A group of thirty mothers were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were actively in labor.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries 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. Armed soldiers stormed the facility, allegedly slaughtering more than 460 innocent people inside.
Rights organizations have labeled it “an unspeakable atrocity,” and a prime example of the collapse in safety for civilians caught in conflict zones in several nations at war.
An Unprecedented Assault Against Maternal Care
Although world powers are signatories to the Geneva conventions, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Women undergoing childbirth are exceptionally vulnerable due to their need for locally available medical care.
Research and compiled data uncover an alarming level of violence: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“This is not inevitable outcomes of conflict. They form a pattern of reproductive violence.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where hundreds of thousands of expectant mothers are stranded.
Women have been killed, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 arrested—sometimes while assisting births.
The Global Crisis for Mothers and Newborns
These figures likely represent a significant underestimate, as they are limited to incidents documented publicly. In many areas of fighting, reporting is limited.
Last year, analysis showed that one in two mothers who lost their lives in maternal circumstances were in a conflict area. This underscores a catastrophic reality.
In addition to the loss of life, these attacks are obliterating maternal and neonatal care facilities, creating a grave danger to demographic stability.
The Situation in Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.
Even after ceasefires, doctors report that women and children are still perishing from a lack of proper treatment, owing to critical shortages of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were inaccessible.
“Our facility has endured missile strikes fired at the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or trying to alter birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress leading to problems during delivery.
“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 can be under attack now,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris may hit a hospital.”
A Culture of Impunity
For the over half a billion females living close to deadly warfare, there are few safeguards and even fewer war crimes prosecutions for those targeting maternity care.
This void of justice has fostered a “atmosphere of lawlessness,” argues a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, are potentially acts of genocide by destroying a group's future.”
Other Conflict Zones
In El Fasher, the area had been cut off 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 damaged a maternity hospital, causing fatalities among patients and staff.
In Myanmar, clinics have been attacked and dozens of midwives and patients have been arrested, killed, or injured 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 destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births without skilled assistance.
“The deliberate attack on maternity wards points toward a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to break societal cohesion,” observes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘prejudicial to the opposing side’, which has often been cited as an excuse.”
