Dozens of women were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were experiencing childbirth.
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 recounts. “They executed everybody inside the hospital. Those who could run, fled.”
This brutal attack stands as among the worst examples in the two-year civil war tearing the North African nation apart. Militiamen forced their way into the building, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have described it as “a crime beyond words,” and a stark illustration of the vanishing safeguards for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence On Childbirth Services
While all major powers are signatories to the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of assaults against medical infrastructure. Expectant mothers are highly exposed due to their need for locally available medical care.
Data analysis and investigations show an shocking trend: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“This is not natural consequences of war. They constitute a pattern of reproductive violence.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where countless of women bearing children are confined.
Deaths have occurred, prevented from accessing care, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 abducted, and 101 arrested—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
These figures likely represent a grave undercount, as they are limited to incidents covered by the media. In many conflict zones, communications are sparse.
Last year, it was reported that 50% of women who died during pregnancy or childbirth were in a conflict area. This underscores a catastrophic reality.
Apart from fatalities, these attacks are wrecking critical infrastructure for mothers and babies, posing a long-term threat 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 part of the basis for accusations of genocidal acts.
Despite periods of calm, doctors report that women and children continue to die from inadequate care, owing to severe deficits of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals could not be reached.
“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 childbirth centers have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to problems during delivery.
“Russia is targeting us deliberately,” says 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 can be under attack now,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact 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 assaulting reproductive health.
This lack of accountability has led to a “environment where anything goes,” argues a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”
Additional Hotspots
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 scarce because of a lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
In Myanmar, clinics have been attacked 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 avoidable with standard medicine, 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.
“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” says a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘harmful to the enemy’, which has often been cited as an excuse.”
