A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Several had recently given birth, 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 recounts. “They were killing everyone inside the hospital. Those who could run, fled.”
This appalling incident stands as a particularly egregious examples in the two-year civil war tearing the African nation apart. Armed soldiers stormed the facility, allegedly slaughtering more than 460 patients and their companions.
Rights organizations have called it “an unspeakable atrocity,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in several nations at war.
An Unprecedented Assault On Childbirth Services
Although world powers have agreed to the Geneva conventions, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Women undergoing childbirth are particularly at risk due to their reliance on locally available medical care.
Research and compiled data reveal an alarming level of violence: 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 pattern of reproductive violence.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where hundreds of thousands of women bearing children are confined.
Deaths have occurred, denied medical attention, 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 killed, 15 taken hostage, and 101 arrested—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
The numbers are probably a grave undercount, as they capture solely incidents documented publicly. In many war-torn areas, communications are sparse.
Last year, it was reported that 50% of women who died during pregnancy or childbirth lived amidst hostilities. This underscores a catastrophic reality.
Beyond killing women and staff, these attacks are obliterating hospitals and wards, posing a long-term threat to community survival.
The Situation in Gaza
In Gaza, the ruinous consequences 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 continue to die from medical shortages, owing to severe deficits of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were out of reach.
“Our facility has endured missile strikes targeting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 hospitals for mothers and babies have been struck and ruined in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and extreme psychological pressure leading to problems during delivery.
“We are being singled out,” says 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,” notes 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 within range of fighting, there are minimal protections and a stark lack of legal accountability for those attacking childbirth services.
This void of justice has fostered a “culture of impunity,” says a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, are potentially acts of genocide by preventing births.”
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 inability to report from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, resulting in tragic loss of life.
In Myanmar, hospitals have come under fire 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
The majority of childbirth fatalities are averted with basic healthcare, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births lacking professional help.
“If maternity hospitals are being deliberately targeted points toward a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” observes 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 ‘militarily advantageous’, which has often been cited as an excuse.”
