A group of thirty mothers were seeking shelter in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were actively in labor.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he states. “They executed everybody inside the hospital. Those who could run, fled.”
This appalling incident stands as one of the most shocking examples in the ongoing war tearing the African nation apart. Combatants stormed the facility, leaving dead more than 460 innocent people inside.
Rights organizations have labeled it “a crime beyond words,” and a clear case of the collapse in safety for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault Against Maternal Care
While all major powers have agreed to the Geneva conventions, which obligate them to protect civilians, the past year has experienced a historic high of violence targeting health services. Expectant mothers are highly exposed due to their reliance on locally available medical care.
Research and compiled data uncover an alarming level of violence: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These are not natural consequences of war. They represent a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.
Deaths have occurred, prevented from accessing care, or made to have their babies in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 abducted, and 101 arrested—sometimes while assisting births.
A Worldwide Emergency in Maternal Health
These figures likely represent a grave undercount, as they capture solely incidents documented publicly. In many areas of fighting, communications are sparse.
Last year, it was reported that 50% of women who perished while pregnant or giving birth lived amidst hostilities. This underscores a catastrophic reality.
Beyond killing women and staff, these attacks are wrecking critical infrastructure for mothers and babies, creating a grave danger to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as a factor in declaring certain actions a genocide.
Following truces, doctors report that women and children continue to die from medical shortages, owing to severe deficits of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals were out of reach.
“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 contested deliberately targeting maternity care or seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure leading to problems during delivery.
“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The reality is, every facility can be under attack now,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”
Accountability Evaporates
For the more than 676 million women living within range of fighting, there are minimal protections and a stark lack of legal accountability for those attacking childbirth services.
This lack of accountability has led to a “environment where anything goes,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by destroying a group's future.”
Additional Hotspots
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 restricted due to a lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
In Myanmar, hospitals have come under fire and dozens of midwives and patients have suffered violence over the past two years of civil war.
The End of Safe Deliveries
The majority of childbirth fatalities 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 points toward a larger and alarming strategy: the use of violence against hospitals as a means of intimidation and to tear apart the social fabric,” observes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘harmful to the enemy’, which has often been cited as an excuse.”
