A group of thirty mothers had taken refuge in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were in the midst of labor.
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 recounts. “They were killing everyone inside the hospital. Survival meant running for your life.”
This horrifying event stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Armed soldiers forced their way into the building, allegedly slaughtering more than 460 individuals receiving care and their families.
Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the collapse in safety for civilians trapped in war-torn areas in several nations at war.
An Unprecedented Assault On Childbirth Services
While all major powers have signed the international laws of war, which require them to safeguard civilians, the past year has experienced a historic high of assaults against medical infrastructure. Mothers in labor are highly exposed due to their need for locally available medical care.
Data analysis and investigations reveal an unprecedented scale of attacks: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These are not standard wartime hazards. They form a deliberate strategy of violence against reproduction.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where countless of women bearing children are confined.
Women have been killed, prevented from accessing care, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 abducted, and 101 detained—sometimes in the act of delivering babies.
The Global Crisis in Maternal Health
These figures likely represent a substantial underreporting, as they only include incidents reported in news outlets. In many conflict zones, communications are sparse.
Last year, it was reported that half of all women who lost their lives in maternal circumstances were in a conflict area. This underscores a catastrophic reality.
Beyond killing women and staff, these attacks are obliterating maternal and neonatal care facilities, posing a long-term threat to community survival.
Conditions within Gaza
In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as part of the basis for genocide allegations.
Despite periods of calm, doctors report that women and children succumb from a lack of proper treatment, owing to critical shortages of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals could not be reached.
“Our facility has endured missile strikes fired at the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or seeking to affect birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been struck and ruined in Ukraine. Journalism from conflict zones describe births occurring in shelters and skyrocketing stress leading to maternal health issues.
“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The reality is, every facility is now a potential target,” notes a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”
A Culture of Impunity
For the over half a billion females living near active conflicts, there are minimal protections and a stark lack of legal accountability for those attacking childbirth services.
This void of justice has led to a “atmosphere of lawlessness,” says a human rights lawyer. “Attacks on reproductive healthcare, 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 restricted due to 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 been arrested, killed, or injured over the past two years of civil war.
The Collapse of Safe Childbirth
The majority of childbirth fatalities 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, pushing them toward risky home births lacking professional help.
“If maternity hospitals are being deliberately targeted points toward a larger and alarming strategy: the use of violence against hospitals as a tool for terror and to break societal cohesion,” notes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”
