A group of thirty mothers had taken refuge in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were in the midst of labor.
Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he states. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This brutal attack stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Militiamen stormed the facility, allegedly slaughtering more than 460 individuals receiving care and their families.
Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the vanishing safeguards for civilians caught in conflict zones in multiple global hotspots.
A Record of Violence Against Maternal Care
Despite every significant nation have agreed to the Geneva conventions, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are highly exposed due to their reliance on locally available medical care.
Research and compiled data uncover 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 incidents do not represent natural consequences of war. They constitute a pattern of reproductive violence.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where hundreds of thousands of pregnant women are trapped.
Mothers have lost their lives, denied medical attention, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been killed, 15 kidnapped, and 101 taken into custody—sometimes while assisting births.
A Worldwide Emergency in Maternal Health
These figures likely represent a significant underestimate, as they are limited to incidents reported in news outlets. In many war-torn areas, communications are sparse.
Last year, analysis showed that 50% of women who died during pregnancy or childbirth 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 genocide allegations.
Following truces, doctors report that women and children succumb from medical shortages, owing to desperate lacks of medicine and equipment. Agencies have reported women having children by the roadside because hospitals could not be reached.
“Our facility has endured missile strikes hitting 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.
The Crisis in Ukraine
Since early 2022, at least 80 hospitals for mothers and babies have been struck and ruined in Ukraine. Reports from frontline hospitals describe births taking place in basements and skyrocketing stress leading to birth complications.
“Russia is targeting us deliberately,” 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. “If a drone is destroyed, the falling debris could impact a hospital.”
A Culture of Impunity
For the hundreds of millions of women living near active conflicts, there are scarce guarantees and rare trials for atrocities for those attacking childbirth services.
This absence of consequences has fostered a “culture of impunity,” says a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, may constitute 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 spiking dangerously, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is restricted due to a inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
In Myanmar, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.
The Collapse of Safe Childbirth
The majority of childbirth fatalities are preventable with routine care, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births lacking professional help.
“When childbirth centers become intentional targets speaks to a wider and more disturbing trend: the use of violence against hospitals as a tool for terror and to tear apart the social fabric,” observes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘prejudicial to the opposing side’, which has often been cited as an excuse.”
