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.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he explains. “They were killing everyone inside the hospital. We who were able to escape, did so.”
This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Armed soldiers raided the hospital, allegedly slaughtering more than 460 innocent people inside.
Rights organizations have labeled it “an unspeakable atrocity,” and a stark illustration of the collapse in safety 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
Despite every significant nation have agreed to the international laws of war, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Expectant mothers are exceptionally vulnerable due to their dependence on locally available medical care.
Data analysis and investigations show 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 direct strikes on hospitals and delivery wards.
“This is not standard wartime hazards. They form a pattern of reproductive violence.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where a vast number of women bearing children are confined.
Women have been killed, blocked from reaching help, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 detained—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
These figures likely represent a grave undercount, as they are limited to incidents reported in news outlets. In many conflict zones, information is scarce.
Last year, analysis showed that half of all women who died during pregnancy or childbirth were in a conflict area. This underscores a catastrophic reality.
Apart from fatalities, these attacks are destroying critical infrastructure for mothers and babies, jeopardizing the future to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind declaring certain actions a genocide.
Following truces, doctors report that women and children succumb from a lack of proper treatment, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside because hospitals were out of reach.
“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 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. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to maternal health issues.
“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The reality is, every facility can be under attack now,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”
A Culture of Impunity
For the more than 676 million women living close to deadly warfare, there are scarce guarantees and a stark lack of legal accountability for those assaulting reproductive health.
This lack of accountability has led to a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by preventing births.”
Other Conflict Zones
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 scarce because of a inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, resulting in tragic loss of life.
In Myanmar, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.
The Collapse of Safe Childbirth
The majority of childbirth fatalities are preventable with routine care, 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 devoid of emergency care.
“If maternity hospitals are being deliberately targeted indicates a broader and more sinister pattern: the use of violence against hospitals as a tool for terror and to break societal cohesion,” says a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”
