Dozens of women had taken refuge in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, 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. “The sounds of screaming reached me of women and children,” he explains. “They were killing everyone inside the hospital. Survival meant running for your life.”
This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Militiamen stormed the facility, leaving dead more than 460 patients and their companions.
Rights organizations have described it as “an act of unspeakable brutality,” and a stark illustration of the vanishing safeguards for civilians trapped in war-torn areas in multiple global hotspots.
A Record of Violence On Childbirth Services
While all major powers have signed the international laws of war, which commit them to defending civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are particularly at risk due to their dependence on locally available medical care.
Data analysis and investigations reveal an shocking trend: nearly 300 violent acts against 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 represent a pattern of reproductive violence.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where hundreds of thousands of pregnant women are trapped.
Women have been killed, prevented from accessing care, 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 murdered, 15 abducted, and 101 taken into custody—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
These figures likely represent a substantial underreporting, as they are limited to incidents covered by the media. In many conflict zones, communications are sparse.
Last year, findings indicated that half of all women who perished while pregnant or giving birth lived amidst hostilities. This underscores a devastating pattern.
Apart from fatalities, these attacks are wrecking hospitals and wards, posing a long-term threat to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as part of the basis for declaring certain actions a genocide.
Following truces, doctors report that women and children continue to die from medical shortages, 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 fired at the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or aiming to influence birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure leading to maternal health issues.
“The attacks on us are intentional,” asserts 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,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris may hit a hospital.”
A Culture of Impunity
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 assaulting reproductive health.
This lack of accountability has fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”
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 hit a neonatal ward, killing mothers, babies, and nurses.
In Myanmar, medical facilities have been bombed and dozens of midwives and patients have faced detention, death, or harm over the past two years of civil war.
The Collapse of Safe Childbirth
The majority of childbirth fatalities are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“If maternity hospitals are being deliberately targeted points toward a wider and more disturbing trend: the use of attacks on medical facilities as a tool for terror and to tear apart the social fabric,” observes a legal researcher.
“Hospitals are not completely safe 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 often been cited as an excuse.”
