A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were actively in labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”
This horrifying event stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Militiamen forced their way into the building, leaving dead more than 460 patients and their companions.
Rights organizations have called it “a crime beyond words,” and a clear case of the collapse in safety for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault On Childbirth Services
Despite every significant nation have signed the Geneva conventions, which obligate them to protect civilians, the past year has experienced a historic high of attacks on healthcare systems. Women undergoing childbirth are highly exposed due to their need for locally available medical care.
An investigation of records reveal an alarming level of violence: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“These incidents do not represent natural consequences of war. They represent 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.
Women have been killed, denied medical attention, or compelled to deliver in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 kidnapped, and 101 taken into custody—sometimes in the act of delivering babies.
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 conflict zones, communications are sparse.
Last year, findings indicated that one in two mothers who perished while pregnant or giving birth were in a conflict area. This underscores a devastating pattern.
In addition to the loss of life, these attacks are destroying critical infrastructure for mothers and babies, posing a long-term threat to demographic stability.
The Situation in Gaza
In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as part of the basis for declaring certain actions a genocide.
Despite periods of calm, doctors report that women and children are still perishing from inadequate care, owing to severe deficits of medicine and equipment. UN officials have relayed women having children by the roadside 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.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure leading to problems during delivery.
“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“In fact, every facility faces the threat of assault,” 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 few safeguards and a stark lack of legal accountability for those assaulting reproductive health.
This lack of accountability has fostered a “culture of impunity,” argues a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, can be understood as acts of genocide by hindering reproduction.”
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, 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 End of Safe Deliveries
The majority of childbirth fatalities are preventable with routine care, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births without skilled assistance.
“The deliberate attack on maternity wards points toward a broader and more sinister pattern: the use of violence against hospitals as a tool for terror and to tear apart the social fabric,” notes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘militarily advantageous’, which has now become a standard defence.”
