A group of thirty mothers were seeking shelter in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he states. “They were killing everyone inside the hospital. We who were able to escape, did so.”
This brutal attack stands as among the worst examples in the two-year civil war tearing the North African nation apart. Combatants stormed the facility, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have described it as “an unspeakable atrocity,” and a prime example of the vanishing safeguards for civilians caught in conflict zones in multiple global hotspots.
A Record of Violence Against Maternal Care
Although world powers have signed the international laws of war, which require them to safeguard civilians, the past year has experienced a historic high of attacks on healthcare systems. Women undergoing childbirth are particularly at risk due to their dependence on locally available medical care.
An investigation of records reveal an unprecedented scale of attacks: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“This is not inevitable outcomes of conflict. They represent a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where a vast number 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 slain, 15 taken hostage, and 101 arrested—sometimes while assisting births.
A Worldwide Emergency for Mothers and Newborns
These figures likely represent a grave undercount, as they are limited to incidents documented publicly. In many war-torn areas, communications are sparse.
Last year, findings indicated that 50% of women who perished while pregnant or giving birth lived amidst hostilities. This underscores a horrifying trend.
Apart from fatalities, these attacks are obliterating maternal and neonatal care facilities, jeopardizing the future to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as one reason behind accusations of genocidal acts.
Despite periods of calm, doctors report that women and children are still perishing from a lack of proper treatment, owing to critical shortages of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals could not be reached.
“We’ve had rockets targeting 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 trying to alter birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births taking place in basements and extreme psychological pressure leading to problems during delivery.
“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“In fact, every facility can be under attack now,” notes a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”
Accountability Evaporates
For the more than 676 million women living within range of fighting, there are scarce guarantees and rare trials for atrocities for those targeting maternity care.
This absence of consequences has created a “culture of impunity,” argues 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 rising sharply, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is limited by a lack of access from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, causing fatalities among patients and staff.
In Myanmar, hospitals have come under fire 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 avoidable with standard medicine, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted points toward a larger and alarming strategy: the use of violence against hospitals as a weapon to spread fear and to destroy community bonds,” notes 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 ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”