By Zac Amos, Features Editor,

In recent years, ransomware has emerged as a critical threat to the healthcare industry, with attacks growing in frequency, sophistication and impact. These cyber assaults disrupt hospital operations, compromise patient safety and undermine data integrity.

Understanding how ransomware tactics have evolved — from basic phishing schemes to complex, multi-faceted attacks — enables healthcare organizations to develop more robust defenses. Staying informed about the latest trends and techniques that cyber criminals use allows healthcare providers to safeguard their systems and ensure the continuity of care.

Initial ransomware attacks

Early ransomware tactics in healthcare were relatively rudimentary but still impactful. The first known ransomware attack — the PC Cyborg or AIDS Trojan — occurred in 1989 and targeted roughly 20,000 researchers and medical institutions. This attack involved distributing infected floppy disks that encrypted file names and paying a ransom to unlock them.

Although primitive by today’s standards, this attack highlighted the vulnerability of healthcare systems. Hospitals faced significant disruptions, affecting patient care and operations. This early incident underscored the potential havoc that ransomware could wreak on the healthcare sector. It set the stage for more sophisticated future threats.

Evolution of attack vectors

The evolution of ransomware in healthcare has seen a significant shift; from simple phishing attacks to sophisticated social engineering techniques. Initially, attackers used basic phishing emails to trick individuals into downloading malicious software.

However, as defenses improved, cyber criminals adapted by using more advanced social engineering tactics. These methods involve conducting detailed research on targets, the creation of personalized messages and placing phone calls, as to gain trust and infiltrate systems.

Alongside this, Remote Desktop Protocol (RDP) exploits have surged. These exploits allow attackers to access healthcare networks remotely by exploiting weak passwords and unpatched systems.

The healthcare sector has also seen a rise in exploited vulnerabilities in medical devices and the IoT. Cyber criminals have increasingly targeted these interconnected systems — which often lack robust security measures — to launch attacks.

This trend was particularly evident in the fourth quarter of 2023. The healthcare industry accounted for 16% of all ransomware attacks, making it the second-most targeted sector during this period. Exploitation of vulnerabilities can disrupt medical services and poses significant risks to patient safety. In turn, this highlights the urgent need for enhanced cyber security measures in healthcare.

Advanced encryption and evasion techniques

As ransomware has evolved, attackers have developed more complex encryption methods to secure healthcare data more effectively. One notable tactic is double extortion, where cyber criminals encrypt data and threaten to release sensitive information if the victim doesn’t meet their demands. This dual threat has increased the pressure on targeted organizations.

Further, 74% of Chief Information Security Officers believe that AI-powered cyber threats, including advanced ransomware, significantly impact their organizations. Attackers are also implementing polymorphic malware, which constantly changes its code to avoid detection by traditional security systems. Techniques like this make it challenging to combat sophisticated threats.

Targeting larger and more critical institutions

Ransomware attackers have shifted from targeting small clinics to targeting large hospitals and extensive healthcare networks, resulting in more significant disruptions and higher ransom demands than previously. Larger institutions have substantial financial resources, which makes them attractive targets for cyber criminals seeking substantial payouts.

The financial impact of the attacks on larger healthcare organizations is profound. In 2023, experts reported data breaches costing an average of $10.93 million each. This cost increase underscores ransomware’s severe financial strain on healthcare providers. It affects their ability to deliver essential services and invest in further security measures.


The rise of Ransomware-as-a-Service (RaaS) platforms has contributed to the proliferation of ransomware attacks in the healthcare sector. These RaaS groups operate on various business models, including monthly subscriptions, one-time license fees, affiliate programs or pure profit-sharing arrangements.

Offering user-friendly interfaces and comprehensive support, RaaS has lowered the barrier to entry for cyber criminals. It even enables those with zero technical expertise to launch sophisticated attacks. This democratization of ransomware has led to an increase in the frequency and diversity of attacks. It poses a more significant threat to healthcare organizations that must now defend against an extremely broad range of adversaries.

Collaboration and sophistication of cyber criminals

The formation of ransomware syndicates and partnerships has further expanded the threat landscape in healthcare. Cyber criminal groups now share resources and intelligence, enhancing their capabilities and effectiveness. In fact, some RaaS operators provide ongoing technical support and grant access to private forums where hackers exchange tips and information, fostering a collaborative environment.

This collective effort allows more sophisticated attacks, as cyber criminals leverage advanced threat intelligence and surveillance to identify vulnerabilities and tailor their strategies. Consequently, healthcare organizations face increasingly coordinated and informed adversaries, making securing their systems even more challenging.

Countermeasures and mitigation strategies

In response to the evolution of advanced ransomware, healthcare organizations have had to enhance their defensive measures. Adopting multi-layered security approaches —  involving a combination of firewalls, intrusion detection systems, regular software updates and employee training — has become paramount.

Additionally, AI and machine learning are crucial in detecting and preventing attacks. These technologies can analyze vast amounts of data in real time and identify unusual patterns more accurately than traditional methods. Leveraging AI-driven tools lets healthcare providers anticipate and mitigate ransomware attacks more effectively than otherwise. It also helps bolster their overall cyber security posture.

Adapting to an evolving threat

The need for continuous adaptation in cyber security strategies is critical as ransomware threats evolve and become more sophisticated. The future landscape of ransomware in healthcare will likely see more advanced tactics. This makes it essential for healthcare organizations to stay vigilant and proactive in their defense measures.

For more insights from Rehack Features Editor, Zac Amos, click here.  Lastly, to receive practical cyber insights, groundbreaking research and emerging threat analyses each week, subscribe to the newsletter.