Thirty women were huddled for safety in a childbirth facility in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were actively in labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “I heard the screams of women and children,” he recounts. “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 protracted internal conflict tearing the 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 stark illustration of the vanishing safeguards for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence On Childbirth Services
Although world powers are signatories to the international laws of war, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Women undergoing childbirth are highly exposed due to their reliance on locally available medical care.
Research and compiled data reveal 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 bombardments of hospitals and delivery wards.
“These incidents do not represent inevitable outcomes of conflict. They form a pattern of reproductive violence.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of pregnant women are trapped.
Deaths have occurred, blocked from reaching help, 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 taken hostage, and 101 arrested—sometimes in the act of delivering babies.
A Worldwide Emergency in Maternal Health
The numbers are probably a grave undercount, as they only include incidents covered by the media. In many war-torn areas, communications are sparse.
Last year, analysis showed that one in two mothers who lost their lives in maternal circumstances resided in a war zone. This underscores a catastrophic reality.
Apart from fatalities, these attacks are wrecking hospitals and wards, creating a grave danger to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as part of the basis for genocide allegations.
Following truces, doctors report that women and children are still perishing from medical shortages, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside because hospitals were inaccessible.
“Our facility has endured missile strikes fired at 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 seeking to affect birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 hospitals for mothers and babies have been struck and ruined in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure leading to birth complications.
“The attacks on us are intentional,” claims 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 over half a billion females living within range of fighting, there are few safeguards and a stark lack of legal accountability for those assaulting reproductive health.
This lack of accountability has led to a “environment where anything goes,” says a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, can be understood as acts of genocide by destroying a group's future.”
Other Conflict Zones
In El Fasher, the area lacked access to 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 limited by a communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.
In Myanmar, medical facilities have been bombed 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
A large proportion of mother deaths are preventable with routine care, but war shatters health systems. 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 speaks to a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to tear apart the social fabric,” says a legal researcher.
“Hospitals are not completely safe 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.”
