Thirty women were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were in the midst of labor.
On duty during that fateful 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 states. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This horrifying event stands as among the worst examples in the two-year civil war tearing the North African nation apart. Armed soldiers stormed the facility, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have described it as “an act of unspeakable brutality,” and a prime example of the vanishing safeguards for civilians caught in conflict zones in several nations at war.
An Unprecedented Assault On Childbirth Services
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 violence targeting health services. Women undergoing childbirth are particularly at risk due to their dependence on locally available medical care.
An investigation of records show an unprecedented scale of attacks: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“These are not standard wartime hazards. They represent a pattern of reproductive violence.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where hundreds of thousands of expectant mothers are stranded.
Mothers have lost their lives, prevented from accessing care, or compelled to deliver in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 arrested—sometimes in the act of delivering babies.
A Worldwide Emergency for Mothers and Newborns
The numbers are probably a significant underestimate, as they are limited to incidents documented publicly. In many areas of fighting, communications are sparse.
Last year, analysis showed that half of all women who died during pregnancy or childbirth lived amidst hostilities. This underscores a horrifying trend.
Apart from fatalities, these attacks are obliterating hospitals and wards, creating a grave danger to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as part of the basis for accusations of genocidal acts.
Despite periods of calm, 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 giving birth in rubble because hospitals were inaccessible.
“Direct shelling fired at 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 seeking to affect birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births taking place in basements and extreme psychological pressure leading to maternal health issues.
“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. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”
Accountability Evaporates
For the hundreds of millions of women living within range of fighting, there are scarce guarantees and a stark lack of legal accountability for those assaulting reproductive health.
This void of justice has created a “atmosphere of lawlessness,” explains a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, are potentially acts of genocide by preventing births.”
Other Conflict Zones
In El Fasher, the area had been cut off from humanitarian aid long before the hospital attack, with malnutrition increasing drastically, 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 damaged a maternity hospital, causing fatalities among patients and staff.
In Myanmar, medical facilities have been bombed and dozens of midwives and patients have suffered violence over the past two years of civil war.
The End of Safe Deliveries
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, leading them to risky home births without skilled assistance.
“When childbirth centers become intentional targets speaks to a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear and to tear apart the social fabric,” notes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘militarily advantageous’, which has now become a standard defence.”
