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 actively in labor.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he recounts. “A massacre was taking place inside the hospital. Those who could run, fled.”
This horrifying event stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Armed soldiers raided the hospital, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have called it “a crime beyond words,” and a stark illustration of the collapse in safety for civilians living amidst warfare in several nations at war.
An Unprecedented Assault Against Maternal Care
While all major powers are signatories to the international laws of war, which commit them to defending civilians, the past year has seen a record number of assaults against medical infrastructure. Expectant mothers are exceptionally vulnerable due to their reliance on locally available medical care.
An investigation of records show an alarming level of violence: 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 represent a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of women bearing children are confined.
Deaths have occurred, 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 detained—sometimes during medical procedures.
A Worldwide Emergency for Mothers and Newborns
The numbers are probably a grave undercount, as they are limited to incidents reported in news outlets. In many areas of fighting, reporting is limited.
Last year, analysis showed that half of all women who lost their lives in maternal circumstances lived amidst hostilities. This underscores a devastating pattern.
In addition to the loss of life, these attacks are obliterating hospitals and wards, jeopardizing the future to community survival.
The Situation in Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind genocide allegations.
Even after ceasefires, doctors report that women and children continue to die from medical shortages, owing to desperate lacks of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals could not be reached.
“Direct shelling targeting 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 childbirth centers have been struck and ruined in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and skyrocketing stress leading to birth complications.
“The attacks on us are intentional,” asserts 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,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”
A Culture of Impunity
For the more than 676 million women living near active conflicts, there are minimal protections and a stark lack of legal accountability for those targeting maternity care.
This void of justice has led to a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”
Other Conflict Zones
In El Fasher, the area had been cut off from humanitarian aid long before the hospital attack, with malnutrition rising sharply, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is scarce because of a lack of access from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, resulting in tragic loss of life.
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
Most maternal deaths are preventable with routine care, but war collapses medical infrastructure. Rights groups note that anxiety is forcing 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 violence against hospitals as a tool for terror and to tear apart the social fabric,” says 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 now become a standard defence.”
