A group of thirty mothers were huddled for safety 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, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he recounts. “A massacre was taking place inside the hospital. Those who could run, fled.”
This brutal attack stands as one of the most shocking examples in the protracted internal conflict tearing the North African nation apart. Combatants raided the hospital, leaving dead more than 460 patients and their companions.
Rights organizations have labeled it “an act of unspeakable brutality,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.
An Unprecedented Assault Against Maternal Care
While all major powers have signed the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of attacks on healthcare systems. Expectant mothers are highly exposed due to their dependence on locally available medical care.
An investigation of records show an alarming level of violence: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“This is not inevitable outcomes of conflict. They represent a deliberate strategy of violence against reproduction.”
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, blocked from reaching help, or forced to give birth in deplorable situations. The data also indicates that at least 68 maternal health workers have been murdered, 15 kidnapped, and 101 detained—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
The numbers are probably a substantial underreporting, as they only include incidents reported in news outlets. In many war-torn areas, reporting is limited.
Last year, findings indicated that half of all women who perished while pregnant or giving birth lived amidst hostilities. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are destroying critical infrastructure for mothers and babies, creating a grave danger 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 a factor in declaring certain actions a genocide.
Despite periods of calm, doctors report that women and children continue to die from medical shortages, owing to critical shortages of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals could not be reached.
“Direct shelling hitting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or seeking to affect birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to problems during delivery.
“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The truth of the matter is, every facility can be under attack now,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
A Culture of Impunity
For the hundreds of millions of women living near active conflicts, there are few safeguards and a stark lack of legal accountability for those assaulting reproductive health.
This absence of consequences has created a “atmosphere of lawlessness,” says a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, may constitute acts of genocide by destroying a group's future.”
Additional Hotspots
In El Fasher, the area was isolated 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 limited by a inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
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 Collapse of Safe Childbirth
Most maternal deaths are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births without skilled assistance.
“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.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘harmful to the enemy’, which has now become a standard defence.”
