Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. 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, managed to survive the ordeal. “I heard the screams of women and children,” he recounts. “They were killing everyone inside the hospital. Those who could run, fled.”
This brutal attack stands as one of the most shocking examples in the protracted internal conflict tearing the North African nation apart. Militiamen raided the hospital, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have called it “an act of unspeakable brutality,” and a stark illustration of the collapse in safety for civilians caught in conflict zones in multiple global hotspots.
A Record of Violence Against Maternal Care
While all major powers are signatories to the international laws of war, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of assaults against medical infrastructure. Mothers in labor are exceptionally vulnerable due to their need for locally available medical care.
Research and compiled data uncover an shocking trend: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“These incidents do not represent standard wartime hazards. They represent a deliberate strategy of violence against reproduction.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where a vast number of pregnant women are trapped.
Deaths have occurred, denied medical attention, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 kidnapped, and 101 taken into custody—sometimes during medical procedures.
The Global Crisis in Maternal Health
These figures likely represent a grave undercount, as they are limited to incidents documented publicly. In many war-torn areas, communications are sparse.
Last year, analysis showed that 50% of women who died during pregnancy or childbirth were in a conflict area. This underscores a horrifying trend.
Apart from fatalities, these attacks are wrecking critical infrastructure for mothers and babies, posing a long-term threat to demographic stability.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights 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 continue to die from a lack of proper treatment, owing to severe deficits of medicine and equipment. Agencies have reported women having children by the roadside because hospitals could not be reached.
“Direct shelling fired at the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or aiming to influence birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and skyrocketing stress leading to birth complications.
“We are being singled out,” asserts 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 can be under attack now,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”
A Culture of Impunity
For the hundreds of millions of women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.
This absence of consequences has led to a “environment where anything goes,” argues a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, 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 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, resulting in tragic loss of life.
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 preventable with routine care, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births lacking professional help.
“When childbirth centers become intentional targets indicates a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation 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 ‘harmful to the enemy’, which has now become a standard defence.”
