Dozens of women were seeking shelter in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. 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. “There were cries of women and children,” he states. “They were killing everyone inside the hospital. Survival meant running for your life.”
This brutal attack stands as one of the most shocking examples in the ongoing war tearing the North African nation apart. Combatants raided the hospital, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the collapse in safety for civilians trapped in war-torn areas in multiple global hotspots.
A Record of Violence Against Maternal Care
Although world powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Women undergoing childbirth are particularly at risk due to their need for locally available medical care.
Research and compiled data reveal an unprecedented scale of attacks: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These incidents do not represent inevitable outcomes of conflict. They form a systematic assault on childbirth.”
The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of pregnant women are trapped.
Deaths have occurred, blocked from reaching help, or made to have their babies in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 abducted, and 101 taken into custody—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
The numbers are probably a significant underestimate, as they only include incidents documented publicly. In many areas of fighting, information is scarce.
Last year, findings indicated that half of all women who perished while pregnant or giving birth lived amidst hostilities. This underscores a devastating pattern.
In addition to the loss of life, these attacks are obliterating hospitals and wards, creating a grave danger to community survival.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind declaring certain actions a genocide.
Following truces, doctors report that women and children succumb from medical shortages, owing to severe deficits of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were inaccessible.
“Our facility has endured missile strikes targeting the wards, operating rooms, and maternity wards,” says 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 struck and ruined in Ukraine. Journalism from conflict zones describe births occurring in shelters and extreme psychological pressure leading to birth complications.
“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“The truth of the matter is, every facility is now a potential target,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike 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 void of justice has led to a “culture of impunity,” says a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, are potentially acts of genocide by destroying a group's future.”
Additional Hotspots
In El Fasher, the area had been cut off 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 inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.
In Myanmar, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.
The End of Safe Deliveries
Most maternal deaths are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births devoid of emergency care.
“If maternity hospitals are being deliberately targeted indicates a wider and more disturbing trend: the use of attacks on medical facilities as a means of intimidation and to break societal cohesion,” 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 ‘harmful to the enemy’, which has now become a standard defence.”
