Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were in the midst of labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “I heard the screams of women and children,” he recounts. “A massacre was taking place 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. Militiamen forced their way into the building, reportedly killing more than 460 patients and their companions.
Rights organizations have described it as “a crime beyond words,” and a stark illustration of the collapse in safety for civilians trapped in war-torn areas in multiple global hotspots.
A Record of Violence Against Maternal Care
While all major powers have signed the international laws of war, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Mothers in labor are exceptionally vulnerable due to their dependence on locally available medical care.
Data analysis and investigations 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 bombardments of hospitals and delivery wards.
“These incidents do not represent natural consequences of war. They form a pattern of reproductive violence.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where countless of pregnant women are trapped.
Mothers have lost their lives, prevented from accessing care, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been killed, 15 abducted, and 101 arrested—sometimes while assisting births.
A Worldwide Emergency in Maternal Health
Statistics are thought to be a substantial underreporting, as they only include incidents covered by the media. In many war-torn areas, communications are sparse.
Last year, it was reported that half of all women who perished while pregnant or giving birth were in a conflict area. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are destroying hospitals and wards, creating a grave danger to demographic stability.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as part of the basis for genocide allegations.
Following truces, doctors report that women and children are still perishing from inadequate care, owing to critical shortages of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals could not be reached.
“Direct shelling 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.
Ukraine's Ordeal
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 birth complications.
“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“In fact, every facility faces the threat of assault,” states a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”
A Culture of Impunity
For the over half a billion females living close to deadly warfare, there are few safeguards and rare trials for atrocities for those attacking childbirth services.
This absence of consequences has led to a “atmosphere of lawlessness,” explains a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”
Other Conflict Zones
In El Fasher, the area had been cut off 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 limited by a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, causing fatalities among patients and staff.
In Myanmar, clinics have been attacked and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The Collapse of Safe Childbirth
A large proportion of mother deaths are averted with basic healthcare, 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,” observes a legal researcher.
“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘prejudicial to the opposing side’, which has now become a standard defence.”
