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 experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he recounts. “They were killing everyone inside the hospital. Those who could run, fled.”
This brutal attack stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Militiamen raided the hospital, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the deteriorating protection for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence On Childbirth Services
Although world powers have agreed to the Geneva conventions, which obligate them to protect civilians, the past year has experienced a historic high of violence targeting health services. Expectant mothers are highly exposed due to their need for locally available medical care.
Data analysis and investigations reveal an unprecedented scale of attacks: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These incidents do not represent inevitable outcomes of conflict. They form a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of women bearing children are confined.
Women have been killed, denied medical attention, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 taken hostage, and 101 arrested—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
The numbers are probably a significant underestimate, as they capture solely incidents covered by the media. In many areas of fighting, communications are sparse.
Last year, it was reported that half of all women who perished while pregnant or giving birth were in a conflict area. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are obliterating hospitals and wards, creating a grave danger to community survival.
The Situation in Gaza
In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as part of the basis for genocide allegations.
Following truces, doctors report that women and children succumb from a lack of proper treatment, owing to severe deficits of medicine and equipment. Accounts describe women having children by the roadside because hospitals could not be reached.
“Direct shelling 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 trying to alter birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 hospitals for mothers and babies have been struck and ruined in Ukraine. Reports from frontline hospitals describe births forced underground 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. Officials from Russia have rejected deliberately targeting civilians.
“In fact, every facility is now a potential target,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”
Accountability Evaporates
For the over half a billion females living near active conflicts, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.
This absence of consequences has fostered a “environment where anything goes,” argues a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, can be understood as acts of genocide by destroying a group's future.”
Other Conflict Zones
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, resulting in tragic loss of life.
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 averted with basic healthcare, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births lacking professional help.
“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 destroy community bonds,” notes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘prejudicial to the opposing side’, which has often been cited as an excuse.”
