A group of thirty mothers were seeking shelter 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, became one of the few known survivors. “The sounds of screaming reached me of women and children,” he states. “They executed everybody 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. Armed soldiers stormed the facility, allegedly slaughtering more than 460 individuals receiving care and their families.
Rights organizations have called it “an unspeakable atrocity,” and a stark illustration of the deteriorating protection for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence Against Maternal Care
While all major powers have signed the Geneva conventions, which commit them to defending civilians, the past year has seen a record number of attacks on healthcare systems. Expectant mothers are highly exposed due to their dependence on locally available medical care.
An investigation of records reveal an shocking trend: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“These incidents do not represent natural consequences of war. They represent a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of pregnant women are trapped.
Deaths have occurred, blocked from reaching help, or made to have their babies in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 taken hostage, and 101 arrested—sometimes in the act of delivering babies.
A Worldwide Emergency for Mothers and Newborns
These figures likely represent a grave undercount, as they capture solely incidents covered by the media. In many areas of fighting, information is scarce.
Last year, findings indicated that one in two mothers who lost their lives in maternal circumstances resided in a war zone. This underscores a horrifying trend.
In addition to the loss of life, these attacks are wrecking hospitals and wards, creating a grave danger 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 one reason behind genocide allegations.
Following truces, doctors report that women and children continue to die from medical shortages, owing to severe deficits of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were out of reach.
“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has denied 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 damaged or destroyed in Ukraine. Reports from frontline hospitals describe births forced underground and extreme psychological pressure leading to problems during delivery.
“Russia is targeting us deliberately,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“In fact, every facility faces the threat of assault,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”
Accountability Evaporates
For the hundreds of millions of women living within range of fighting, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.
This lack of accountability has created a “environment where anything goes,” explains a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, are potentially acts of genocide by destroying a group's future.”
Other Conflict Zones
In El Fasher, the area was isolated from 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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, resulting in tragic loss of life.
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 preventable with routine care, but war collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“If maternity hospitals are being deliberately targeted indicates a wider and more disturbing trend: the use of violence against hospitals as a weapon to spread fear and to destroy community bonds,” says a legal researcher.
“There is no absolute protection 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 increasingly been used as a justification.”
