Thirty women were huddled for safety 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, Abdo-Rabo Ahmed, became one of the few known survivors. “The sounds of screaming reached me of women and children,” he states. “A massacre was taking place inside the hospital. We who were able to escape, did so.”
This horrifying event stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Militiamen forced their way into the building, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have described it as “an act of unspeakable brutality,” and a clear case of the collapse in safety for civilians trapped in war-torn areas in several nations at war.
An Unprecedented Assault Against Maternal Care
Despite every significant nation have agreed to the Geneva conventions, which commit them to defending civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Women undergoing childbirth are particularly at risk due to their need for locally available medical care.
An investigation of records reveal an alarming level of violence: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These are not standard wartime hazards. They represent a systematic assault on childbirth.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where a vast number of pregnant women are trapped.
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 killed, 15 taken hostage, and 101 arrested—sometimes while assisting births.
A Worldwide Emergency in Maternal Health
These figures likely represent a substantial underreporting, as they capture solely incidents covered by the media. In many war-torn areas, communications are sparse.
Last year, it was reported that one in two mothers who perished while pregnant or giving birth resided in a war zone. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are wrecking maternal and neonatal care facilities, 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 one reason behind declaring certain actions a genocide.
Despite periods of calm, doctors report that women and children continue to die from medical shortages, owing to severe deficits of medicine and equipment. Agencies have reported women having children by the roadside because hospitals could not be reached.
“Direct shelling fired at the wards, operating rooms, and maternity wards,” says 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 childbirth centers have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births forced underground 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. Officials from Russia have rejected deliberately targeting civilians.
“The truth of the matter is, 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 over half a billion females living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those attacking childbirth services.
This absence of consequences has fostered a “atmosphere of lawlessness,” explains a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by hindering reproduction.”
Additional Hotspots
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 communication blackout 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 averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births devoid of emergency care.
“If maternity hospitals are being deliberately targeted speaks to a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to destroy community bonds,” notes a legal researcher.
“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘prejudicial to the opposing side’, which has often been cited as an excuse.”
