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Background: Modern healthcare devices can be connected to computer networks and many western healthcareinstitutions run those devices in networks. At the same time, cyber attacks are on the rise and there is evidence thatcybercriminals do not spare critical infrastructure such as major hospitals, even if they endanger patients. Intuitively,the more and closer connected healthcare devices are to public networks, the higher the risk of getting attacked.
Methods: To asses the current connectivity status of healthcare devices, we surveyed the field of German hospitalsand especially University Medical Center UMCs.
Results: The results show a strong correlation between the networking degree and the number of medical devices.The average number of medical devices is 25.150, with a median of networked medical devices of 3.600. Actual keyusers of networked medical devices are the departments Radiology, Intensive Care, Radio-Oncology RO, NuclearMedicine NUC, and Anaesthesiology in the group of UMCs. In the next five years, the usage of networked medicaldevices will increase significantly in the departments of Surgery, Intensive Care, and Radiology. We detected a strongcorrelation between the degree of connectivity and the likelihood of being attacked.The survey answers regarding the cyber security status reveal a lack of security basics in some of the inquiredhospitals. We did discover successful attacks in hospitals with separated or subsidiary departments. A fusion ofcompetencies on an organizational level facilitates the right behavior here. Most hospitals rated themselvespredominantly positively in the self-assessment but also stated the usefulness of IT security insurance.Conclusions:Concluding our results, hospitals are already facing the consequences of omitted measures within theirgrowing pool of medical devices. Continuously relying on historically grown structures without adaption and trustingmanufactures to solve vectors is a critical behavior that could seriously endanger patients.
Technical and organizational steps are necessary to mitigate cyber threats and reduce risks. Human behavior is the last line of defense for many hospitals and is considered as equally important as technical security. Medical staff must be properly trained to perform such procedures. This paper presents the first qualitative, interdisciplinary research on how members of an intermediate care unit react to a cyberattack against their patient monitoring equipment. We conducted a simulation in a hospital training environment with 20 intensive care nurses. By the end of the experiment, 12 of the 20 participants realized the monitors’ incorrect behavior. We present a qualitative behavior analysis of high performing participants (HPP) and low performing participants (LPP). The HPP showed fewer signs of stress, were easier on their colleagues, and used analog systems more often than the LPP. With 40% of our participants not recognizing the attack, we see room for improvements through the use of proper tools and provision of adequate training to prepare staff for potential attacks in the future.
Sichere ABAP-Programmierung
(2009)
Seitenkanäle mit Untiefen: Manche Webanwendungen spielen Angreifern unfreiwillig Informationen zu
(2012)
TLS is one of today's most widely used and best-analyzed encryption technologies. However, for historical reasons, TLS for email protocols is often not used directly but negotiated via STARTTLS. This additional negotiation adds complexity and was prone to security vulnerabilities such as naive STARTTLS stripping or command injection attacks in the past.
We perform the first structured analysis of STARTTLS in SMTP, POP3, and IMAP and introduce EAST, a semi-automatic testing toolkit with more than 100 test cases covering a wide range of variants of STARTTLS stripping, command and response injections, tampering attacks, and UI spoofing attacks for email protocols. Our analysis focuses on the confidentiality and integrity of email submission (email client to SMTP server) and email retrieval (email client to POP3 or IMAP server). While some of our findings are also relevant for email transport (from one SMTP server to another), the security implications in email submission and retrieval are more critical because these connections involve not only individual email messages but also user credentials that allow access to a user's email archive.
We used EAST to analyze 28 email clients and 23 servers. In total, we reported over 40 STARTTLS issues, some of which allow mailbox spoofing, credential stealing, and even the hosting of HTTPS with a cross-protocol attack on IMAP. We conducted an Internet-wide scan for the particularly dangerous command injection attack and found that 320.000 email servers (2% of all email servers) are affected. Surprisingly, several clients were vulnerable to STARTTLS stripping attacks. In total, only 3 out of 28 clients did not show any STARTTLS-specific security issues. Even though the command injection attack received multiple CVEs in the past, EAST detected eight new instances of this problem. In total, only 7 out of 23 tested servers were never affected by this issue. We conclude that STARTTLS is error-prone to implement, under-specified in the standards, and should be avoided.
The Portable Document Format, better known as PDF, is one of themost widely used document formats worldwide, and in order to en-sure information confidentiality, this file format supports documentencryption. In this paper, we analyze PDF encryption and showtwo novel techniques for breaking the confidentiality of encrypteddocuments. First, we abuse the PDF feature ofpartially encrypteddocuments to wrap the encrypted part of the document withinattacker-controlled content and therefore, exfiltrate the plaintextonce the document is opened by a legitimate user. Second, we abusea flaw in the PDF encryption specification to arbitrarily manipulateencrypted content. The only requirement is that a single block ofknown plaintext is needed, and we show that this is fulfilled bydesign. Our attacks allow the recovery of the entire plaintext of en-crypted documents by using exfiltration channels which are basedon standard compliant PDF properties.We evaluated our attacks on 27 widely used PDF viewers andfound all of them to be vulnerable. We responsibly disclosed thevulnerabilities and supported the vendors in fixing the issue
OOXML and ODF are the de facto standard data formats for word processing, spreadsheets, and presentations. Both are XML-based, feature-rich container formats dating back to the early 2000s. In this work, we present a systematic analysis of the capabilities of malicious office documents. Instead of focusing on implementation bugs, we abuse legitimate features of the OOXML and ODF specifications. We categorize our attacks into five classes: (1) Denial-of-Service attacks affecting the host on which the document is processed. (2) Invasion of privacy attacks that track the usage of the document. (3) Information disclosure attacks exfiltrating personal data out of the victim's computer. (4) Data manipulation on the victim's system. (5) Code execution on the victim's machine. We evaluated the reference implementations – Microsoft Office and LibreOffice – and found both of them to be vulnerable to each tested class of attacks. Finally, we propose mitigation strategies to counter these attacks.
We show practical attacks against OpenPGP and S/MIMEencryption and digital signatures in the context of email. Instead of tar-geting the underlying cryptographic primitives, our attacks abuse legiti-mate features of the MIME standard and HTML, as supported by emailclients, to deceive the user regarding the actual message content. Wedemonstrate how the attacker can unknowingly abuse the user as a de-cryption oracle by replying to an unsuspicious looking email. Using thistechnique, the plaintext of hundreds of encrypted emails can be leakedat once. Furthermore, we show how users could be tricked into signingarbitrary text by replying to emails containing CSS conditional rules.An evaluation shows that "out of" OpenPGP-capable email clients,as well as "out of" clients supporting S/MIME, are vulnerable to atleast one attack. We provide different countermeasures and discuss theiradvantages and disadvantages.