A group of thirty mothers had taken refuge in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were experiencing childbirth.
Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “I heard the screams of women and children,” he explains. “They executed everybody inside the hospital. Survival meant running for your life.”
This brutal attack stands as among the worst examples in the ongoing war tearing the African nation apart. Combatants forced their way into the building, reportedly killing more than 460 innocent people inside.
Rights organizations have described it as “an unspeakable atrocity,” and a prime example of the vanishing safeguards for civilians living amidst warfare in multiple global hotspots.
A Record of Violence Against Maternal Care
While all major powers are signatories to the Geneva conventions, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Women undergoing childbirth are highly exposed due to their dependence on locally available medical care.
Research and compiled data show an unprecedented scale of attacks: 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 are not inevitable outcomes of conflict. They constitute a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of pregnant women are trapped.
Deaths have occurred, prevented from accessing care, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 taken hostage, and 101 arrested—sometimes while assisting births.
A Worldwide Emergency in Maternal Health
These figures likely represent a substantial underreporting, as they are limited to incidents reported in news outlets. In many conflict zones, reporting is limited.
Last year, findings indicated that 50% of women who died during pregnancy or childbirth resided in a war zone. This underscores a horrifying trend.
Apart from fatalities, these attacks are destroying hospitals and wards, jeopardizing the future to community survival.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.
Following truces, doctors report that women and children succumb from a lack of proper treatment, owing to severe deficits of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals were inaccessible.
“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 seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to maternal health issues.
“Russia is targeting us deliberately,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“The reality is, every facility faces the threat of assault,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris may hit a hospital.”
A Culture of Impunity
For the more than 676 million women living within range of fighting, there are minimal protections and a stark lack of legal accountability for those assaulting reproductive health.
This absence of consequences has fostered a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, may constitute acts of genocide by preventing births.”
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 restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, 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
A large proportion of mother deaths are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted points toward a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to destroy community bonds,” observes 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 ‘militarily advantageous’, which has increasingly been used as a justification.”
