Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were experiencing childbirth.
On duty during that fateful night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he explains. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This horrifying event stands as a particularly egregious examples in the two-year civil war tearing the African nation apart. Militiamen stormed the facility, leaving dead more than 460 patients and their companions.
Rights organizations have labeled it “an unspeakable atrocity,” and a stark illustration of the collapse in safety for civilians living amidst warfare in multiple global hotspots.
An Unprecedented Assault Against Maternal Care
Although world powers are signatories to the Geneva conventions, which require them to safeguard civilians, the past year has experienced a historic high of attacks on healthcare systems. Expectant mothers are highly exposed due to their need for locally available medical care.
Data analysis and investigations show an alarming level of violence: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“This is not inevitable outcomes of conflict. They constitute a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where hundreds of thousands of expectant mothers are stranded.
Women have been killed, 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 murdered, 15 taken hostage, and 101 detained—sometimes in the act of delivering babies.
The Global Crisis for Mothers and Newborns
These figures likely represent a substantial underreporting, as they capture solely incidents reported in news outlets. In many war-torn areas, reporting is limited.
Last year, analysis showed that half of all women who perished while pregnant or giving birth resided in a war zone. This underscores a devastating pattern.
Beyond killing women and staff, these attacks are wrecking maternal and neonatal care facilities, posing a long-term threat to demographic stability.
Conditions within Gaza
In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as one reason behind genocide allegations.
Following truces, doctors report that women and children continue to die from medical shortages, owing to desperate lacks of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were out of reach.
“We’ve had rockets fired at the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or aiming to influence birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to maternal health issues.
“We are being singled out,” says 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. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
Accountability Evaporates
For the hundreds of millions of women living near active conflicts, there are minimal protections and a stark lack of legal accountability for those assaulting reproductive health.
This lack of accountability has led to a “environment where anything goes,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, 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 restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.
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
A large proportion of mother deaths are averted with basic healthcare, but war destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“The deliberate attack on maternity wards speaks to a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear and to break societal cohesion,” says 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 ‘militarily advantageous’, which has often been cited as an excuse.”
