Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he explains. “They were killing everyone inside the hospital. Survival meant running for your life.”
This appalling incident stands as among the worst examples in the ongoing war tearing the African nation apart. Combatants forced their way into the building, reportedly killing more than 460 innocent people inside.
Rights organizations have described it as “an act of unspeakable brutality,” and a clear case of the vanishing safeguards for civilians caught in conflict zones in multiple global hotspots.
An Unprecedented Assault Against Maternal Care
Despite every significant nation have agreed to the international laws of war, which require them to safeguard civilians, the past year has seen a record number of assaults against medical infrastructure. Expectant mothers are highly exposed due to their reliance on locally available medical care.
Data analysis and investigations uncover 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 direct strikes on hospitals and delivery wards.
“These incidents do not represent natural consequences of war. They represent a pattern of reproductive violence.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.
Women have been killed, blocked from reaching help, or made to have their babies in deplorable situations. The data also indicates that at least 68 maternal health workers have been slain, 15 taken hostage, and 101 arrested—sometimes in the act of delivering babies.
The Global Crisis for Mothers and Newborns
These figures likely represent a substantial underreporting, as they are limited to incidents reported in news outlets. In many conflict zones, reporting is limited.
Last year, analysis showed that one in two mothers who died during pregnancy or childbirth lived amidst hostilities. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are wrecking critical infrastructure for mothers and babies, posing a long-term threat to community survival.
The Situation in Gaza
In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as a factor in declaring certain actions a genocide.
Despite periods of calm, doctors report that women and children succumb from a lack of proper treatment, owing to critical shortages of medicine and equipment. Agencies have reported women having children by the roadside because hospitals could not be reached.
“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 denied 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. Journalism from conflict zones describe births occurring in shelters and skyrocketing stress leading to problems during delivery.
“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“The reality is, every facility is now a potential target,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”
A Culture of Impunity
For the hundreds of millions of women living within range of fighting, there are scarce guarantees and even fewer war crimes prosecutions for those assaulting reproductive health.
This absence of consequences has created a “atmosphere of lawlessness,” explains a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by preventing births.”
Additional Hotspots
In El Fasher, the area lacked access to 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 scarce because of a communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.
In Myanmar, hospitals have come under fire 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
The majority of childbirth fatalities 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 devoid of emergency care.
“The deliberate attack on maternity wards 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,” says a legal researcher.
“Safeguards are not guaranteed 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.”
