Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were in the midst of labor.
Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “I heard the screams of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”
This appalling incident stands as among the worst examples in the ongoing war tearing the African nation apart. Militiamen raided the hospital, reportedly killing more than 460 innocent people inside.
Rights organizations have described it as “an act of unspeakable brutality,” and a prime example of the deteriorating protection for civilians trapped in war-torn areas 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 Geneva conventions, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Mothers in labor are highly exposed due to their reliance on locally available medical care.
Data analysis and investigations uncover 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 natural consequences of war. They form a systematic assault on childbirth.”
The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.
Deaths have occurred, blocked from reaching help, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been killed, 15 kidnapped, and 101 detained—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
These figures likely represent a significant underestimate, as they only include incidents covered by the media. In many war-torn areas, information is scarce.
Last year, analysis showed that half of all women who died during pregnancy or childbirth resided in a war zone. This underscores a catastrophic reality.
Apart from fatalities, these attacks are wrecking critical infrastructure for mothers and babies, jeopardizing the future to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in declaring certain actions a genocide.
Even after ceasefires, doctors report that women and children are still perishing from medical shortages, owing to severe deficits of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were out of reach.
“Our facility has endured missile strikes hitting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or aiming to influence birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and extreme psychological pressure leading to problems during delivery.
“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The truth of the matter is, every facility can be under attack now,” comments 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 hundreds of millions of women living within range of fighting, there are minimal protections and even fewer war crimes prosecutions for those assaulting reproductive health.
This absence of consequences has fostered a “culture of impunity,” argues a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, are potentially acts of genocide by destroying a group's future.”
Additional Hotspots
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 limited by a communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
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
A large proportion of mother deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that fear is now driving 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 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 often been cited as an excuse.”
