Dozens of women had taken refuge in a maternity hospital in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were actively in labor.
Working that night, 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 states. “They executed everybody inside the hospital. Those who could run, fled.”
This horrifying event stands as one of the most shocking examples in the protracted internal conflict tearing the North African nation apart. Combatants stormed the facility, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have described it as “a crime beyond words,” and a clear case of the vanishing safeguards for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence Against Maternal Care
While all major powers have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has experienced a historic high of assaults against medical infrastructure. Mothers in labor are particularly at risk due to their reliance on locally available medical care.
Data analysis and investigations 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 direct strikes on hospitals and delivery wards.
“These incidents do not represent standard wartime hazards. They constitute a systematic assault on childbirth.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.
Deaths have occurred, blocked from reaching help, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 abducted, and 101 taken into custody—sometimes while assisting births.
A Worldwide Emergency for Mothers and Newborns
Statistics are thought to be a substantial underreporting, as they are limited to incidents covered by the media. In many conflict zones, information is scarce.
Last year, findings indicated that one in two mothers who lost their lives in maternal circumstances were in a conflict area. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are obliterating critical infrastructure for mothers and babies, jeopardizing the future to demographic stability.
Conditions within Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as one reason behind accusations of genocidal acts.
Following truces, doctors report that women and children continue to die from inadequate care, owing to severe deficits of medicine and equipment. Agencies have reported women giving birth in rubble because hospitals could not be reached.
“Our facility has endured missile strikes targeting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or aiming to influence birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births taking place in basements and extreme psychological pressure leading to maternal health issues.
“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The truth of the matter is, every facility faces the threat of assault,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”
Accountability Evaporates
For the over half a billion females living within range of fighting, there are minimal protections and even fewer war crimes prosecutions for those attacking childbirth services.
This lack of accountability has led to a “environment where anything goes,” explains a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by destroying a group's future.”
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, causing fatalities among patients and staff.
In Myanmar, clinics have been attacked and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The Collapse of Safe Childbirth
A large proportion of mother deaths are averted with basic healthcare, but war destroys healthcare networks. 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 violence against hospitals 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 ‘militarily advantageous’, which has often been cited as an excuse.”
