eyad el Sarraj pointed to the significance of highlighting such statistics and showing the direct impacts of the siege on the citizens. He stressed on the importance of the accuracy and avoiding exaggeration in stating any statistics. Sarraj focused on the 'victim psychology'. He said:
Since we, as Palestinians, shouldn't adopt the role of victim, and exaggerate in blaming others and defaming ourselves. Our priority should be national reconciliation and unity and supporting the Palestinian resiliency so as to achieve our legitimate rights, endorsed by international conventions.
Concluding the conference the mental health experts reiterated that it was crucial that the siege must end and professionals must undertake their roles in the field of education and mental health. This would be the first step in to bring some semblance of normality to the lives of the Gaza Community. This step was vital, in order to enable them to cope with negative consequences of the siege and minimize the resultant burdens. Moreover, it was agreed to work on the promotion of mental resilience programs for ending the siege and developing coping strategies to counter the negative mental health consequences.
It was agreed that the Palestinian people are steadfast and live with dignity, and should not bend or despair and take matters positively and effectively in order to resist all schemes aiming at weakening Palestinian social fabric, and to achieve the Palestinian rights in freedom, independence and establishing the Palestinian state. Further, the attendants emphasized the importance of working, as specialists in various fields, on influencing the decision makers in the Palestinian society and acquaint them with the destructive impacts of the siege at all levels, especially the mental health of the future Palestinian generations.
The physical and mental health needs of sufferers of Gaza are extremely challenging to address, particularly the psychological and emotional crises. During the last Israeli military strike in the period from December 2008 to January 2009, approximately 1380 Palestinians were killed, of whom 431 were children and 112 women. (United Nations Population Fund (UNFPA) (2009). At least 5380 people were injured, including 1872 children and 800 women. In these improvised settings within health facilities such as maternity wards and operating theatres were transformed into trauma units. The consequences must be drastic in terms of maternal and child morbidity and mortality because 3500 deliveries were expected to have taken place during the twenty-three days of military operations. Findings from a recent UNFPA assessment indicate that, during that period there was an increased number of miscarriages in pregnant women (Shifa, Al Aqsa, Naser, Rafah), and an increased neonatal mortality in Shifa Hospital in Gaza City. (UNFPA, (2009).
According to World Health Organization (WHO), only the rough estimates show that during the last Gaza crisis 25000 to 50000 people underwent severe mental stress and need some form of psychological intervention to address long-term effects. Women, separated children, elderly people, and people with prior physical or mental disabilities are at high risk of severe emotional distress than others. The restoration of normal socioeconomic conditions, secure living
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