A group of thirty mothers had taken refuge in a maternity hospital in El Fasher, Sudan, as the slaughter began. 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, lived to tell the tale. “I heard the screams of women and children,” he explains. “They were killing everyone inside the hospital. Survival meant running for your life.”
This brutal attack stands as a particularly egregious examples in the two-year civil war tearing the North African nation apart. Combatants raided the hospital, leaving dead more than 460 patients and their companions.
Rights organizations have labeled it “an act of unspeakable brutality,” and a clear case of the vanishing safeguards for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault Against Maternal Care
Although world powers have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has seen a record number of violence targeting health services. Mothers in labor are highly exposed due to their need for locally available medical care.
An investigation of records show an unprecedented scale of attacks: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“These incidents do not represent natural consequences of war. They form a pattern of reproductive violence.”
The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where hundreds of thousands of pregnant women are trapped.
Mothers have lost their lives, blocked from reaching help, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 taken hostage, and 101 detained—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
Statistics are thought to be a grave undercount, as they only include incidents documented publicly. In many areas of fighting, communications are sparse.
Last year, findings indicated that one in two mothers who lost their lives in maternal circumstances were in a conflict area. This underscores a devastating pattern.
Apart from fatalities, these attacks are wrecking hospitals and wards, 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 one reason behind genocide allegations.
Following truces, doctors report that women and children continue to die from a lack of proper treatment, owing to critical shortages of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were inaccessible.
“We’ve had rockets 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 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to maternal health issues.
“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The reality is, every facility can be under attack now,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”
Accountability Evaporates
For the hundreds of millions of women living close to deadly warfare, there are minimal protections and even fewer war crimes prosecutions for those targeting maternity care.
This lack of accountability has fostered a “culture of impunity,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, are potentially 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 lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, resulting in tragic loss of life.
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 averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“When childbirth centers become intentional targets indicates a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” notes a legal researcher.
“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘harmful to the enemy’, which has increasingly been used as a justification.”
