Thirty women were seeking shelter in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were in the midst of labor.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “The sounds of screaming reached me of women and children,” he explains. “They were killing everyone inside the hospital. We who were able to escape, did so.”
This brutal attack stands as a particularly egregious examples in the ongoing war tearing the North African nation apart. Armed soldiers stormed the facility, leaving dead more than 460 innocent people inside.
Rights organizations have labeled it “an unspeakable atrocity,” and a prime example of the deteriorating protection for civilians trapped in war-torn areas in several nations at war.
An Unprecedented Assault On Childbirth Services
While all major powers have agreed to the Geneva conventions, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Women undergoing childbirth are exceptionally vulnerable due to their reliance on locally available medical care.
Research and compiled data show an shocking trend: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“This is not natural consequences of war. They constitute a systematic assault on childbirth.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where a vast number of pregnant women are trapped.
Women have been killed, prevented from accessing care, or compelled to deliver in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 abducted, and 101 arrested—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
These figures likely represent a grave undercount, as they only include incidents documented publicly. In many conflict zones, communications are sparse.
Last year, analysis showed that half of all women who died during pregnancy or childbirth lived amidst hostilities. This underscores a devastating pattern.
Beyond killing women and staff, these attacks are destroying maternal and neonatal care facilities, posing a long-term threat to demographic stability.
Conditions within Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in genocide allegations.
Even after ceasefires, doctors report that women and children are still perishing from inadequate care, owing to desperate lacks of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals were inaccessible.
“Direct shelling 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 aiming to influence 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 forced underground and extreme psychological pressure leading to maternal health issues.
“Russia is targeting us deliberately,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The reality is, every facility can be under attack now,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
Accountability Evaporates
For the over half a billion females living near active conflicts, there are scarce guarantees and a stark lack of legal accountability for those targeting maternity care.
This absence of consequences has created a “environment where anything goes,” explains a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, are potentially 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 rising sharply, 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, resulting in tragic loss of life.
In Myanmar, hospitals have come under fire and dozens of midwives and patients have suffered violence over the past two years of civil war.
The End of Safe Deliveries
The majority of childbirth fatalities are preventable with routine care, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births devoid of emergency care.
“When childbirth centers become intentional targets speaks to a wider and more disturbing trend: the use of attacks on medical facilities as a means of intimidation and to destroy community bonds,” notes 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 increasingly been used as a justification.”
