Dozens of women had taken refuge in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were experiencing childbirth.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he states. “A massacre was taking place inside the hospital. Those who could run, fled.”
This brutal attack stands as a particularly egregious examples in the two-year civil war tearing the African nation apart. Armed soldiers stormed the facility, allegedly slaughtering more than 460 innocent people inside.
Rights organizations have labeled it “a crime beyond words,” and a prime example of the deteriorating protection for civilians caught in conflict zones in several nations at war.
An Unprecedented Assault On Childbirth Services
While all major powers have signed the Geneva conventions, which commit them to defending civilians, the past year has experienced a historic high of violence targeting health services. Mothers in labor are particularly at risk due to their reliance on locally available medical care.
Research and compiled data reveal an shocking trend: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“These incidents do not represent standard wartime hazards. They form a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of pregnant women are trapped.
Deaths have occurred, 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 killed, 15 kidnapped, and 101 taken into custody—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
Statistics are thought to be a substantial underreporting, as they are limited to incidents documented publicly. In many areas of fighting, communications are sparse.
Last year, analysis showed that half of all women who perished while pregnant or giving birth were in a conflict area. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are obliterating hospitals and wards, posing a long-term threat to demographic stability.
The Situation in 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 critical shortages of medicine and equipment. Agencies have reported 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 denied deliberately targeting maternity care or trying to alter birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to maternal health issues.
“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The reality is, every facility faces the threat of assault,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”
Accountability Evaporates
For the more than 676 million women living within range of fighting, there are few safeguards and rare trials for atrocities for those assaulting reproductive health.
This void of justice has led to a “atmosphere of lawlessness,” says a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, are potentially acts of genocide by hindering reproduction.”
Additional Hotspots
In El Fasher, the area was isolated from humanitarian aid long before the hospital attack, with malnutrition increasing drastically, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is limited by a communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
In Myanmar, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.
The End of Safe Deliveries
A large proportion of mother deaths are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births lacking professional help.
“If maternity hospitals are being deliberately targeted speaks to a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” notes a legal researcher.
“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”
