Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were experiencing childbirth.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he explains. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This horrifying event stands as among the worst examples in the ongoing war tearing the North African nation apart. Combatants forced their way into the building, allegedly slaughtering more than 460 patients and their companions.
Rights organizations have labeled it “a crime beyond words,” and a clear case of the collapse in safety for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence Against Maternal Care
Although world powers have agreed to the international laws of war, which require them to safeguard civilians, the past year has seen a record number of attacks on healthcare systems. Women undergoing childbirth are highly exposed due to their dependence on locally available medical care.
Data analysis and investigations reveal an shocking trend: nearly 300 incidents targeting or hindering 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 constitute a systematic assault on childbirth.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of expectant mothers are stranded.
Women have been killed, prevented from accessing care, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 abducted, and 101 detained—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
These figures likely represent a grave undercount, as they capture solely incidents reported in news outlets. In many war-torn areas, information is scarce.
Last year, it was reported that half of all women who lost their lives in maternal circumstances lived amidst hostilities. This underscores a catastrophic reality.
Apart from fatalities, these attacks are destroying maternal and neonatal care facilities, posing a long-term threat to demographic stability.
Conditions within Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in accusations of genocidal acts.
Despite periods of calm, doctors report that women and children succumb from inadequate care, owing to desperate lacks of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals were inaccessible.
“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or trying to alter birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and skyrocketing stress leading to maternal health issues.
“Russia is targeting us deliberately,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“The truth of the matter is, every facility can be under attack now,” comments 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 within range of fighting, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.
This absence of consequences has led to a “atmosphere of lawlessness,” says a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, are potentially acts of genocide by destroying a group's future.”
Other Conflict Zones
In El Fasher, the area was isolated from humanitarian aid long before the hospital attack, with malnutrition increasing drastically, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is scarce because of 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 Collapse of Safe Childbirth
Most maternal deaths are avoidable with standard medicine, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted points toward a broader and more sinister pattern: the use of violence against hospitals as a means of intimidation and to tear apart the social fabric,” observes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”
