Dozens of women had taken refuge in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were actively in labor.
On duty during that fateful night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he explains. “They executed everybody inside the hospital. Survival meant running for your life.”
This appalling incident stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Armed soldiers forced their way into the building, allegedly slaughtering more than 460 innocent people inside.
Rights organizations have described it as “an act of unspeakable brutality,” and a clear case of the collapse in safety for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault On Childbirth Services
While all major powers have signed the Geneva conventions, which obligate them to protect civilians, the past year has experienced a historic high of assaults against medical infrastructure. Expectant mothers are particularly at risk due to their reliance on locally available medical care.
An investigation of records uncover an unprecedented scale of attacks: 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.
“This is not natural consequences of war. They represent a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.
Mothers have lost their lives, denied medical attention, or compelled to deliver in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 arrested—sometimes while assisting births.
The Global Crisis in Maternal Health
These figures likely represent a grave undercount, as they only include incidents covered by the media. In many areas of fighting, reporting is limited.
Last year, it was reported that 50% of women who died during pregnancy or childbirth were in a conflict area. This underscores a devastating pattern.
Apart from fatalities, these attacks are wrecking maternal and neonatal care facilities, 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 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. UN officials have relayed women delivering babies amidst ruins because hospitals were inaccessible.
“Direct shelling hitting the wards, operating rooms, and maternity wards,” states 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 childbirth centers have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births taking place in basements and skyrocketing stress leading to problems during delivery.
“The attacks on us are intentional,” claims 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.”
Accountability Evaporates
For the more than 676 million women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.
This absence of consequences has led to a “environment where anything goes,” says a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, can be understood as acts of genocide by hindering reproduction.”
Other Conflict Zones
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 restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, resulting in tragic loss of life.
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 End of Safe Deliveries
A large proportion of mother deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted indicates a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to break societal cohesion,” observes a legal researcher.
“There is no absolute protection 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.”
