Dozens of women were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he states. “A massacre was taking place 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. Militiamen raided the hospital, leaving dead more than 460 patients and their companions.
Rights organizations have labeled it “an unspeakable atrocity,” and a prime example of the vanishing safeguards for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence On Childbirth Services
Although world powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Mothers in labor are highly exposed due to their need for locally available medical care.
Data analysis and investigations uncover an unprecedented scale of attacks: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These incidents do not represent inevitable outcomes of conflict. They represent a deliberate strategy of violence against reproduction.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of expectant mothers are stranded.
Women have been killed, prevented from accessing care, 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 in the act of delivering babies.
A Worldwide Emergency in Maternal Health
Statistics are thought to be a significant underestimate, as they are limited to incidents covered by the media. In many conflict zones, information is scarce.
Last year, findings indicated that one in two mothers who perished while pregnant or giving birth lived amidst hostilities. This underscores a catastrophic reality.
Beyond killing women and staff, these attacks are wrecking hospitals and wards, jeopardizing the future to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as part of the basis for declaring certain actions a genocide.
Following truces, doctors report that women and children continue to die from a lack of proper treatment, owing to severe deficits of medicine and equipment. Accounts describe women having children by the roadside because hospitals could not be reached.
“Our facility has endured missile strikes hitting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or aiming to influence birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to birth complications.
“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 reality is, every facility can be under attack now,” states 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 within range of fighting, there are scarce guarantees and rare trials for atrocities for those targeting maternity care.
This absence of consequences has led to a “environment where anything goes,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”
Other Conflict Zones
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 scarce because of a lack of access from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, resulting in tragic loss of life.
In Myanmar, medical facilities have been bombed 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 avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births without skilled assistance.
“When childbirth centers become intentional targets indicates a broader and more sinister pattern: the use of attacks on medical facilities as a tool for terror and to break societal cohesion,” observes a legal researcher.
“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has now become a standard defence.”
