Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “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 a particularly egregious examples in the two-year civil war tearing the African nation apart. Combatants forced their way into the building, allegedly slaughtering more than 460 innocent people inside.
Rights organizations have labeled it “an unspeakable atrocity,” and a clear case of the deteriorating protection for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence Against Maternal Care
Despite every significant nation have signed the international laws of war, which require them to safeguard civilians, the past year has experienced a historic high of attacks on healthcare systems. Women undergoing childbirth are highly exposed due to their reliance on locally available medical care.
An investigation of records reveal an alarming level of violence: nearly 300 attacks on and disruptions to 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 systematic assault on childbirth.”
The majority of these incidents have happened in regions embroiled in intense conflict, where countless of women bearing children are confined.
Deaths have occurred, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been slain, 15 abducted, and 101 taken into custody—sometimes while assisting births.
A Worldwide Emergency in Maternal Health
Statistics are thought to be a significant underestimate, as they only include incidents documented publicly. In many war-torn areas, information is scarce.
Last year, analysis showed that one in two mothers who lost their lives in maternal circumstances lived amidst hostilities. This underscores a horrifying trend.
Apart from fatalities, these attacks are destroying maternal and neonatal care facilities, posing a long-term threat to community survival.
The Situation in Gaza
In Gaza, the catastrophic impact 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 continue to die from medical shortages, owing to critical shortages of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals could not be reached.
“Our facility has endured missile strikes targeting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or trying to alter birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births occurring in shelters and extreme psychological pressure leading to birth complications.
“The attacks on us are intentional,” asserts 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 is now a potential target,” comments 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 minimal protections and a stark lack of legal accountability for those targeting maternity care.
This lack of accountability has led to a “culture of impunity,” explains a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, may constitute acts of genocide by destroying a group's future.”
Other Conflict Zones
In El Fasher, the area had been cut off 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 restricted due to a inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
In Myanmar, hospitals have come under fire and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The End of Safe Deliveries
Most maternal deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: the use of violence against hospitals as a tool for terror and to destroy community bonds,” notes 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 increasingly been used as a justification.”
