Dozens of women were seeking shelter in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, 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. “I heard the screams of women and children,” he states. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Combatants forced their way into the building, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have called it “an unspeakable atrocity,” and a clear case of the collapse in safety for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence Against Maternal Care
While all major powers are signatories to the Geneva conventions, which commit them to defending civilians, the past year has seen a record number of attacks on healthcare systems. Expectant mothers are highly exposed due to their reliance on locally available medical care.
An investigation of records uncover an alarming level of violence: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“This is not inevitable outcomes of conflict. They form a systematic assault on childbirth.”
The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.
Women have been killed, denied medical attention, or compelled to deliver in deplorable situations. The data also indicates that at least 68 maternal health workers have been murdered, 15 kidnapped, and 101 taken into custody—sometimes while assisting births.
A Worldwide Emergency for Mothers and Newborns
The numbers are probably a substantial underreporting, as they are limited to incidents documented publicly. In many conflict zones, communications are sparse.
Last year, findings indicated that half of all women who perished while pregnant or giving birth lived amidst hostilities. This underscores a catastrophic reality.
In addition to the loss of life, these attacks are obliterating critical infrastructure for mothers and babies, creating a grave danger to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the catastrophic impact 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 succumb from inadequate care, owing to severe deficits of medicine and equipment. Accounts describe women having children by the roadside because hospitals could not be reached.
“We’ve had rockets 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 trying to alter birthrates.
The Crisis in Ukraine
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 occurring in shelters and skyrocketing stress leading to birth complications.
“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The reality is, every facility faces the threat of assault,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”
A Culture of Impunity
For the over half a billion females living near active conflicts, there are minimal protections and even fewer war crimes prosecutions for those attacking childbirth services.
This void of justice has fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, are potentially acts of genocide by hindering reproduction.”
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 inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.
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 Collapse of Safe Childbirth
Most maternal deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births devoid of emergency care.
“When childbirth centers become intentional targets indicates a broader and more sinister pattern: the use of violence against hospitals as a weapon to spread fear 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 ‘harmful to the enemy’, which has increasingly been used as a justification.”
