Threat of Melee-related Terrorist Attacks: A Retrospective Analysis of Patterns, Mortality, and Public Health Impact

Disaster Med Public Health Prep. 2026 May 29;20:e108. doi: 10.1017/dmp.2026.10372.

ABSTRACT

BACKGROUND: Melee-based terrorism refers to attacks involving non-projectile weapons such as knives or blunt objects. This study analyzes the prevalence, injury patterns, and mortality associated with melee-based terrorist attacks.

METHODS: A retrospective analysis was conducted using the Global Terrorism Database from 1970 to 2020 to identify and characterize melee-related terrorist attacks worldwide. Incidents were included if melee weapons were the primary mode of assault and included injuries or death. Descriptive statistics were used to summarize attack characteristics and casualties, and negative binomial regression was performed to identify predictors of mortality outcomes.

RESULTS: A total of 1,505 melee-related terrorist attacks were identified, resulting in 5,528 injuries and 5,110 fatalities. Each incident caused an average of 3.40 deaths and 3.67 injuries. European Region accounted for the largest proportion of attacks (25.65%), while African Region exhibited the highest death ratio, with mean number of deaths per attack at 14.54, demonstrating significantly greater rate ratio of deadly attacks (IRR = 18.33; 95% CI 10.18-33.01). Knives and sharp objects were the predominant weapons (58.63%), with the greatest rate ratio of death (IRR = 10.32, 95% CI 6.07-17.54).

CONCLUSIONS: Melee-related terrorist attacks represent a persistent and escalating global threat with substantial mortality and injury burden.

PMID:42210760 | DOI:10.1017/dmp.2026.10372