A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “The sounds of screaming reached me of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”
This horrifying event stands as one of the most shocking examples in the protracted internal conflict tearing the African nation apart. Militiamen raided the hospital, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have called it “an unspeakable atrocity,” and a clear case of the vanishing safeguards for civilians caught in conflict zones in multiple global hotspots.
An Unprecedented Assault Against Maternal Care
While all major powers have agreed to the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of attacks on healthcare systems. Women undergoing childbirth are exceptionally vulnerable due to their need for locally available medical care.
An investigation of records uncover an shocking trend: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“This is not standard wartime hazards. They represent a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in regions embroiled in intense conflict, where countless of expectant mothers are stranded.
Mothers have lost their lives, blocked from reaching help, or made to have their babies in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 kidnapped, and 101 taken into custody—sometimes during medical procedures.
The Global Crisis in Maternal Health
These figures likely represent a significant underestimate, as they capture solely incidents documented publicly. In many areas of fighting, communications are sparse.
Last year, it was reported that one in two mothers who died during pregnancy or childbirth resided in a war zone. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are wrecking hospitals and wards, posing a long-term threat to community survival.
Conditions within Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as one reason behind declaring certain actions a genocide.
Despite periods of calm, doctors report that women and children continue to die from a lack of proper treatment, owing to severe deficits of medicine and equipment. Accounts describe women having children by the roadside because hospitals could not be reached.
“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or aiming to influence birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure leading to birth complications.
“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The truth of the matter is, every facility faces the threat of assault,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
A Culture of Impunity
For the more than 676 million women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those attacking childbirth services.
This lack of accountability has fostered a “environment where anything goes,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, may constitute acts of genocide by preventing births.”
Additional Hotspots
In El Fasher, the area had been cut off from humanitarian aid long before the hospital attack, with malnutrition spiking dangerously, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is limited by a inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, killing mothers, babies, and nurses.
In Myanmar, clinics have been attacked and dozens of midwives and patients have faced detention, death, or harm over the past two years of civil war.
The End of Safe Deliveries
Most maternal deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births devoid of emergency care.
“When childbirth centers become intentional targets speaks to a larger and alarming strategy: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” says a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has now become a standard defence.”
