A group of thirty mothers were seeking shelter in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were experiencing childbirth.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he explains. “They executed everybody inside the hospital. We who were able to escape, did so.”
This appalling incident stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Armed soldiers forced their way into the building, leaving dead more than 460 patients and their companions.
Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the vanishing safeguards for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault Against Maternal Care
Despite every significant nation are signatories to the international laws of war, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are exceptionally vulnerable due to their need for locally available medical care.
Data analysis and investigations uncover an unprecedented scale of attacks: 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.
“These are not natural consequences of war. They represent a systematic assault on childbirth.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of women bearing children are confined.
Mothers have lost their lives, blocked from reaching help, or compelled to deliver in deplorable situations. The data also indicates that at least 68 maternal health workers have been slain, 15 kidnapped, and 101 arrested—sometimes in the act of delivering babies.
The Global Crisis in Maternal Health
Statistics are thought to be a significant underestimate, as they only include incidents covered by the media. In many areas of fighting, information is scarce.
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 destroying critical infrastructure for mothers and babies, posing a long-term threat to societal repopulation and recovery.
Conditions within 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.
Even after ceasefires, doctors report that women and children succumb from medical shortages, owing to critical shortages of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were out of reach.
“We’ve had rockets fired at the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or seeking to affect 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 occurring in shelters and extreme psychological pressure leading to maternal health issues.
“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The truth of the matter is, every facility is now a potential target,” states a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”
A Culture of Impunity
For the hundreds of millions of women living close to deadly warfare, there are few safeguards and rare trials for atrocities for those assaulting reproductive health.
This void of justice has fostered a “culture of impunity,” argues a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, are potentially acts of genocide by destroying a group's future.”
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 restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, causing fatalities among patients and staff.
In Myanmar, medical facilities have been bombed 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
A large proportion of mother deaths are avoidable with standard medicine, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted indicates a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” observes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘militarily advantageous’, which has often been cited as an excuse.”
