Dozens of women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were in the midst of labor.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he explains. “A massacre was taking place inside the hospital. We who were able to escape, did so.”
This brutal attack stands as one of the most shocking examples in the protracted internal conflict tearing the African nation apart. Combatants raided the hospital, leaving dead more than 460 patients and their companions.
Rights organizations have labeled it “a crime beyond words,” and a prime example of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.
A Record of Violence On Childbirth Services
While all major powers have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has seen a record number of violence targeting health services. Mothers in labor are particularly at risk due to their need for locally available medical care.
An investigation of records show 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.
“These are not standard wartime hazards. They constitute a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.
Deaths have occurred, blocked from reaching help, 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 abducted, and 101 arrested—sometimes while assisting births.
A Worldwide Emergency in Maternal Health
Statistics are thought to be a significant underestimate, as they are limited to incidents documented publicly. In many conflict zones, information is scarce.
Last year, findings indicated that one in two mothers who perished while pregnant or giving birth resided in a war zone. This underscores a catastrophic reality.
Apart from fatalities, these attacks are obliterating critical infrastructure for mothers and babies, jeopardizing the future to community survival.
The Situation in 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.
Despite periods of calm, doctors report that women and children continue to die from inadequate care, owing to critical shortages of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were out of reach.
“We’ve had rockets fired at 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 trying to alter birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to maternal health issues.
“Russia is targeting us deliberately,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“In fact, every facility is now a potential target,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”
A Culture of Impunity
For the hundreds of millions of women living near active conflicts, there are few safeguards and a stark lack of legal accountability for those attacking childbirth services.
This void of justice has led to a “environment where anything goes,” argues a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, 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 restricted due to a lack of access from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, killing mothers, babies, and nurses.
In Myanmar, clinics have been attacked 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
Most maternal deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: the use of attacks on medical facilities as a means of intimidation and to destroy community bonds,” notes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘prejudicial to the opposing side’, which has now become a standard defence.”
