Thirty women had taken refuge in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were actively in labor.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he recounts. “They executed everybody inside the hospital. Those who could run, fled.”
This appalling incident stands as a particularly egregious examples in the two-year civil war tearing the African nation apart. Combatants forced their way into the building, reportedly killing more than 460 innocent people inside.
Rights organizations have labeled it “an act of unspeakable brutality,” and a stark illustration of the deteriorating protection for civilians living amidst warfare in several nations at war.
An Unprecedented Assault On Childbirth Services
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 violence targeting health services. Mothers in labor are highly exposed due to their need for locally available medical care.
An investigation of records uncover an unprecedented scale of attacks: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“This is not standard wartime hazards. They form a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where countless of women bearing children are confined.
Mothers have lost their lives, denied medical attention, or made to have their babies in perilous and unsafe environments. 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
These figures likely represent a significant underestimate, as they only include incidents covered by the media. In many areas of fighting, information is scarce.
Last year, analysis showed that one in two mothers who lost their lives in maternal circumstances lived amidst hostilities. This underscores a catastrophic reality.
Beyond killing women and staff, these attacks are destroying critical infrastructure for mothers and babies, jeopardizing the future to community survival.
Conditions within Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as one reason behind declaring certain actions a genocide.
Following truces, doctors report that women and children succumb from inadequate care, owing to severe deficits of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals could not be reached.
“Direct shelling fired at the wards, operating rooms, and maternity wards,” explains 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. Accounts from embattled medical centers describe births taking place in basements and extreme psychological pressure leading to problems during delivery.
“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The truth of the matter is, every facility faces the threat of assault,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
Accountability Evaporates
For the more than 676 million women living near active conflicts, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.
This lack of accountability has led to a “atmosphere of lawlessness,” argues a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by destroying a group's future.”
Other Conflict Zones
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 damaged a maternity hospital, resulting in tragic loss of life.
In Myanmar, hospitals have come under fire 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 preventable with routine care, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births lacking professional help.
“If maternity hospitals are being deliberately targeted points toward a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to break societal cohesion,” observes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘militarily advantageous’, which has now become a standard defence.”
