Dozens of women had taken refuge in a childbirth facility in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were in the midst of labor.
Working that 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 states. “They executed everybody inside the hospital. We who were able to escape, did so.”
This brutal attack stands as one of the most shocking examples in the ongoing war tearing the North African nation apart. Armed soldiers stormed the facility, reportedly killing more than 460 patients and their companions.
Rights organizations have called it “a crime beyond words,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault On Childbirth Services
Although world powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of violence targeting health services. Women undergoing childbirth are highly exposed due to their dependence on locally available medical care.
Data analysis and investigations show 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 direct strikes on hospitals and delivery wards.
“This is not natural consequences of war. They constitute a deliberate strategy of violence against reproduction.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.
Women have been killed, prevented from accessing care, or made to have their babies in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 abducted, and 101 taken into custody—sometimes during medical procedures.
The Global Crisis in Maternal Health
The numbers are probably a substantial underreporting, as they only include incidents documented publicly. In many areas of fighting, information is scarce.
Last year, analysis showed that 50% of women who died during pregnancy or childbirth resided in a war zone. This underscores a devastating pattern.
Apart from fatalities, these attacks are obliterating critical infrastructure for mothers and babies, creating a grave danger to demographic stability.
Conditions within Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in 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. UN officials have relayed women delivering babies amidst ruins because hospitals could not be reached.
“Our facility has endured missile strikes targeting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or seeking to affect 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 taking place in basements and skyrocketing stress leading to birth complications.
“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The reality is, every facility can be under attack now,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”
A Culture of Impunity
For the hundreds of millions of women living within range of fighting, there are minimal protections and a stark lack of legal accountability for those assaulting reproductive health.
This absence of consequences has created a “atmosphere of lawlessness,” argues a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, may constitute acts of genocide by hindering reproduction.”
Other Conflict Zones
In El Fasher, the area was isolated 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 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, clinics have been attacked and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The Collapse of Safe Childbirth
Most maternal 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, resulting in risky home births lacking professional help.
“When childbirth centers become intentional targets indicates a wider and more disturbing trend: the use of attacks on medical facilities as a tool for terror and to break societal cohesion,” says a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘harmful to the enemy’, which has often been cited as an excuse.”
