Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were experiencing childbirth.
Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he recounts. “They executed everybody inside the hospital. Survival meant running for your life.”
This horrifying event stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Combatants raided the hospital, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have called it “a crime beyond words,” and a prime example of the collapse in safety for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence Against Maternal Care
Although world powers have signed the Geneva conventions, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Mothers in labor are particularly at risk due to their dependence on locally available medical care.
Research and compiled data uncover an shocking trend: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“This is not inevitable outcomes of conflict. They constitute a deliberate strategy of violence against reproduction.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where countless of expectant mothers are stranded.
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 childbirth professionals and specialists have been slain, 15 kidnapped, and 101 arrested—sometimes while assisting births.
The Global Crisis for Mothers and Newborns
Statistics are thought to be a substantial underreporting, as they capture solely incidents covered by the media. In many war-torn areas, communications are sparse.
Last year, it was reported 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 destroying critical infrastructure for mothers and babies, jeopardizing the future to demographic stability.
Conditions within Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.
Following truces, doctors report that women and children are still perishing from inadequate care, owing to critical shortages of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals could not be reached.
“Our facility has endured missile strikes targeting 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 trying to alter birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births taking place in basements and skyrocketing stress leading to maternal health issues.
“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“In fact, every facility faces the threat of assault,” states a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”
A Culture of Impunity
For the hundreds of millions of women living near active conflicts, there are few safeguards and even fewer war crimes prosecutions for those targeting maternity care.
This lack of accountability has created a “environment where anything goes,” explains a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by destroying a group's future.”
Additional Hotspots
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 lack of access from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, causing fatalities among patients and staff.
In Myanmar, medical facilities have been bombed 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
A large proportion of mother deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births lacking professional help.
“The deliberate attack on maternity wards points toward a wider and more disturbing trend: the use of violence against hospitals as a tool for terror and to destroy community bonds,” notes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘harmful to the enemy’, which has now become a standard defence.”
