Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were experiencing childbirth.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “I heard the screams of women and children,” he explains. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This appalling incident stands as among the worst examples in the ongoing war tearing the North African nation apart. Militiamen stormed the facility, allegedly slaughtering more than 460 patients and their companions.
Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the vanishing safeguards for civilians caught in conflict zones 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 international laws of war, which obligate them to protect civilians, the past year has seen a record number of attacks on healthcare systems. Women undergoing childbirth are exceptionally vulnerable due to their need for locally available medical care.
An investigation of records show an unprecedented scale of attacks: 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 form a pattern of reproductive violence.”
The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where countless of expectant mothers are stranded.
Women have been killed, prevented from accessing care, or forced to give birth in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 kidnapped, and 101 detained—sometimes while assisting births.
A Worldwide Emergency for Mothers and Newborns
These figures likely represent a significant underestimate, as they are limited to incidents documented publicly. In many conflict zones, information is scarce.
Last year, analysis showed that one in two mothers who perished while pregnant or giving birth resided in a war zone. This underscores a devastating pattern.
Apart from fatalities, these attacks are obliterating maternal and neonatal care facilities, jeopardizing the future to community survival.
Conditions within Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in accusations of genocidal acts.
Despite periods of calm, doctors report that women and children succumb from a lack of proper treatment, owing to severe deficits of medicine and equipment. Accounts describe women giving birth in rubble 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 rejected deliberately targeting maternity care or aiming to influence birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 hospitals for mothers and babies 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.
“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“In fact, every facility is now a potential target,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris may hit a hospital.”
A Culture of Impunity
For the hundreds of millions of women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.
This lack of accountability has led to a “culture of impunity,” explains a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, are potentially acts of genocide by hindering reproduction.”
Other Conflict Zones
In El Fasher, the area lacked access to humanitarian aid long before the hospital attack, with malnutrition increasing drastically, 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 damaged a maternity hospital, resulting in tragic loss of life.
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
Most maternal deaths are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births devoid of emergency care.
“When childbirth centers become intentional targets points toward a wider and more disturbing trend: the use of attacks on medical facilities as a means of intimidation and to break societal cohesion,” observes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘harmful to the enemy’, which has often been cited as an excuse.”
