A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were in the midst of labor.
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 recounts. “They executed everybody inside the hospital. We who were able to escape, did so.”
This appalling incident stands as among the worst examples in the two-year civil war tearing the African nation apart. Militiamen raided the hospital, allegedly slaughtering more than 460 patients and their companions.
Rights organizations have described it as “an unspeakable atrocity,” and a stark illustration of the collapse in safety for civilians living amidst warfare 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 international laws of war, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Expectant mothers are particularly at risk due to their reliance on locally available medical care.
Data analysis and investigations show an unprecedented scale of attacks: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“This is not standard wartime hazards. They represent a systematic assault on childbirth.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where hundreds of thousands of expectant mothers are stranded.
Deaths have occurred, blocked from reaching help, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been killed, 15 kidnapped, and 101 arrested—sometimes during medical procedures.
The Global Crisis in Maternal Health
The numbers are probably a grave undercount, as they are limited to incidents documented publicly. In many areas of fighting, reporting is limited.
Last year, findings indicated that one in two mothers who lost their lives in maternal circumstances lived amidst hostilities. This underscores a horrifying trend.
In addition to the loss of life, these attacks are obliterating maternal and neonatal care facilities, creating a grave danger to community survival.
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 declaring certain actions a genocide.
Despite periods of calm, doctors report that women and children continue to die from a lack of proper treatment, owing to severe deficits of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals could not be reached.
“We’ve had rockets 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 aiming to influence birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure leading to problems during delivery.
“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The truth of the matter is, every facility is now a potential target,” states a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”
A Culture of Impunity
For the more than 676 million women living close to deadly warfare, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.
This lack of accountability has led to a “culture of impunity,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by destroying a group's future.”
Other Conflict Zones
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 struck a baby care unit, 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 destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births without skilled assistance.
“When childbirth centers become intentional targets indicates a broader and more sinister pattern: the use of violence against hospitals as a tool for terror 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 ‘prejudicial to the opposing side’, which has often been cited as an excuse.”
