Islamic State—Khorasan Province (ISKP) has intensified its focus on targeting mid-tier cities within the United States, aiming to disrupt emergency services and sideline first responders. Hospitals have emerged as a potential target in this strategy. See the image below—note that on March 26, 2025, the American Hospital Association provided an update stating that the Federal Bureau of Investigation (FBI) “has not identified any specific credible threat targeting hospitals in any U.S. city.” However, given that the information originated from ISKP terrorist camps along the Pakistan-Afghanistan border—and considering that the FBI lacked access to thwart ISKP’s last U.S.-based plot on January 1, 2025, in New Orleans, Louisiana—it would be more accurate for them to acknowledge their limited visibility into ISKP’s ongoing plotting rather than assert that no plot exists.
Building on these concerns, recent threat reporting indicates some probing activity around hospitals in several states, suggesting that bad actors are at least assessing the viability of such targets. Swatting incidents—two of which occurred at hospitals, one at Loma Linda University Children’s Hospital in San Bernardino, California, on March 12, 2025, and another at Marshfield Medical Center in Marshfield, Wisconsin, on March 14, 2025—could also provide adversaries with valuable insights into police and emergency personnel deployment. This underscores the need for proactive security measures to deter terrorist targeting by making hospitals less attractive. Enhanced surveillance detection training for security personnel, strengthened cooperation between law enforcement and hospital administrators, and ongoing threat assessments are critical to this effort.
Geographically, ISKP-related planning, surveillance, and cell activities have likely occurred in Oklahoma, Virginia, New York, New Jersey, California, Pennsylvania, and Arizona. While exact attack locations remain difficult to determine, these states have shown indicators of potential targeting. Beyond hospitals, other potential targets include churches, as highlighted previously, public transportation hubs, shopping centers, street fairs, and nightclubs. These locations align with ISKP’s objective of attacking areas with high civilian concentrations to maximize impact; they are also prime targets for multi-phase attacks, which can be executed more effectively in such environments.
Multi-phase attacks have been a hallmark of IS-affiliated operations, as demonstrated in the Paris attacks of November 2015, where suicide bombings, mass shootings, and hostage-taking were carried out in rapid succession. Similarly, the Sri Lanka bombings in April 2019 targeted churches and hotels simultaneously to inflict mass casualties and overwhelm emergency responders. The Brussels attacks of March 2016 followed a comparable approach, with coordinated bombings at an airport and a metro station to create widespread disruption. The ISKP attack in New Orleans on January 1st, where explosives failed to detonate as intended— a key component of the attack that could have resulted in many more deaths than the fourteen lost— underscores the group's continued intent to execute synchronized strikes using multiple attack methods.
This warning is not intended to cause fear but to ensure that communities, first responders, and security professionals have the time and resources to prepare and implement defensive measures. The adversary’s intent is clear: they seek to bring the battlefield to U.S. soil. With the Islamic State reportedly maintaining an estimated 500 operatives within the U.S. homeland and al-Qaeda claiming even larger numbers, vigilance and preparedness are essential. The best course of action is to harden potential targets, enhance local information-sharing, and remain proactive in disrupting ISKP’s and other terrorists’ ability to execute their attacks.