Executive Summary

This whitepaper addresses the escalating threat of Distributed Denial of Service (DDoS) attacks in the healthcare sector and underscores the importance of implementing robust cybersecurity defences. With the healthcare industry becoming increasingly dependent on digital technologies, the potential impact of cyber-attacks can have dire consequences for patient care and privacy. Harpp DDoS Mitigator is presented as an essential on-premises solution that offers advanced protection, ensuring healthcare services remain uninterrupted and secure against both DDoS attacks and secondary cyber threats.

Introduction

The healthcare industry is increasingly reliant on digital technology, from electronic patient records and telemedicine to data-driven diagnostics and treatment plans. While these advancements have brought about unprecedented levels of efficiency and patient care, they have also exposed healthcare providers to a host of cybersecurity threats. Among these, Distributed Denial of Service (DDoS) attacks represent a significant and growing danger.
DDoS attacks aim to cripple networked systems by flooding them with an overwhelming amount of traffic, rendering services inaccessible to legitimate users. For healthcare providers, the consequences of such attacks can be dire—disrupting critical care services, compromising patient data, and undermining public trust in healthcare systems.
With the landscape of cyber threats constantly evolving and the sophistication of DDoS attacks increasing, it is imperative for healthcare institutions to fortify their defences. Harpp DDoS Mitigator stands at the forefront of this defensive strategy. As an on-premises solution, it offers robust protection tailored to the unique demands of the healthcare sector.

Cyber Threat Landscape in Healthcare

The digital infrastructure of the healthcare sector is a complex and sensitive ecosystem, crucial for the delivery of modern medical services. However, this digital dependency also opens up multiple vectors for potential cyber threats. The landscape is particularly challenging due to several factors:
• Sensitive Data: Healthcare organizations handle vast amounts of sensitive data, including personal health information (PHI), which is highly valuable on the black market. The storage and transmission of this data must be protected against unauthorized access or theft.
• Legacy Systems: Many healthcare institutions still rely on legacy systems with outdated security measures, making them particularly vulnerable to cyber threats. Upgrading these systems is often a financial and logistical challenge.
• Interconnectivity: The interconnection of devices and systems for improved patient care (such as electronic health records and telemedicine) also increases the risk of cyber-attacks. A breach in one part of the system can quickly spread to others.
• Regulatory Compliance: Healthcare providers must comply with strict regulations, such as HIPAA in the United States, which govern the security and privacy of health information. Non-compliance can lead to significant fines and legal issues.
• Ransomware and Malware: Beyond DDoS, healthcare systems face threats from ransomware and other malware that can lock access to critical data and systems, demanding payment for their release.
• Insider Threats: Not all threats are external. Employees or contractors with access to healthcare systems can accidentally or maliciously expose the network to cyber threats.
• Phishing Attacks: Healthcare employees are often targeted by phishing attacks aimed at stealing credentials to gain access to secure systems.
• Resource Constraints: Cybersecurity requires investment in technology and training. Healthcare institutions, especially smaller ones, may not have the resources to maintain a robust cybersecurity posture.
Given this multifaceted threat landscape, the need for comprehensive and sophisticated cybersecurity measures is clear.

DDoS Landscape

The trend of Distributed Denial of Service (DDoS) attacks over the past three years has shown a significant rise in frequency, complexity, and size.
• Ransom DDoS attacks have seen a substantial increase, with a reported 67% year-on-year and 24% quarter-on-quarter growth. Online industries were particularly targeted, experiencing a 131% quarter-on-quarter and a staggering 300% year-on-year rise in application-layer DDoS attacks​​.[1]
• Cisco had predicted a significant escalation in the number of DDoS attacks, expecting them to double from 7.9 million in 2018 to 15.4 million by 2023. This forecast was based on historical data and projected trends, noting a notable 807% increase in DDoS attacks in the nine years leading up to 2022​​.
• According to Kaspersky, nearly 57,116 DDoS attacks were reported within a single quarter, and Cloudflare observed a 67% increase in ransom DDoS attacks in 2022 alone. Fridays have been the busiest days for such attacks​​.[2]
• The average DDoS attack utilized 5.17 Gbps of data, with Zayo Group reporting that the average attack size across all industries was 3 Gbps in the first half of 2023, which is a 200% increase from 2022​​.[3]
• There was a 74% year-on-year increase in the number of DDoS attacks in 2022, though the growth rate began to slow down in the fourth quarter, with attacks decreasing by 53% by December. Despite this, the power of botnets surged, capable of launching over 2 Tbit/s attacks lasting up to three days​​.[4]
• In 2020, a sophisticated DDoS attack utilizing 14 different vectors was discovered. User Datagram Protocol (UDP) assaults accounted for over 62% of these attacks, with Transmission Control Protocol (TCP) attacks also notable at 11.4%. Moreover, in 2023, the FBI shut down 13 DDoS-for-hire marketplaces​​.[5]
• In 2022, Microsoft’s cyber defense operations mitigated an average of 1,435 DDoS attacks per day. The maximum number of attacks in a single day was 2,215, and the minimum was 680. Throughout the year, they dealt with over 520,000 unique DDoS attacks against their global infrastructure​​.[6]
• According to research by Lumen Technologies, nearly 90% of the DDoS attacks in the fourth quarter of 2022 were ‘hit and run’ style, which are brief probing attacks. This report also provided predictions for 2023, along with a cost breakdown and data from their DDoS mitigation efforts​​.[7]
• Increditools reports that in 2023, the average size of DDoS attacks is expected to be around 100 Gbps. Small to medium-sized businesses may spend on average $120,000 to restore services after a DDoS attack. The average number of DDoS attacks per day in 2023 has been 29.3, and each attack can cost a company between $20,000 to $40,000 per hour​​.[8]

These statistics highlight a concerning upward trend in the scale and sophistication of DDoS attacks globally, underscoring the need for continued vigilance and investment in cybersecurity measures.

Impacts of DDoS Attacks on Healthcare

In the healthcare sector, the ramifications of DDoS attacks extend beyond mere inconvenience. They can disrupt patient care delivery, lead to potential life-threatening situations if emergency services are affected, and result in substantial financial losses. The following impacts are commonly observed:
• Service Disruption: DDoS attacks can shut down online appointment systems, delay access to electronic health records, and interrupt communication channels within healthcare networks, affecting both patients and providers.
• Operational Strain: Healthcare IT teams may become overburdened during an attack, which can divert their focus from other critical IT functions and maintenance.
• Reputation Damage: Trust is paramount in healthcare. An institution that falls victim to cyber-attacks may suffer a loss of patient trust, which can be difficult to rebuild.
 

Spotlight on Significant Incidents

The healthcare sector’s reliance on interconnected digital systems makes it a prime target for cyber-attacks. The following incidents illustrate the severity and impact of DDoS attacks and other cyber threats on healthcare services around the globe:

Singapore Health System Attack, November 2023 (Singapore):

Singapore’s public healthcare institutions faced a severe DDoS attack that resulted in a seven-hour disruption to internet-based healthcare services. Key details of the attack include:
• Blackout Duration: Services were offline for seven hours, starting from around 9:20 am.
• Attack Subtype: This was a volumetric DDoS attack, overwhelming the network with substantial traffic.
• Attack Duration: The intense traffic persisted for several hours, peaking during the initial phase of the attack.
• Attack Magnitude: The traffic volume was significantly beyond the network’s capacity, indicating a well-coordinated attack effort.

Hospital Ransomware Attack, March 2022 (United States):

A widespread ransomware attack on a major hospital chain encrypted patient records and disabled key operational infrastructure. The fallout included:
• Delayed medical procedures: Critical surgeries were postponed.
• Diverted emergency response: Ambulances were rerouted to other hospitals, affecting emergency medical care.

Healthcare Provider Phishing Scam, July 2022 (Canada):

A Canadian healthcare provider fell victim to a sophisticated phishing attack that compromised employee credentials and patient information, emphasizing the need for proactive security training and measures.

Medical Device Manufacturer Breach, January 2023 (Germany):

A German medical device manufacturer experienced a significant data breach through a targeted attack on its cloud services provider, resulting in the exposure of sensitive patient data.

UK National Health Service (NHS) Cyber Incident, October 2023 (United Kingdom)

The UK’s NHS was subjected to a complex cyber-attack that disrupted healthcare IT systems across multiple facilities. Details of the incident are as follows:
• Service Impact: The attack led to appointment cancellations and access issues to patient records.
• Attack Complexity: The multi-vector attack combined DDoS with other exploitative techniques, complicating the response and recovery efforts.
• Response Time: Recovery operations took several days, reflecting the attack’s extensive reach within the NHS infrastructure.
These incidents, spanning continents, underline the global nature of cyber threats to healthcare and the need for comprehensive defences.

The Smokescreening Effect of DDoS Attacks

While DDoS attacks are often aimed at disrupting services, they can also serve a more insidious purpose: acting as a smokescreen for more severe and stealthy cyber threats. Attackers may deploy DDoS as a distraction, consuming the attention and resources of the cybersecurity team while simultaneously executing a more subtle and significant attack, such as data breach or malware insertion.
During a DDoS attack, conventional network security equipment, such as firewalls and intrusion prevention systems (IPS), can become overwhelmed by the sheer volume of malicious traffic. Their inspection capabilities are stretched to the limit, which may cause legitimate but unusual network requests to go unscrutinised. It is during this window of vulnerability that attackers may launch secondary attacks, which can be far more damaging than the DDoS attack itself.
The Harpp DDoS Mitigator is designed to address this challenge by maintaining its defensive posture even under the barrage of a DDoS attack. It ensures that other network security defences remain operational and vigilant, providing the following benefits:
• Persistent Performance: Unlike traditional security equipment that may falter under heavy loads, Harpp DDoS Mitigator is engineered to withstand large-scale DDoS attacks without compromising its performance or the performance of other security layers.
• Intelligent Traffic Analysis: Harpp DDoS Mitigator employs advanced traffic analysis to differentiate between malicious and legitimate traffic. This ensures that even during a DDoS attack, the system is alert to other types of intrusion attempts.
• Seamless Integration: The solution integrates seamlessly with existing security infrastructure, bolstering the overall resilience of the network without creating performance bottlenecks or single points of failure.
• Real-time Response: With real-time mitigation capabilities, Harpp DDoS Mitigator quickly neutralizes DDoS attacks, thereby minimizing the window of opportunity for secondary attacks to take place.
By deploying DDoS mitigation measures, healthcare institutions can ensure that their defences remain up even when faced with the dual threat of a DDoS attack and secondary cyber threats. This comprehensive protection is critical for maintaining the integrity of healthcare services and the privacy of patient data, ultimately fostering a secure and trustworthy healthcare environment. 

On-Premises Mitigation with Harpp DDoS Mitigator

While cloud-based DDoS protections play a crucial role in defending against volumetric attacks, which flood networks at the network layer (OSI Layer 4), they can mostly fall short in addressing more sophisticated application-layer (OSI Layer 7) attacks. These attacks target specific aspects of web applications and services, which require a nuanced approach to detection and mitigation.

Application-Layer (Layer 7) Focus:

Harpp DDoS Mitigator specializes in protecting against Layer 7 attacks, which are often more complex and stealthy than volumetric attacks. These can include protocol specific flood attacks, not necessarily web, which mimic legitimate traffic and can be difficult to detect without specialized on-premises solutions that can analyse the nature of the traffic deeply.
• Deep DDoS Inspection: Harpp DDoS Mitigator employs sophisticated algorithms to scrutinize web traffic for malicious patterns indicative of application-layer attacks, ensuring that legitimate traffic is not impeded while neutralizing threats.
• Real-Time Protection: With its on-premises deployment, Harpp DDoS Mitigator offers real-time response capabilities, significantly reducing the time to detect and mitigate an attack, which is crucial for maintaining service availability and performance.

Seamless Integration and Control:

On-premises solutions like Harpp DDoS Mitigator provide healthcare institutions with direct control over their cybersecurity defences, allowing for immediate adjustments and customized protection based on the specific needs of the network and applications.
• Customized Defence Strategies: Harpp DDoS Mitigator can be tailored to the specific security profile of the healthcare institution, providing a level of personalization that cloud-based solutions may not offer.
• Local Compliance and Data Sovereignty: On-premises solutions ensure that all data remains within the control of the healthcare institution, which is critical for meeting stringent regulatory and compliance requirements. Another point, Harpp will provide evidence for any legal cases.

Bridging the Gap with Hybrid Solutions:

While cloud-based solutions are effective for absorbing large-scale volumetric attacks, they can be complemented by on-premises solutions like Harpp DDoS Mitigator, which excel in dealing with the intricacies of Layer 7 attacks. A hybrid approach ensures comprehensive protection across all layers of the OSI model.
• Winning Solution – Layer 4 and Layer 7 Synergy: By combining cloud-based and on-premises defences, healthcare providers can benefit from robust protection against both volumetric and application-layer attacks, providing a multi-layered defence strategy.
• Enhanced Security Posture: With Harpp DDoS Mitigator as part of a hybrid solution, healthcare providers are equipped to address the entire spectrum of DDoS threats, resulting in a fortified security posture that is resilient against evolving cyber threats.
On-premises deployment of Harpp DDoS Mitigator offers healthcare institutions a specialized and comprehensive defence mechanism against the sophisticated and often overlooked application-layer attacks, thereby ensuring the security and integrity of critical healthcare services.
• Persistent Protection: Even under the strain of a DDoS attack, Harpp DDoS Mitigator ensures that healthcare institutions can maintain access to critical systems and data.
• Integrated Security Posture: By integrating with existing security frameworks, Harpp DDoS Mitigator enhances the overall security posture without compromising existing defences
• Strategic Control: With Harpp DDoS Mitigator, healthcare institutions maintain control over their security, ensuring that all aspects of their network are protected from both DDoS and secondary attacks.

Conclusion

As DDoS attacks continue to evolve, so too must the defenses of healthcare providers. Harpp DDoS Mitigator offers a proactive and powerful defense mechanism, ensuring that healthcare services can operate without interruption. By choosing Harpp DDoS Mitigator, healthcare institutions can protect themselves against the immediate threat of DDoS attacks and the secondary risks that accompany them.
For more information on how Harpp DDoS Mitigator can secure your institution against the threat of DDoS attacks, visit https://harppddos.com.

References

[1]- https://www.comparitech.com/blog/information-security/ddos-statistics-facts/#:~:text=Ransom%20DDoS%20attacks%20increased%20by,in%20the%20number%20of%20attacks
[2]- https://www.getastra.com/blog/security-audit/ddos-attack-statistics/#:~:text=According%20to%20Kaspersky%E2%80%99s%20quarterly%20report%2C,on%20Thursday
[3]- https://laptopjudge.com/ddos-attack-statistics#:~:text=the%20average%20DDoS%20attack%20utilized,Security%20Blog%20reported%20that
[4]- https://www.infosecurity-magazine.com/blogs/2022-ddos-yearinreview/#:~:text=Global%20DDoS%20attack%20trends%20in,stretched%20up%20to%203%20days
[5]- https://learn.g2.com/ddos-attack-statistics#:~:text=In%202020%2C%20a%20DDoS%20attack,Source%3A%20KrebsonSecurity
[6]- https://www.microsoft.com/en-us/security/blog/2023/02/21/2022-in-review-ddos-attack-trends-and-insights/#:~:text=In%202022%2C%20Microsoft%20mitigated%20an,Figure%201
[7]- https://news.lumen.com/2023-02-13-Lumen-research-reveals-latest-DDoS-stats,-trends,-predictions-and-costs
[8]- https://increditools.com/ddos-attack-statistics/#:~:text=The%20average%20size%20of%20the,between%20%2420%2C000%20to%20%2440%2C000%20hourly