A group of thirty mothers had taken refuge in a maternity hospital in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were in the midst of labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he recounts. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This appalling incident stands as among the worst examples in the two-year civil war tearing the North African nation apart. Combatants stormed the facility, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have labeled it “an unspeakable atrocity,” and a stark illustration of the vanishing safeguards for civilians living amidst warfare in multiple global hotspots.
A Record of Violence Against Maternal Care
While all major powers have signed the international laws of war, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Mothers in labor are highly exposed due to their reliance on locally available medical care.
An investigation of records show an alarming level of violence: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“This is not natural consequences of war. They constitute a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where countless of expectant mothers are stranded.
Women have been killed, prevented from accessing care, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 kidnapped, and 101 detained—sometimes while assisting births.
The Global Crisis for Mothers and Newborns
Statistics are thought to be a significant underestimate, as they are limited to incidents reported in news outlets. In many areas of fighting, communications are sparse.
Last year, findings indicated that half of all women who lost their lives in maternal circumstances resided in a war zone. This underscores a catastrophic reality.
Apart from fatalities, these attacks are obliterating maternal and neonatal care facilities, posing a long-term threat to societal repopulation and recovery.
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.
Despite periods of calm, doctors report that women and children continue to die from inadequate care, owing to severe deficits of medicine and equipment. Accounts describe women having children by the roadside because hospitals could not be reached.
“Our facility has endured missile strikes targeting 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 seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births occurring in shelters 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.
“The truth of the matter is, every facility faces the threat of assault,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”
Accountability Evaporates
For the hundreds of millions of women living within range of fighting, there are few safeguards and a stark lack of legal accountability for those attacking childbirth services.
This lack of accountability has led to a “environment where anything goes,” argues a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, 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 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 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
A large proportion of mother deaths are preventable with routine care, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births lacking professional help.
“When childbirth centers become intentional targets indicates a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to tear apart the social fabric,” says a legal researcher.
“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘harmful to the enemy’, which has now become a standard defence.”
