Dozens of women had taken refuge in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were in the midst of labor.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “There were cries of women and children,” he states. “A massacre was taking place inside the hospital. We who were able to escape, did so.”
This horrifying event stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Armed soldiers forced their way into the building, reportedly killing more than 460 patients and their companions.
Rights organizations have labeled it “a crime beyond words,” and a stark illustration of the vanishing safeguards for civilians living amidst warfare in several nations at war.
A Record of Violence On Childbirth Services
Although world powers have signed the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of violence targeting health services. Mothers in labor are exceptionally vulnerable 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 places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“These are not standard wartime hazards. They form a pattern of reproductive violence.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where a vast number of pregnant women are trapped.
Mothers have lost their lives, blocked from reaching help, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been slain, 15 abducted, and 101 arrested—sometimes in the act of delivering babies.
The Global Crisis for Mothers and Newborns
The numbers are probably a grave undercount, as they are limited to incidents reported in news outlets. In many conflict zones, communications are sparse.
Last year, analysis showed that one in two mothers 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, jeopardizing the future 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 a factor in accusations of genocidal acts.
Following truces, doctors report that women and children succumb from inadequate care, owing to desperate lacks of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals were inaccessible.
“Direct shelling hitting 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 trying to alter birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births forced underground and extreme psychological pressure leading to problems during delivery.
“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“In fact, every facility faces the threat of assault,” notes a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”
A Culture of Impunity
For the over half a billion females living close to deadly warfare, there are minimal protections and rare trials for atrocities for those attacking childbirth services.
This void of justice has led to a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by destroying a group's future.”
Additional Hotspots
In El Fasher, the area had been cut off from 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 hit a neonatal ward, killing mothers, babies, and nurses.
In Myanmar, medical facilities have been bombed and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The End of Safe Deliveries
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 without skilled assistance.
“If maternity hospitals are being deliberately targeted points toward a broader and more sinister pattern: the use of attacks on medical facilities as a tool for terror and to break societal cohesion,” observes 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 ‘harmful to the enemy’, which has increasingly been used as a justification.”
