Dozens of women had taken refuge in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “I heard the screams of women and children,” he explains. “They executed everybody inside the hospital. Survival meant running for your life.”
This horrifying event stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Militiamen stormed the facility, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have called it “a crime beyond words,” and a stark illustration of the collapse in safety for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence 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 violence targeting health services. Women undergoing childbirth are highly exposed due to their need for locally available medical care.
Research and compiled data show 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.
“This is not natural consequences of war. They constitute a pattern of reproductive violence.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where hundreds of thousands of expectant mothers are stranded.
Women have been killed, prevented from accessing care, or made to have their babies in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 abducted, and 101 detained—sometimes in the act of delivering babies.
The Global Crisis for Mothers and Newborns
Statistics are thought to be a significant underestimate, as they capture solely incidents documented publicly. In many conflict zones, communications are sparse.
Last year, findings indicated that half of all women who lost their lives in maternal circumstances resided in a war zone. This underscores a catastrophic reality.
Apart from fatalities, 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 catastrophic impact on the right to maternal care has been cited by a UN commission as part of the basis for accusations of genocidal acts.
Following truces, doctors report that women and children succumb from medical shortages, owing to desperate lacks of medicine and equipment. Accounts describe women having children by the roadside because hospitals were inaccessible.
“We’ve had rockets 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 seeking to affect birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been struck and ruined in Ukraine. Journalism from conflict zones describe births occurring in shelters and extreme psychological pressure leading to problems during delivery.
“The attacks on us are intentional,” claims 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,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
Accountability Evaporates
For the hundreds of millions of women living close to deadly warfare, there are few safeguards and even fewer war crimes prosecutions for those attacking childbirth services.
This lack of accountability has led to a “environment where anything goes,” argues a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, may constitute acts of genocide by destroying a group's future.”
Additional Hotspots
In El Fasher, the area lacked access to humanitarian aid long before the hospital attack, with malnutrition spiking dangerously, 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 faced detention, death, or harm over the past two years of civil war.
The End of Safe Deliveries
Most maternal deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“When childbirth centers become intentional targets indicates a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” observes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”
