A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, as the slaughter began. 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, became one of the few known survivors. “I heard the screams 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 protracted internal conflict tearing the African nation apart. Militiamen stormed the facility, leaving dead more than 460 patients and their companions.
Rights organizations have called it “a crime beyond words,” and a prime example of the vanishing safeguards for civilians living amidst warfare in multiple global hotspots.
An Unprecedented Assault On Childbirth Services
Although world powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of attacks on healthcare systems. Women undergoing childbirth are highly exposed due to their dependence on locally available medical care.
An investigation of records reveal an shocking trend: nearly 300 violent acts against 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 standard wartime hazards. They constitute a systematic assault on childbirth.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where a vast number of expectant mothers are stranded.
Mothers have lost their lives, prevented from accessing care, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been murdered, 15 taken hostage, and 101 arrested—sometimes during medical procedures.
The Global Crisis in Maternal Health
Statistics are thought to be a grave undercount, as they only include incidents documented publicly. In many war-torn areas, communications are sparse.
Last year, it was reported that one in two mothers who died during pregnancy or childbirth were in a conflict area. This underscores a devastating pattern.
In addition to the loss of life, these attacks are destroying critical infrastructure for mothers and babies, jeopardizing the future to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as part of the basis for genocide allegations.
Despite periods of calm, doctors report that women and children are still perishing from medical shortages, owing to desperate lacks of medicine and equipment. Agencies have reported women giving birth in rubble because hospitals were out of reach.
“We’ve had rockets fired at 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.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been struck and ruined in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress leading to birth complications.
“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“In fact, every facility is now a potential target,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”
A Culture of Impunity
For the over half a billion females living near active conflicts, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.
This lack of accountability 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 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 increasing drastically, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is scarce because of a lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
In Myanmar, medical facilities have been bombed 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
Most maternal 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 lacking professional help.
“The deliberate attack on maternity wards indicates a larger and alarming strategy: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” says 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 ‘harmful to the enemy’, which has often been cited as an excuse.”
