A group of thirty mothers had taken refuge in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were experiencing childbirth.
Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he states. “They executed everybody inside the hospital. Survival meant running for your life.”
This appalling incident stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Armed soldiers raided the hospital, reportedly killing more than 460 innocent people inside.
Rights organizations have described it as “a crime beyond words,” and a prime example of the deteriorating protection for civilians caught in conflict zones in several nations at war.
An Unprecedented Assault On Childbirth Services
While all major powers have signed the international laws of war, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are particularly at risk due to their reliance on locally available medical care.
An investigation of records reveal an unprecedented scale of attacks: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“This is not standard wartime hazards. They form a systematic assault on childbirth.”
The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where hundreds of thousands of pregnant women are trapped.
Women have been killed, denied medical attention, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been killed, 15 taken hostage, and 101 detained—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
The numbers are probably a grave undercount, as they capture solely incidents reported in news outlets. In many war-torn areas, communications are sparse.
Last year, it was reported that half of all women who lost their lives in maternal circumstances lived amidst hostilities. This underscores a devastating pattern.
In addition to the loss of life, these attacks are obliterating hospitals and wards, posing a long-term threat to demographic stability.
The Situation in Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as one reason behind genocide allegations.
Despite periods of calm, doctors report that women and children continue to die from medical shortages, owing to critical shortages of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were out of reach.
“Our facility has endured missile strikes targeting 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 aiming to influence birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and skyrocketing stress leading to birth complications.
“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The reality is, every facility faces the threat of assault,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
Accountability Evaporates
For the more than 676 million women living near active conflicts, there are few safeguards and a stark lack of legal accountability for those assaulting reproductive health.
This lack of accountability has led to a “atmosphere of lawlessness,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, may constitute acts of genocide by preventing births.”
Additional Hotspots
In El Fasher, the area had been cut off 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 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, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.
The Collapse of Safe Childbirth
The majority of childbirth fatalities are preventable with routine care, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: the use of violence against hospitals 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 increasingly been used as a justification.”
