Take the Terror out of Terrorism

The word 'terrorism' was first used in England in 1795 when the Jacobins ruled in a period known simply as 'The Terror'. The favourite Jacobin slogan during the horrific years following the French revolution was 'Let terror be the order of the day'. The fear was caused because there was an unseen enemy amongst the ordinary population. Every village, street and even family had a spy who would report every whisper of dissent against the revolution leading to death by the guillotine for the perpetrator. This was a fear of the unknown, yet within familiar surroundings and amongst familiar people.

Terrorism is defined by Title 22 of the US Code as 'politically motivated violence perpetrated in a clandestine manner against non-combatants'. Experts add a further aspect: 'The act is committed in order to create a fearful state of mind in an audience different from the victims'. The anthrax outbreaks in October 2001 caused a fearful state of mind in the whole US population even though only a few victims were affected. The essence of terrorism is to create danger and fear amongst people carrying out their everyday activities and so hope to weaken the resolve of a population and eventually that of the government.

Terrorism plays on the fear that law and order will not protect you or your family. Normal activities such as travel on the underground or a plane flight create an anxiety and will lead to changes in behaviour of a population which the terrorists hope will cause disruption to normal life and damage the economy and confidence of a nation.

Informing the Public

The government must try to take the terror out of terrorism. This is a balancing act of informing but not alarming and of reassuring without appearing complacent. The current policy of the government is found on the Home Office website.

There is currently no information that would lead us to advise you to take special precautions against the threat of terrorism.

If that situation should change, and you need to take specific action, we will issue advice immediately, through radio, television and all forms necessary. At the moment, we do not believe that the best way to offer useful, up-to-date advice is to issue a national leaflet.

So what information is needed for the government to take special precautions against the threat of terrorism?

This is a difficult decision for any government faced with a likely terrorist attack. There is a choice. If the government releases information on how to prepare for a terrorist attack, as has been done in the US or Australia, they face the accusation of scare mongering. Some would also argue that this would create an increased level of public fear with no obvious benefit.

The other choice is to deny the need for further information and so reduce the profile of a potential terrorist attack and provide a sense of calm and control.

This second option would be sensible if the risk of a further terrorist attack was low. However on 7 January 2003 Tony Blair rather countered this argument when he said: 'This danger is present and real and with us now and its potential is huge'. The risk has therefore moved from unlikely to very likely and a worried population are looking for the government to provide information.

Lessons from Medicine and Fire Prevention

When facing difficult decisions it is often useful to look at similar challenges faced by professionals in other disciplines. The medical profession has to balance the risk of giving too much or too little information to patients with cancer. Many papers have been published on how best to approach this difficult subject and some parallel lessons can be learnt.

The fear expressed by many patients who have been diagnosed with cancer is that of the unknown. Research has shown that a diagnosis of cancer may invoke uncertainty, fear and loss that can be alleviated by information. In a study published in the British Medical Journal four out of five patients wanted as much information as possible. The information required was about treatment, prognosis and recovery.

Cancer and terrorism both conjure up exaggerated images of helplessness in people's minds. So like cancer perhaps peoples fear of terrorism could be alleviated by information.

Another example is in fire prevention. In 2000 there were over 56000 accidental house fires in the UK injuring over 17000 people and killing over 500 people. Being caught in your burning home trying to save your children has to be one of the most fearful experiences comparable to any terrorist attack. Providing information about preventing fires and knowing what to do in a house fire including first aid is not only sensible but is an essential public duty of any government. It is too late to reach for a fire safety manual as smoke swirls around your eyes in semi darkness. Reading and understanding the basic fire safety points beforehand is the obvious way to keep you and your family safe.

I believe that there could be similar information relating to a terrorist attack as there is in preparing for a possible fire at home.

So if information can reduce fear three questions need to be answered:

A) Are the public concerned? B) How should the information be presented? C) What information is of practical use?

Are the Public Concerned?

There have not been any recent polls to answer this question but one week after 11 September ICM commissioned a poll which found that although 94 per cent were continuing to spend money as usual, 68 per cent were now more concerned about the safety and well-being of themselves and their family.

The War Report commissioned a poll more recently to determine the scale of the fear of Terrorism. The question was asked: 'How worried are you about the prospect of chemical or biological weapons being used in a terrorist attack on the UK?' Fifty per cent were worried, with women twice as likely to be concerned as men; sixty-four per cent of women were anxious compared to just 35 per cent of men.

How should the Information be Presented?

There are a few essential descriptions that must be fulfilled in order to create the most appropriate information:

1) Authoritative.

2) Accurate

3) Accessible

4) Readable

5) Relevant

6) Reassuring

1) As with any advice or health information it is essential that the information have been compiled from completely reliable sources. In medicine this means using only information that is published in a peer-reviewed journal. Some major decisions will be made from the information so authority is essential.

2) Many sources of information can become out of date very quickly. Booklets need reprints and websites will need updating regularly. Evidence changes, government advice changes, the terrorist threat changes creating a dynamic source of information.

3) The information must be accessible. This means that different mediums are needed such as websites, CD ROMs, booklets and even tapes. At the time of an event there may not be any access to the computer so a booklet would be the ideal back up.

4) Practical information involves checklists and explanations of procedures such as contamination. Reading the information should lead to a plan that anyone can put into place. There has to be a plan that can be put into place after reading the information. Keep words short and reduce the number of main points to a handful. No detail will be remembered so keep to major principles.

5) Keep it relevant. Who are the target audience? What are their ideas concerns and expectations about the terrorist threat? Have their needs been met, have their questions been answered. Is it applicable to where the reader lives and works?

6) The tone of any information should be to reassure. Often this involves correcting unsound beliefs or recalibrating a faulty perceived risk. Openly talking about the effect of a nuclear advice can be reassuring if in the next sentence the risk of this occurring is almost negligible.

What Information is of Practical Use?

Most people we have heard from would like to feel that they have all the information to help protect themselves and their family during the first few critical hours if they were caught up in a terrorist attack. Parents have asked many questions such as do we pick up our children from school or how do we look after pets if we are evacuated? They appreciate having the time to make plans and feel that being prepared in such an event can alleviate much of the anxiety. The other reassurance is that people have overestimated the risk of a terrorist attack affecting their family. Even a large terrorist attack is likely to be confined to a small but strategic area but it is the resulting fear and anxiety that would cause the most disruption. There is still the myth that there is nothing anyone can do since it will all be too late. This is simply not true. There is a lot of preparation that will make a big difference to how one deals with an event and remain in control.

Many people would like to have levels of information, which allow them to drill down to a level that they feel comfortable. Practical advice about being prepared, coping with fear and anxiety and what to do during an actual event would occupy the first level. This would provide checklists and so on. A second level would look at the possible ways in which terrorists could target the food chain or water supply and how the authorities would respond to an attack. The final level is a list of all biological radiological or chemical agents that could be used and the symptoms they can cause.

Terrorism succeeds when a nation is disrupted by fear and anxiety. The terror is the unknown and the helpless acceptance that we have no control. As with other unpleasant realities such as cancer or house fires, information can reduce the fear and possibly help one to survive an attack. This information can help create a realistic picture of a likely scenario which, when described and faced, will cause much of the fear to evaporate.

William Bird is Medical Director, Synigence PLC