A group of thirty mothers were seeking shelter in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were in the midst of labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he states. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This appalling incident stands as among the worst examples in the ongoing war tearing the North African nation apart. Militiamen raided the hospital, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have called it “an act of unspeakable brutality,” and a clear case of the collapse in safety for civilians trapped in war-torn areas in multiple global hotspots.
A Record of Violence On Childbirth Services
Although world powers have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has seen a record number of attacks on healthcare systems. Expectant mothers are particularly at risk due to their reliance on locally available medical care.
Data analysis and investigations uncover an shocking trend: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These are not inevitable outcomes of conflict. 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 expectant mothers are stranded.
Mothers have lost their lives, blocked from reaching help, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been slain, 15 kidnapped, and 101 detained—sometimes in the act of delivering babies.
The Global Crisis in Maternal Health
The numbers are probably a substantial underreporting, as they only include incidents covered by the media. In many war-torn areas, information is scarce.
Last year, it was reported that one in two mothers who perished while pregnant or giving birth resided in a war zone. This underscores a devastating pattern.
In addition to the loss of life, these attacks are obliterating maternal and neonatal care facilities, posing a long-term threat to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as one reason behind declaring certain actions a genocide.
Even after ceasefires, doctors report that women and children succumb from inadequate care, owing to desperate lacks of medicine and equipment. Accounts describe women having children by the roadside because hospitals were out of reach.
“Direct shelling 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 seeking to affect birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and skyrocketing stress leading to problems during delivery.
“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“In fact, every facility can be under attack now,” states a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”
Accountability Evaporates
For the hundreds of millions of women living near active conflicts, there are scarce guarantees and even fewer war crimes prosecutions for those targeting maternity care.
This absence of consequences has led to a “environment where anything goes,” argues a human rights lawyer. “Attacks on reproductive healthcare, 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 increasing drastically, 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 hit a neonatal ward, causing fatalities among patients and staff.
In Myanmar, medical facilities have been bombed and dozens of midwives and patients have suffered violence over the past two years of civil war.
The End of Safe Deliveries
Most maternal deaths are preventable with routine care, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births lacking professional help.
“If maternity hospitals are being deliberately targeted points toward a larger and alarming strategy: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” observes 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.”
