Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were in the midst of 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. “They executed everybody inside the hospital. We who were able to escape, did so.”
This horrifying event stands as among the worst examples in the two-year civil war tearing the North African nation apart. Combatants forced their way into the building, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have labeled it “an act of unspeakable brutality,” 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 Geneva conventions, which commit them to defending civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Women undergoing childbirth are exceptionally vulnerable due to their need for locally available medical care.
Data analysis and investigations reveal 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 bombardments of hospitals and delivery wards.
“These are not standard wartime hazards. They constitute a systematic assault on childbirth.”
The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where a vast number of expectant mothers are stranded.
Women have been killed, denied medical attention, or made to have their babies in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been killed, 15 kidnapped, and 101 detained—sometimes during medical procedures.
A Worldwide Emergency for Mothers and Newborns
These figures likely represent a grave undercount, as they capture solely incidents documented publicly. In many war-torn areas, reporting is limited.
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.
In addition to the loss of life, these attacks are wrecking maternal and neonatal care facilities, jeopardizing the future to demographic stability.
The Situation in Gaza
In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as part of the basis for declaring certain actions a genocide.
Despite periods of calm, doctors report that women and children continue to die from medical shortages, owing to severe deficits of medicine and equipment. Agencies have reported women giving birth in rubble because hospitals were inaccessible.
“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 contested deliberately targeting maternity care or seeking to affect birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to birth complications.
“We are being singled out,” asserts 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 is now a potential target,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”
A Culture of Impunity
For the more than 676 million women living within range of fighting, there are scarce guarantees and even fewer war crimes prosecutions for those targeting maternity care.
This lack of accountability has fostered a “environment where anything goes,” says a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, may constitute 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 scarce because of a inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, causing fatalities among patients and staff.
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 Collapse of Safe Childbirth
Most maternal deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted speaks to a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear and to break societal cohesion,” notes 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 increasingly been used as a justification.”
