• Nobhojit Roy, Vikas Kapil, Italo Subbarao, and Isaac Ashkenazi.
• Jamsetji Tata Centre for Disaster Management, Tata Institute of Social Sciences, Mumbai, India. nroy@jhsph.edu
• Disaster Med Public Health Prep. 2011 Dec 1; 5 (4): 273-9.

ObjectivesThe November 26-29, 2008, terrorist attacks on Mumbai were unique in its international media attention, multiple strategies of attack, and the disproportionate national fear they triggered. Everyone was a target: random members of the general population, iconic targets, and foreigners alike were under attack by the terrorists.MethodsA retrospective, descriptive study of the distribution of terror victims to various city hospitals, critical radius, surge capacity, and the nature of specialized medical interventions was gathered through police, legal reports, and interviews with key informants.ResultsAmong the 172 killed and 304 injured people, about four-fifths were men (average age, 33 years) and 12% were foreign nationals. The case-fatality ratio for this event was 2.75:1, and the mortality rate among those who were critically injured was 12%. A total of 38.5% of patients arriving at the hospitals required major surgical intervention. Emergency surgical operations were mainly orthopedic (external fixation for compound fractures) and general surgical interventions (abdominal explorations for penetrating bullet/shrapnel injuries).ConclusionsThe use of heavy-duty automatic weapons, explosives, hostages, and arson in these terrorist attacks alerts us to new challenges to medical counterterrorism response. The need for building central medical control for a coordinated response and for strengthening public hospital capacity are lessons learned for future attacks. These particular terrorist attacks had global consequences, in terms of increased security checks and alerts for and fears of further similar "Mumbai-style" attacks. The resilience of the citizens of Mumbai is a critical measure of the long-term effects of terror attacks.

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