🔗 Share this article

Dozens of women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were experiencing childbirth.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “I heard the screams of women and children,” he states. “They were killing everyone inside the hospital. Survival meant running for your life.”

This brutal attack stands as among the worst examples in the two-year civil war tearing the North African nation apart. Armed soldiers raided the hospital, reportedly killing more than 460 innocent people inside.

Rights organizations have called it “an act of unspeakable brutality,” and a clear case of the vanishing safeguards for civilians living amidst warfare in several nations at war.

An Unprecedented Assault On Childbirth Services

Although world powers have agreed to the Geneva conventions, 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 need for locally available medical care.

Data analysis and investigations 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 natural consequences of war. They form a deliberate strategy of violence against reproduction.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where hundreds of thousands of expectant mothers are stranded.

Mothers have lost their lives, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been killed, 15 kidnapped, and 101 arrested—sometimes during medical procedures.

The Global Crisis in Maternal Health

Statistics are thought to be a significant underestimate, as they only include incidents documented publicly. In many conflict zones, reporting is limited.

Last year, analysis showed that half of all women who lost their lives in maternal circumstances were in a conflict area. This underscores a devastating pattern.

In addition to the loss of life, these attacks are wrecking hospitals and wards, jeopardizing the future to societal repopulation and recovery.

Conditions within Gaza

In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind accusations of genocidal acts.

Even after ceasefires, doctors report that women and children succumb from inadequate care, owing to desperate lacks of medicine and equipment. UN officials have relayed women giving birth in rubble 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.

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births taking place in basements and skyrocketing stress leading to maternal health issues.

“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“In fact, every facility can be under attack now,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”

Accountability Evaporates

For the hundreds of millions of women living within range of fighting, there are scarce guarantees and a stark lack of legal accountability for those targeting maternity care.

This lack of accountability has fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, may constitute 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 increasing drastically, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is limited by a lack of access from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, resulting in tragic loss of life.

In Myanmar, hospitals have come under fire 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 shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births lacking professional help.

“If maternity hospitals are being deliberately targeted indicates a larger and alarming strategy: the use of attacks on medical facilities as a weapon to spread fear and to tear apart the social fabric,” notes 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 ‘harmful to the enemy’, which has now become a standard defence.”