A group of thirty mothers were huddled for safety in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were actively in labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he recounts. “They executed everybody inside the hospital. We who were able to escape, did so.”
This appalling incident stands as one of the most shocking examples in the ongoing war tearing the African nation apart. Militiamen forced their way into the building, reportedly killing more than 460 innocent people inside.
Rights organizations have called it “an act of unspeakable brutality,” and a clear case of the vanishing safeguards for civilians caught in conflict zones in several nations at war.
An Unprecedented Assault Against Maternal Care
While all major powers are signatories to the Geneva conventions, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are particularly at risk due to their need for locally available medical care.
Research and compiled data reveal an alarming level of violence: 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 are not natural consequences of war. They constitute a systematic assault on childbirth.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of pregnant women are trapped.
Mothers have lost their lives, denied medical attention, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 abducted, and 101 detained—sometimes in the act of delivering babies.
The Global Crisis for Mothers and Newborns
These figures likely represent a grave undercount, as they capture solely incidents documented publicly. In many war-torn areas, reporting is limited.
Last year, it was reported that 50% of women who died during pregnancy or childbirth lived amidst hostilities. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are obliterating maternal and neonatal care facilities, jeopardizing the future to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as a factor in accusations of genocidal acts.
Following truces, doctors report that women and children succumb from inadequate care, owing to desperate lacks of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals could not be reached.
“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to problems during delivery.
“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.”
A Culture of Impunity
For the more than 676 million women living near active conflicts, there are scarce guarantees and rare trials for atrocities for those targeting maternity care.
This lack of accountability has led to a “environment where anything goes,” explains a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, can be understood as acts of genocide by hindering reproduction.”
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 scarce because of a communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, 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 avoidable with standard medicine, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births devoid of emergency care.
“If maternity hospitals are being deliberately targeted speaks to a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to break societal cohesion,” says a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘harmful to the enemy’, which has often been cited as an excuse.”
