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 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 states. “They executed everybody inside the hospital. Survival meant running for your life.”
This brutal attack stands as one of the most shocking examples in the protracted internal conflict tearing the North African nation apart. Combatants forced their way into the building, reportedly killing more than 460 patients and their companions.
Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the deteriorating protection for civilians caught in conflict zones in several nations at war.
An Unprecedented Assault On Childbirth Services
Despite every significant nation have agreed to the Geneva conventions, which commit them to defending civilians, the past year has seen a record number of attacks on healthcare systems. Women undergoing childbirth are exceptionally vulnerable due to their reliance on locally available medical care.
Research and compiled data uncover an alarming level of violence: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women 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 deliberate strategy of violence against reproduction.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where hundreds of thousands of women bearing children are confined.
Deaths have occurred, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 abducted, and 101 arrested—sometimes in the act of delivering babies.
A Worldwide Emergency for Mothers and Newborns
These figures likely represent a significant underestimate, as they only include incidents documented publicly. In many conflict zones, reporting is limited.
Last year, findings indicated that half of all women who perished while pregnant or giving birth resided in a war zone. This underscores a catastrophic reality.
Apart from fatalities, these attacks are obliterating critical infrastructure for mothers and babies, posing a long-term threat to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as a factor in genocide allegations.
Following truces, doctors report that women and children are still perishing from medical shortages, owing to desperate lacks of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals could not be reached.
“Our facility has endured missile strikes fired at 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 trying to alter birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births taking place in basements and extreme psychological pressure leading to birth complications.
“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“In fact, 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 within range of fighting, there are scarce guarantees and rare trials for atrocities for those targeting maternity care.
This lack of accountability has fostered a “culture of impunity,” explains a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, may constitute acts of genocide by hindering reproduction.”
Additional Hotspots
In El Fasher, the area had been cut off 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 lack of access 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 suffered violence over the past two years of civil war.
The Collapse of Safe Childbirth
A large proportion of mother deaths are preventable with routine care, 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 lacking professional help.
“The deliberate attack on maternity wards speaks to a larger and alarming strategy: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” says a legal researcher.
“There is no absolute protection 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.”
