A group of thirty mothers were huddled for safety in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were actively in labor.
Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “I heard the screams of women and children,” he explains. “They were killing everyone inside the hospital. Survival meant running for your life.”
This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the African nation apart. Armed soldiers stormed the facility, reportedly killing more than 460 patients and their companions.
Rights organizations have called it “an act of unspeakable brutality,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in several nations at war.
An Unprecedented Assault Against Maternal Care
Although world powers have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has experienced a historic high of attacks on healthcare systems. Expectant mothers are particularly at risk due to their reliance on locally available medical care.
Data analysis and investigations uncover an unprecedented scale of attacks: 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.
“These are not natural consequences of war. They represent a systematic assault on childbirth.”
The majority of these incidents have happened in regions embroiled in intense conflict, where countless of pregnant women are trapped.
Mothers have lost their lives, prevented from accessing care, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 kidnapped, and 101 arrested—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
These figures likely represent a significant underestimate, as they are limited to incidents covered by the media. In many conflict zones, reporting is limited.
Last year, analysis showed that 50% of women who perished while pregnant or giving birth lived amidst hostilities. This underscores a devastating pattern.
Beyond killing women and staff, these attacks are obliterating maternal and neonatal care facilities, posing a long-term threat to demographic stability.
Conditions within Gaza
In Gaza, the ruinous consequences on reproductive health rights 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 continue to die from inadequate care, owing to severe deficits of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals were inaccessible.
“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 rejected deliberately targeting maternity care or trying to alter 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 problems during delivery.
“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 reality is, every facility faces the threat of assault,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”
Accountability Evaporates
For the hundreds of millions of women living near active conflicts, there are scarce guarantees and a stark lack of legal accountability for those targeting maternity care.
This lack of accountability has fostered a “atmosphere of lawlessness,” explains a human rights lawyer. “Assaults against maternal services, 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 rising sharply, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is limited by a communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, resulting in tragic loss of life.
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 End of Safe Deliveries
The majority of childbirth fatalities are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births lacking professional help.
“The deliberate attack on maternity wards speaks to a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to destroy community bonds,” says a legal researcher.
“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘militarily advantageous’, which has often been cited as an excuse.”
