A group of thirty mothers were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were actively in labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he recounts. “They executed everybody inside the hospital. Survival meant running for your life.”
This brutal attack stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Militiamen raided the hospital, leaving dead more than 460 innocent people inside.
Rights organizations have labeled it “an act of unspeakable brutality,” and a prime example of the collapse in safety for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence On Childbirth Services
Although world powers have signed the international laws of war, which require them to safeguard civilians, the past year has experienced a historic high of attacks on healthcare systems. Expectant mothers are exceptionally vulnerable due to their need for locally available medical care.
Data analysis and investigations uncover an unprecedented scale of attacks: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“These are not standard wartime hazards. They form a systematic assault on childbirth.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where hundreds of thousands of women bearing children are confined.
Deaths have occurred, prevented from accessing care, 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 taken hostage, and 101 arrested—sometimes in the act of delivering babies.
The Global Crisis for Mothers and Newborns
The numbers are probably a significant underestimate, as they only include incidents covered by the media. In many areas of fighting, communications are sparse.
Last year, it was reported that one in two mothers who lost their lives in maternal circumstances resided in a war zone. This underscores a devastating pattern.
Beyond killing women and staff, these attacks are destroying maternal and neonatal care facilities, creating a grave danger to demographic stability.
Conditions within Gaza
In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as one reason behind genocide allegations.
Following truces, doctors report that women and children succumb from medical shortages, owing to desperate lacks of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were inaccessible.
“Our facility has endured missile strikes fired at the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or aiming to influence birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Reports from frontline hospitals describe births forced underground and extreme psychological pressure leading to problems during delivery.
“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“In fact, every facility can be under attack now,” comments 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 over half a billion females living within range of fighting, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.
This absence of consequences has fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, may constitute acts of genocide by hindering reproduction.”
Other Conflict Zones
In El Fasher, the area was isolated from 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 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, clinics have been attacked 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 collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, resulting in risky home births without skilled assistance.
“The deliberate attack on maternity wards indicates a broader and more sinister pattern: the use of violence against hospitals as a weapon to spread fear and to tear apart the social fabric,” notes 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 often been cited as an excuse.”
