A group of thirty mothers were huddled for safety in a childbirth facility 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, 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. Those who could run, fled.”
This brutal attack stands as among the worst examples in the two-year civil war tearing the African nation apart. Militiamen stormed the facility, leaving dead more than 460 innocent people inside.
Rights organizations have described it as “a crime beyond words,” and a stark illustration of the collapse in safety for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault Against Maternal Care
While all major powers are signatories to the Geneva conventions, which commit them to defending civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are exceptionally vulnerable due to their need for locally available medical care.
Data analysis and investigations uncover an shocking trend: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“These are not standard wartime hazards. They constitute a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of women bearing children are confined.
Women have been killed, prevented from accessing care, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 detained—sometimes in the act of delivering babies.
A Worldwide Emergency in Maternal Health
The numbers are probably a substantial underreporting, as they only include incidents reported in news outlets. In many areas of fighting, information is scarce.
Last year, analysis showed that half of all women who lost their lives in maternal circumstances resided in a war zone. This underscores a catastrophic reality.
Beyond killing women and staff, these attacks are obliterating critical infrastructure for mothers and babies, jeopardizing the future to demographic stability.
Conditions within Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as one reason behind accusations of genocidal acts.
Following truces, doctors report that women and children are still perishing from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Accounts describe women having children by the roadside because hospitals were inaccessible.
“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births forced underground and skyrocketing stress leading to problems during delivery.
“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,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
Accountability Evaporates
For the hundreds of millions of women living close to deadly warfare, there are few safeguards and rare trials for atrocities for those assaulting reproductive health.
This absence of consequences has fostered a “culture of impunity,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, may constitute acts of genocide by hindering reproduction.”
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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
In Myanmar, hospitals have come under fire and dozens of midwives and patients have suffered violence over the past two years of civil war.
The Collapse of Safe Childbirth
A large proportion of mother deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted speaks to a wider and more disturbing trend: the use of violence against hospitals as a weapon to spread fear and to destroy community bonds,” notes a legal researcher.
“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘militarily advantageous’, which has now become a standard defence.”
