A group of thirty mothers were huddled for safety 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, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries 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 protracted internal conflict tearing the African nation apart. Armed soldiers forced their way into the building, allegedly slaughtering more than 460 innocent people inside.
Rights organizations have described it as “an act of unspeakable brutality,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.
A Record of Violence Against Maternal Care
While all major powers have signed the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of violence targeting health services. Mothers in labor 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 places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“This is not standard wartime hazards. They form a systematic assault on childbirth.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where hundreds of thousands of women bearing children are confined.
Mothers have lost their lives, prevented from accessing care, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 taken hostage, and 101 arrested—sometimes during medical procedures.
The Global Crisis in Maternal Health
These figures likely represent a significant underestimate, as they capture solely incidents covered by the media. In many war-torn areas, communications are sparse.
Last year, analysis showed that half of all women who lost their lives in maternal circumstances lived amidst hostilities. This underscores a horrifying trend.
Apart from fatalities, these attacks are wrecking critical infrastructure for mothers and babies, creating a grave danger to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as one reason behind declaring certain actions a genocide.
Following truces, doctors report that women and children succumb from medical shortages, owing to severe deficits of medicine and equipment. Agencies have reported women having children by the roadside 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 trying to alter birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births taking place in basements and extreme psychological pressure leading to problems during delivery.
“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied 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 may hit a hospital.”
Accountability Evaporates
For the over half a billion females living near active conflicts, there are few safeguards and a stark lack of legal accountability for those targeting maternity care.
This lack of accountability has led to a “environment where anything goes,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”
Additional Hotspots
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, killing mothers, babies, and nurses.
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 End of Safe Deliveries
The majority of childbirth fatalities are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that anxiety is forcing 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 wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” says a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘prejudicial to the opposing side’, which has now become a standard defence.”
