A group of thirty mothers were seeking shelter in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, 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. “There were cries of women and children,” he states. “They were killing everyone inside the hospital. We who were able to escape, did so.”
This horrifying event stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Combatants forced their way into the building, reportedly killing more than 460 patients and their companions.
Rights organizations have described it as “a crime beyond words,” and a stark illustration of the collapse in safety for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
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 attacks on healthcare systems. Women undergoing childbirth are particularly at risk due to their reliance on locally available medical care.
Data analysis and investigations reveal an unprecedented scale of attacks: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“These are not natural consequences of war. They constitute a pattern of reproductive violence.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where a vast number of women bearing children are confined.
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 childbirth professionals and specialists have been killed, 15 taken hostage, and 101 arrested—sometimes while assisting births.
The Global Crisis in Maternal Health
These figures likely represent a grave undercount, as they capture solely incidents reported in news outlets. In many war-torn areas, reporting is limited.
Last year, it was reported that 50% of women who lost their lives in maternal circumstances resided in a war zone. This underscores a catastrophic reality.
Beyond killing women and staff, these attacks are wrecking critical infrastructure for mothers and babies, jeopardizing the future to demographic stability.
The Situation in Gaza
In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as part of the basis for accusations of genocidal acts.
Even after ceasefires, doctors report that women and children succumb from medical shortages, owing to critical shortages of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were inaccessible.
“Direct shelling fired at 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 seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births forced underground and extreme psychological pressure leading to maternal health issues.
“Russia is targeting us deliberately,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“The truth of the matter is, every facility faces the threat of assault,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”
A Culture of Impunity
For the more than 676 million women living near active conflicts, there are scarce guarantees and a stark lack of legal accountability for those targeting maternity care.
This void of justice has created a “environment where anything goes,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as 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 increasing drastically, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is restricted due to a inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, resulting in tragic loss of life.
In Myanmar, clinics have been attacked 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 averted with basic healthcare, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births lacking professional help.
“If maternity hospitals are being deliberately targeted points toward a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear and to tear apart the social fabric,” notes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has often been cited as an excuse.”
