A group of thirty mothers were huddled for safety in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were actively in labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he explains. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This brutal attack stands as one of the most shocking examples in the two-year civil war tearing the African nation apart. Militiamen raided the hospital, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have described it as “an act of unspeakable brutality,” and a prime example of the deteriorating protection for civilians caught in conflict zones in several nations at war.
An Unprecedented Assault Against Maternal Care
Despite every significant nation have signed the international laws of war, which require them to safeguard civilians, the past year has seen a record number of violence targeting health services. Expectant mothers are exceptionally vulnerable due to their need for locally available medical care.
Data analysis and investigations show an unprecedented scale of attacks: 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.
“These are not natural consequences of war. They form a systematic assault on childbirth.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where countless of pregnant women are trapped.
Women have been killed, 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 killed, 15 kidnapped, and 101 taken into custody—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
The numbers are probably a substantial underreporting, as they are limited to incidents documented publicly. In many areas of fighting, communications are sparse.
Last year, analysis showed that 50% of women who died during pregnancy or childbirth lived amidst hostilities. This underscores a horrifying trend.
In addition to the loss of life, these attacks are obliterating maternal and neonatal care facilities, posing a long-term threat to community survival.
The Situation in Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as a factor in genocide allegations.
Despite periods of calm, doctors report that women and children succumb from inadequate care, owing to severe deficits of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals were inaccessible.
“Our facility has endured missile strikes hitting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or trying to alter birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births forced underground 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. The government has disputed deliberately targeting civilians.
“The reality is, every facility is now a potential target,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”
A Culture of Impunity
For the more than 676 million women living within range of fighting, there are minimal protections and a stark lack of legal accountability for those targeting maternity care.
This absence of consequences has fostered a “environment where anything goes,” argues a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, may constitute acts of genocide by hindering reproduction.”
Additional Hotspots
In El Fasher, the area lacked access to 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 restricted due to a lack of access from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, causing fatalities among patients and staff.
In Myanmar, hospitals have come under fire and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The End of Safe Deliveries
The majority of childbirth fatalities are preventable with routine care, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births devoid of emergency care.
“When childbirth centers become intentional targets indicates a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to tear apart the social fabric,” observes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘harmful to the enemy’, which has now become a standard defence.”
