Thirty women were huddled for safety 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, became one of the few known survivors. “The sounds of screaming reached me 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 two-year civil war tearing the North African nation apart. Militiamen forced their way into the building, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have labeled it “an act of unspeakable brutality,” and a clear case of the deteriorating protection for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence Against Maternal Care
Despite every significant nation have signed the Geneva conventions, which obligate them to protect civilians, the past year has seen a record number of attacks on healthcare systems. Expectant mothers 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 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 constitute a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.
Women have been killed, blocked from reaching help, or made to have their babies in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been slain, 15 kidnapped, and 101 detained—sometimes during medical procedures.
The Global Crisis in Maternal Health
These figures likely represent a significant underestimate, as they are limited to incidents documented publicly. In many areas of fighting, information is scarce.
Last year, analysis showed that one in two mothers who perished while pregnant or giving birth lived amidst hostilities. This underscores a devastating pattern.
Beyond killing women and staff, these attacks are obliterating critical infrastructure for mothers and babies, creating a grave danger to demographic stability.
The Situation in Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as a factor in accusations of genocidal acts.
Despite periods of calm, doctors report that women and children continue to die from medical shortages, owing to critical shortages of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals were out of reach.
“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 damaged or destroyed in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to problems during delivery.
“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“In fact, every facility can be under attack now,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”
Accountability Evaporates
For the more than 676 million women living within range of fighting, there are minimal protections and rare trials for atrocities for those targeting maternity care.
This void of justice has fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, may constitute 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 rising sharply, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is limited by a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, killing mothers, babies, and nurses.
In Myanmar, hospitals have come under fire 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, resulting in risky home births lacking professional help.
“The deliberate attack on maternity wards speaks to a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to break societal cohesion,” observes 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.”
