Terrorism and its Aftermath

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.

Psychological Terror

Whatever is their modus operandi, terrorists share very similar aims. Alexander and Klein (2006)[1] 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)[2] 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).[3]

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).[4]

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).[5]

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).[6]

Normal individual reactions to a terrorist attack are:

1. Emotional Reactions : shock, numbness, denial , fear, anxiety , helplessness, hopelessness.
2. Cognitive dysfunctions as disorientation, confusion ,intrusive thoughts, images, memories ,hypervigilance (i.e. increased sense of risk),impaired concentration and memory.
3. 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

1. Autonomic hyper-arousal, insomnia, loss of energy.
2. Emotional shock, numbness, denial, fear, anxiety helplessness, hopelessness.
3. Cognitive disorientation, confusion, intrusive thoughts, images, memories.Hyper-vigilance, impaired concentration and memory.
4. 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).[7] 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).[8]

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). [9]

As regards community reactions, they may present with distinct features. Tyhurst provides a three phase model of community response. (Tyhurst, 1951).[10] 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).[11] 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).[12]

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).[13] 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).[14] 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),[15] others focus on the human suffering, which is not identical to psychiatric morbidity (Wessely 2003),[16] and on community and cultural factors that enable people to endure the stressful event (Hobfoll, 2003).[17] 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).[18]

Experiencing or witnessing a violent attack does not necessarily mean that the individual 'will inevitably develop psychiatric morbidity' (Curran, and Miller, 2001).[19] 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).[20]

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);[21] Shalev et al.; Shalev,[22] Tuval-Mashiach & Hadar, 2004; Kaplan et al.; Kaplan,[23] Matar, Kamin, et al., 2005; Billig, Kohn, and Levav, 2004).[24]

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).[25]

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:[26]

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).[27]

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 conditions and adequate psycho-social support services are undoubtedly needed to bring some peace and tranquillity in the lives of the long suffering Gaza Palestinians. (World Health Organization, 2009).[28]

Psycho-Social Impacts of War against Terrorism on Pakistan

Starting from the Soviet invasion of Afghanistan in the early-80s, Pakistan has suffered from trauma and terror for almost three decades now. Traumatic experiences arising from natural disasters such as the earthquake of 2005 in the country differ widely from those arising as a result of terrorist and war-related activities in context and meaning to the sufferers (and perpetrators). Terrorism is widely propagated as anti-West activity, although, it has affected far more lives of Pakistani and other non-Western communities. The effects of trauma resulting from terrorists' activities have not been studied as extensively as in other forms of trauma, particularly in countries like Pakistan. A complex interplay of social, political and religious values, along with the frequent violent suicide bombing incidents, has serious implications for the mental health of the Pakistani's. Particularly, in the North West-Frontier Province (NWFP) of Pakistan, which has been the center stage for all violent activities of militants since the early eighties. The civilian population has been the target of terrorism, and unfortunately they have been blamed as perpetrators of these terrorist activities, which have led to resentment and confusion in the civilian population in other areas of Pakistan. Such negative impact further deteriorates the trust and cohesion between the different provinces of Pakistan, thereby, adding to the deleterious effects of trauma on the mental health of all the citizens of the country.

Pakistan is among one of the leading countries which provided majority of the troops for UN peace-keeping forces. It is a country which is fully supporting and practically fighting this 'War against Terrorism'. These are clear evidences of commitment of Pakistan for international peace. Yet this is the country which is paying the highest price for fighting this war. Tremendous losses have been sustained in terms of political, economic, social, psychological and emotional distress. Pakistan is expecting an expenditure of Rs 678 billion on 'War against Terror' during the current financial year (2008-09) with a 40 per cent increase as compared to 2007-08. (Pakistan News Watch, 2009).[29] In this underdeveloped country, this amount could have been invested in other development projects. Nearly 2100 Pakistani law enforcement personnel have been killed in fighting this war which is traumatic not only for their families and children but a great loss for the country. The socio-political disharmony, associated with this war is a further burden on the distressed Pakistani people.

Major Bomb Blasts in Pakistan

Several bomb blasts have occurred in Pakistan. The notable amongst them are the ones that exploded at the time of: Benazir Bhutto's arrival; the Benazir assassination; the attack on Marriot Hotel, Islamabad; attack on Sri-Lankan Cricket Team building of Police Headquarters, Islamabad; and the Police Training Centre, Punjab. Besides these major blasts, numerous other attacks have taken place on mosques and other public places in the last three years.

What are the reasons for this rising rate of terrorism in Pakistan? Other than national and international political conflicts, the major reasons seem to be the social problems of illiteracy, poverty and economic disparity which are gripping the country. Aristotle agreed a long time ago upon the assertion that, Poverty is mother of Terrorism and Revolution'. In many Muslim countries including Pakistan, there is high prevalence of poverty, which makes it easier for terrorist groups to hire people. Secondly, poor literacy rates, and the totallycompletely incorrect interpretation of the concept of Jihad in Islam, is another important reason for the poor miserable young boys, particularly the orphans from Afghan War in madressah's (religious seminary) to sacrifice their lives for jannat (heaven) in the next world.

According to Daniel Pipes (2002):

As long as there is poverty, inequality, injustice and repressive political systems, militant Islamic tendencies will grow in the world. (Pipes, 2002).[30]

Terrorist attacks have seriously affected the quality of life of an average Pakistani. There is a definite increase in the anxiety disorders, panic attacks and mood disorders in the Pakistani population, particularly in the larger cities of Karachi, Lahore and Islamabad. There has been an increase in cases of both acute and chronic PTSD at the author's private practice in the suburbs of Karachi. A rough estimate of about 3 patients-a-month refer themselves or are referred by the families for symptoms of PTSD.

Psychological and Emotional Aspects of Terrorist Attacks on People Living in Pakistan

Frequent terrorist attacks in Pakistan have created a sense of fear in the minds of people. This fear has resulted in further dissatisfaction in the lives of the already suffering Pakistani population. There is a general feeling of hopelessness among the people regarding their personal and social well-being. To add to this, the Pakistani media gives graphic coverage of the horrific incidents of terrorism in Pakistan and the world over. As a consequence, patients suffering from phobic and anxiety disorders who have been stabilized suffer from relapses following each terrorist attack. Anger resentment, anxiety, depression and frustration have affected the work performance and interpersonal relationships of a large proportion of people. Continuous news of fresh terrorist attacks in the country has resulted in loss of social interaction and cohesion among people. People end up continuously watching television where distressing news and horrific images of bomb blasts or the plight of IDP'S in the camps are constantly being flashed across the screen. The detailed interviews of the families shown on television who have lost their loved ones create distress in audience which adds to their sense of insecurity and anxiety. Many are afraid of travelling even in their own vehicles; nothing seems secure enough; very often, parents are reluctant to send their children to educational institutions after hearing apprehensive news; and mothers constantly worry about the security of their adolescent children till they reach home.

There is perplexity and confusion in the minds of people, as they have lost faith in their leaders and their clergy. 'Who is the enemy and who is the friend of Pakistan' is a dilemma facing every Pakistani. People have also lost their trust in the government and the state, and there is an escalation of anger and bitterness among common people against the government and the state apparatus. The result is the rise in anti-government protest and destruction of government and public property. Frequent strikes and protests for rising inflation, joblessness, law and order situation and the energy crises, all are routine occurrences in the lives of Pakistani citizens.

Terrorist activities have seriously harmed business and economy of the country. Many established businesses have been closed down and businessmen have moved abroad which has resulted in a reduction of job opportunities for ordinary people. As a result there is increase in poverty, and lack of basic amenities, which in turn leads to frustration and increase in crime rates, eroding the social fabric of the society. (Michael, 2007).[31] Due to the fear of terrorist attacks people try to escape from their social and professional responsibilities. The medical profession has suffered greatly because of terrorism. Primary care interventions that need access to large population groups have been affected most, particularly immunization and family planning campaigns (Warraich, 2008).[32] In one incident a suicide bomber killed himself with 26 others, and injured 35, outside the emergency department of a hospital in the north-western town of Dera Ismail Khan. This incident created fear among medical healthcare providers for days.

The recent attacks on Marriot Hotel, Islamabad; the Sri-Lankan cricket team, Lahore; and on the police training centre, Islamabad and Lahore has escalated this fear. In the last few terrorist attacks large numbers of police personnel and security guards have been killed in Pakistan. Targeting police personnel and departments is a statement by the terrorists that the organs responsible for providing security to the people are themselves not secure. Such situations of constant stress and apprehension are undoubtedly detrimental to the social, emotional and psychological well-being of the common man of Pakistan.

Experience of Witnessing a Suicide Bombing Attack

Some of the following repercussions of a terrorist attacks can be gleaned from this write up by a highly trained physician, caught in the suicide bombing incidence in Islamabad, Pakistan which illustrates the dimensions of this amorphous phenomenon of 'terrorism:

It's with great trepidation that I'm writing my experience. Initially when it happened I talked about it a lot and quite without emotion, today however it is a different issue. Basically I thought I had forgotten about the whole thing. But when I write this note, the entire picture is still so vivid and real, as if it was yesterday!

Well it was an afternoon in Feb. 2008 and we were going home after having lunch. I was sitting on the rear seat with my sister. After a short ride we stopped due to traffic ahead of us. Suddenly there was an eerie silence as though the air had been sucked out of the atmosphere, and then a loud explosion with smoke rising like a semicircular cloud in front of a Suzuki van that was standing in front of us. Suddenly there was the smell of burnt meat/flesh, and charred bits of flesh landing on the windshield and the rest of the car. There was an awful smell of burning and an old smell I recalled from the '65 war of gun powder. There were large pieces of whitish metal flying over the roof of the car. (Apparently from another car that had also been damaged).

I rushed out of the car and saw a part of a face with jet black hair and part of the jaw with the teeth intact lying beside the wheel of the car. Strangely enough there were no burns on it. The flesh seemed so real. There was a hand stuck on the other side of the car which I was told later. We walked quickly away from the car, but returned shortly back as we wanted to get away from that macabre scene. Hoards of people were walking towards the car that had been blown up, eager to take photographs. I was just numbed and did everything automatically. I drove back home in a daze.

After effects, no flashbacks, but I remained very agitated for days, just could not concentrate on anything, felt anxious. Went to Karachi for a visit, after a few weeks, but somehow I felt uncomfortable in the restaurants, or busy streets.

I preferred to meet family and friends in their homes, whereas I always loved eating out with friends in Karachi.

I still do feel very uncomfortable in a traffic jam around that area. It has been more than a year now.(author's name withheld on request).

What becomes powerfully clear is that only through deeper understanding can we fully grasp the present dangers of a phenomenon whose repercussions are far from over.

Terrorist Attacks in Pakistan

There have been a number of deadly terrorist attacks in Pakistan over the last few months. Most of them were suicide attacks:

27 December 2007: Pakistani opposition leader Benazir Bhutto is murdered in a bombing in Rawalpindi. Twenty other people died along with the politician, who was twice prime minister. The interior Ministry blamed the attack on extremists connected.

16 February 2008: Forty-seven people were killed and around 150 injured in an attack on an office of an independent political candidate for parliament ahead of elections scheduled for two days later. The suicide bomber drove a car bomb in the election office in Parachinar on the border with Afghanistan.

2 March 2008: Around 40 people were killed and many more seriously injured in a suicide attack in the country's northwest. The attacker detonated the bomb during a tribal assembly of around 1000 participants in the city of Darra Adam Khel. Tribal leaders had called the assembly to discuss combating Islamist extremists in Parachinar on the border with Afghanistan.

11 March 2008: In two suicide attacks in the eastern city of Lahore, at least 27 people were killed and 200 injured. The first attack struck the regional headquarters of the Pakistani federal justice ministry. The second attack took place in an advertising agency near the residence of Asif Ali Zardar, the leader of the Pakistani People's Party (PPP) and the widower of murdered former premier Benazir Bhutto.

2 June 2008: A car bomb attack on the Danish embassy in Islamabad left at least six people dead, Pakistani government sources said. The al-Qaeda terrorist network claimed responsibility, seeking revenge for the publication of 'insulting caricatures' of Islam's prophet Muhammed (PBUH).

19 August 2008: At least 23 people were killed and 20 injured in an attack on a hospital in the North-West Frontier Province. Police said the suicide bomber blew up among a crowd outside the hospital's emergency room in the city of Dera Ismail Khan.

20 August2008: In north-western Pakistan three suicide bombers killed at least 78 people in the city of Wah. Some 100 people were injured in the explosion outside of a weapons factory. Tehrik-e-Taliban claimed responsibility.

20 September 2008: In a car-bomb attack on the Marriott Hotel in the centre of the capital Islamabad, 53 people were killed and 260 injured, according to government sources. Among the dead were the Czech ambassador and other foreigners. The radical Islamist group Fedayin-e-Islam claimed responsibility for the suicide attack. The group has contacts with the group Tehrik-e-Taliban, the Pakistani branch of the formerly Afghan-based Islamist extremist Taliban.

(South Asia News 10 October 2008)[33]

In 2007, 1,503 terrorist attacks, including all the suicide attacks, target killings and assassinations, resulted in 3,448 casualties and 5,353 injuries, according to the Pakistan Institute for Peace Studies( PIPS)security report. These casualties', were128 pe rcent and 491.7 percent higher as compared with 2006 and 2005, respectively. The report also states that Pakistan faced 60 suicide attacks (mostly targeted at security forces) during 2007, which killed at least 770, besides injuring another 1,574 people. Pakistan Institute for Peace Studies report (PIPS) shows noticeable increase in suicide attacks after Lal Masjid Operation

In 2008, Pakistan faced 2,148 terrorist attacks, which led to 2,267 fatalities and 4,558 injuries. Human Rights Commission of Pakistan (HRCP) in its annual report pointed out that at least 67 suicide attacks occured across Pakistan, killing 973 people and injuring 2,318 .Another source in the investigation agencies disclosed that the total number of suicide blasts in Pakistan since 2002 rose to 140 (till December 21, 2008) while 56 bombers had struck in 2007.

An upsurge in acts of terrorism, militancy and violence further destroyed the security landscape of Pakistan which resulted in highest number of militancy-related casualties in 2009 since launch of War on Terror in 2001. The militants intensified their attacks, diversified their targets and expanded their areas of operation although they were killed, injured and arrested in large numbers in military and search-and-hunt operations in Swat, South Waziristan and other regions . 2009, was the worst year in Pakistan ; 2,586 terrorist, insurgent and sectarian-related incidents were reported that killed 3,021 people and injured 7,334, according to the "Pakistan Security Report 2009" published by PIPS. These casualties number , was 48 percent higher as compared to 2008. On the other hand, the rate of suicide attacks surged by one third to 87 bombings that killed 1,300 people and injured 3,600.

PIPS Annual Security Report 2009 .. Islamabad , Pakistan

Suicide Terrorism and its New Target —Pakistan (by Dr Muhammad Irfan and Zeeshan-ul-Hassan Usmani)

People commit suicide to kill themselves; while suicide attackers definitely die, along with killing others. Why do they do it? Are they reactionary or is there any psychopathology involved? Is religion playing a role or is it nationalism in the name of religion? What is meant by f 'Frontline State, and which side of the line is Pakistan on?

In search of the answers to these questions and thinking about the appropriate definition of suicide terrorism, I heard the music of 'Breaking News' on a popular news television channel. As I became attentive to it, I heard the news: Twenty-seven persons, including 25 soldiers, were killed when a suicide attacker rammed his explosive-laden car into a security forces convoy near the Doaba check post in Hangu.' This was 4:25 pm on the 18 April 2009 and this marked the hundred and sixty-ninth suicide terrorist activity in Pakistan.

What is Suicide Terrorism?

Suicide terrorism is definitely a challenging term to define as no proper definition of terrorism is available even today in fact strong arguments prevail over the existing ones. Hence, keeping these ongoing arguments into consideration, 'suicide terrorism' has been attempted to be defined as: 'a diversity of violent actions perpetrated by people who are aware that the odds they will return alive are close to zero'.1 This definition includes suicide attack; suicide bombing; and a wide range of suicide tactics.

There are no specific state of the art definitions available for suicide attack and suicide bombing, but for the ease of use, they may be defined as:

'An attack intended to kill others and inflict widespread damage in the knowledge that oneself will die in the process',2 while the best workable definition for suicide bombing can be stated as: 'A politically motivated, violent attack perpetrated by a self-aware individual who actively and purposely causes his own death by blowing himself up along with his chosen target. The perpetrator's death is a precondition for the success of the mission.' 3

The use of the term 'suicide bombing' may be dated back to 10 August 1940 when it was mentioned in an article in the New York Times writing on German tactics used during the Second World War. In another article dated 4 March 1942, the term 'suicide bombing' was used for the Japanese who attempted an attack on an American carrier. The terms 'suicide bomb' and 'suicide attack' were also used by The Times, London, respectively, in its articles dated 21 Aug. 1945 and 15 Apr. 1947, in reference to Japanese tactics. The use in the recent past of the term 'suicide bomber' holding the meaning of 'an attacker blowing up himself or a vehicle to kill others', came out in 1981 when Thomas Baldwin in an Associated Press article used it to describe the Iraqi Embassy bombing in Beirut.2

Suicide Bombing - Reaction of the Deprived to Deal with the Mighty

The etiology of the phenomenon of suicide bombing in not uni-dimensional. Several provoking are involved here including revenge, hatred, anger and frustration which are fuelled by emulation, piety, pride and honour.4 This can be seen in the context of its strategic affectivity, which may be limited, as the goal is to highlight the targets' weakness and vulnerability; as well as the superiority, resolution and 'spiritual' strength of the attacker making it an act of defiance and empowerment'.5 Thus the presence of pride and honour in the etiology, strength and resolution in the thought; and defiance and empowerment through the actions make a perfect combination of a reactive force by the deprived towards the mighty. Thus a suicide bomber is considered to be very lethal and viewed militarily as a 'smart-bomb', which can readily act according to the local 'on the ground' situation, in 'real-time'. 6

History of Suicide Attacks

The first reported suicide attack comes from the story of Samson, a strong Nazarite judge that hated the Philistines for oppressing Israel for 40 years, who killed himself along with his victims as he destroyed a Philistine temple:

'Samson said, "Let me die with the Philistines!" Down came the temple on the rulers and all the people in it. Thus he killed many more as he died than while he lived.' (Holy Bible, Judges 16:30).7

The radical Jewish groups of ancient Rome, namely Zealots and Sicaris are considered to be the world's first documented suicide terrorists from 4 BC to AD 70. Acts of violence intended to stir up a popular revolt against the Roman occupiers of Judea were carried out,8-12 and members of these groups were remunerated through public campaigns of assassination. ;

The Persian Hashshashins (Assassins), a mystical society of Ismailis in the eleventh and twelfth centuries initially began suicide missions against the ruling Sunni Muslim leaders and later, against leaders of the occupying Christian Crusaders.9,10,12,13

Dutch soldiers used gunpowder to blow themselves up along with their enemies rather than be taken prisoners if they were injured while fighting against Koxinga's forces for Taiwan's control in 1661.14 Similarly, during the Belgian Revolution,2 the Dutch Lieutenant Jan van Speijk ignited his own ship in the Antwerp's harbour to prevent being captured by the Belgians.

The Sinhalese conducted numerous suicide attacks against the British during their revolts in the late-1700s, 1818 and 1848 with a tactic to hide inside a hollowed Kitul Palm tree trunk and blow themselves up when surrounded by British troops.2

The Prussian soldier Karl Klinke blew a hole in a Danish fortification, killing himself at the Battle of Dybbøl on 19 April 1864.2

The assassination of Czar Alexander II of Russia in 1881 by a member of Narodnaya Volya, Ignacy Hryniewiecki, was also a suicide attack as the attacker died during the attack while intentionally exploding the bomb.2

During the Battle for Berlin, the Luftwaffe using aircrafts flew 'self-sacrifice missions' against Soviet bridges over the River Oder and destroyed 17 bridges (17-20 Apr. 1945).15

Following World War II, Viet Minh's 'death volunteers' fought against the French colonial army by using a long stick-like explosive to explode their tanks.2

The phenomenon of 'suicide attack' gained immense popularity when during the Second World War Japanese kamikaze pilots used the idea to sacrifice their lives in the name of national honour. 9-13,16 The tactics of the Kamikaze, a ritual act of self-sacrifice, were used during the end of World War II by Japanese state military forces against United States Navy and Royal Navy aircraft carriers. In these attacks, airplanes were used as flying bombs and even outfitted with explosives specific to the task of a suicide mission later. Three thousand-eight-hundred and forty Japanese pilots gave their lives sinking at least 375 US naval vessels; killing 12,300 servicemen; and wounding another 36,400. This act received strong social support partly due to Japanese cultural history, in which seppuku' (honourable suicide) was part of Samurai duty.

Suicide Attacks in the Modern World

Statistics show that no acts of suicide terrorism occurred between 1945 ( post-World War II) to 1980 when it re-emerged and took the world by surprise.10 The Islamic Dawa Party's car bombing of the Iraqi embassy in Beirut in December 1981 can be termed as the beginning of the rejuvenation of Suicide Terrorism.2

Hezbollah's (Islamic Shi'ite group of Lebanon) bombing of the US embassy in April 1983 killing 241 US marines; and attack on the French and US marine barracks in October 1983 brought international attention to suicide bombings. 10,12,13,17,18

Lebanon saw the first bombing, but it was the Liberation Tigers of Tamil Eelam (LTTE) in Sri Lanka (founded in 1976) who perfected the tactic and inspired its use elsewhere. 9,10,12,17,19 Their Black Tiger unit has committed 69 suicide bombings since its inception in 1987, the highest number of the world's suicide bombings between 1980 and 2003,10 including the former Indian Prime Minister, Rajiv Gandhi (killed by the first and most high-profile female suicide bomber, Dhanu, wearing a suicide vest for the first time), and the President of Sri Lanka, Ranasinghe Premadasa.20,21 Robert A. Pape, a political scientist from Chicago University, while collecting data on suicide attacks between 1980 and 2003 (almost a quarter of a century) in his database book, Dying to Win: The Strategic Logic of Suicide Terrorism, has rightly called the Black Tiger unit as world's 'leading instigator' of suicide attacks. Between 1980 and 2003, out of 315 global suicide attacks involving 462 individual suicide attackers, the Black Tiger unit accounts for 76 attacks. The second on the list is the Islamic Resistance Movement or Hamas which carried out 54 suicide attacks. He also emphasized on the fast growth and increased tempo of the suicide terrorism as the number of attacks using suicide tactics has grown from an average of less than 5- a-year in the 1980s to 180-per-year between 2000 and 2005; and from 81 suicide attacks in 2001 to 460 in 2005 .22

The Kurdistan Workers' Party (PKK), since the beginning of their insurgency against the Turkish state in 1984, has also employed suicide bombings in the scope of its guerrilla attacks on Turkish security forces.9,10

But the incidence that changed the course of actions around the world is undoubtedly, the 11 September 2001 attacks (9/11) that involved the hijacking of large passenger jets and their subsequent strike into the twin towers of the World Trade Center in New York City and the Pentagon, killing everyone aboard the planes and thousands more in and around the targeted buildings.10,12,23

After the US-led invasion of Iraq in 2003, Iraq became the hub of suicide bombings, attacking not only US military targets but killing fellow Iraqis as well. Afghanistan has also emerged as a good breeding place for this activity and many suicide bombings have taken place there. This should be seen in the context of the presence of NATO forces on their soil; and this supports Pape's idea that foreign occupation and/or military presence are the necessary conditions for suicide terrorism.10

Pakistan - The Reward for being the Frontline State

A simple 'yes' to the question, 'Are you with us?' has led Pakistan to face the music and 'enjoy' the reward for being the front-line state in the 'war on terror'.24 This should be seen in the context of the years between 1947 till the above mentioned 'yes' when only two isolated suicide attacks, one hitting the Egyptian Embassy and the other a local newspaper, took place in Pakistan, respectively. Comparing this to the statistics available by the end of April 2009, in the eight years following the 9/11 attacks, 167 more similar activities occurred. It was after this that Pakistan was declared as a 'frontline state' in the 'war on terror'. The dictatorial rule prevailing in the country did not consider, at any point, to involve the people or their representatives before taking the decision of whether to be or not to be a part of this. It was only in the last year (2008) that Pakistan overtook Iraq and Afghanistan in terms of causalities suffered by suicide bombings with a total of 64 bombings. 25

The data in Graph 1 shows that North-West Frontier Province (NWFP) with 53 (31.36%) attacks heads the list of suicide bombing attacks. The other three provinces, namely Punjab (24 attacks), Sindh (9 attacks), and Balochistan (10 attacks), accumulatively have lesser number of attacks than NWFP. The situation looks even graver when the attacks on Provincially Administered Tribal Areas (PATA), and Federally Administered Tribal Areas (FATA) (24 and 36 respectively) are also considered with the attacks occurring in NWFP as these areas. Although, for other reasons, PATA and FATA appear to be separate from NWFP, but they share the same type of inhabitants along with a similar set of values and culture. So a tally of 103 (66.86%) attacks is accumulated which displays the misery of people living in this part of the world. The national capital, Islamabad, with all its security, also shares the burden of facing suicide attacks with 13 (7.69%) attacks occurring there in the recent past.

Graph 1: Suicide Attacks in Administrative Units of Pakistan

Apart from the provincial break-up, the city-wise break-up shows that Swat leads the list with 21 suicide bombings followed by Islamabad and Peshawar with 13 and 11 respectively (Graph 2). The Federally Administered Tribal Areas (FATA) leads this list with 15 places (Miranshah, Mir Ali, Wana, Parachinar, Jandola, Razmak, Mamond, Ghalanai, Khar, Darra Adamkhel, Landi Kotal, Michni, Khadezai, Kalaya and Jamrud) were targeted, compared to 13 cities in NWFP (Peshawar, Bannu, Dera Ismail Khan, Kohat, Hangu, Dargai, Laki Marwat, Tank, Charsadda, Haripur, Nowshera, Mardan and Shabqadar) and 3 in PATA(Swat, Shangla and Buner). Regarding the remaining three provinces, in Punjab, 10 cities (Lahore, Rawalpindi, Attock, Kharian, Sargodha, Kamra, Wah, Bhakkar, Dera Ghazi Khan and Chakwal); in Sindh, only Karachi; and in Balochistan 5 cities (Quetta, Fatehpur, Hub Pasheen and Zhob) were subjected to suicide attacks.

Graph 2: Suicide Attacks in Cities of Pakistan

To date, in Pakistan 2327 people have lost their lives due to suicide attacks while 5410 have been injured. This number is on a rise with 2 such incidences taking 25 deaths and leaving 70 injured in 2002, compared to 64 suicide bombing attacks with 866 deaths and 2090 injured people in 2008. (Graph 3).

Graph 3: Year-Wise Distribution of Dead and Injured in Suicide Attacks in Pakistan

The most deadly suicide attack took place in Karachi (18 October 2007) near the Karsaz Bridge, on a crowd welcoming former Prime Minister Benazir Bhutto in which 143 were killed and 500 were injured. Although she escaped unhurt at that time, but could not survive another attack on her on 27 December 2007 at Liaquat Bagh, Rawalpindi. The second and third deadliest suicide attacks were when the driver of a truck loaded with explosives blew the truck up in front of Marriot Hotel, Islamabad, killing 80 and injuring 300 people; and when a suicide bomber blew up his explosive-laden vehicle on a meeting of elders at Khadezai, Orakzai Agency killing 62 and injuring 300 people. (Graph 4 and 5).

Graph 4: Representation of Dead Persons in Suicide Attacks in Pakistan

Graph 5: Representation of Injured Persons in Suicide Attacks in Pakistan

Psychological Standpoint on Suicide Terrorism

A general approach about the majority of those who commit suicide is that they are suffering at the time from some form of mental disorder, mostly depressive illness, schizophrenia, substance misuse etc.26 And the ones who kill themselves without a mental disorder are few.27

Keeping this general notion in mind, it may easily be thought that a suicide attacker may well be suffering from a mental disorder like anyone who commits suicide, but the statistics do not match. The researchers on this topic have not been able to find any severe psychopathology among these individuals and none of them suffered from psychotic disorders or even clinical depression.28. In the 384 psychological histories of suicide bombers accumulated by Robert Pape; there was not a single documented case of mental illness, such as depression, psychosis, or even a past suicide attempt.10 Joseph Lelyveld, a journalist from the New York Times while claiming that suicide bombers have no underlying psychopathology, emphasized that in fact, it is their mental stability that helps them to endure pressure of committing such attacks.29 This concept was supported with a report stating that organizations like Hamas and Palestenian Islamic Jihad (PIJ) recruiters will not select candidates with suicidal tendencies. One PIJ member is quoted saying, 'In order to be a Martyr bomber, you have to want to live'.30 Similarly forensic psychiatrist Marc Sageman while studying 400 members of the Al Qaeda network was not able to find antisocial behaviour, mental illness, early social trauma or behavioural disorders such as rage, paranoia, narcissism in these individuals.31 Moreover, there was no evidence of major criminal behaviour nor a single report that a suicide attacker was gay, an adulterer, or otherwise living in a way that would bring shame in a traditional society.12

It is suggested that personal identity that has been shattered by helplessness, shame, humiliation and is craving for clearer definition and meaning for existence is replaced by group identity in suicide terrorists32 and thus the group becomes the only source of support and friendship for them and issues like sense of belonging; meaning in life; even their sense of identity, is derived from the relationships within the group.11 To them, this group is the representative of the community:

Thus future suicide bombers feel normal, and often experience enhanced self-esteem in a group. They become, in a sense, a spokesperson for the traumatized community and assume that they, at least temporarily, can reverse the shared sense of victimization and helplessness by expressing the community's rage.32

Argo, a political scientist, while discussing about suicide terrorists suggested that:

Interpersonal relationships were at the center of these individuals' radicalization, not psychopathologies, discipleship, or prior ideological beliefs. 33

So it is important to understand the psychology of large-group identity in this context as people strongly adhere to their large group identity in societies under stress and today even 'normal' persons can be pushed to become candidates for terrorist acts for their vulnerability to the recruitment and brainwashing by charismatic leaders9,17 and apparently this actually is happening in Pakistan, although no study has been conducted to support the evidence.

In a nutshell, despite many attempts to psychologically profile suicide bombers, it has not been successful and thus it has been suggested that for combating suicide bombing, the onward research in this field should focus on the processes of propagation, screening, and training of suicide terrorists and selection of individuals for leadership roles in terrorist organizations.9,34,35

The Role of Religion in Suicide Terrorism

Religion is however neither an essential, nor sufficient factor in the generation of suicide attacks and the taproot of suicide terrorism is nationalism not religion.10

Liberation Tigers of Tamil Eelam (LTTE), a group that, as already discussed, leads Pape's list of suicide bombing attacks, and it recruits from the predominantly Hindu Tamil population in northern and eastern Sri Lanka with an ideology that has Marxist/Leninist elements which is predominantly ethnic and nationalist in outlook and motives, with religion not playing a role in its actions. Same is the case in Turkey with the Kurdish nationalist suicide activities, which though Muslim in origin are secular in orientation.10

Holmes, while analyzing statements issued by Al-Qaeda has emphasized that Osama bin Laden's rationale for 9/11 have usually been secular rather than religious, focused towards 'punishing Western injustices, not impieties'.36

Robert A. Pape also suggested that it is the response to foreign occupation or (since 11 Sept. 2001) to perceptions of general political oppression in the Muslim world, and this is the principal motivation for suicide attacks. He further elaborates by giving a very pertinent example: 'Though it speaks of Americans as infidels, Al-Qaeda is less concerned with converting us to Islam than removing us from Arab and Muslim lands,' 10, 37 and beneath the religious rhetoric, it occurs largely in the service of secular aims. He concludes that, 'Religion plays a role in suicide terrorism, but mainly in the context of national resistance' and not Islam per se but 'the dynamics of religious difference' is what matter.10

This can also be seen in the present context of Pakistan where such groups (and/or their allies) while demanding for the imposition of shariah laws, want them to be imposed in a particular region i.e., the Malakand Division.38 They managed to achieve their goal in the form of the Nizam-e-Adl Regulation, 2009, but peace is yet to come in these areas as was expected.39

Suicide is contrary to Islamic law40 with low frequency in Muslim societies41 and since its rejection is unarguable, Muslim scholars, in this context, reject suicide attacks too.42

However, some influential Muslim clerics have supported suicide attacks on perceived enemies of Islam. Sheikh Yusuf al-Qaradawi, sometimes termed as 'the world's most quoted independent Islamic jurist', has called martyrdom operations:

The greatest of all sorts of Jihad in the Cause of Allah. A martyr operation is carried out by a person who sacrifices himself, deeming his life less valuable than striving in the Cause of Allah, in the cause of restoring the land and preserving the dignity.43

Also the Imam of the Khana Ka'aba (Grand Mosque) in Makkah, Abdul-Rahman Al-Sudayyis and the former President of Al-Azhar University, Ahmad Omar Hashem have urged on suicide operations by Muslims.44 Sayed Mohammed Musawi, head of the World Islamic League in London, although, condemning the London bombings insisted:

There should be a clear distinction between the suicide bombing of those who are trying to defend themselves from occupiers, which is something different from those who kill civilians, which is a big crime.45

The stance of Sheikh Muhammad Sayyid Tantawy, the top Egyptian cleric of Al ­Azhar University is reported to have changed since shortly after 9/11, he issued a statement opposing suicide attacks,46 but lately, a translation from Al ­Azhar website quotes him as supporting suicide attacks on Jews in Israel as part of the Palestinian struggle 'to strike horror into the hearts of the enemies of Islam.47

One of the most influential Muslim clerics of Pakistan, Sheikhul Hadith Maulana Hassan Jan, while signing a fatwa (decree) against suicide bombing in Pakistan, described the perpetrators as 'cruel and ignorant people', and that these people have 'no knowledge and education'. He said that suicide bombing was haraam (forbidden) and against the Sharia, and added that the situation in Afghanistan and Iraq was different from our country. He concluded: 'We are completely against suicide activities in our country.'48

Nevertheless, Islamic organizations involved in these attacks (including Al-Qaeda, Hamas and Islamic Jihad) continue to argue that suicide operations are justified according to Islamic law, despite Islam's strict prohibition of suicide and murder.49Irshad Manji, in a conversation with one leader of Islamic Jihad noted their ideology.

What's the difference between suicide, which the Koran condemns, and martyrdom?' I asked. 'Suicide,' he replied, 'is done out of despair. But remember: most of our martyrs today were very successful in their earthly lives.' In short, there was a future to live for and they detonated it anyway.

Finally, Pape's verdict regarding the etiology of modern suicide attacks declares:

The presence of American military forces for combat operations on the homeland territory of the suicide terrorists is stronger than Islamic fundamentalism in predicting whether individuals from that country will become Al-Qaeda suicide terrorists.10

This can be further seen in the words of Scott Atran, who while referring to 2004 and 2005, mentioned that:

In the last two years, suicide attackers have struck in 18 countries, mostly among US allies linked to undemocratic regimes, such as Pakistan, Saudi Arabia, Uzbekistan, and Egypt, or in places with perceived occupations, such as the Palestinian territories, Chechnya, Kashmir, Afghanistan, and Iraq.22

Discussion and Suggestions

Suicide terrorism can't be explained in a straightforward way, rather the approach should be multi-dimensional, multi-faceted. It involves several factors and dilemma of its description may be solved, according to Robert A. Pape, at three levels i.e., on strategic, social and individual level. According to him, on the strategic forefront, it exerts coercive power against democratic states to cease occupation of the territory, terrorists consider as their homeland; on a social level, mass support is an important factor; and on individual level it is motivated by altruism and selflessness as suicide terrorism is mainly a response to foreign occupation. Foreign occupation is defined in terms of territory (not military occupation alone). While rejecting Frum-Perle view that the root of the problem is in Islam, he states that, 'the taproot is American military policy" and "An attempt by the West to force Muslim societies to transform is likely to dramatically increase the threat we (the Americans) face.10

From the information available through conducted studies, it can be easily suggested that nearly all suicide terrorist attacks have specific secular and strategic goals: 'to compel modern democracies to withdraw military forces from territory that the terrorists consider to be their homeland,' and as American policies are directly influencing these issues, he suggested that, 'it is important that Americans understand this growing phenomenon.10

Still in terms of being outclassed militarily, some may assert that suicide bombings are necessary. For example, the former leader of Hamas Sheikh Ahmad Yassin stated:

Once we have warplanes and missiles, then we can think of changing our means of legitimate self-defense. But right now, we can only tackle the fire with our bare hands and sacrifice ourselves. 50

This motive has gained popularity in areas where the oppressors and the mighty have not given the deprived and the suppressed any liberty but have faced quite contradicting responses otherwise but one may feel that as this is the reaction of the 'deprived' to the 'mighty', this idea may be welcomed in future unless the 'mighty' does not interfere in each and every thing of the deprived and give them breathing space and enough margin to live their lives as per their choice.

To conclude, it is suggested that in the face of complexity of the issue, multidimensional policies must be employed to overcome this problem. Firstly, focusing on the prevention in which the most practical being working with the media to downplay the glorification of terror and to change attitudes to suicide bombing and later on de-glorification in educational programs in the schools and in the community.9 Secondly, on the psychological front, the need is to initiate and sustain the softening the rigid armour of regressed societies and prioritizing the development of a strong self identity with prevention of humiliation, oppression or abuse of various sectors of the general population.9,17 The third aspect is to imply efforts on political, socio-cultural and religious fronts with a clear thinking, not relying on short cuts, and with efforts employed for a sufficient period of time.17 Religious leaders can play an important role in this regard as potential suicide bombers often seek religious father-figures early in their careers.17 These efforts may also need global support in terms of improvement of the attitudes of 'Western Democracies' toward 'Eastern' countries undergoing rapid and turbulent social changes.17 This will definitely need an equal approach in treatment and they should avoid the attitude like that of a character in George Orwell's Animal Farm that, 'All animals are equal but some animals are more equal than others.'

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