Dozens of women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were experiencing childbirth.
Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he states. “They executed everybody inside the hospital. We who were able to escape, did so.”
This horrifying event stands as a particularly egregious examples in the ongoing war tearing the North African nation apart. Combatants stormed the facility, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have called it “an act of unspeakable brutality,” and a clear case of the collapse in safety for civilians living amidst warfare in multiple global hotspots.
A Record of Violence On Childbirth Services
While all major powers have agreed to the international laws of war, which commit them to defending civilians, the past year has seen a record number of attacks on healthcare systems. Mothers in labor are highly exposed due to their reliance on locally available medical care.
Research and compiled data uncover an unprecedented scale of attacks: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These incidents do not represent standard wartime hazards. They form a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in regions embroiled in intense conflict, where countless of women bearing children are confined.
Deaths have occurred, prevented from accessing care, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 abducted, and 101 taken into custody—sometimes while assisting births.
The Global Crisis in Maternal Health
These figures likely represent a substantial underreporting, as they capture solely incidents covered by the media. In many conflict zones, reporting is limited.
Last year, analysis showed that 50% of women who lost their lives in maternal circumstances resided in a war zone. This underscores a devastating pattern.
In addition to the loss of life, these attacks are obliterating critical infrastructure for mothers and babies, posing a long-term threat to demographic stability.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind genocide allegations.
Even after ceasefires, doctors report that women and children succumb from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were inaccessible.
“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” states 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 forced underground and extreme psychological pressure leading to birth complications.
“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“The truth of the matter is, every facility is now a potential target,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”
Accountability Evaporates
For the over half a billion females living within range of fighting, there are scarce guarantees and even fewer war crimes prosecutions for those assaulting reproductive health.
This void of justice has fostered a “culture of impunity,” says a human rights lawyer. “Attacks on reproductive healthcare, 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 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 struck a baby care unit, resulting in tragic loss of life.
In Myanmar, hospitals have come under fire and dozens of midwives and patients have faced detention, death, or harm 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 lacking professional help.
“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: 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 are not inviolable if used for acts deemed ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”
