Dozens of women were seeking shelter in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were in the midst of labor.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he recounts. “They executed everybody inside the hospital. We who were able to escape, did so.”
This brutal attack stands as a particularly egregious examples in the two-year civil war tearing the African nation apart. Armed soldiers raided the hospital, allegedly slaughtering more than 460 innocent people inside.
Rights organizations have described it as “an act of unspeakable brutality,” and a prime example of the vanishing safeguards for civilians trapped in war-torn areas in multiple global hotspots.
A Record of Violence Against Maternal Care
While all major powers have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has experienced a historic high of violence targeting health services. Mothers in labor are highly exposed due to their reliance on locally available medical care.
An investigation of records show an unprecedented scale of attacks: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“This is not inevitable outcomes of conflict. They form a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of women bearing children are confined.
Deaths have occurred, prevented from accessing care, or made to have their babies in deplorable situations. The data also indicates that at least 68 maternal health workers have been murdered, 15 abducted, and 101 arrested—sometimes in the act of delivering babies.
The Global Crisis in Maternal Health
The numbers are probably a significant underestimate, as they capture solely incidents documented publicly. In many war-torn areas, communications are sparse.
Last year, analysis showed that one in two mothers who died during pregnancy or childbirth resided in a war zone. This underscores a devastating pattern.
Beyond killing women and staff, these attacks are destroying critical infrastructure for mothers and babies, posing a long-term threat to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as one reason behind accusations of genocidal acts.
Even after ceasefires, doctors report that women and children continue to die from inadequate care, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside because hospitals were out of reach.
“Direct shelling fired at 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.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births taking place in basements and extreme psychological pressure leading to birth complications.
“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 is now a potential target,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
Accountability Evaporates
For the hundreds of millions of women living within range of fighting, there are scarce guarantees and a stark lack of legal accountability for those assaulting reproductive health.
This lack of accountability has created a “culture of impunity,” says a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”
Additional Hotspots
In El Fasher, the area was isolated 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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, 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
The majority of childbirth fatalities are averted with basic healthcare, 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.
“The deliberate attack on maternity wards speaks to a wider and more disturbing trend: 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 are not inviolable if used for acts deemed ‘harmful to the enemy’, which has now become a standard defence.”
