A group of thirty mothers were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he recounts. “They were killing everyone inside the hospital. We who were able to escape, did so.”
This horrifying event stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Militiamen stormed the facility, reportedly killing more than 460 patients and their companions.
Rights organizations have called it “a crime beyond words,” and a stark illustration of the vanishing safeguards for civilians trapped in war-torn areas in multiple global hotspots.
A Record of Violence On Childbirth Services
While all major powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of assaults against medical infrastructure. Expectant mothers are particularly at risk due to their dependence on locally available medical care.
Data analysis and investigations show an shocking trend: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“This is not natural consequences of war. They form a systematic assault on childbirth.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of women bearing children are confined.
Mothers have lost their lives, denied medical attention, or compelled to deliver 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 detained—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
These figures likely represent a grave undercount, as they capture solely incidents covered by the media. In many war-torn areas, communications are sparse.
Last year, findings indicated that half of all women who lost their lives in maternal circumstances were in a conflict area. This underscores a catastrophic reality.
Beyond killing women and staff, these attacks are obliterating critical infrastructure for mothers and babies, posing a long-term threat to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as a factor in accusations of genocidal acts.
Even after ceasefires, doctors report that women and children succumb from inadequate care, owing to desperate lacks of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were out of reach.
“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or aiming to influence birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births forced underground and skyrocketing stress leading to birth complications.
“The attacks on us are intentional,” asserts 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,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”
A Culture of Impunity
For the hundreds of millions of women living close to deadly warfare, there are scarce guarantees and even fewer war crimes prosecutions for those assaulting reproductive health.
This lack of accountability has led to a “culture of impunity,” argues a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, may constitute 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 rising sharply, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is scarce because of a communication blackout 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 been arrested, killed, or injured over the past two years of civil war.
The Collapse of Safe Childbirth
Most maternal deaths are avoidable with standard medicine, 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.
“When childbirth centers become intentional targets indicates a broader and more sinister pattern: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” says a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘militarily advantageous’, which has often been cited as an excuse.”
