Dozens of women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, 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, became one of the few known survivors. “I heard the screams of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”
This appalling incident stands as among the worst examples in the two-year civil war tearing the North African nation apart. Combatants forced their way into the building, leaving dead more than 460 patients and their companions.
Rights organizations have described it as “an unspeakable atrocity,” and a prime example of the vanishing safeguards for civilians living amidst warfare in several nations at war.
An Unprecedented Assault Against Maternal Care
Although world powers have agreed to the Geneva conventions, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are particularly at risk due to their reliance on locally available medical care.
Research and compiled data reveal an shocking trend: nearly 300 violent acts against 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 inevitable outcomes of conflict. They represent a systematic assault on childbirth.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where hundreds of thousands of expectant mothers are stranded.
Mothers have lost their lives, prevented from accessing care, or forced to give birth in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 taken hostage, and 101 taken into custody—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
Statistics are thought to be a significant underestimate, as they only include incidents reported in news outlets. In many conflict zones, communications are sparse.
Last year, it was reported that one in two mothers who perished while pregnant or giving birth were in a conflict area. This underscores a catastrophic reality.
In addition to the loss of life, these attacks are wrecking critical infrastructure for mothers and babies, jeopardizing the future to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in genocide allegations.
Despite periods of calm, doctors report that women and children are still perishing from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Accounts describe women having children by the roadside because hospitals were out of reach.
“We’ve had rockets targeting 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.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births forced underground and extreme psychological pressure leading to problems during delivery.
“Russia is targeting us deliberately,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The reality is, every facility faces the threat of assault,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”
A Culture of Impunity
For the hundreds of millions of women living within range of fighting, there are scarce guarantees and rare trials for atrocities for those targeting maternity care.
This lack of accountability 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 preventing births.”
Other Conflict Zones
In El Fasher, the area was isolated 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 limited by a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, 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 Collapse of Safe Childbirth
The majority of childbirth fatalities are preventable with routine care, but war shatters health systems. 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 indicates a wider and more disturbing trend: the use of violence against hospitals as a tool for terror and to tear apart the social fabric,” 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 ‘militarily advantageous’, which has now become a standard defence.”
