Thirty women had taken refuge in a maternity hospital in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were experiencing childbirth.
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. Survival meant running for your life.”
This horrifying event stands as one of the most shocking examples in the two-year civil war tearing the African nation apart. Militiamen raided the hospital, allegedly slaughtering more than 460 individuals receiving care and their families.
Rights organizations have labeled it “an act of unspeakable brutality,” and a clear case of the vanishing safeguards for civilians trapped in war-torn areas in several nations at war.
An Unprecedented Assault On Childbirth Services
Although world powers have signed the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of attacks on healthcare systems. Mothers in labor are particularly at risk due to their reliance on locally available medical care.
Research and compiled data uncover 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 targeted attacks against hospitals and delivery wards.
“These incidents do not represent inevitable outcomes of conflict. They constitute a pattern of reproductive violence.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of expectant mothers are stranded.
Mothers have lost their lives, blocked from reaching help, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 kidnapped, and 101 arrested—sometimes during medical procedures.
The Global Crisis in Maternal Health
These figures likely represent a substantial underreporting, as they are limited to incidents documented publicly. In many conflict zones, communications are sparse.
Last year, it was reported that half of all women who perished while pregnant or giving birth were in a conflict area. This underscores a horrifying trend.
In addition to the loss of life, these attacks are destroying critical infrastructure for mothers and babies, jeopardizing the future to demographic stability.
Conditions within Gaza
In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as a factor in genocide allegations.
Even after ceasefires, doctors report that women and children succumb from inadequate care, owing to critical shortages of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were out of reach.
“Direct shelling fired at the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or trying to alter birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress leading to birth complications.
“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The truth of the matter is, every facility is now a potential target,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
A Culture of Impunity
For the more than 676 million women living near active conflicts, there are minimal protections and rare trials for atrocities for those targeting maternity care.
This void of justice has fostered a “environment where anything goes,” explains a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by preventing births.”
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 inability to report 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 preventable with routine care, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births without skilled assistance.
“When childbirth centers become intentional targets speaks to a larger and alarming strategy: 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 are not inviolable if used for acts deemed ‘harmful to the enemy’, which has increasingly been used as a justification.”
