Thirty women were huddled for safety in a childbirth facility in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were actively in labor.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “There were cries of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”
This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Combatants raided the hospital, allegedly slaughtering more than 460 individuals receiving care and their families.
Rights organizations have called it “a crime beyond words,” and a clear case of the deteriorating protection for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault Against Maternal Care
Although world powers are signatories to the international laws of war, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of assaults against medical infrastructure. Expectant mothers are highly exposed due to their reliance on locally available medical care.
Data analysis and investigations show an alarming level of violence: nearly 300 violent acts against 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 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.
Deaths have occurred, denied medical attention, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been murdered, 15 abducted, and 101 detained—sometimes while assisting births.
A Worldwide Emergency in Maternal Health
The numbers are probably a significant underestimate, as they only include incidents covered by the media. In many war-torn areas, information is scarce.
Last year, it was reported that one in two mothers who perished while pregnant or giving birth lived amidst hostilities. This underscores a horrifying trend.
Apart from fatalities, these attacks are obliterating 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 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. Agencies have reported 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,” states the head of a major hospital’s gynecology department. A military spokesperson has contested 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. Accounts from embattled medical centers describe births taking place in basements and skyrocketing stress leading to birth complications.
“The attacks on us are intentional,” asserts 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,” notes 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 close to deadly warfare, there are few safeguards and a stark lack of legal accountability for those targeting maternity care.
This void of justice has fostered a “environment where anything goes,” argues a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, may constitute acts of genocide by hindering reproduction.”
Other Conflict Zones
In El Fasher, the area lacked access to 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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, killing mothers, babies, and nurses.
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 Collapse of Safe Childbirth
The majority of childbirth fatalities are preventable with routine care, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births without skilled assistance.
“The deliberate attack on maternity wards points toward a broader and more sinister pattern: the use of attacks on medical facilities as a tool for terror and to tear apart the social fabric,” observes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘prejudicial to the opposing side’, which has often been cited as an excuse.”
