A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were experiencing childbirth.
Present at the hospital after dark, 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 recounts. “They were killing everyone inside the hospital. Survival meant running for your life.”
This horrifying event stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Combatants forced their way into the building, leaving dead more than 460 innocent people inside.
Rights organizations have described it as “a crime beyond words,” and a clear case of the deteriorating protection for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence On Childbirth Services
Although world powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are exceptionally vulnerable due to their need for locally available medical care.
Data analysis and investigations reveal an unprecedented scale of attacks: 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.
“This is not natural consequences of war. They constitute a pattern of reproductive violence.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where hundreds of thousands of women bearing children are confined.
Deaths have occurred, prevented from accessing care, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been killed, 15 abducted, and 101 detained—sometimes while assisting births.
The Global Crisis for Mothers and Newborns
The numbers are probably a grave undercount, as they are limited to incidents documented publicly. In many areas of fighting, information is scarce.
Last year, analysis showed that 50% of women who perished while pregnant or giving birth lived amidst hostilities. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are destroying critical infrastructure for mothers and babies, creating a grave danger to community survival.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.
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 delivering babies amidst ruins because hospitals were inaccessible.
“We’ve had rockets 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.
Ukraine's Ordeal
Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births taking place in basements and extreme psychological pressure leading to problems during delivery.
“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The reality is, every facility is now a potential target,” notes a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”
Accountability Evaporates
For the over half a billion females living within range of fighting, there are scarce guarantees and a stark lack of legal accountability for those assaulting reproductive health.
This lack of accountability has led to a “environment where anything goes,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, may constitute 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 increasing drastically, 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 struck a baby care unit, 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
The majority of childbirth fatalities are averted with basic healthcare, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births lacking professional help.
“If maternity hospitals are being deliberately targeted indicates a larger and alarming strategy: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” observes 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 ‘harmful to the enemy’, which has increasingly been used as a justification.”
