Thirty women were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were experiencing childbirth.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “There were cries of women and children,” he explains. “They were killing everyone inside the hospital. Those who could run, fled.”
This appalling incident stands as among the worst examples in the ongoing war tearing the African nation apart. Combatants raided the hospital, reportedly killing more than 460 patients and their companions.
Rights organizations have called it “an act of unspeakable brutality,” and a clear case of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.
A Record of Violence Against Maternal Care
Although world powers have agreed to the international laws of war, which require them to safeguard civilians, the past year has seen a record number of attacks on healthcare systems. Expectant mothers are exceptionally vulnerable due to their dependence on locally available medical care.
Research and compiled data uncover an shocking trend: nearly 300 incidents targeting or hindering 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 inevitable outcomes of conflict. They constitute a systematic assault on childbirth.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where a vast number of women bearing children are confined.
Deaths have occurred, prevented from accessing care, or made to have their babies in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 taken hostage, and 101 taken into custody—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
The numbers are probably a substantial underreporting, as they capture solely incidents covered by the media. In many war-torn areas, information is scarce.
Last year, it was reported that one in two mothers who died during pregnancy or childbirth resided in a war zone. This underscores a catastrophic reality.
Apart from fatalities, these attacks are destroying maternal and neonatal care facilities, jeopardizing the future to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.
Despite periods of calm, doctors report that women and children succumb from inadequate care, owing to critical shortages of medicine and equipment. Accounts describe women giving birth in rubble because hospitals could not be reached.
“Direct shelling targeting the wards, operating rooms, and maternity wards,” explains 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. Journalism from conflict zones describe births taking place in basements and skyrocketing stress leading to maternal health issues.
“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The truth of the matter 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 close to deadly warfare, there are minimal protections and even fewer war crimes prosecutions for those attacking childbirth services.
This lack of accountability has fostered a “culture of impunity,” explains a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”
Other Conflict Zones
In El Fasher, the area was isolated from humanitarian aid long before the hospital attack, with malnutrition spiking dangerously, 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 struck a baby care unit, killing mothers, babies, and nurses.
In Myanmar, clinics have been attacked and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The Collapse of Safe Childbirth
A large proportion of mother deaths are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births devoid of emergency care.
“If maternity hospitals are being deliberately targeted points toward 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.
“Safeguards are not guaranteed 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 increasingly been used as a justification.”
