Dozens of women were seeking shelter in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were in the midst of labor.
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 states. “They executed everybody 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 African nation apart. Combatants raided the hospital, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have labeled it “an unspeakable atrocity,” and a stark illustration of the deteriorating protection for civilians caught in conflict zones in several nations at war.
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 experienced a historic high of assaults against medical infrastructure. Women undergoing childbirth are highly exposed due to their dependence on locally available medical care.
An investigation of records 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 bombardments of hospitals and delivery wards.
“These incidents do not represent standard wartime hazards. They represent a pattern of reproductive violence.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where hundreds of thousands of expectant mothers are stranded.
Deaths have occurred, 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 abducted, and 101 taken into custody—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
These figures likely represent a substantial underreporting, as they only include incidents reported in news outlets. In many areas of fighting, information is scarce.
Last year, analysis showed that one in two mothers who perished while pregnant or giving birth resided in a war zone. This underscores a catastrophic reality.
In addition to the loss of life, these attacks are wrecking maternal and neonatal care facilities, creating a grave danger 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 a factor in accusations of genocidal acts.
Even after ceasefires, doctors report that women and children are still perishing from inadequate care, owing to critical shortages of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals were inaccessible.
“Our facility has endured missile strikes 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 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. Accounts from embattled medical centers describe births taking place in basements and extreme psychological pressure leading to maternal health issues.
“Russia is targeting us deliberately,” asserts 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,” notes a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”
A Culture of Impunity
For the hundreds of millions of women living near active conflicts, there are scarce guarantees and even fewer war crimes prosecutions for those assaulting reproductive health.
This void of justice has led to a “atmosphere of lawlessness,” explains a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, may constitute acts of genocide by hindering reproduction.”
Other Conflict Zones
In El Fasher, the area had been cut off 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 struck a baby care unit, causing fatalities among patients and staff.
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 End of Safe Deliveries
The majority of childbirth fatalities are avoidable with standard medicine, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births lacking professional help.
“When childbirth centers become intentional targets indicates a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation 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 ‘harmful to the enemy’, which has often been cited as an excuse.”
